Areerat Nirunsittirat

Objectives: This study aimed to compare the magnitude of pulp space narrowing over time—measured as the change in pulp/tooth proportion from baseline—between mandibular molars treated with different types of vital pulp therapy (VPT) and their contralateral sound molars (controls). This study also investigated factors influencing the magnitude of pulp space narrowing in molars that have undergone VPT.Methods: This retrospective cohort study involved the assessment of bitewing radiographs of VPT-treated molars and controls at baseline and follow-up. Using reference points and lines on the radiograph, pulp/tooth proportions were measured by examiners. The intraclass correlation coefficient (ICC) was used to report examiner reliability. The changes in pulp/tooth proportions from baselines were compared between subgroups using multilevel mixed effect linear regression and the Wald test.Results: A total of 382 bitewing radiographs from 134 teeth were included. The follow-up period ranged from 6 to 84 months (mean, 27.12 ± 17.67 months). ICC values indicated good to excellent examiner reliability. Compared to the controls, changes in pulp/tooth proportion from baselines, indicating pulp space narrowing, were significantly greater in teeth with partial pulpotomy (at pulp chamber width) and coronal pulpotomy (at pulp canal width). Factors affecting the magnitude of pulp space narrowing included the more invasive type of VPT and the more severe preoperative diagnosis.Conclusions: The magnitude of pulp space narrowing was greater in VPT-treated molars than in controls. The more invasive type of VPT and severe preoperative diagnosis were factors contributing to the magnitude of pulp space narrowing.

Objectives: To investigate the associations between nutritional status and early childhood caries (ECC) in a Thai population, hypothesizing that nutritional extremes, including undernutrition and overnutrition, are associated with increased ECC risk. Methods: Data from a birth cohort study of Thai children in Khon Kaen were analyzed. Nutritional status at 2 y of age was assessed using anthropometric measurements (height-for-age, weight-for-age, weight-for-height, and body mass index–for-age [BMI-for-age]) categorized by Z-scores adjusted for age and sex. Dental caries was assessed at ages 3 to 4 y using World Health Organization criteria, with ECC defined by the presence of cavitated lesions. Modified Poisson and negative binomial regression analyses with robust variance estimated relative risks (RRs) and 95% confidence intervals (CIs) for ECC prevalence and dmft scores, adjusting for maternal education, breastfeeding duration, sweet consumption frequency, and visible plaque. Results: Among 549 children, overweight/obese children (n = 27) exhibited a significantly lower prevalence of ECC compared with those with normal weight (n = 471) or wasting (n = 50; 59.3% versus 89% and 94%, respectively; P < 0.001). The adjusted RR for overweight/obesity was 0.66 (95% CI: 0.48–0.92) compared with normal weight and 0.64 (95% CI: 0.46 –0.90) compared with wasting. Children with normal weight and those with wasting had comparable ECC prevalence rates (P = 0.50). Similar trends were observed for dmft scores, with overweight/obese children having significantly lower scores compared with those with normal weight or wasting (4.3 versus 7.3 and 8.0, respectively; P = 0.004). Height-for-age and weight-for-age were not significantly associated with ECC, while BMI-for-age yielded results consistent with those for weight-for-height. Conclusion: This study reveals an unexpected inverse relationship between overweight status and ECC, suggesting a more complex interplay between nutrition and caries risk. These findings underscore the need for further research into the mechanisms underlying this relationship to inform ECC prevention strategies. Knowledge Transfer Statement: Our findings challenge the hypothesis that all nutritional extremes increase caries risk, revealing an unexpected protective effect of being overweight. This highlights the complex nutrition–caries relationship and the need for context-specific evidence. Further research into the mechanisms behind this surprising link is essential to develop effective and targeted preventive strategies, rather than assuming all nutritional improvements are beneficial for dental health.

Background: The Family Impact Scale (FIS) is a validated caregiver-reported outcome measure that gauges the impact of children’s oral and orofacial conditions on their families. As its use continues to expand across countries and cultures, the quality of its translated versions and their psychometric properties must be rigorously evaluated. This systematic review sought to assess the translations, cross-cultural adaptations and measurement properties of FIS-14 and FIS-8. Methods: This review followed PRISMA 2020 guidelines and the COSMIN methodology. PubMed, Scopus, and Embase were searched, with studies being eligible if they translated or adapted the FIS and evaluated at least one psychometric property among caregivers of children aged 6–14 years. Data extraction and quality appraisal were performed independently by two reviewers. Translation and adaptation processes were evaluated using the framework for translation and cultural adaptation process for patient-reported outcomes measures. Psychometric properties and risk of bias were assessed using COSMIN criteria. Results: Fourteen studies met the inclusion criteria, including three studies utilising FIS-8, ten studies utilising the FIS-14 and one study using both versions, covering nine different language adaptations in total. Most studies adhered to core translation and adaptation steps, but key methodological elements, such as reconciliation, cognitive debriefing and proofreading, were frequently inadequately reported. Content validity was frequently rated “doubtful” due to a lack of methodological clarity. The internal consistency of FIS-14 was acceptable (FIS-14: α = 0.79–0.88), but FIS-8 exhibited inconsistent results. Test–retest reliability was generally good (ICC = 0.75–0.96) but often lacked confidence intervals or model specification. Construct validity was supported in most studies. Measurement error and responsiveness were underreported. Structural validity was only assessed in two studies, while cross-cultural and criterion validity were not evaluated in any studies. Conclusions: FIS-14 demonstrates acceptable reliability and construct validity across a diverse range of settings, supporting its use in assessments of oral health-related quality of life. However, substantial methodological gaps persist when it comes to content validation, responsiveness, structural validity and cross-cultural testing. Future adaptations should follow established guidelines and employ robust statistical methods to ensure comparability and interpretability across different populations.

Oral health literacy (OHL) is increasingly recognized as a determinant of oral health outcomes; however, its relationship with children’s oral health related quality of life (OHRQoL) in rural Latin-American settings remains unclear. The objective was to examine the correlation between caregiver’s OHL and children’s OHRQoL in rural schools in Arauco, Chile. A cross-sectional study was conducted with 152 caregivers. Data was collected using the validated Cupé-Araujo OHL scale and the Early Childhood Oral Health Impact Scale (ECOHIS). OHRQoL was assessed through caregiver’s proxy reporting. Normality was tested with the Kolmogorov–Smirnov test, and Spearman’s rho (ρ) was used to evaluate associations. The average OHL score was 2.98 ± 0.9, and the mean ECOHIS score was 5.79 ± 6.17. A weak but statistically significant negative correlation was observed between OHL and OHRQoL (ρ = –0.173, P = 0.033). Higher OHL was observed among caregivers with greater education and better access to oral-health information (P < 0.05). Although no significant correlation was identified between caregivers’ OHL and children’s OHRQoL, socio-educational and informational factors appear to influence oral-health outcomes. These findings highlight the need for culturally tailored interventions to strengthen oral-health literacy in rural communities.

Purpose To evaluate the performance of a deep learning-based convolutional neural network (CNN) algorithm and compare it with that of general dentists and dental students in classifying caries lesions in primary teeth using bitewing radiographs. Methods A total of 1400 bitewing radiographs (4715 tooth images) were divided into training, validation, and testing datasets, with carious lesions classified into four and seven classes. After training, the best-performing ResNet model was selected and compared with three general dentists and three dental students via a reference test. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), macro F1 score, area under the curve (AUC), and confusion matrices were evaluated. Results ResNet-152 outperformed ResNet-50 and ResNet-101 in the validation process. In the 4 class classification, ResNet-152 and Dental student 1 achieved accuracies exceeding 0.7, while most examiners ranged between 0.62 and 0.67. Only Dental student 1 and ResNet-152 achieved specificity and NPV values of 0.9 or higher. ResNet-152 and most examiners exhibited lower sensitivity for initial and moderate lesions than for extensive lesions. In the 7 class classification, the accuracy ranged from 0.37 to 0.58, with the best-performing comparators—Dental student 1, ResNet-152, and General dentist 3 exceeding 0.5. The sensitivity, PPV, and macro F1 score followed similar trends. ResNet-152 achieved a favourable AUC of 0.85. Conclusion ResNet-152 performed comparably to its leading human comparators, general dentists and dental students, demonstrating favourable performance in caries lesion classification. CNNs could serve as a second option in caries lesion classification, potentially leading to improved treatment decisions.

Purpose To compare sealant retention, patient satisfaction, and operator preference between EasyPrep^® and cotton roll isolation. Methods This university-based, superiority, split-mouth randomised controlled trial enrolled 92 children aged 6–12 years with matched contralateral pairs of maxillary or mandibular permanent first molars (PFMs). Each participant was randomised to receive sealants using either EasyPrep^® or cotton roll isolation on one side, followed by the alternative method on the contralateral side. All sealants were placed by dental students under the faculty supervision and were assessed for retention by two blinded examiners at 6- and 12-month follow-ups. Sealant retention success was compared between groups using risk regression with generalised estimating equations. Patient satisfaction and operator preference were assessed through interview-based questionnaires and summarised using descriptive statistics. Results Of the 180 pairs of PFMs included at baseline, 155 and 110 were evaluated at the 6- and 12-month follow-ups, respectively. The relative risks of sealant retention success with EasyPrep^® compared to cotton roll isolation were 0.95 (95% confidence interval [CI] 0.83; 1.09, p > 0.05) at 6 months and 0.96 (95% CI 0.76; 1.23, p > 0.05) at 12 months. These results indicate a slightly lower probability of retention success with EasyPrep^® at both time points, although the differences were not statistically significant. Moreover, children tended to prefer cotton roll isolation (44.6%), whereas operators favoured EasyPrep^® (59.8%). Conclusion Although most operators preferred EasyPrep^®, its sealant retention was not superior to that of cotton roll isolation. Moreover, patients’ preference was more toward cotton roll isolation.

Purpose This retrospective cohort study using propensity score matching aimed to compare the 7-year survival probabilities of direct resin composites (DRCs) and stainless-steel crowns (SSCs) in young permanent first molars treated with either partial or coronal pulpotomy. Methods To evaluate the presence of restorative failures, the efficacy research with a retrospective cohort design was conducted by reviewing electronic dental records of patients aged 6–16 years who received pulpotomy and attended recall programs between September 2012 and December 2021. To reduce confounding bias associated with treatment indications and contraindications, one-to-one matching of comparison groups was conducted using propensity scores. Kaplan–Meier analysis and log-rank test were performed to estimate and compare survival probabilities between groups. Cox proportional hazards regression was used to estimate hazard ratio (HR) and its confidence interval (CI) for failures. Results From 136 children, 156 treated molars were initially included. Finally, a total of 56 molars were matched for analysis (28 molars in each group). The 7-year cumulative survival probability of SSCs (87.4%) was significantly (p < 0.05) higher than that of DRCs (35.5%). Moreover, the molars restored with DRCs had a 7.6 times higher risk of failure compared to those restored with SSCs (HR 7.64, 95% CI 1.88–31.01, p < 0.05). Conclusion Compared to DRCs, SSCs demonstrated a significantly higher survival probability for coronal restorations following pulpotomy in young permanent first molars over a period of up to 7 years.

Purpose To investigate the effectiveness and predictive factors of nitrous oxide and oxygen inhalation sedation (NOIS) in Thai paediatric dental patients. Methods A retrospective chart review of children receiving dental treatments under NOIS between March 2022 and August 2024 was conducted. A sedation session was evaluated as effective when the Overall Houpt Behaviour Rating Scale was greater than or equal to 4 and there were no acute adverse events from NOIS during or within 24 h of sedation. Predictive factors were assessed using the Poisson regression with robust error variance and generalised estimating equations. Results A total of 224 sedation sessions from 134 Thai patients aged 3–12 years were included. Of these sessions, 86.2% were considered effective. In the multivariable analysis, previous NOIS experience and the child’s preoperative anxiety level were associated with the effectiveness of NOIS. The risk ratio for effective sedation was 13% higher for children with prior NOIS experience compared to those undergoing NOIS for the first time (RR: 1.13, 95% CI 1.02–1.25, p value < 0.05). In addition, the risk ratio for effective sedation in non-anxious children was 41% higher than for extremely anxious children (RR: 1.41, 95% CI 1.07–1.86, p value < 0.05). Conclusion NOIS is safe and effective for dental treatment in Thai children, with minimal adverse events. Its effectiveness is particularly pronounced in children who have prior experience with NOIS and present as non-anxious.

Background: Vital pulp therapy (VPT) is one of the treatments recommended for vital deep carious permanent molars. However, postoperative pain remains underexplored in children and adolescents who have undergone VPT.Aim: This study investigated the incidence, intensity, duration, temporal pattern, and analgesic intake of postoperative pain following VPT in children and adolescents. Additionally, factors associated with postoperative pain incidence were explored.Design: A prospective cohort study was conducted in 159 patients aged 6–18 years, involving 174 VPT‐treated teeth. Pain intensity, measured with the Wong–Baker FACES Pain Scale (WBFPS), and analgesic intake were recorded daily for 7 days post treatment.Results: Over the 7‐day period, 40.23% of patients experienced postoperative pain. Mean pain intensity decreased from 3.43 ± 1.96 on Day 1 to 1.26 ± 1.71 on Day 2. About 52.86% of patients were pain‐free between Days 1 and 2, and over 97% were pain‐free by Day 7. Analgesics were taken by 25.86% of patients. Compared with the protective liners group, the more invasive types of VPT were associated with higher odds of pain.Conclusion: Postoperative pain following VPT was common; however, it was mild, controllable with analgesics, and resolved in most patients. The more invasive VPT types were linked to an increased incidence of pain.

Objectives To investigate the survival probability of permanent first molars (PFMs) after coronal pulpotomy (CP) using two outcome definitions: success-focused and functional survival-focused, and to identify factors influencing tooth survival. Materials and methods A retrospective cohort study reviewing records of children undergoing CP with calcium silicate-based cements (CSCs) on PFMs. Each CP-treated PFM was classified as success, uncertain, failure, or censored. Survival probability was analyzed using Kaplan–Meier estimators. Success-focused definition considered failures and uncertain outcomes as events, while functional survival-focused definition considered only failures as events. Prognostic factors were analyzed using Cox regression analysis. Results Seventy-seven CP-treated PFMs with a follow-up period of 6–111 months. Using the success-focused definition (two failures and 12 uncertain outcomes as events), survival probabilities were 93.1% (95% CI 84.3–97.1%) at 12 months, 78.7% (95% CI 65.6–87.3%) at 36 months, and 74.9% (95% CI 59.5–89.0%) at 60–111 months. However, with the functional survival-focused definition, survival probabilities were 100% at 12 months and 96.6% (95% CI 86.9–99.1%) at 24–111 months. In multivariable analysis, proximal lesions increased failure risk compared to occlusal lesions (HR 17.17, 95% CI 2.18–135.31, p < 0.01), and resin composite restorations had higher failure risk than stainless steel crowns (HR 13.97, 95% CI 1.49–130.69, p < 0.05). Conclusions CP using CSCs shows long-term survival potential as an alternative treatment for cariously exposed PFMs in children. Clinical relevance Proximal lesions and resin composite restoration could contribute to the lower survival, indicating the need for careful consideration of restoration options and lesion location during treatment planning.