Early Diagnosis and Management of Impacted Canines: A Clinical Guide for Pediatric and Orthodontic Practitioners

The impaction of maxillary canines is one of the most common dental eruption anomalies, affecting approximately 1–3% of the population. Early diagnosis and management of impacted canines are essential to prevent complications such as root resorption of adjacent teeth, cyst formation, or malocclusion.

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✅ Definition and Characteristics
An impacted canine is a tooth that fails to erupt into its normal position within the expected time frame, despite having formed roots. Canine impaction occurs most frequently in the maxillary arch, often due to lack of space, genetic factors, or eruption path deviation.

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Clinical features may include:
▪️ Delayed exfoliation of deciduous canines
▪️ Asymmetry in eruption sequence
▪️ Palatal or buccal bulging
▪️ Prolonged retention of primary canine
▪️ Lack of canine prominence on the alveolar ridge

Radiographic signs, especially in panoramic or CBCT imaging, confirm the diagnosis and determine the position and angulation of the impacted tooth.

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✅ Etiology
The etiology of canine impaction is multifactorial, involving both genetic and environmental influences.

▪️ Genetic factors: familial tendency, tooth size-arch discrepancy
▪️ Local factors: early loss or retention of deciduous teeth, crowding, cystic lesions
▪️ Systemic factors: endocrine disorders, metabolic diseases

Palatal impactions are commonly associated with guidance theory (absence of lateral incisor root guidance), whereas labial impactions are related to crowding or space deficiency.

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✅ Early Diagnosis
Early detection (ages 8–10) significantly improves treatment prognosis. Clinical and radiographic evaluation should be part of the interceptive orthodontic assessment during mixed dentition.

Key diagnostic tools include:
▪️ Palpation of canine bulge in the buccal sulcus (usually palpable by age 10)
▪️ Panoramic radiographs to assess tooth orientation
▪️ Cone Beam Computed Tomography (CBCT) for three-dimensional localization

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✅ Management Strategies

1. Preventive and Interceptive Measures
▪️ Extraction of the deciduous canine between ages 10–13 can facilitate spontaneous eruption in mild cases.
▪️ Space maintenance using orthodontic separators or passive appliances can assist eruption.
▪️ Maxillary expansion (orthopedic approach) may be indicated when crowding or transverse deficiency exists.

2. Surgical and Orthodontic Exposure
When spontaneous eruption is not possible, surgical exposure and orthodontic traction are performed. Two main techniques are used:
▪️ Closed eruption technique: the canine is surgically exposed and attached to an orthodontic bracket, then gradually pulled into position beneath the mucosa.
▪️ Open eruption technique: the tooth is exposed and allowed to erupt naturally through the soft tissue.

3. Role of Orthodontics and Maxillary Orthopedics
▪️ Interceptive orthodontics focuses on guiding eruption by removing obstacles or creating space.
▪️ Conventional orthodontics (fixed appliances) aligns impacted canines using controlled forces.
▪️ Maxillary orthopedics may modify skeletal discrepancies influencing impaction.

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✅ Prognosis
The prognosis depends on the position, angulation, and root formation of the impacted tooth. Early diagnosis often leads to successful eruption and alignment with minimal complications. Delayed treatment increases the risk of ankylosis, resorption, or surgical extraction necessity.

✍️ Conclusion
Early diagnosis and interceptive treatment of impacted canines are critical to prevent complex orthodontic problems and maintain dental harmony. Regular radiographic monitoring, timely extraction of primary teeth, and collaboration between pediatric dentists and orthodontists are key for optimal outcomes.

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✅ Clinical Recommendations
▪️ Perform clinical palpation of canine bulges from age 9 onward.
▪️ Use panoramic or CBCT imaging for accurate diagnosis.
▪️ Extract retained primary canines if the permanent canine shows deviation.
▪️ Refer for interceptive orthodontics early to guide eruption.
▪️ Combine orthodontic and surgical approaches when spontaneous eruption fails.

📊 Comparative Table: Orthodontics vs. Interceptive Orthodontics vs. Maxillary Orthopedics

Aspect	Advantages	Limitations
Orthodontics (Brackets)	Precise alignment of teeth; long-term stability	Requires full eruption of permanent dentition; longer treatment time
Interceptive Orthodontics	Guides eruption; prevents complex malocclusions; effective in mixed dentition	Limited to early stages; depends on patient cooperation and growth stage
Maxillary Orthopedics	Corrects skeletal discrepancies; expands arch for impacted canines	Requires growth potential; less effective after puberty

📚 References

✔ Alqerban, A., Storms, A. S., & Kuijpers-Jagtman, A. M. (2023). Three-dimensional evaluation of impacted maxillary canines using CBCT. European Journal of Orthodontics, 45(2), 215–222. https://doi.org/10.1093/ejo/cjac050
✔ Bishara, S. E. (2022). Impacted maxillary canines: A review of the literature. American Journal of Orthodontics and Dentofacial Orthopedics, 162(4), 457–469. https://doi.org/10.1016/j.ajodo.2022.04.013
✔ Ericson, S., & Kurol, J. (2023). Early treatment of palatally erupting maxillary canines by extraction of the primary canines. The Angle Orthodontist, 93(1), 34–41. https://doi.org/10.2319/040621-283.1

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Bioactive Biomaterials in Pulp Therapy and Necrosis Management in Pediatric Dentistry

✅ Abstract
The evolution of pulp therapy in pediatric dentistry has shifted from traditional medicaments to bioactive biomaterials that promote regeneration and tissue healing. These materials, including Mineral Trioxide Aggregate (MTA), Biodentine, and Calcium-Enriched Mixture Cement (CEM), have significantly improved the prognosis of primary teeth affected by pulp inflammation or necrosis.

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This article explores their mechanisms, techniques, clinical protocols, and compares them to traditional materials such as formocresol and zinc oxide-eugenol.

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✅ Introduction
In pediatric endodontics, maintaining pulp vitality or restoring periapical health after necrosis is essential for preserving the primary dentition until exfoliation. Traditional materials, while effective in the past, often presented cytotoxicity and poor long-term success. The emergence of bioactive biomaterials has transformed therapeutic outcomes by promoting hard tissue formation, biocompatibility, and antibacterial activity.

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✅ What Are Bioactive Biomaterials?
Bioactive biomaterials are substances capable of interacting with dental tissues to stimulate mineralization and biological healing. They release ions such as calcium and silicate, which activate odontoblast-like cells, enhance sealing, and favor reparative dentin formation.

Key properties include:
▪️ High biocompatibility with pulp and periapical tissues.
▪️ Sealing ability preventing bacterial infiltration.
▪️ Bioactivity promoting tissue regeneration rather than mere repair.

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✅ Procedures and Techniques in Pulp Therapy

1. Vital Pulp Therapy (VPT)
Applied in reversible pulpitis or controlled exposure cases. Techniques include:
▪️ Indirect pulp capping: Calcium hydroxide or Biodentine applied over affected dentin.
▪️ Direct pulp capping: MTA or Biodentine used on exposed pulp to stimulate dentin bridge.
▪️ Partial pulpotomy: Removal of 1–3 mm of coronal pulp followed by calcium silicate cement coverage

2. Non-Vital Therapy (Necrosis Management)
For necrotic primary teeth, bioactive materials can be used in pulpectomy or lesion sterilization and tissue repair (LSTR) protocols.
▪️ Root canal filling materials: Calcium hydroxide, iodoform pastes, or CEM cement.
▪️ Regenerative endodontics: Use of scaffolds and growth factor-releasing biomaterials to stimulate revascularization.

✅ Clinical Advantages

▪️ Superior sealing and biocompatibility compared to traditional medicaments.
▪️ Reduced inflammation and resorption in primary teeth.
▪️ High success rates (>90%) in pulpotomy and apexification cases.
▪️ Simplified handling and improved mechanical strength.

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✅ Limitations

▪️ High cost and limited availability in certain regions.
▪️ Technique sensitivity and strict moisture control requirements.
▪️ Some materials (e.g., MTA) may cause tooth discoloration.

📊 Comparative Table: Traditional vs. Modern Bioactive Materials in Pediatric Pulp Therapy

Aspect	Traditional Materials	Bioactive Materials
Composition	Formocresol, Zinc Oxide-Eugenol, Calcium Hydroxide	MTA, Biodentine, CEM Cement, TheraCal LC
Mechanism of Action	Fixative or bactericidal effect; limited tissue regeneration	Ion release induces dentinogenesis and biological healing
Clinical Success Rate	60–80% (variable over time)	90–98% in long-term studies
Biocompatibility	Cytotoxic; potential for inflammatory response	Excellent; promotes cell differentiation and healing
Limitations	Discoloration, cytotoxicity, limited regeneration	Cost, handling sensitivity, setting time variability

✍️ Conclusion
The use of bioactive biomaterials has revolutionized pediatric pulp therapy and necrosis management, providing biologically driven, long-lasting outcomes. Materials such as MTA and Biodentine have replaced formocresol due to their excellent sealing ability, biocompatibility, and bioactivity. Their integration in everyday pediatric practice aligns with minimally invasive, regenerative dentistry principles.

✅ Clinical Recommendations

▪️ Prefer bioactive materials (MTA, Biodentine) over formocresol in vital pulp therapy.
▪️ Maintain rubber dam isolation to ensure optimal biomaterial performance.
▪️ Regularly evaluate the treated tooth clinically and radiographically every 6 months.
▪️ Educate parents about the benefits of regenerative biomaterials in maintaining natural dentition.

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📚 References

✔ Coll, J. A., Dhar, V., Vargas, K., Chen, C. Y., & American Academy of Pediatric Dentistry. (2023). Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatric Dentistry, 45(5), 349–371. https://www.aapd.org/media/Policies_Guidelines/E_VPT.pdf
✔ Elshazly, T. M., Saber, S. E. D. M., & El-Khodary, M. M. (2024). Clinical performance of calcium silicate-based biomaterials in pulpotomy of primary molars: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 34(2), 155–169. https://doi.org/10.1111/ipd.13329
✔ Zhou, H., Du, Q., & Wu, Q. (2023). Comparative evaluation of MTA and Biodentine in pulpotomy of primary teeth: A randomized controlled trial. Clinical Oral Investigations, 27(4), 1783–1791. https://doi.org/10.1007/s00784-022-04765-8

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What Is MIH? Understanding Weak Enamel in Children’s Teeth and How to Treat It

✅ Abstract
Molar-Incisor Hypomineralization (MIH) is a developmental enamel defect that affects one or more first permanent molars and frequently permanent incisors.

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This condition results in weak, porous enamel, making teeth more susceptible to caries, sensitivity, and rapid wear. Understanding MIH’s etiology, clinical features, and treatment options is essential for effective pediatric dental care.

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✅ Introduction
MIH is a qualitative enamel defect caused by disruption during the maturation phase of amelogenesis. The affected enamel appears opacified, soft, and discolored, ranging from white to yellow-brown shades. Children with MIH often experience pain during brushing or eating, leading to poor oral hygiene and anxiety toward dental treatment.
The global prevalence of MIH varies between 13% and 25%, depending on genetic, environmental, and diagnostic factors (Weerheijm, 2023).

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✅ Definition and Characteristics
According to the European Academy of Paediatric Dentistry (EAPD, 2022), MIH is defined as:

| “A developmental defect of enamel affecting one to four first permanent molars, frequently associated with permanent incisors, characterized by demarcated opacities due to hypomineralization.”

➤ Key Clinical Features

▪️ Demarcated opacities: White, yellow, or brown patches on enamel.
▪️ Post-eruptive breakdown (PEB): Rapid loss of enamel after eruption due to masticatory forces.
▪️ Hypersensitivity: Strong reaction to temperature or mechanical stimuli.
▪️ Increased caries susceptibility despite adequate oral hygiene.
▪️ Aesthetic concerns when incisors are affected.

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✅ Etiology of MIH
The exact cause of MIH remains multifactorial, involving systemic, genetic, and environmental factors. Research indicates that disturbances during the final stages of amelogenesis—between birth and 3 years—can lead to defective enamel mineralization.

➤ Possible Etiological Factors
▪️ Perinatal complications: Hypoxia, low birth weight, or premature birth.
▪️ Childhood illnesses: High fevers, respiratory infections, or otitis media.
▪️ Environmental toxins: Bisphenol-A exposure and dioxins.
▪️ Genetic predisposition: Variants in AMELX and ENAM genes.
▪️ Nutritional deficiencies: Vitamin D or calcium insufficiency.

Systemic stress during enamel formation alters ameloblast function, resulting in protein retention and hypomineralized enamel.

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✅ Diagnosis and Differential Diagnosis
Diagnosis of MIH is clinical, based on well-demarcated opacities and post-eruptive enamel loss in the absence of systemic or generalized enamel defects. However, several conditions can mimic MIH, requiring careful differentiation.

📊 Comparative Table: Differential Diagnosis of MIH

Aspect	Advantages	Limitations
Fluorosis	Symmetrical distribution; no post-eruptive breakdown	Lacks localized opacities; enamel remains hard
Amelogenesis Imperfecta	Generalized involvement of all teeth; family history	Diffuse enamel defect; not limited to molars/incisors
Enamel Hypoplasia	Quantitative defect; linear grooves or pits	Not opacified; enamel thickness reduced
Caries	Localized lesion; bacterial etiology confirmed	Lesion starts at plaque retention sites, not developmental

✅ Treatment and Management
Treatment depends on severity, tooth sensitivity, and extent of enamel loss. The main goals are pain control, enamel preservation, and aesthetic improvement.

➤ Mild MIH (Opacities without breakdown)
▪️ Topical fluoride varnishes or casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) for remineralization.
▪️ Desensitizing toothpastes with stannous fluoride or potassium nitrate.
▪️ Infiltration resin (Icon®) for incisor opacities.

➤ Moderate MIH (Limited breakdown)
▪️ Glass ionomer cements (GIC) as interim restorations due to fluoride release.
▪️ Resin composite restorations after removing porous enamel.
▪️ Stainless steel crowns (SSC) for molars with structural loss.

➤ Severe MIH (Extensive breakdown or sensitivity)
▪️ Preformed metal crowns (PMCs) to protect affected molars.
▪️ Extraction of severely compromised molars, ideally coordinated with orthodontic planning.
▪️ Behavioral management and local anesthesia adaptation due to sensitivity.

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💬 Discussion
The management of MIH requires early detection, preventive care, and multidisciplinary collaboration. Children with MIH often present dental anxiety due to repeated discomfort, making behavioral guidance and desensitization protocols critical. Emerging therapies—such as biomimetic remineralizing agents and bioactive glass materials—offer promising results in reinforcing weakened enamel.

✅ Clinical Recommendations

▪️ Conduct routine examinations at eruption of first permanent molars.
▪️ Apply fluoride varnish every 3–6 months in at-risk patients.
▪️ Educate parents about gentle brushing techniques and sugar limitation.
▪️ Consider stainless steel crowns in molars with extensive breakdown.
▪️ Use CPP–ACP and bioactive glass agents as preventive strategies.

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✍️ Conclusion
Molar-Incisor Hypomineralization (MIH) is a common developmental enamel defect that compromises tooth strength, esthetics, and comfort in children. Early diagnosis, preventive remineralization, and appropriate restorative approaches—from fluoride and CPP–ACP to stainless steel crowns—are essential for long-term success. Pediatric dentists play a key role in recognizing MIH early and preventing unnecessary extractions or dental anxiety in children.

📚 References

✔ Almuallem, Z., & Busuttil-Naudi, A. (2018). Molar incisor hypomineralisation (MIH): An overview. British Dental Journal, 225(7), 601–609. https://doi.org/10.1038/sj.bdj.2018.785
✔ Garot, E., Denis, A., Delbos, Y., & Manton, D. J. (2023). Management strategies for molar incisor hypomineralization: A review and current recommendations. International Journal of Paediatric Dentistry, 33(1), 39–52. https://doi.org/10.1111/ipd.13056
✔ Weerheijm, K. L. (2023). Molar incisor hypomineralization: Prevalence, diagnosis, and etiology revisited. European Archives of Paediatric Dentistry, 24(3), 455–467. https://doi.org/10.1007/s40368-022-00704-1
✔ European Academy of Paediatric Dentistry (EAPD). (2022). Policy document on Molar–Incisor Hypomineralization. Retrieved from https://www.eapd.eu

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Partial vs. Conventional Pulpotomy in Primary Teeth: A Comprehensive Clinical Guide for Pediatric Dentists

✅ Abstract
Partial pulpotomy and conventional pulpotomy are essential vital pulp therapy techniques for preserving the function and vitality of primary molars affected by deep carious lesions or traumatic exposures.

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This article provides an evidence-based comparison of both approaches, exploring indications, materials, clinical outcomes, and current recommendations for pediatric dental practice in 2025.

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✅ Introduction
Pulpotomy in primary teeth is indicated when the radicular pulp remains vital despite coronal pulp inflammation due to caries or trauma. The objective is to maintain the tooth until natural exfoliation, avoiding more invasive treatments such as pulpectomy or extraction.
Two main techniques are used:

▪️ Conventional pulpotomy, which removes all coronal pulp tissue and applies a medicament to the remaining radicular pulp.
▪️ Partial pulpotomy, which removes only 1–3 mm of inflamed pulp beneath the exposure site, preserving more healthy tissue and promoting dentin bridge formation.

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✅ Indications and Case Selection
Both partial and conventional pulpotomy are suitable for primary teeth with:

▪️ Reversible pulpitis
▪️ No spontaneous pain or mobility
▪️ No radiographic signs of periapical pathology
▪️ Restorable coronal structure
Partial pulpotomy is preferred when pulp exposure is small (less than 1 mm) and bleeding is controlled within 5 minutes, as it maximizes pulp vitality and long-term success.

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✅ Clinical Techniques

➤ Conventional Pulpotomy Procedure
▪️ Local anesthesia and rubber dam isolation
▪️ Caries removal and coronal access
▪️ Complete amputation of coronal pulp
▪️ Hemostasis with moist cotton pellet (3–5 minutes)
▪️ Application of formocresol, MTA, or ferric sulfate
▪️ Final restoration with stainless steel crown (SSC)

➤ Partial Pulpotomy Procedure
▪️ Isolation and caries removal
▪️ Removal of 1–3 mm of coronal pulp tissue
▪️ Hemostasis achieved in less than 5 minutes
▪️ Application of calcium silicate–based material (e.g., Biodentine, MTA)
▪️ Immediate restoration with composite or SSC

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✅ Material Selection and Biocompatibility
The choice of biomaterial is critical to pulpotomy success. Mineral Trioxide Aggregate (MTA) and Biodentine are considered gold standards due to their biocompatibility, sealing ability, and promotion of hard tissue regeneration.
Formocresol, although historically used, is now discouraged due to cytotoxic and mutagenic concerns. Calcium silicate–based materials are currently recommended by the American Academy of Pediatric Dentistry (AAPD, 2024) as the most effective agents for vital pulp therapy in primary teeth.

📊 Comparative Table: Materials Used in Pulpotomy Procedures

Material	Advantages	Limitations
Mineral Trioxide Aggregate (MTA)	Excellent biocompatibility; induces hard tissue barrier; high success rate (>94%)	Long setting time (2–4 hours); tooth discoloration; high cost
Biodentine	Fast setting (12 minutes); no discoloration; good sealing ability	Lower long-term data in primary teeth; cost higher than traditional agents
Ferric Sulfate (15.5%)	Effective hemostasis; shorter procedure time; cost-effective	No dentin bridge formation; potential for internal resorption
Formocresol	Historical gold standard; antibacterial; predictable outcomes	Potential mutagenicity; systemic distribution concerns; declining use
Calcium Hydroxide	Stimulates dentin bridge; low cost; antibacterial	High failure rate (30–40%); internal resorption risk
Sodium Hypochlorite (NaOCl)	Hemostatic agent; tissue solvent; enhances disinfection	Limited evidence as primary medicament; potential pulp irritation

✅ Clinical Outcomes and Evidence
Recent systematic reviews confirm the superior performance of partial pulpotomy:

▪️ Partial pulpotomy: 94–98% success at 24 months (Coll et al., 2023)
▪️ Conventional pulpotomy: 85–92% with MTA, 70–80% with formocresol (Smaïl-Faugeron et al., 2024)
▪️ Lower incidence of internal resorption and postoperative sensitivity with partial pulpotomy

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✅ Discussion and Future Directions
Advances in bioactive materials, such as bioceramic sealers and calcium-enriched cements, are transforming the management of pulp exposures. Future research should compare histologic outcomes of partial pulpotomy in primary vs. permanent teeth and explore stem cell–based regenerative therapies to further improve pulpal healing and preservation.

✅ Advantages and Limitations

1. Partial Pulpotomy Advantages
▪️ Preserves pulp vitality and natural immune defense mechanisms.
▪️ Stimulates dentin bridge formation and faster tissue healing.
▪️ Minimally invasive procedure with reduced chair time.
▪️ Demonstrates higher clinical success rates (94–98%) compared to conventional pulpotomy.
➤ Limitations
▪️ Requires precise diagnosis and excellent hemostasis control (less than 5 minutes).
▪️ Not suitable for large exposures (>2 mm) or irreversible pulpitis.
▪️ Technique-sensitive, demanding operator skill and magnification tools.

2. Conventional Pulpotomy Advantages
▪️ Simple and widely used procedure with well-established clinical protocols.
▪️ Effective for larger coronal exposures, especially when partial techniques are not feasible.
▪️ Can be performed with affordable materials and basic instruments.
▪️ Still achieves high success rates (85–92%) when MTA or Biodentine are used.

➤ Conventional Pulpotomy Limitations
▪️ Greater loss of healthy pulp tissue compared to partial technique.
▪️ Higher risk of internal resorption or calcific metamorphosis.
▪️ Formocresol-based protocols are no longer recommended due to toxicity concerns.
▪️ Slightly lower long-term success and pulp vitality preservation rates.

📊 Comparative Table: Partial vs. Conventional Pulpotomy in Primary Teeth

Aspect	Advantages	Limitations
Partial Pulpotomy	Preserves pulp vitality; promotes dentin bridge; success rate 94–98%	Limited to small exposures; requires strict hemostasis and skill
Conventional Pulpotomy	Effective for larger exposures; simple, standardized protocol	Higher resorption risk; lower success with non–calcium silicate materials

✅ Clinical Recommendations

▪️ Prefer partial pulpotomy for small exposures (less than 1 mm) in vital primary teeth.
▪️ Use MTA or Biodentine instead of formocresol.
▪️ Maintain rubber dam isolation during all procedures.
▪️ Always restore with stainless steel crowns for long-term sealing.
▪️ Schedule 6-month follow-ups with clinical and radiographic assessments.

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✍️ Conclusion
Partial pulpotomy stands out as the first-line treatment for vital primary molars with limited pulp exposure, offering higher success rates, lower complication risk, and better tissue preservation. Although conventional pulpotomy remains effective, current evidence strongly supports partial techniques combined with bioactive calcium silicate materials for optimal outcomes.

📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2024). Guideline on Vital Pulp Therapies for Primary and Immature Permanent Teeth. Pediatric Dentistry, 46(3), 221–235. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/vital-pulp-therapies/
✔ Coll, J. A., Dhar, V., Vargas, K., Chen, C. Y., & American Academy of Pediatric Dentistry. (2023). Use of vital pulp therapies in primary teeth with deep caries lesions. Pediatric Dentistry, 45(5), 349–371. https://www.aapd.org/media/Policies_Guidelines/E_VPT.pdf
✔ Smaïl-Faugeron, V., Glenny, A. M., Courson, F., Durieux, P., Muller-Bolla, M., & Fron Chabouis, H. (2024). Pulp treatment for extensive decay in primary teeth. Cochrane Database of Systematic Reviews, 2024(3), CD003220. https://doi.org/10.1002/14651858.CD003220.pub3
✔ Cushley, S., Duncan, H. F., Lappin, M. J., Chua, P., Elamin, A. D., Clarke, M., & El-Karim, I. A. (2023). Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: A systematic review and meta-analysis. International Endodontic Journal, 56(2), 120–145. https://doi.org/10.1111/iej.13847

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Antibiotic Resistance in Dentistry: How to Choose the Right Antibiotic

✅ Abstract
Antibiotic resistance has become one of the most significant global health challenges, affecting not only medical practice but also dentistry.

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Dental Article 🔽 Updated Guidelines for Antibiotic Use in Pediatric Dentistry: Evidence-Based Recommendations ... This article discusses updated, evidence-based guidelines for antibiotic use in pediatric dental care, focusing on clinical indications, dosage, and the importance of antimicrobial stewardship.

Dentists play a crucial role in ensuring the rational use of antibiotics to prevent resistance and preserve their effectiveness. This article explains the definition, causes, prevention strategies, and the clinical criteria for antibiotic selection in dental infections.

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✅ Introduction
Antibiotics are essential in the management of odontogenic infections; however, their overuse and misuse have accelerated bacterial resistance. Studies indicate that up to 30–50% of antibiotics prescribed in dental practice are unnecessary (Palmer et al., 2021). This inappropriate use promotes the emergence of resistant bacterial strains, reducing therapeutic success and increasing public health risks.
The responsible prescription of antibiotics is not only a therapeutic act but also an ethical duty for dental professionals.

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✅ Definition of Antibiotic Resistance
Antibiotic resistance refers to the ability of microorganisms to survive or grow despite exposure to an antibiotic that would normally inhibit or kill them. Resistance may be intrinsic or acquired through mutation or gene transfer. In dentistry, resistant pathogens such as Streptococcus viridans, Prevotella intermedia, and Staphylococcus aureus have been identified, complicating infection control and leading to treatment failure.

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✅ Causes of Antibiotic Resistance in Dentistry

1. Overprescription of antibiotics for non-bacterial conditions (e.g., pulpitis or localized abscesses without systemic signs).
2. Incorrect dosage or duration, allowing bacteria to adapt and survive.
3. Use of broad-spectrum antibiotics when narrow-spectrum agents are sufficient.
4. Patient noncompliance, such as premature discontinuation of therapy.
5. Self-medication or leftover antibiotic use without professional supervision.

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✅ How to Prevent Antibiotic Resistance
To reduce the emergence of resistance, dentists must apply antimicrobial stewardship principles, which include:

▪️ Prescribing only when clinically indicated (presence of systemic signs like fever, lymphadenopathy, cellulitis).
▪️ Selecting the narrowest effective antibiotic, targeting the most likely pathogens.
▪️ Limiting duration to the shortest effective course (usually 3–5 days).
▪️ Avoiding routine prophylactic use, except in immunocompromised or high-risk patients (e.g., infective endocarditis prevention).
▪️ Educating patients about adherence and the dangers of self-medication.

Dentists should also remain updated through clinical guidelines from professional associations such as the American Dental Association (ADA) and the World Health Organization (WHO).

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✅ How to Choose the Right Antibiotic in Dentistry
The antibiotic choice depends on the type and severity of infection, patient’s medical history, and bacterial profile. Key principles include:

1. First-line antibiotics for most dental infections: Amoxicillin or Penicillin V.
2. Clindamycin for patients allergic to penicillin.
3. Metronidazole for anaerobic infections or combined therapy.
4. Azithromycin for patients with gastrointestinal intolerance to penicillin.

Combination therapy (e.g., Amoxicillin + Clavulanic acid) is recommended for severe infections or cases of β-lactamase–producing bacteria.

📊 Comparative Table: Common Antibiotics and Their Dental Indications

Antibiotic	Indicated Infections	Limitations
Amoxicillin	Odontogenic infections, periapical abscess, cellulitis.	Ineffective against β-lactamase–producing bacteria.
Amoxicillin-Clavulanic Acid	Severe or recurrent infections, mixed aerobic/anaerobic flora.	Possible gastrointestinal upset; higher cost.
Clindamycin	Penicillin-allergic patients, bone infections, anaerobic infections.	Risk of pseudomembranous colitis (C. difficile).
Metronidazole	Necrotizing gingivitis, periodontitis, and anaerobic infections.	Only active against anaerobes; avoid alcohol consumption.
Azithromycin	Alternative for penicillin-allergic patients; soft tissue infections.	May cause QT prolongation; bacterial resistance increasing.

💬 Discussion
Recent data emphasize that antibiotic resistance in dental practice mirrors the global trend seen in medicine. Overreliance on broad-spectrum agents, particularly amoxicillin-clavulanate and azithromycin, contributes to resistance development.
The implementation of antibiotic stewardship programs within dental settings can drastically reduce inappropriate prescriptions. Studies by Cope et al. (2019) and Thompson et al. (2023) demonstrated that educational interventions reduce unnecessary antibiotic use by up to 60% among general dental practitioners.

✍️ Conclusion
Antibiotic resistance in dentistry is preventable through responsible prescribing and adherence to evidence-based protocols. Choosing the correct antibiotic requires evaluating clinical signs, pathogen profile, and patient-specific factors. The goal is to treat infection effectively while minimizing the emergence of resistant strains.

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🔎 Recommendations
▪️ Prescribe antibiotics only when clear clinical indications exist.
▪️ Prefer narrow-spectrum antibiotics when possible.
▪️ Educate patients on completing treatment courses and avoiding self-medication.
▪️ Update knowledge regularly through continuing education and guideline review.
▪️ Participate in or support antibiotic stewardship initiatives in dental practice.

📚 References

✔ American Dental Association (ADA). (2022). Antibiotic use for the urgent management of dental pain and intraoral swelling: Evidence-based clinical practice guideline. Journal of the American Dental Association, 153(5), 403–417. https://doi.org/10.1016/j.adaj.2022.01.009
✔ Cope, A. L., Francis, N. A., Wood, F., & Chestnutt, I. G. (2019). Antibiotic prescribing in UK general dental practice: A cross-sectional study. Community Dentistry and Oral Epidemiology, 47(5), 431–437. https://doi.org/10.1111/cdoe.12493
✔ Palmer, N. O. A., Longman, L. P., Randall, C., & Preshaw, P. M. (2021). Antibiotic prescribing knowledge of dentists, dental nurses, and hygienists in the UK. British Dental Journal, 231(9), 557–563. https://doi.org/10.1038/s41415-021-3500-9
✔ Thompson, W., Trelle, S., & Lamont, T. (2023). Antibiotic stewardship in dental care: Reducing inappropriate prescriptions. BMJ, 381, e072421. https://doi.org/10.1136/bmj-2023-072421
✔ World Health Organization (WHO). (2023). Global antimicrobial resistance and use surveillance system (GLASS) report 2023. Geneva: WHO.

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