Purpose: To investigate changes in body mass index (BMI) following surgery to treat severe early childhood caries (S-ECC). Methods: Children no older than 71 months of age undergoing surgery to treat S-ECC were recruited into a prospective cohort study in Manitoba, Canada. Heights and weights were measured at baseline (day of surgery) and follow-up (minimum of 3 months after treatment) to calculate BMI z-scores. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) classification systems were used to determine BMI health status. Descriptive statistics, bivariate analyses, change tests, and regression models were used. Results: Overall, 150 parti- cipants were recruited (mean age=47.7±14.2 months), and 104 children returned for follow-up. Mean BMI z-scores increased significantly (5.8±2.7 months; P<0.001) following surgery. Based on the WHO classification, 44% of children remained healthy based on BMI following surgery (43% for CDC), while 30% declined from the healthy to unhealthy category based on the WHO classification at follow-up (29% for CDC). Those with a household income of less than $28,000 (CAD) were more likely to be at an unhealthy BMI (P=0.01). Conclusions: Children in this study experienced a significant increase in BMI and a decline in health at follow-up. Early childhood caries and BMI share similar risk factors. Lower family income was associated with worse health after surgery when controlling for other variables. Children undergoing surgery for S-ECC would benefit from dietary, lifestyle, and physical activity interventions to improve both overall and oral health.

Purpose:To compare primary care utilization before and after human papillomavirus vaccination delivered through a medical-dental integration (MDI) program. Methods: This retrospective cohort study included patients aged 9 to 17 years who had at least 1 dental visit and were due for HPV vaccination during a 1-year MDI intervention in which vaccination was offered at dental appointments and administered by nursing staff. WCV utilization was compared for eligible patients in the year before and the year after the intervention. Results: Among 1,694 eligible adolescents, 375 HPV vaccines were administered. WCV attendance did not differ among this cohort before versus after the intervention or between those who received an HPV vaccine and those who declined. Conclusion: Human papillomavirus vaccination coordinated during dental visits was not associated with a decrease in primary care utilization, supporting medical-dental integration as a strategy to improve vaccination access without compromising preventive care.

Purpose: To determine if virtual reality (VR) is associated with reduced dental anxiety in neurotypical children and children with special health care needs compared with usual care or other distraction methods. Methods: This systematic review was conducted following PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251126502). A comprehensive search was performed in August 2025 in PubMed, Scopus, LILACS, CAPES, Cochrane Library, ClinicalTrials. gov, and Google Scholar without language or date restrictions. Reference lists of relevant publications were also hand-searched. Two reviewers independently extracted data on study populations, dental procedures, VR type, comparators, outcomes, and findings, with discrepancies resolved by consensus. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for nonrandomized trials; certainty of evidence was evaluated using GRADE. Results: A total of 23 studies met the inclusion criteria. Evidence indicates that VR is consistently associated with a reduction in dental anxiety and improved cooperative behavior in neurotypical children and children with autism spectrum disorder. Findings for children with attention-deficit/hyperactivity disorder, mild intellectual disabilities, or children who are deaf or hard of hearing were heterogeneous and showed mixed or modest effects. Pain outcomes varied significantly across studies, precluding clear conclusions. Conclusions: Virtual reality appears to be a promising adjunct for managing pediatric dental anxiety, particularly in neurotypical children and those with autism spectrum disorder. However, heterogeneity of study designs and limited evidence for other disability groups currently restrict routine clinical implementation. Further rigorous trials are needed to clarify effectiveness across diverse pediatric populations.

Purpose: To comparatively evaluate the accuracy, readability, and concision (word count) of 7 generative artificial intelligence platforms (GenAIs) that developed multilingual postoperative instructions (POIs) for pediatric dental procedures. Methods: Standard prompts were developed and uploaded to 7 trained or untrained GenAIs to create POIs for 5 pediatric dental procedures in 3 languages: English, Spanish, and Polish. Two masked, calibrated, bilingual, simulated parents assessed the accuracy, clarity, cultural neutrality, and language appropriateness of 70 GenAI-developed POIs using an ordinal scale (AI-instructify) for each language pair (English-Spanish, English-Polish). The readability, understandability, actionability, and concision of GenAIs were calculated using evidence-based indices, and the data were statistically evaluated (a =0.05). Results: Trained GenAIs improved the accuracy and readability of multilingual POIs (P<0.05). POIs in English consistently received higher AI-instructify scores than POIs in Spanish and Polish. However, POIs from untrained GenAIs or in the Polish language were concise (lower word count) as compared to those in English and Spanish languages (P<0.001). Most POIs received a score indicating they were "easily" or "fairly easily" readable, understandable, and actionable at a sixth-grade level (the standard literacy level for the US population). Conclusions: Trained generative artificial intelligence platforms produced accurate, readable postoperative instructions. Despite generic content, GenAIs showed promise in generating multi-lingual instructions suitable for diverse populations with lower health literacy.

Purpose: To compare the effects of different agents on the reduction of discoloration and remineralization potential in artificial-dentincaries lesions treated with silver diammine fluoride (SDF). Methods: A total of 120 caries-free primary-molars were divided into 6 groups as follows: SDF-only: 38% SDF as the positive control; SDF+KI: SDF followed by potassium iodide (KI); SDF+HP: SDF followed by 40% hydrogen peroxide (HP); SDF+KI+HP: SDF followed by KI and then HP; SDF+GSH: SDF premixed with 20% glutathione (GSH); and SDF+GSH+KI: SDF premixed with GSH followed by KI. Following application of the materials to the artificial-dentincaries lesions, the samples were subjected to a 7-day pH-cycling protocol. Microhardness testing, spectrophotometry, and confocal laser scanning microscopy were used to analyze changes in the dentin. Data were analyzed using Kruskal-Wallis, Friedman, and Bonferroni tests (P<0.05). Results: All groups exhibited post-treatment increases in surface microhardness from the demineralized state (P<0.001), and post-treatment hardness values approached baseline (sound dentin; P>0.05). Betweengroup comparisons revealed no differences in post-treatment surface microhardness (P=0.454) or lesion depth (P=0.113). However, the SDF+HP group showed lower lesion fluorescence (P<0.001). Spectrophotometric analyses revealed that the KI (approximately 54%) and HP (approximately 41%) subgroups reduced post-treatment discoloration compared to the SDF-only group (P<0.001). Conclusions: None of the tested combinations had a negative effect on the remineralization capacity of silver diammine fluoride under the evaluated parameters. Potassium iodide and hydrogen peroxide effectively reduced SDF-related discoloration, improving its esthetic acceptability without compromising its therapeutic efficacy.

Purpose: To provide evidence-based recommendations for managing infants with restrictive lingual frenum and breastfeeding difficulties. Methods: Recommendations were informed by 2 recent systematic reviews regarding outcomes such as the diagnostic criteria for ankyloglossia, association of ankyloglossia with feeding difficulties, and evidence for surgical release of the lingual frenum. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach guided consensus on problem prioritization, certainty of evidence, benefit-risk balance, patient values, acceptability, and feasibility. Results: Twelve conditional recommendations were developed addressing the diagnosis and management of symptomatic ankyloglossia. Both anatomical and functional assessments were advised for a comprehensive assessment of the tongue. Evidence suggested an association between restrictive lingual frenum and feeding difficulties and potential benefits of frenotomy on feeding in carefully selected cases. This document provides guidance on preferred surgical techniques, postoperative care, and counseling regarding possible adverse events, aiming to support clinical decision making for dental professionals. Conclusions: All recommendations were conditional and grounded in very low-certainty evidence, underscoring the need for high-quality research. Clinicians should engage in multidisciplinary, shared decision making with parents to determine the most appropriate intervention from available options, incorporating the family's values and preferences.

Purpose: To compare moderate enteral sedation regulations across the 50 US states and evaluate alignment with the American Academy of Pediatrics/American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) guidelines. Methods: An online review of all state dental sedation laws was conducted from January to June 2025. Extracted variables include permit type, renewal interval, site visit, and education requirements. State regulations were compared with the AAPD Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures and the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students.Results: Forty-eight states (96%) require a permit to administer moderate enteral sedation. The most common renewal interval is 2 years (58%), and two-thirds of states require 1 to 5 annual continuing education hours. Twenty states (40%) require a pediatric endorsement. Nearly all states (98%) mandate advanced life-support training for pediatric patients. More than half (64%) require an initial site visit, and 50% require regular emergency drills. Educational standards vary, though 60 didactic hours and 20 cases are most common. Most states (86%) require Basic Life Support (BLS) for monitoring personnel, and 56% require at least 2 individuals during procedures. Conclusions: Despite increased alignment with published sedation guidelines in recent decades, significant variability persists among state permit definitions and requirements. These findings highlight the need for standardized, evidence-based state dental practice acts that clearly define sedation depths, routes, and training requirements.

Purpose: To investigate pediatric dental providers' experiences with parent radiographic imaging refusal and identify practice and parent characteristics associated with refusal. Methods: American Academy of Pediatric Dentistry (AAPD) members were invited via email in October and November 2024 to participate in an online questionnaire about radiograph imaging refusal (intraoral, extraoral, and cone beam computed tomography [CBCT]). Chi-square tests identified factors associated with refusal. Results: A total of 695 of 8,295 dental providers responded to the survey (8.4%). Most were women (60.7%) and White (71.8%). Between 9% and 23% reported parent radiographic imaging refusal as a big or medium-sized problem (intraoral=23%; extraoral=12%; CBCT=9%). Intraoral and extraoral refusal was more commonly reported by private practice providers (versus community health centers or university/hospitals) and providers treating fewer than 50% Medicaid-insured patients (versus more than 50% Medicaid-insured patients; P<0.05). Providers reported that parents who refused bitewing radiographs also tended to refuse fluoride and immunizations. Most providers (87.6%) continued to use lead shielding because of the belief that it improves acceptance of radiographs (71.9%). Conclusions: Parent intraoral radiography refusal is a commonly reported challenge in dentistry and highlights the importance of developing chairside strategies aimed at supporting parent decision-making and timely dental disease diagnosis and treatment.

Purpose: This study quantified age-specific differences in organ and effective doses during intraoral radiography in pediatric patients, with emphasis on identifying developmental stages associated with increased radiation exposure to critical organs. Methods: Monte Carlo simulations were performed using PCXMC 2.0 software for 3 pediatric age groups (5, 10, and 15 years), representing key developmental stages. Simulated full-mouth intraoral radiographic series used 4 exposure combinations: 60 kilovolt peak (kVp)/3 milliampere (mA), 60 kVp/6 mA, 70 kVp/3 mA, and 70 kVp/6 mA. Organ dose distributions and total effective doses were calculated according to the 2007 recommendations of the International Commission on Radiological Protection. One-way analysis of variance with post hoc tests assessed differences between groups. Results: Clear age-dependent variations in organ and effective radiation doses were observed. The 5-year-old group showed the highest effective doses (62.4 to 129.6 microsieverts [μSv]), despite fewer exposures. The 10-year-olds had the lowest doses (37.2 to 76.8 μSv). Thyroid doses in 5-year-olds were 3.2 times higher than in older groups (P<0.001), due to anatomical proximity. Bone surface doses were similar in 5 and 15-year-olds but lower in 10-year-olds. These trends persisted across exposure combinations, though optimized settings (60 kVp/3 mA) reduced doses by over 50%. Conclusions: Age significantly influences radiation dose in pediatric dental imaging, with 5-year-olds receiving higher organ doses, especially to the thyroid. These findings stress the importance of age-specific protection strategies beyond adjusting exposure settings, emphasizing the developmental stage in radiation safety.

Purpose: This study investigated whether the age of permanent tooth emergence in US adolescents has shifted over the past 40 years and whether these changes vary by gender or race. Methods: A retrospective review of clinical records from 751 patients aged 9 to 16 years was conducted across three cohorts: 1978 to 1982, 1998 to 2002, and 2018 to 2022. Intraoral photographs were analyzed to assess the presence of maxillary and mandibular canines, premolars, and second molars at half-year intervals. Logistic regression modeled the probability of tooth presence based on age, cohort, gender, and race. Results: Median age of tooth emergence was found to be earlier by 0.5 to 0.9 years for most teeth. Compared to 1980, the odds of tooth presence were significantly higher in 2000 (odds ratio [OR]=1.75) and 2020 (OR=3.01), indicating a consistent trend toward earlier emergence. Females demonstrated significantly earlier emergence than males (OR equals 0.63), and Black children exhibited higher odds of tooth presence compared to White and Hispanic peers. Conclusions: This study provides evidence of a trend toward earlier emergence of permanent dentition in a US adolescent population. Gender and racial differences suggest that emergence timing is influenced by both biological and environmental factors.

Purpose: To assess California pediatric dentists' perspectives on Senate Bill 501 (SB 501) and its impact on sedation practice in pediatric dentistry. Methods: An electronic survey was delivered to all 818 members of the California Society of Pediatric Dentistry. The 18-question survey inquired about the participants' demographic information, sedation experience, and insights about the changes made by SB 501. Data were anal- yzed using frequency distribution and chi-squared analyses (P<0.05). Results: A total of 124 pediatric dentists responded to the survey (15.2% response; 78.7% had previously applied for a sedation permit, while 21.3% did not. Among the 96 respondents with a previous sedation permit, 83% reported that SB 501 impacted their practices. Additionally, 72.9% of the respondents with previous sedation experience hold an active permit, and 53.1% are currently using oral sedation in-office. The top barriers linked to SB 501 were the cost of hiring a second Pediatric Advanced Life Support (PALS)-certified support personnel dedicated to patient monitoring (34.5%), the requirement to complete 20 sedation cases for each age category to obtain pediatric endorsements (26.2%), other reasons (18.2%), application fees (15.5%), and continuing education requirements (3.6%). Conclusions: Based on these findings, new sedation permit regulations in California in 2022 have significantly impacted pediatric sedation practices. A marked decrease in sedation permit holders may lead to diminished access to care for pediatric patients. Many respondents urged the revision of this legislation to better support offering safe and effective sedation care.

Purpose: This study evaluated associations among breastfeeding duration and combined breast/formula feeding on childhood dental caries. Methods: This was a cross-sectional study of 3- to 6-year-old children (n =1,256) in the National Health and Nutrition Examination Survey, 2015-2018. Duration of breastfeeding and breast/formula feeding were assessed through structured interviews. Caries experience was assessed as having at least 1 decayed and filled tooth. Survey-weighted logistic regression adjusted for confounders evaluated associations. Results: The average maternal age at delivery was 28 years (standard error=0.28). About half (49.7%) of the children were girls. Thirty-eight percent of the children were breastfed for no more than 6 months, 20% for more than 6 to 12 months, and approximately 9% were breastfed for more than 12 to 18 months and over 18 months, while 24% were exclusively formula-fed. Relative to children breastfed for no more than 6 months, those breastfed for longer than 18 months had a nonsignificant covariate-adjusted caries experience odds (odds ratio [OR]=1.55, 95 percent confidence interval [95% CI]=0.80 to 3.01). Relative to children who were exclusively breastfed, those who were nonconcurrently breastfed/formula-fed (ie, there was no overlap in breastfeeding and formula feeding) had higher covariate-adjusted caries experience odds (OR=3.01, 95% CI=1.18 to 7.67). Conclusions: Nonconcurrent breast/formula feeding was associated with increased dental caries prevalence. Additional studies are needed to confirm these results and evaluate underlying mechanisms.

Purpose: To evaluate the physical and mechanical properties of 3 types of preformed crowns used in pediatric dentistry. Methods: Thirty crowns each were used for 3 study groups: Group 1-BioFlx® Crowns (BFCs); Group 2-stainless steel crowns (SSCs); and Group 3-preformed zirconia crowns (PZCs). The crowns (mandibular right second molar, size 4) were cemented on identical 3D printed teeth models. These were then mounted in acrylic blocks for the assessment of wear, compressive strength, and microhardness. Results: A significant difference (P ≤ 0.05) was observed in the compressive strength of the crowns evaluated. The highest compressive strength was seen in SSCs, followed by BFCs, and the lowest with PZCs. The difference in the microhardness of the 3 crowns was significant (P ≤ 0.001), with the highest demonstrated by PZCs, followed by SSCs, and the lowest with BFCs. The wear rate was found to be highest with SSCs, followed by PZCs, and lowest with BFCs. Conclusion: Stainless steel crowns and preformed zirconia crowns demonstrate high compressive strength and microhardness respectively, while BioFlx® Crowns showed the highest wear resistance of the 3 crowns tested.