Ana Luísa Costa

Background/Objectives: Ankyloglossia diagnosis and management remain widely debated in dentistry, with variability reported in clinical decision-making and treatment approaches. Limited international evidence exists comparing how dental professionals diagnose and manage this condition in early childhood. This study aimed to compare the knowledge, diagnostic criteria, and clinical management of ankyloglossia among dental professionals in six countries and to assess whether shared diagnostic and management approaches exist for babies (≤6 months) and infants (>6 months). Methods: A multicountry cross-sectional study was conducted using a validated 27-item online questionnaire distributed between February 2023 and February 2025 to dental professionals in Spain, Italy, Portugal, Brazil, Ecuador, and Chile. Participants included paediatric dentists, oral surgeons, general dentists, and other dental specialists. Only fully completed questionnaires were analyzed. Primary outcomes included self-reported diagnostic practices, use of classification systems, and management strategies for ankyloglossia. Secondary outcomes included professional training, interdisciplinary collaboration, surgical techniques, and pain management practices. Results: A total of 1188 dental professionals participated. Overall, 80.7% reported routinely examining the lingual frenulum, while 42.4% used formal classification systems. Tongue mobility assessment was the most commonly reported diagnostic method, with significant variation across countries and professional groups (p < 0.001). Specific training in diagnosis was reported by 67.2% of participants, whereas 50.6% reported treatment training, with marked inter-country differences (p < 0.001). Surgical intervention was the most commonly reported management strategy (38.7%), particularly in babies ≤ 6 months, with frenotomy/frenulotomy being the predominant procedure. Considerable variability was observed in surgical techniques, pain management, and recommendations for adjunctive therapies. Conclusions: Substantial international variability exists in the diagnosis, classification, and management of ankyloglossia among dental professionals. These findings highlight gaps in training and the absence of standardized, evidence-based clinical guidelines, underscoring the need for consensus-driven protocols to support consistent and multidisciplinary clinical care.

Background: This observational ambispective longitudinal international study explored dentists’ practices and patient records concerning dental caries risk management across four European countries (Bulgaria, Greece, Poland and Portugal). Methods: Dentist volunteers recruited patients needing caries risk management, either through preventive or curative measures, from their regular practice. Analyses focused on assessing dentists’ practices in caries risk assessment and management, along with gathering information on patient and dentist characteristics, oral health assessments, and caries risk evaluation. Results: A total of 51 dentists recruited 1008 patients. Across the countries studied, caries risk assessment and management methods varied, with fewer than 15% of dentists using standardized tools. Primary assessment methods included oral examinations and medical interviews, while nutritional and fluoride intake assessments were less common, and salivary or microbiological tests were rare. There was an inverse association between the risk of dental caries and patients’ socioeconomic status. Specific university training on caries risk showed a positive correlation with adherence to recommendations. Conclusions: Our findings emphasize the importance of clinicians adapting their approaches to individual patient needs in caries risk assessment and management. However, the wide array of available risk assessment tools presents a challenge, underscoring the necessity of integrating biopsychosocial models into dental practice to effectively deliver personalized care.

The occurrence of triplication in the deciduous teeth is rare. However, it can cause several problems in primary dentition, alteration of development, and eruption of permanent successors. Case Presentation: A three-year-old boy presented with an exuberant acute periapical abscess in the left front teeth region of the upper jaw. Examination revealed a presence of a triple tooth involving the central and lateral left primary incisors and a supernumerary tooth. Radiographs showed that the fused teeth had separate roots, pulp chambers and root canals. The implemented treatment was extraction under local anesthesia. After 2 years of observation, surgical exposure of the crowns of the permanent maxillary central incisor was performed. After seven years, the permanent dentition was completed without any sequelae. Discussion: Triple tooth, as observed in this case report, results from the union of three tooth germs, potentially influenced by physical, hereditary, or environmental factors, leading to esthetic and functional issues and increased susceptibility to caries. Treatment is challenging, requiring preventive care, complex endodontic procedures, and, in some cases, extraction with space maintenance to avoid future orthodontic complications. Conclusion: Early diagnosis, an adequate treatment plan and clinical monitoring should be performed, aiming at preventing the possible disturbances.

Vital pulp therapy aims to preserve the vitality of dental pulp exposed due to caries, trauma, or restorative procedures. The aim of the present review was to evaluate the clinical, radiographic, and histological outcomes of different calcium silicate-based cements used in vital pulp therapy for both primary and permanent teeth. The review included 40 randomized controlled trials from a search across PubMed, LILACS, and the Cochrane Collaboration, as well as manual searches and author inquiries according to specific inclusion and exclusion criteria. A critical assessment of studies was conducted, and after data extraction the results were submitted to a quantitative statistical analysis using meta-analysis. The studies, involving 1701 patients and 3168 teeth, compared a total of 18 different calcium silicate-based cements in both dentitions. The qualitative synthesis showed no significant differences in short-term outcomes (up to 6 months) between different calcium silicate-based cements in primary teeth. ProRoot MTA and Biodentine showed similar clinical and radiographic success rates at 6 and 12 months. In permanent teeth, although the global results appeared to be well balanced, ProRoot MTA generally seemed to perform better than other calcium silicate-based cements except for Biodentine, which had comparable or superior results at 6 months. Meta-analyses for selected comparisons showed no significant differences in clinical and radiographic outcomes between ProRoot MTA and Biodentine over follow-up periods. The present review highlights the need for standardized definitions of success and follow-up periods in future studies to better guide clinical decisions. Despite the introduction of new calcium silicate-based cements aiming to address limitations of the original MTA. ProRoot MTA and Biodentine remain the most used and reliable materials for vital pulp therapy, although the results did not deviate that much from the other calcium silicate-based cements. Further long-term studies are required to establish the optimal CSC for each clinical scenario in both dentitions.

This study aimed to assess and compare the impact of COVID-19 pandemic lockdowns on the oral health attitudes, dietary habits and access to dental care of Portuguese and Spanish children. A cross-sectional observational study involving caregivers of 3–17-year-old children who had cohabited during a COVID-19 pandemic lockdown in Spain and Portugal was conducted. Caregivers completed an online anonymous questionnaire. Aiming groups comparison, chi-square test was used for qualitative variables. 770 surveys were obtained. Significant changes in the children’s routine were higher in Portugal (p < 0.001). Both countries showed a large percentage of children who had between 2–3 snacks between meals (p < 0.001) and a higher consumption of snacks was particularly noticed among Spanish children with untreated dental caries during the lockdown (p = 0.003). Most caregivers reported children’s oral hygiene habits did not suffer noteworthy alterations (p = 0.417), although parental supervision of toothbrushing was associated with dental attendance during the lockdown. The majority of the sample had no dental attendance during confinement. Confinement appears to have not markedly affected the oral health status and habits of the majority of these children, although an important impact of some demographic and behavioral factors upon dietary and oral care/habits was detected.

Objectives: To define the timing of the first deciduous tooth eruption in a sample of Portuguese children. Methods: Observational study including a convenience sample of 2115 healthy Portuguese children aged between 1-24 months. A single clinician performed the oral observation under an artificial light source, identifying the first erupted deciduous tooth and registering age (in months). Data were analyzed with IBM® SPSS® v24, R v3.3.2, and Python v3.7.1 (α=0.05). The percentiles of the age of first tooth eruption were determined, along with the cumulative probability curve for both genders and the proportion of first erupted tooth type per gender with its confidence interval. Results: The age of first tooth eruption was slightly inferior in males (mean=7.01 (± 2.24); median=6.0 months; 95% CI [5.8, 6.2]) than in females (mean=7.55 (± 2.41); median=6.5 months; 95% CI [6.3, 6.7]), with a statistically significant difference. The first deciduous tooth erupting was the mandibular central incisor, on average, at 6.94 (± 2.10) months in males and 7.49 (± 2.17) months in females. Conclusions: The present study indicates that, unequivocally, the mandibular central incisor was most often the first deciduous tooth to erupt, and, on average, that happened at 6.94 months for males and at 7.49 months for females.

Purpose To evaluate the clinical efficacy at 6 months (6 M) and 12 months (12 M) of 3 adhesive strategies (two-step etch-and-rinse; two-step self-etch; one step self-etch) used in composite resin restorations in primary molars. Methods This randomized clinical study involved 101 class II restorations in primary molars of 34 children (4–8 years old), distributed by 3 groups according to the 3 tested adhesive systems: GI- Clearfil^TMS³Bond Plus (CSB); GII- Clearfil^TMSE Protect Bond (CSEPB); GIII- Prime&Bond®XP (PBXP). Restorations were evaluated according to FDI criteria, immediately after execution, at 6 M and 12 M. All ethical and legal requirements were met. Statistical analysis was performed using IBM®SPSS®v26 and MS Excel® (5% significance level). Results The aesthetic, biological and most of the functional parameters evaluated remained without significant changes over time. Statistically significant differences were only found regarding the "marginal adaptation" parameter at 12 M, with worsening of scores for the three groups (p < 0.001). Comparing the groups, no significant differences were detected between any of the evaluated parameters (aesthetics properties: p = 0.721; functional properties: p = 0.122). Conclusions After a one-year period, the self-etch adhesives tested presented a clinical efficacy similar to the etch-and-rinse adhesive in restoring class II cavities in primary molars. Trial registration number ISRCTN11458186.

Background: Calcium-silicate-based cements (CSC) have gained an increasing scientific and clinical relevance, enabling more conservative approaches, namely pulp preservation and regeneration therapies. This research aims to study the influence of four clinical variables on the interfaces between CSC and composite adhesive restoration, concerning shear bond strength (SBS) and ultra-morphological patterns. Methods: SBS tests were performed in 320 specimens divided in 16 groups (n = 20) according to: two CSC (NuSmile^® NeoMTA, Biodentine^TM); two adhesive systems (Clearfil^TM SE Bond 2 (CSEB2), Clearfil^TM Universal Bond Quick (CUBQ)); optional application of an additional hydrophobic bonding layer (HBL); two restoration times (immediate, seven days). Scanning electron microscopy (SEM) was performed to conduct the ultra-morphology interface analysis in 32 deciduous molars prepared and randomly allocated into the 16 groups. Results: Globally, SBS tests showed higher bond strength of CUBQ compared to CSEB2 (p < 0.001), as with an additional HBL application (p = 0.014) and delayed restoration (p < 0.001). SEM showed the interpenetration between adhesive systems and CSC forming a hybrid layer, whose depth and thickness depended on the restoration time and adhesive strategy. Conclusions: The independent clinical variables adhesive system, application of an additional HBL and restoration time affected the bond performance and ultra-morphological interface between composite adhesive restoration and CSC.

Objectives: To assess the level of knowledge and attitudes regarding prenatal and infant oral health in a sample of pregnant women from Coimbra, Portugal. Methods: A self-applied questionnaire was administered to randomly selected pregnant women who attended prenatal check-ups at two public health institutions in Coimbra. Collected data included sociodemographic information, oral health knowledge and practices in pregnancy, and knowledge on oral health in children. All ethical requirements were met. Statistical analysis was conducted using descriptive and inferential methods. Variables were tested for independence using a chi-square test with a 95% confidence interval. Results: A total of 120 women enrolled in the study. Although 68.9% of participants brushed their teeth twice daily, 36.4% reported not using floss, with a statistically significant association with age (p=0.004). Half of the respondents had not attended a dental appointment before pregnancy, and 59.2% believed pregnancy could be harmful to oral health. Findings showed limited knowledge of the possible consequences of gingivitis and periodontitis to the course of pregnancy and the importance of diet in oral health. Moreover, a low level of understanding was noted regarding the existence and prevention of early childhood caries. Conclusions: Oral health-related knowledge and practices of surveyed women were in general deficient. Considering pregnancy is a period of particular interest for acquiring knowledge and good oral health practices, which are decisive for both the expectant mother and the child, our results highlight an urgent need to implement prenatal oral health care programs in this study population. (C) 2021 Sociedade Portuguesa de Estomatologia e Medicina Dentaria. Published by SPEMD.