Stainless Steel Crowns for Kids: When and Why They’re the Best Option

Stainless steel crowns (SSCs) are one of the most reliable restorations used in pediatric dentistry, especially for baby molars that have severe decay or have undergone pulp therapy.

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First introduced in the 1950s, they are still widely used because they are strong, affordable, and long-lasting—often outperforming white fillings in baby teeth.

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✅ When Are Stainless Steel Crowns Used in Children?
Pediatric dentists commonly use SSCs when:

° A baby tooth has large cavities that can’t be fixed with a regular filling
° The tooth has been treated with a pulpotomy or pulpectomy
° The enamel is weak due to conditions like enamel hypoplasia or molar-incisor hypomineralization (MIH)
° The tooth has fractured due to trauma
° The child is at high risk of cavities or has special healthcare needs

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✅ Benefits of Stainless Steel Crowns for Baby Teeth

° Long-lasting protection (often until the tooth naturally falls out)
° Full coverage and excellent seal against bacteria
° Quick and easy placement in a single visit
° Ideal for young children or those who have trouble cooperating
° Lower cost than most other restorative options

✅ How Pediatric Dentists Place a Stainless Steel Crown

1. Examine and diagnose the tooth
2. Choose the correct crown size
3. Reduce the biting surface and sides of the tooth
4. Try in the crown to ensure a proper fit
5. Cement it using glass ionomer cement
6. Check the bite and remove any excess cement

The entire process can often be done in one appointment, which is especially helpful for children with limited patience or dental anxiety.

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✅ Why Not Just Do a Filling?

White fillings (composite) or silver fillings (amalgam) may work for small cavities, but they often fail in baby teeth with major decay. Stainless steel crowns are stronger, more protective, and have a much lower failure rate—especially when the child is at high risk for future cavities.
While some parents may prefer tooth-colored crowns, research shows that SSCs have a success rate of over 90%, even after several years. Esthetic crowns like zirconia are more expensive, and not always ideal for very young or uncooperative children.

💡 Conclusion

Stainless steel crowns remain the gold standard for restoring primary molars with major damage. They offer reliable, long-term protection, are cost-effective, and reduce the need for future dental work.
If your child needs treatment for a decayed or weakened baby tooth, talk to your pediatric dentist about whether a stainless steel crown is the right option. In many cases, it’s the best way to keep their smile healthy and pain-free until the adult teeth come in.

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📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Clinical Practice Guidelines: Restorative Dentistry. Reference Manual, 45(6), 372–380. https://www.aapd.org/research/oral-health-policies--recommendations/

✔ Lynch, C. D., O'Sullivan, V. R., & McConnell, R. J. (2020). Success and survival of stainless steel crowns placed in primary molars: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 30(3), 212–222. https://doi.org/10.1111/ipd.12612

✔ Santos, J. M., Diniz, M. B., Oliveira, B. H., & Braga, M. M. (2021). Longevity of restorations in primary teeth: A systematic review and meta-analysis. Pediatric Dentistry, 43(1), 16–24. https://www.aapd.org

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Risk Factors, Signs & Modern Management of Tongue Cancer: 2025 Review

Tongue cancer—primarily squamous cell carcinoma (SCC)—represents a significant portion of head and neck malignancies. Although relatively rare (less than 1 % of new cancer cases), its incidence is rising among younger, non‑smoking populations .

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This review synthesizes risk factors, clinical presentation, diagnostic pathways, treatment modalities, and preventive strategies over the past six years.

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✅ Risk Factors

° Tobacco smoking and smokeless tobacco: Primary risk factor; smoking increases risk 3–6× and smokeless forms similarly elevate risk.
° Alcohol consumption: Heavy alcohol use independently increases risk (~20 % of oral cancers), synergizes with tobacco to cause ~72 % of head and neck cancers.
° HPV infection: High-risk strains (HPV‑16/18) are strongly linked to base‑of‑tongue SCC; rising HPV-driven oropharyngeal cancers.
° Betel nut and paan chewing: Doubles oral cancer risk even without tobacco, contributing up to 40 % of cases in endemic regions.
° Chronic inflammation and oral dysbiosis: Emerging research links chronic oral irritation/infections with oxidative stress and carcinogenesis.
° Non-modifiable factors: Includes age (≥ 40), male sex (2× risk), race (higher in African‑American men), family or personal cancer history.

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✅ Signs & Symptoms

° Non-healing ulcers or sores, red/white patches (erythroplakia, leukoplakia).
° Lumps or thickening on tongue; easy bleeding.
° Pain, burning, numbness, or discomfort in mouth/jaw .
° Functional issues: difficulty chewing, swallowing, speaking; ear, throat, or jaw pain; loose teeth .
° Late-stage signs: neck lymphadenopathy, weight loss, bleeding, voice changes.

✅ Diagnosis

° Clinical exam: Visual and manual inspection, mirror or endoscopic (nasendoscopy) evaluation.
° Biopsy & histopathology: Essential for definitive diagnosis. HPV testing often included.
° Imaging: CT, MRI, ultrasound, PET‑CT to assess tumor extent and lymph node involvement.

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✅ Treatment

° Surgery: Primary for early-stage disease; transoral resections for oral tongue; neck dissection as needed.
° Radiation therapy: Often adjuvant post-surgery or primary modality for advanced/inoperable cases.
° Chemotherapy & chemoradiation: Platinum-based regimens, especially for HPV-negative or bulky disease .
° Targeted therapies & immunotherapy: Emerging modalities; microenvironment-targeted immunotherapy under study.
° Supportive care: Speech/swallow rehabilitation, nutritional support to manage side effects.

✅ Prevention

° Smoking cessation and reduced alcohol intake are the most effective strategies.
° HPV vaccination (recommended through age 45) may reduce HPV-driven tongue cancer.
° Avoid betel nut/paan; improve oral hygiene and diet (fruit/vegetable intake).
° Regular dental/oral screenings with prompt evaluation of lesions persisting >2–3 weeks .

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💬 Discussion

Recent epidemiological trends indicate an increase in tongue cancer among young, non-smoking individuals, highlighting the growing importance of HPV and alternative risk factors. Concurrently, advancements in diagnostic imaging, minimally invasive surgical techniques, and immunotherapies offer improved outcomes and functional preservation. However, challenges persist: late-stage presentation, therapy-related toxicity, and disparities in access to HPV vaccination and specialist care.

💡 Conclusion

Tongue cancer is a multifactorial disease shaped by lifestyle, viral, environmental, and biological determinants. Contemporary understanding underscores the interplay of traditional risks—tobacco and alcohol—with newer drivers like HPV, chronic inflammation, and betel nut use. Early detection and a multidisciplinary treatment approach remain paramount. Preventive measures, especially smoking cessation, alcohol reduction, and HPV vaccination, are critical for reducing incidence.

📚 References

✔ American Cancer Society. (2021). Risk Factors for Oral Cavity and Oropharyngeal Cancers. Retrieved from American Cancer Society website.

✔ Cleveland Clinic. (2023). Tongue cancer: symptoms, causes & treatment. Cleveland Clinic.

✔ Mayo Clinic Staff. (2025, November). Tongue cancer: symptoms and causes. Mayo Clinic.

✔ Current trends on prevalence, risk factors and prevention of oral... Frontiers in Oral Health, 2024.

✔ Exploration Pub. (2024). Risk factors, prevention, diagnosis, and immunotherapy’s role in oral cancer.

✔ Verywell Health. (2024, April 22). Tongue Cancer: Everything You Need to Know.

✔ New York Post. (2025, May). Top Chef alum Shirley Chung cancer update.

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Common Complications of Dental Implants: Diagnosis and Treatment Guide

Dental implants have become the gold standard for replacing missing teeth due to their high success rate and ability to restore function and aesthetics. However, like any surgical procedure, implant placement is not free of complications.

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Understanding the nature of these complications—ranging from peri-implant diseases to mechanical failures—is crucial for timely diagnosis and appropriate management. This article reviews the most common problems associated with dental implants, including their definitions, clinical characteristics, diagnostic strategies, and current treatment options.

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✅ 1. Peri-Implant Mucositis

➤ Definition:
° Peri-implant mucositis is a reversible inflammatory reaction of the soft tissues surrounding a dental implant without accompanying bone loss.
➤ Clinical Features:
° Redness and swelling of peri-implant mucosa
° Bleeding on probing (BOP)
° No radiographic bone loss
° Patient may report mild discomfort or sensitivity
➤ Diagnosis:
° Probing depth measurement
° Presence of BOP
° Radiographs confirm absence of bone loss
° Exclusion of other causes such as food impaction or residual cement
➤ Treatment:
° Mechanical debridement with plastic or titanium curettes
° Antimicrobial mouth rinses (e.g., chlorhexidine)
° Improved patient oral hygiene
° Re-evaluation after 2–4 weeks

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✅ 2. Peri-Implantitis

➤ Definition:
° Peri-implantitis is a progressive inflammatory disease affecting both the soft and hard tissues around an osseointegrated implant, leading to bone loss.
➤ Clinical Features:
° BOP and/or suppuration
° Increased probing depth (>5 mm)
° Progressive radiographic bone loss
° Possible implant mobility in advanced cases
➤ Diagnosis:
° Periodontal charting (baseline comparison)
° Radiographic bone level analysis
° Microbial analysis in severe or refractory cases
➤ Treatment:
° Mechanical debridement and antiseptic therapy
° Local or systemic antibiotics (e.g., amoxicillin + metronidazole)
° Surgical intervention (e.g., resective or regenerative surgery)
° Implant surface decontamination with lasers or air abrasives

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✅ 3. Implant Failure (Early and Late)

➤ Definition:
° Implant failure is classified as early (before osseointegration) or late (after functional loading), resulting in implant mobility or loss.
➤ Clinical Features:
° Pain or discomfort on function
° Mobility of implant
° Radiographic evidence of peri-implant radiolucency
° Soft tissue inflammation
➤ Diagnosis:
° Clinical mobility testing
° Percussion and tactile evaluation
° Radiographs to assess integration and bone levels
➤ Treatment:
° Removal of failed implant
° Management of infection or bone defects
° Possible delayed or immediate re-implantation depending on case

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✅ 4. Mechanical Complications

a. Screw Loosening or Fracture
➤ Definition:
° Mechanical dislodgment or breakage of abutment or prosthetic screws.
➤ Clinical Features:
° Mobility of crown or prosthesis
° Clicking or instability during function
° Possible pain or soft tissue trauma
➤ Diagnosis:
° Clinical inspection
° Radiographs to detect screw fracture or misfit
➤ Treatment:
° Retightening or replacement of screws
° Use of torque-controlled drivers
° Avoidance of occlusal overload

b. Prosthetic Fracture (e.g., Crown or Bridge)
➤ Definition:
° Fracture of the prosthetic components due to stress, fatigue, or poor design.
➤ Clinical Features:
° Fractured ceramic or acrylic visible
° Aesthetic compromise
° Patient may report altered bite or discomfort
➤ Diagnosis:
° Clinical examination
° Assessment of occlusal forces and design flaws
➤ Treatment:
° Repair or replacement of prosthesis
° Occlusal adjustment
° Use of more durable materials (e.g., zirconia)

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✅ 5. Neurological Complications

➤ Definition:
° Nerve injury typically occurs during implant placement in the mandibular region, resulting in temporary or permanent paresthesia.
➤ Clinical Features:
° Numbness or tingling of lower lip, chin, or tongue
° Burning sensation
° Pain or discomfort during healing
➤ Diagnosis:
° Clinical sensory testing (light touch, pinprick)
° Radiographic assessment of implant proximity to nerve canal
° Cone beam computed tomography (CBCT) if needed
➤ Treatment:
° Immediate implant removal if impingement is suspected
° Corticosteroids to reduce inflammation
° Referral to a neurologist for persistent symptoms

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💬 Discussion
Dental implant complications can significantly impact treatment outcomes and patient satisfaction. Peri-implant diseases, including mucositis and peri-implantitis, are among the most common biological complications and share many features with periodontal diseases. Mechanical and neurological complications, although less frequent, require early recognition and targeted management. Preventive strategies such as accurate surgical planning, patient education, and regular maintenance therapy play a vital role in minimizing the occurrence of complications.

💡 Conclusion
While dental implants are highly predictable, complications—both biological and mechanical—can arise. Timely identification and management based on clinical and radiographic findings are essential for preserving implant function and health. Clinicians must stay updated on the latest diagnostic protocols and treatment strategies to ensure long-term success and patient safety.

📚 References

✔ Lang, N. P., Berglundh, T., & Working Group 4 of the Seventh European Workshop on Periodontology. (2011). Periimplant diseases: Where are we now? – Consensus of the Seventh European Workshop on Periodontology. Journal of Clinical Periodontology, 38(s11), 178–181. https://doi.org/10.1111/j.1600-051X.2010.01674.x

✔ Heitz-Mayfield, L. J., & Mombelli, A. (2014). The therapy of peri-implantitis: A systematic review. The International Journal of Oral & Maxillofacial Implants, 29(Suppl), 325–345. https://doi.org/10.11607/jomi.2014suppl.g5.3

✔ Esposito, M., Hirsch, J. M., Lekholm, U., & Thomsen, P. (1998). Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. European Journal of Oral Sciences, 106(1), 527–551. https://doi.org/10.1046/j.0909-8836.1998.eos106111.x

✔ Misch, C. E. (2020). Dental Implant Prosthetics (3rd ed.). Mosby.

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Updated Guidelines for Antibiotic Use in Pediatric Dentistry: Evidence-Based Recommendations

The judicious use of antibiotics in pediatric dentistry is crucial to combat antimicrobial resistance and ensure optimal patient outcomes. Overprescription and inappropriate antibiotic use in children contribute to the global health threat of antibiotic resistance, adverse drug reactions, and disruption of normal microbiota.

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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.

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✅ Indications for Antibiotic Use in Pediatric Dentistry
According to the American Academy of Pediatric Dentistry (AAPD) and other professional bodies, antibiotics should be prescribed in pediatric patients only when there is clear evidence of systemic involvement or the risk of spread of odontogenic infections. The primary indications include:

° Acute facial swelling or cellulitis with systemic symptoms (fever, malaise)
° Rapidly progressing infections such as Ludwig’s angina or deep space infections
° Persistent infections not resolved by local measures alone
° Prophylaxis in patients at risk of infective endocarditis or with immunocompromising conditions

Local dental infections like localized abscesses or pulpitis do not typically require systemic antibiotics and are best managed by definitive dental treatment such as extraction or pulpectomy.

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✅ Commonly Recommended Antibiotics and Dosage
For pediatric patients, the most frequently recommended antibiotics are:

° Amoxicillin: 20–40 mg/kg/day divided every 8 hours, or 25–45 mg/kg/day if given twice daily
° Amoxicillin with Clavulanic Acid: Used when beta-lactamase resistance is suspected
° Clindamycin: 8–20 mg/kg/day in three divided doses (for penicillin-allergic patients)
° Azithromycin: 5–12 mg/kg on the first day followed by lower doses over 4 days

Prescribers must adjust dosages based on weight and age and consider the patient’s medical history, including allergies and hepatic or renal function.

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✅ Antibiotic Prophylaxis
The AAPD, following the American Heart Association (AHA) guidelines, recommends antibiotic prophylaxis for pediatric patients at high risk of infective endocarditis, especially before procedures likely to cause bleeding (e.g., tooth extractions, periodontal surgery). This includes:

° Children with prosthetic heart valves
° Previous infective endocarditis
° Certain congenital heart conditions
° Cardiac transplant recipients with valvulopathy

The standard prophylactic regimen is amoxicillin 50 mg/kg orally one hour before the procedure.

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💬 Discussion
Despite clear guidelines, studies reveal frequent antibiotic overprescription in pediatric dentistry. A cross-sectional study by Al-Jundi et al. (2022) indicated that many dentists prescribe antibiotics for non-indicated conditions such as reversible pulpitis, primarily due to parental expectations or time constraints. This inappropriate practice fosters resistance and increases adverse drug reactions, including gastrointestinal issues, allergic reactions, and alterations in the child’s developing microbiome.
Moreover, the COVID-19 pandemic initially led to increased remote consultations and a spike in empirical antibiotic prescriptions, further underscoring the need for robust antimicrobial stewardship programs in dental settings.
Educational interventions, integration of prescribing guidelines into electronic health systems, and continuing professional development can help reduce inappropriate prescribing practices. Collaborative efforts between pediatricians, pharmacists, and pediatric dentists are also essential.

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💡 Conclusion
Antibiotic use in pediatric dentistry should be reserved for cases with systemic involvement or significant risk of progression. Adherence to updated, evidence-based guidelines is critical to minimizing resistance and ensuring patient safety. Dental professionals must prioritize definitive treatment over pharmacologic management when possible and engage in continuous education to refine prescribing practices.

📚 References

✔ Al-Jundi, S. H., Mahmoud, S. Y., & Alsafadi, Y. H. (2022). Antibiotic prescribing practices among pediatric dentists in Jordan: A cross-sectional survey. BMC Oral Health, 22(1), 105. https://doi.org/10.1186/s12903-022-02156-3

✔ American Academy of Pediatric Dentistry. (2023). Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/antibiotic-therapy/

✔ Wilson, W., Taubert, K. A., Gewitz, M., Lockhart, P. B., Baddour, L. M., Levison, M., ... & Baltimore, R. S. (2007). Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation, 116(15), 1736–1754. https://doi.org/10.1161/CIRCULATIONAHA.106.183095

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Medications for Pulp Capping in Primary Teeth: Indications, Composition, and Clinical Management

Pulp capping in primary teeth is a conservative procedure aimed at preserving pulp vitality following an accidental or intentional pulp exposure during caries removal.

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Its success largely depends on the material or medication used, which must be biocompatible, promote tissue repair, and provide an adequate marginal seal. With advances in biomaterials, the range of available products has expanded, making it essential to understand their properties, advantages, and limitations for proper clinical application.

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✅ Main Medications Used

1. Calcium Hydroxide (Ca(OH)₂)

➤ Composition: Pure calcium hydroxide or formulated with hardening agents (e.g., Dycal®).
➤ Indications: Small pulp exposures without prolonged bleeding, in vital primary teeth.
➤ Advantages:
° Stimulates reparative dentin formation.
° Antibacterial properties.
° Easy to handle.
➤ Disadvantages:
° Soluble in oral fluids.
° Poor sealing ability.
° Fragile under mechanical stress.
➤ Handling: Apply a thin layer over the exposure, followed by a protective material such as resin-modified glass ionomer (RMGI).

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2. Mineral Trioxide Aggregate (MTA)

➤ Composition: Calcium, silicate, and aluminum oxides. Commercial examples: ProRoot® MTA, MTA Angelus®.
➤ Indications: Direct pulp capping in vital pulps, small pulp perforations.
➤ Advantages:
° High biocompatibility.
° Excellent sealing ability.
° Stimulates dentin bridge formation.
➤ Disadvantages:
° High cost.
° Long setting time (~2–4 hours).
° Difficult to manipulate.
➤ Handling: Mix with sterile distilled water and apply over the pulp; allow complete setting before final restoration.

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3. Biodentine®

➤ Composition: Calcium oxide, tricalcium silicate, zirconium oxide (radiopacifier).
➤ Indications: Modern alternative to MTA for direct pulp capping.
➤ Advantages:
° Faster setting time (~12 minutes).
° Biocompatible.
° Better mechanical properties than MTA.
➤ Disadvantages:
° High cost.
° May require training for proper handling.
➤ Handling: Applied directly to the exposure with a spatula, no intermediate layer needed.

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4. Zinc Oxide Eugenol (ZOE)

➤ Composition: Zinc oxide mixed with eugenol.
➤ Indications: Indirect pulp capping only (not for direct use) due to cytotoxicity risks.
➤ Advantages:
° Sedative effect on pulp tissue.
° Easy handling.
Disadvantages:
° Cytotoxic if in direct contact with the pulp.
° Inhibits polymerization of resin composites.
➤ Handling: Used as a base in deep cavities with no pulp exposure.

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5. Resin-Modified Glass Ionomer (RMGI)

➤ Composition: Polyalkenoic acid, fluoroaluminosilicate glass, hydrophilic resin (HEMA).
➤ Indications: Intermediate layer over medications like Ca(OH)₂ or MTA.
➤ Advantages:
° Excellent adhesion to dentin.
° Fluoride release.
° Good mechanical resistance.
➤ Disadvantages:
° Should not be used alone in direct contact with pulp.
➤ Handling: Apply with microbrush or spatula, light-cure, and proceed with final restoration.

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💡 Conclusion
Choosing the appropriate medication for pulp capping in primary teeth should consider factors such as exposure size, pulp vitality, the material's ability to stimulate dentinogenesis, handling properties, and cost. While calcium hydroxide remains widely used, materials like MTA and Biodentine offer significant advantages in sealing ability and biocompatibility. Using an additional protective layer, such as RMGI, improves treatment longevity and reduces microleakage risk. Continuous education in modern biomaterials is essential for achieving predictable and successful outcomes in pediatric dentistry.

📚 References

✔ Aguilar, P., & Linsuwanont, P. (2011). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 37(5), 581–587. https://doi.org/10.1016/j.joen.2010.12.004

✔ Fuks, A. B. (2008). Vital pulp therapy with new materials for primary teeth: New directions and treatment perspectives. Journal of Endodontics, 34(7 Suppl), S18–S24. https://doi.org/10.1016/j.joen.2008.02.028

✔ Murray, P. E., García-Godoy, F., & Hargreaves, K. M. (2007). Regenerative endodontics: A review of current status and a call for action. Journal of Endodontics, 33(4), 377–390. https://doi.org/10.1016/j.joen.2006.09.013

✔ Nowicka, A., Lipski, M., Parafiniuk, M., Sporniak-Tutak, K., Lichota, D., Kosierkiewicz, A., … & Buczkowska-Radlińska, J. (2013). Response of human dental pulp capped with biodentine and mineral trioxide aggregate. Journal of Endodontics, 39(6), 743–747. https://doi.org/10.1016/j.joen.2013.01.005

✔ Rodd, H. D., Waterhouse, P. J., Fuks, A. B., Fayle, S. A., & Moffat, M. A. (2006). Pulp therapy for primary molars. International Journal of Paediatric Dentistry, 16(s1), 15–23. https://doi.org/10.1111/j.1365-263X.2006.00774.x

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Pulpotec® in Pulpotomy: Composition, Indications, Protocol & Clinical Pros and Cons

Pulpotec® is a radiopaque, non‑resorbable medicament widely used for pulpotomy/pulpitis treatment in vital primary and immature permanent molars, as well as for emergency root canal dressings.

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This in-depth article reviews its composition, clinical indications, advantages, disadvantages, and a standardized application protocol. Information is supported by recent clinical evidence.

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✅ 1. Composition
Pulpotec® is a two-part resinous paste comprising:

➤ Powder: polyoxymethylene, iodoform, and zinc oxide.
➤ Liquid: dexamethasone acetate, formaldehyde, phenol, guaiacol, and excipients.

These components combine to yield antimicrobial, anti-inflammatory, hemostatic, and soothing effects.

✅ 2. Indications
Pulpotec® demonstrates broad clinical applications:

➤ Primary molars: vital or mildly infected, including cases with abscess when pulpotomy is indicated.
➤ Immature permanent molars: to facilitate continued root development.
➤ Permanent molars in adults: pulpitis treatment or as a prep for abutments in prosthetics.

It is also effective in emergency intracanal dressings to relieve pain and swelling across multiple appointments.

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✅ 3. Advantages
Clinical studies support Pulpotec® due to its:

➤ High success rates: Clinical success of 93–100% and radiographic success of 83–100% in pulpotomies; compared favorably with MTA and formocresol.
➤ Rapid symptom relief: 80–100% of patients report immediate pain reduction; flare-ups post-op are rare (~1%).
➤ Ease of use and efficiency: Simplifies emergency endodontic treatment and supports long-term pulp health.

✅ 4. Disadvantages
Potential drawbacks include:

➤ Non‑resorbability: This may complicate exfoliation in primary molars.
➤ Formaldehyde content: Concerns over toxicity and rare allergic reactions.
➤ Limited histological regeneration: It promotes sclerosis rather than dentin bridge formation.
➤ Need for coronal seal: Success depends on proper restoration to prevent microleakage.

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✅ 5. Step-by-Step Clinical Use Protocol

Step 1. Diagnose pulpitis suitable for vital pulp therapy.
Step 2. Anesthetize and isolate the tooth (rubber dam recommended).
Step 3. Access and remove coronal pulp to canal orifice level.
Step 4. Irrigate with 5% NaOCl; dry chamber.
Step 5. Prepare a salin-damped sterile cotton pellet; confirm bleeding control.
Step 6. Insert Pulpotec® paste into chamber (or canal up to ~5 mm from apex in root-filled cases) using a file.
Step 7. Place a dry cotton pellet and temporary restorative material (e.g., IRM/Cavit).
Step 8. Schedule recall after 7 days; proceed to definitive restoration—ideally stainless steel crown or adhesive restoration.
Step 9. Evaluate post-op pain at intervals (8 h, 24 h, 48 h, 3 d, 1 wk).

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✅ 6. Clinical Evidence

➤ Prospective RCT (860 teeth): Pulpotec® intracanal dressing reduced incidence of inter-appointment flare-up to 1.16% at 24 h and 0.69% at 48 h, with complete pain relief by 7 days.
➤ Comparative pediatric studies:
° Pulpotec® and MTA showed 100% clinical success at 3–9 months; radiographic success favored Pulpotec® (100%) over MTA (92.9%) and formocresol (78.6%).
° At 24 months, radiographic success was 94.3% for Pulpotec®, 91.2% for MTA, 83.3% for formocresolile cotton pellet; confirm bleeding control.

💡 Conclusion
Pulpotec® is an effective and efficient pulpotomy and intracanal medicament providing high clinical and radiographic success, rapid pain relief, and broad indications. However, formaldehyde content and non-resorbability in primary teeth demand careful case selection and precise restoration. Clinicians should weigh its benefits and limitations against alternatives such as MTA or Biodentine.

📚 References

✔ Al-Dahan, Z. A. A., Zwain, A. M., & Haidar, A. (2013). Clinical and radiographical evaluation of pulpotomy in primary molars treated with Pulpotec®, Formocresol, and Mineral Trioxide Aggregate (MTA). Journal of Bagh College Dentistry, 25(4), 164–170.

✔ Faraj, B. M. (2013). Four years of clinical experience with the efficacy of Pulpotec® as a root canal dressing for the management and control of odontogenic pain: A prospective randomized clinical trial. Open Access Emergency Medicine, 12(4), 280–283.

✔ Karrem, M. A. (2012). Clinical and histopathological evaluation of different pulpotomy agents in primary teeth. Iraqi Academic Scientific Journal.

✔ Maslak, E. E., et al. (2020). Pulpotomy efficiency in primary molars: Outcomes of 24‑month randomized clinical trial. Tanta Dental Journal, 17(1), 9–14.

✔ Pulpotec®. (n.d.). Scientific data about Pulpotec® – Swiss solution for pulpotomy. Retrieved from pd-pulpotec.com

✔ Sandhu, S. S., & Nanda, S. (2013). Dental pulp response to collagen and Pulpotec cement. Journal of Conservative Dentistry, PMC3778626.

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Oral Manifestations of STDs: Diagnosis, Signs, and Dental Management

Sexually transmitted diseases (STDs) remain a global health concern. Several infections, including syphilis, HIV, herpes simplex virus (HSV), gonorrhea, and human papillomavirus (HPV), present oral signs that may be the first indication of systemic illness.

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Dentists are in a unique position to detect and refer these cases early.

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✅ Diagnosis in dental practice
A thorough medical and sexual history should be taken. Diagnostic tools include:

° Biopsy and exfoliative cytology
° PCR testing for viral identification (HPV, HSV)
° Serologic testing (VDRL, ELISA, Western Blot)
° Referral to specialists for confirmatory diagnosis

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✅ Common oral manifestations of STDs

✅ Dental management
A thoughtful and professional approach is essential when treating patients with oral manifestations of STDs. Management includes:

1. Thorough clinical examination:
° Detailed intraoral inspection to identify ulcers, warts, vesicles, leukoplakia, or other lesions.
° Clinical photography (with consent) for documentation and follow-up.
2. Detailed medical history:
° Focus on systemic conditions, sexual history, and risk behaviors (e.g., smoking, drug use, multiple partners).
3. Symptomatic management:
° Topical anesthetics or systemic analgesics for pain.
° Antiviral therapy (e.g., Acyclovir, Valacyclovir) for herpes infections.
° Systemic antibiotics for bacterial STDs (e.g., syphilis or gonorrhea)—in coordination with medical treatment.
° Antifungal therapy for HIV-related oral candidiasis (e.g., Nystatin, Fluconazole).
4. Patient education and counseling:
° Clarify the link between STDs and oral health.
° Promote safer sex practices and regular testing.
° Encourage communication with physicians and follow-up care.
5. Referral and interdisciplinary care:
° Timely referral to infectious disease specialists or physicians.
° Collaboration with medical teams for systemic management.

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✅ Basic biosafety protocols in dental practice
To ensure safety for both dental personnel and patients, the following standard precautions must be implemented:

➤ Personal Protective Equipment (PPE):
° Gloves, surgical mask or N95 respirator (if aerosol is generated), protective eyewear, and disposable gowns.
➤ Strict hand hygiene:
° Follow the WHO's five moments of hand hygiene protocol before and after patient contact.
➤ Surface and instrument sterilization:
° Proper cleaning and disinfection of all equipment and environmental surfaces between patients.
➤ Aerosol minimization:
° Use low-speed instruments or hand techniques when possible, especially with active lesions or immunocompromised patients.
➤ Biological waste management:
° Proper segregation and disposal of contaminated materials per regulations.
➤ Informed consent:
° Secure written consent before biopsy, photo documentation, or referral procedures.

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💡 Conclusion
Oral signs may be the first or only indication of STDs. Dentists must stay updated on their recognition and management to improve public health outcomes through early diagnosis and referral.

📚 References

✔ Fatahzadeh, M., & Schwartz, R. A. (2007). Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. Journal of the American Academy of Dermatology, 57(5), 737–763. https://doi.org/10.1016/j.jaad.2007.06.020

✔ Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2015). Oral and Maxillofacial Pathology (4th ed.). Elsevier Health Sciences.

✔ Centers for Disease Control and Prevention (CDC). (2023). Sexually Transmitted Infections Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/default.htm

✔ Reznik, D. A. (2006). Oral manifestations of HIV disease. Topics in HIV Medicine, 14(5), 143–148. https://pubmed.ncbi.nlm.nih.gov/17133174/

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