Viral Diseases of the Oral Mucosa in Pediatric Dentistry: Symptoms, Diagnosis, and Treatment - Comparative Table 📊

Viral diseases affecting the oral mucosa are frequent in pediatric dentistry and often present diagnostic and therapeutic challenges. The most common conditions include primary herpetic gingivostomatitis (HSV-1), hand-foot-mouth disease (HFMD, caused by Coxsackie and enteroviruses), and herpangina. Other relevant viral infections include varicella-zoster virus (VZV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV).

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This article reviews the main viral oral diseases in children, including their signs, symptoms, diagnostic approaches, clinical features, pharmacological management, and therapeutic options, ending with a discussion and clinical conclusion.

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1. Major Viral Oral Diseases in Children

1.1 Primary Herpetic Gingivostomatitis (HSV-1)

➤ Signs and symptoms: Painful vesicles and ulcers on gingiva, lips, and oral mucosa; fever, malaise, cervical lymphadenopathy, and refusal to eat or drink, increasing the risk of dehydration.
➤ Diagnosis: Mainly clinical. In uncertain cases, PCR, viral culture, or Tzanck smear may be used.
➤ Treatment: Oral acyclovir (40–80 mg/kg/day in 3–4 doses for 7–14 days) is the drug of choice. Valacyclovir or famciclovir are options for recurrences. Topical antivirals are less effective.
➤ Clinical features: Highly contagious; recurrences are common and may benefit from daily prophylaxis in selected cases.

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1.2 Hand-Foot-Mouth Disease (HFMD)

➤ Signs and symptoms: Painful ulcers (2–4 mm) on tongue, gingiva, and palate; accompanied by papules and vesicles on hands and feet; fever and malaise are common.
➤ Diagnosis: Clinical. In atypical presentations, throat or stool samples may confirm viral etiology.
➤ Treatment: No specific antiviral therapy exists. Management includes analgesics (acetaminophen, ibuprofen), hydration, and topical anesthetics for oral pain. Aspirin should be avoided in children.
➤ Clinical features: Self-limiting, resolving within 7–10 days. High transmissibility in children under 5 years of age.

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1.3 Herpangina

➤ Signs and symptoms: High fever, sore throat, and headache, followed by small vesicles on the soft palate, tonsillar pillars, and uvula that evolve into ulcers ≤5 mm.
➤ Diagnosis: Clinical; differentiation from HSV is based on posterior vs. anterior lesion distribution.
➤ Treatment: Supportive; pain relief and hydration. Symptoms usually resolve within 5–7 days.

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2. Other Viral Infections of the Oral Cavity
Other less frequent but clinically relevant infections include varicella-zoster (chickenpox and herpes zoster), infectious mononucleosis (EBV), CMV infections, and oral papillomavirus lesions. These conditions may present with vesicles, erythematous patches, or papillary growths such as squamous papilloma and focal epithelial hyperplasia.

3. Diagnostic Considerations
A careful evaluation of lesion distribution, systemic symptoms, and medical history is crucial. In complex or atypical cases, laboratory tests such as PCR, serology, or biopsy may be required to confirm viral etiology.

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4. Management and Pharmacological Interventions

° Herpangina & HFMD: Supportive care with analgesics and hydration.
° HSV-1: Oral acyclovir remains the gold standard; valacyclovir and famciclovir are effective alternatives in adolescents and recurrent cases.
° Other viral infections: Generally self-limited; antiviral therapy is rarely required, except in immunocompromised patients or severe cases.

Comparative Table: Viral Oral Diseases in Children

Feature	Primary Herpetic Gingivostomatitis (HSV-1)	Hand-Foot-Mouth Disease (HFMD)	Herpangina
Etiology	Herpes simplex virus type 1 (HSV-1)	Coxsackie A16, Enterovirus 71	Coxsackie A, B
Age group	6 months – 5 years	<5 years	<10 years
Oral lesion location	Anterior mucosa, gingiva, lips	Tongue, gingiva, hard palate	Soft palate, tonsillar pillars, uvula
Lesion type	Vesicles → painful ulcers	Vesicles and small ulcers	Small gray vesicles → ulcers
Systemic symptoms	High fever, malaise, lymphadenopathy	Low-grade fever, malaise	High fever, sore throat, headache
Transmission	Saliva, direct contact	Fecal-oral, droplets	Fecal-oral, droplets
Duration	10–14 days	7–10 days	5–7 days
Treatment	Oral acyclovir, hydration, pain control	Symptomatic: analgesics, hydration	Symptomatic: analgesics, hydration
Complications	Dehydration, recurrence, secondary infection	Dehydration, nail changes (rare)	Dehydration, rare complications

5. Discussion
Viral oral infections in children are highly prevalent and must be correctly identified to ensure proper management. Although most are self-limiting, they can significantly affect nutrition, hydration, and quality of life. Pediatric dentists must differentiate among herpetic gingivostomatitis, HFMD, and herpangina to prevent misdiagnosis and overtreatment.
Recent literature emphasizes decision-making algorithms for pediatric oral lesions, highlighting the need for continuous education in pediatric dentistry.

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6. Conclusion
The most common viral diseases of the oral mucosa in children—HSV-1, HFMD, and herpangina—present distinct features that allow clinical differentiation. While HSV requires specific antiviral therapy, HFMD and herpangina rely on symptomatic management. Accurate diagnosis prevents complications such as dehydration and secondary infections. Pediatric dentists must remain updated on viral oral manifestations to provide evidence-based care.

📚 References

✔ American Academy of Family Physicians (AAFP). (2010). Nongenital herpes simplex virus. American Family Physician, 82(9), 1075-1082. Retrieved from https://www.aafp.org/pubs/afp/issues/2010/1101/p1075.html
✔ Guillouet, C., et al. (2022). Oral lesions of viral, bacterial, and fungal diseases in children: Diagnostic decision tools. Frontiers in Pediatrics. https://pmc.ncbi.nlm.nih.gov/articles/PMC9358008/
✔ Mayo Clinic. (2025, July 26). Hand-foot-and-mouth disease: Diagnosis & treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/diagnosis-treatment/drc-20353041
✔ Santosh, A. B. R., & Muddana, K. (2020). Viral infections of the oral cavity: Clinical presentation, pathogenic mechanism, investigations, and management. Journal of Family Medicine and Primary Care, 9(1), 36–42. https://journals.lww.com/jfmpc/fulltext/2020/09010/viral_infections_of_oral_cavity.8.aspx


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Adverse Effects of Local Anesthesia in Pediatric Dentistry: Types, Symptoms, and Management

Local anesthetics are indispensable for ensuring pain-free dental procedures and reducing anxiety in children.

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However, due to factors such as age, body weight, and immature metabolism, pediatric patients are at higher risk of adverse reactions (Malamed, 2022). Understanding the potential complications and their management is critical to ensuring safe dental practice.

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✅ Types of Local Anesthetics in Pediatric Dentistry

➤ Lidocaine 2% with epinephrine: considered the “gold standard,” safe with low toxicity risk.
➤ Mepivacaine 2% and 3%: useful for patients sensitive to vasoconstrictors, though the 3% plain solution has a higher risk of systemic toxicity.
➤ Articaine 4% with epinephrine: highly effective with superior bone diffusion, but associated with an increased risk of paresthesia.
➤ Prilocaine 3%: lower vasodilatory effect, but may induce methemoglobinemia in high doses.
➤ Bupivacaine 0.5%: long-acting, recommended for extensive procedures, but carries a higher risk of cardiotoxicity.

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✅ Local Adverse Effects

➤ Injection site pain: localized inflammation or hematoma.
➤ Trismus: muscle trauma or irritation from improper technique.
➤ Paresthesia: most commonly linked to articaine and prilocaine, involving the lingual or inferior alveolar nerve.
➤ Tissue necrosis: associated with high vasoconstrictor concentration.

✅ Systemic Adverse Effects
Often linked to overdose, rapid absorption, or idiosyncratic reactions:

➤ Central Nervous System (CNS): dizziness, drowsiness, blurred vision, tremors, seizures.
➤ Cardiovascular system: bradycardia, hypotension, arrhythmias, cardiovascular collapse.
➤ Allergic reactions: rare, but may include urticaria, bronchospasm, or anaphylaxis.
➤ Methemoglobinemia: related to high doses of prilocaine, leading to cyanosis and respiratory distress.

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✅ Clinical Signs and Symptoms

➤ Pale skin, dizziness, blurred vision after injection.
➤ Drowsiness or unusual behavior in children.
➤ Seizures in severe overdose cases.
➤ Tachycardia or bradycardia depending on drug and dosage.
➤ Cyanosis and breathing difficulties in methemoglobinemia.

✅ Management and Treatment

1. Prevention:
° Calculate maximum safe dose in mg/kg (e.g., lidocaine 4.4 mg/kg; mepivacaine 4.4 mg/kg; articaine 7 mg/kg).
° Avoid high concentrations in underweight patients.
° Aspirate before injection to prevent intravascular administration.
2. Treatment:
° Stop anesthetic administration immediately.
° Place patient in a supine position with a clear airway.
° Provide supplemental oxygen.
° Manage seizures with benzodiazepines (midazolam or diazepam).
° Severe allergic reactions: intramuscular epinephrine, corticosteroids, and antihistamines.
° Methemoglobinemia: intravenous methylene blue (1%).
° Continuous monitoring and hospital transfer if necessary.

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💬 Discussion
Balancing analgesic efficacy with safety is crucial when using local anesthetics in pediatric dentistry. Solutions at 2% concentration generally present lower toxicity risk compared to higher concentrations, making them preferable in younger patients. While severe complications are rare, their potential impact highlights the importance of proper pharmacological knowledge, accurate dosage calculation, and readiness to handle emergencies.

✍️ Conclusion
Local anesthesia is safe in pediatric dentistry when applied correctly and within recommended dosages. Early recognition of adverse effects and proper clinical management are key to minimizing risks. Continuous education in dental pharmacology and the availability of emergency protocols in the dental office are essential for optimal patient care.

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📚 References

✔ Malamed, S. F. (2022). Handbook of Local Anesthesia (7th ed.). Elsevier.
✔ Haas, D. A. (2022). Adverse effects of local anesthetics in dentistry. Journal of the Canadian Dental Association, 88, m8.
✔ Pogrel, M. A. (2019). Permanent nerve damage from inferior alveolar nerve blocks—An update to include articaine. Journal of the California Dental Association, 47(3), 127–133.
✔ Becker, D. E., & Reed, K. L. (2012). Local anesthetics: Review of pharmacological considerations. Anesthesia Progress, 59(2), 90–102. https://doi.org/10.2344/0003-3006-59.2.90
✔ Meechan, J. G. (2018). Local anaesthesia for children. British Dental Journal, 225(4), 299–304. https://doi.org/10.1038/sj.bdj.2018.633

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Do Wisdom Teeth Cause Dental Crowding? Updated Evidence and Clinical Insights

Wisdom teeth, or third molars, typically erupt between the ages of 17 and 21, coinciding with the period when patients often notice anterior crowding of the mandibular incisors.

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This temporal association has led to the widespread belief that wisdom teeth push other teeth forward, causing malalignment. However, modern research challenges this assumption, emphasizing multifactorial causes of dental crowding.

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✅ Current Systematic Evidence

° A systematic review by Lyros et al. (2023) found no statistically significant association between the presence of mandibular third molars and late incisor crowding. The effect was minimal and lacked clinical relevance.
° Conversely, Palikaraki et al. (2024) reported a slight tendency toward increased crowding and reduced arch length in patients with third molars. However, the authors highlighted the need for stronger prospective evidence.

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✅ Observational and Clinical Studies

° Aldhorae et al. (2025), using CBCT in a Yemeni population, found no significant difference in Little’s irregularity index between patients with or without mandibular third molars
° Richardson (1982) suggested a passive role of third molars in late lower crowding, but not strong enough to justify causality.
° Demyati et al. (2024) showed that third molar angulation and lack of space might worsen preexisting crowding, but again, not as a primary cause.

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✅ Professional Opinions
A survey conducted by Gavazzi et al. (2014) among Italian orthodontists and oral surgeons revealed consensus that wisdom teeth do not exert sufficient pressure to cause significant crowding. Therefore, prophylactic extraction is not recommended solely for orthodontic reasons.

✅ Multifactorial Nature of Late Crowding
Late mandibular incisor crowding is now understood as a natural, multifactorial phenomenon, influenced by:

° Genetic and hereditary traits.
° Limited mandibular growth compared to the maxilla.
° Early loss of primary teeth.
° Oral habits during childhood.
° Physiological late crowding: even in patients without third molars, anterior teeth tend to shift with age due to arch changes and muscular forces.

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✍️ Conclusion
Wisdom teeth are not a major cause of dental crowding. Current evidence suggests their role is minimal, and prophylactic extraction should not be performed solely to prevent orthodontic relapse. Dental crowding should be seen as a multifactorial process, with genetics, growth patterns, oral habits, and natural aging playing central roles. Clinical decisions regarding third molar extraction must rely on clear indications such as pain, pericoronitis, or risk of caries, rather than unproven preventive motives.

📚 References

✔ Aldhorae, K., Ishaq, R., Alhaidary, S., Alhumaidi, A. M., Moaleem, M. M. A., Harazi, G. A., ... & Elayah, S. A. (2025). The association of third molars with mandibular incisor crowding in a group of the Yemeni population in Sana’a city: cone-beam computed tomography. BMC Oral Health.
✔ Gavazzi, M., De Angelis, D., Blasi, S., Pesce, P., & Lanteri, V. (2014). Third molars and dental crowding: different opinions of orthodontists and oral surgeons among Italian practitioners. Progress in Orthodontics, 15, 60.
✔ Lyros, I., et al. (2023). The effect of third molars on mandibular anterior crowding: A systematic review. Journal of Orthodontics.
✔ Palikaraki, G., et al. (2024). Effect of mandibular third molars on crowding of mandibular anterior teeth. Angle Orthodontist.
✔ Richardson, M. E. (1982). The role of the third molar in the cause of late lower arch crowding. Angle Orthodontist.
✔ Demyati, A. K., et al. (2024). Assessment of the relationship between impacted third molars and anterior crowding. Clinical Oral Investigations

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Cold Sore, Canker Sore, and Oral Thrush: Key Differences You Should Know

Cold sores, canker sores, and oral thrush are among the most frequent oral lesions, often mistaken for one another.

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This article explains their main features, clinical presentation, diagnosis, and treatment in both children and adults, providing practical keys for differentiation.

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✅ Introduction
Oral lesions are common in dentistry and general practice. Cold sores (herpes labialis), canker sores (recurrent aphthous stomatitis), and oral thrush (candidiasis) are frequent conditions, but they differ in etiology: viral, inflammatory, and fungal, respectively. Correct identification is essential for adequate management, prevention, and recurrence control.

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1. Cold Sore (Herpes Labialis)

➤ Etiology
Caused by herpes simplex virus type 1 (HSV-1).
➤ Signs and Symptoms
° Prodromal stage: tingling, itching, or burning on the lip.
° Lesion: grouped vesicles on the vermilion border that ulcerate and form crusts.
➤ Diagnosis
Mainly clinical; PCR or serology can be used in atypical cases.
➤ Treatment
° Adults: oral or topical antivirals (acyclovir, valacyclovir).
° Children: symptomatic management; antivirals in severe cases.

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2. Canker Sore (Recurrent Aphthous Stomatitis)

➤ Etiology
Multifactorial: genetic predisposition, nutritional deficiencies (iron, folic acid, vitamin B12), trauma, or stress.
➤ Signs and Symptoms
° Round, painful ulcers with a white-yellow base and red halo.
° Pain can impair eating and speaking.
➤ Diagnosis
Clinical, based on ulcer morphology and absence of vesicular stage.
➤ Treatment
° Adults and children: antiseptic rinses (chlorhexidine), topical anesthetics (lidocaine), and topical corticosteroids for severe episodes.

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3. Oral Thrush (Oral Candidiasis)

➤ Etiology
Fungal infection caused by Candida albicans. Risk factors: immunosuppression, antibiotic use, inhaled corticosteroids, dentures.
➤ Signs and Symptoms
° Forms:

• Pseudomembranous: removable white plaques with red underlying mucosa.
• Atrophic: painful red mucosa.
• Hyperplastic: non-removable white lesions.

° Burning sensation, dysphagia, taste disturbances.
➤ Diagnosis
Mainly clinical; confirmed with exfoliative cytology or fungal culture.
➤ Treatment
° Adults: topical antifungals (nystatin, miconazole) or systemic antifungals (fluconazole) in resistant cases.
° Children: oral suspension of nystatin.

📊 Comparative Table: Cold Sore, Canker Sore, and Oral Thrush

💬 Discussion
Although similar in appearance, these conditions can be clearly distinguished through careful clinical evaluation. Cold sores show a vesicular stage and recurrence, canker sores are isolated painful ulcers without vesicles, and oral thrush presents as persistent plaques or erythematous mucosa. Treatment differs according to etiology, highlighting the need for precise diagnosis and tailored therapy in both children and adults.

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✍️ Conclusion
Recognizing the differences between cold sores, canker sores, and oral thrush ensures appropriate treatment and reduces recurrence or complications. Patient education, preventive measures, and early evaluation remain key in managing these frequent oral conditions.

📚 References

✔ Arduino, P. G., & Porter, S. R. (2008). Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. Journal of Oral Pathology & Medicine, 37(2), 107-121. https://doi.org/10.1111/j.1600-0714.2007.00586.x
✔ Belenguer-Guallar, I., Jiménez-Soriano, Y., & Claramunt-Lozano, A. (2014). Treatment of recurrent aphthous stomatitis. A literature review. Journal of Clinical and Experimental Dentistry, 6(2), e168–e174. https://doi.org/10.4317/jced.51402
✔ Scully, C., & Porter, S. (2008). Oral candidosis: current concepts in pathogenesis and therapy. Dental Update, 35(9), 606-612. https://doi.org/10.12968/denu.2008.35.9.606

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What Are Nolla’s Stages and Why Are They Important in Dentistry?

Nolla’s stages are a widely used method in dentistry to evaluate tooth development through crown and root formation.

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They are essential in pediatric dentistry, orthodontics, and oral surgery, as they allow clinicians to estimate dental age and improve treatment planning accuracy.

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✅ Introduction
Determining dental age is a key procedure in several dental specialties. One of the most applied methods is Nolla’s stages, first proposed in 1960, which classify tooth development into 11 stages, ranging from no calcification to complete apical closure (Nolla, 1960).
This system is clinically valuable for diagnostic, therapeutic, and forensic purposes, as it provides a biological maturity estimate rather than relying solely on chronological age.

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✅ Definition of Nolla’s Stages
Nolla’s classification is a radiographic method describing dental development across 11 consecutive stages, from no calcification (stage 0) to closed root apex (stage 10).

✅ Clinical Importance
Nolla’s stages are used to:

° Estimate dental age in children and adolescents.
° Plan orthodontic treatment, identifying the right timing for interceptive interventions.
° Support pediatric dentistry, especially in patients with delayed or altered tooth development.
° Assist forensic investigations, by estimating age in legal and anthropological contexts.

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✅ Comparison with Other Methods
Compared to systems such as Demirjian or Moorrees, Nolla’s method is simpler and widely accepted. However, some studies suggest it may underestimate age in certain populations (Lee et al., 2022).

💬 Discussion
The relevance of Nolla’s stages remains strong due to their practicality and broad clinical applications. Nonetheless, their accuracy may vary depending on the studied population. For this reason, many authors recommend combining Nolla’s system with other age estimation techniques.
In clinical practice, they are particularly useful in orthodontics and pediatric dentistry, where treatment timing depends heavily on dental maturity.

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✍️ Conclusion
Nolla’s stages represent a reliable diagnostic tool in dentistry, allowing clinicians to assess tooth development and estimate dental age with reasonable accuracy. Their use enhances treatment planning, improves prognostic evaluation, and supports both clinical and forensic decision-making.

📚 References

✔ Lee, J. Y., Kim, Y. K., & Park, J. H. (2022). Accuracy of Nolla’s stages in dental age estimation across populations: A systematic review and meta-analysis. Journal of Forensic Odonto-Stomatology, 40(1), 15–22.
✔ Nolla, C. M. (1960). The development of the permanent teeth. Journal of Dentistry for Children, 27(4), 254–266.
✔ Willems, G., Van Olmen, A., Spiessens, B., & Carels, C. (2001). Dental age estimation in Belgian children: Demirjian’s technique revisited. Journal of Forensic Sciences, 46(4), 893–895.
✔ AlQahtani, S. J., Hector, M. P., & Liversidge, H. M. (2010). Brief communication: The London atlas of human tooth development and eruption. American Journal of Physical Anthropology, 142(3), 481–490. https://doi.org/10.1002/ajpa.21258 br />

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Nolla Stages: Clinical Guide and Comparative Table

Dental age estimation is a key process in pediatric dentistry, orthodontics, and forensic sciences. The Nolla method (1960) established 11 stages of dental maturation, from the absence of calcification to the complete eruption of the tooth in the arch.

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Its clinical value remains relevant due to its simplicity, reliability, and applicability across populations.

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✅ Nolla stages: clinical description

✅ Clinical application in dentistry

➤ Pediatric dentistry
° Evaluates dental maturation to determine the right timing for interceptive treatments.
° Useful in diagnosing delayed or advanced eruption.
➤ Orthodontics
° Guides treatment planning during mixed dentition.
° Helps determine the timing for serial extractions or appliance placement.
➤ Forensic sciences
° Standard tool for estimating chronological age in children and adolescents.

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✅ Comparison with other methods

💬 Discussion
The Nolla method remains one of the most reliable systems in daily clinical practice. Its main strength is the ease of radiographic application, making it a cost-effective and relatively accurate diagnostic tool. However, recent studies indicate variability in accuracy depending on the population being assessed (Cadenas de Llano-Pérula et al., 2020).
Compared to Demirjian, Nolla offers more stages but less validation in multicenter research. In Latin America and the U.S., it continues to be widely used in preventive orthodontics and forensic applications.

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✍️ Conclusion
The Nolla system is a fundamental clinical guide for assessing dental development in children and adolescents. Its usefulness in pediatric dentistry, orthodontics, and forensic sciences keeps it relevant, though combining it with other methods is recommended for higher diagnostic accuracy across populations.

📚 References

✔ Cadenas de Llano-Pérula, M., Alonso-Ezpeleta, O., & Vicente, A. (2020). Dental age estimation using Nolla’s and Demirjian’s methods: A comparative study in a Spanish population. Forensic Science International, 310(110261). https://doi.org/10.1016/j.forsciint.2020.110261
✔ Nolla, C. M. (1960). The development of permanent teeth. Journal of Dentistry for Children, 27(4), 254–266.
✔ Willems, G., Oliveira-Santos, C., Froneman, M., & Thevissen, P. W. (2018). Dental age estimation in children: A widely used method revisited. Forensic Science International, 292, 124–128. https://doi.org/10.1016/j.forsciint.2018.09.002

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Hall Technique vs Conventional Stainless Steel Crowns in Pediatric Dentistry: Effectiveness, Pros and Cons

Stainless steel crowns (SSC) are the gold standard for restoring extensively carious primary molars. The conventional technique requires caries removal, anesthesia, and tooth preparation.

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In contrast, the Hall Technique seals caries under a preformed metal crown without local anesthesia, tooth preparation, or caries removal, aligning with the principles of minimally invasive dentistry.

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✅ Advantages and Disadvantages

1. Hall Technique
➤ Advantages
° High success rates (~94–97% at medium-term follow-up).
° No anesthesia, drilling, or caries removal, reducing anxiety in pediatric patients.
° Shorter chair time (4–5 minutes vs ~28 minutes for conventional SSCs).
° Well accepted by children and parents.
° Spontaneous occlusal adjustment within weeks.
➤ Disadvantages
° Initial occlusal vertical dimension increase (resolves in 2–30 days).
° Not suitable in advanced pulpal involvement or extensive root resorption.
° Aesthetic limitations (visible metal).
° Requires orthodontic separators in tight contacts, which may cause discomfort.

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2. Conventional Stainless Steel Crowns (SSC)
➤ Advantages
° Long clinical track record, widely taught in dental curricula.
° Effective in a broad range of clinical cases.
➤ Disadvantages
° Invasive: requires anesthesia, tooth preparation, and caries removal.
° More time-consuming (~28 minutes per case).
° Patient discomfort and possible trauma.
° Comparable survival to Hall but requires more resources

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💬 Discussion
The Hall Technique demonstrates comparable or superior survival rates to conventional SSCs in primary molars, with additional benefits of reduced chair time, less invasiveness, and higher patient acceptance. Although initial occlusal changes and esthetics remain challenges, evidence shows these issues resolve or are clinically acceptable. The Hall Technique is especially valuable in anxious children, special needs patients, or resource-limited settings.

✍️Conclusion
Both Hall and conventional SSC techniques are effective for managing extensively carious primary molars. However, the Hall Technique offers a minimally invasive, patient-friendly alternative with high success rates and reduced treatment burden. Proper case selection remains essential to ensure long-term success.

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📚 References

✔ Altoukhi, D. H., & El-Housseiny, A. A. (2020). Hall technique for carious primary molars: A review of the literature. Dentistry Journal, 8(2), 35. https://doi.org/10.3390/dj8020035

✔ Innes, N. P. T., Ricketts, D., Chong, L. Y., Keightley, A. J., Lamont, T., & Santamaria, R. M. (2019). Preformed crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews, 2019(5), CD005512. https://doi.org/10.1002/14651858.CD005512.pub3

✔ Ludwig, K. H., Fontana, M., Vinson, L. A., Platt, J. A., & Dean, J. A. (2014). The success of stainless steel crowns placed with the Hall technique. Journal of the American Dental Association, 145(12), 1248–1253. https://doi.org/10.14219/jada.2014.95

✔ Elamin, F., Abdelazeem, N., & Honkala, E. (2019). Comparison of Hall technique and conventional stainless steel crown techniques for primary molars: A randomized controlled trial. European Archives of Paediatric Dentistry, 20(5), 467–474. https://doi.org/10.1007/s40368-019-00421-3

✔ Ayedun, O. S., Folayan, M. O., & Oyedele, T. A. (2021). Comparison of the treatment outcomes of the Hall technique and conventional stainless steel crown technique. Nigerian Journal of Clinical Practice, 24(4), 548–554. https://doi.org/10.4103/njcp.njcp_507_19

✔ Badar, S. B., Tabassum, S., & Khan, F. R. (2019). Effectiveness of Hall technique for carious primary molars: A meta-analysis. International Journal of Clinical Pediatric Dentistry, 12(2), 132–138. https://doi.org/10.5005/jp-journals-10005-1622

✔ Hu, S. (2022). Hall technique for managing carious primary molars: A systematic review. Journal of Stomatology, Oral and Maxillofacial Surgery, 123(6), 581–588. https://doi.org/10.1016/j.jormas.2022.01.003

Herkar, P. P., Karkera, R., & Thomas, A. (2022). A comparative study of stress distribution in primary molars restored with Hall and conventional SSC techniques using finite element analysis. Journal of Pediatric Dentistry, 40(3), 205–212. https://doi.org/10.4103/jpd.jpd_25_22

✔ MedRxiv. (2025, May 19). Comparative survival of Hall vs conventional preformed metal crowns in primary molars. MedRxiv. https://doi.org/10.1101/2025.05.18.25327863

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Maxillary Orthopedics vs. Interceptive Orthodontics: Key Differences, Similarities, and Treatments

1. Introduction
Maxillary orthopedics and interceptive orthodontics are closely related but distinct fields. While both aim to improve oral and facial harmony in growing patients, their approaches, timing, and appliances differ.

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2. Definitions
➤ Maxillary Orthopedics: A specialty focused on correcting discrepancies in the growth and development of the jaws using functional or fixed appliances. It is most effective between ages 6–12, when craniofacial plasticity is greatest (Solución Dental, 2024; TopDoctors, 2024; Clínica Dental Acosta Cubero, 2024).
➤ Interceptive Orthodontics: An early form of orthodontics aimed at intervening during mixed dentition to prevent or guide skeletal and dental development, correct harmful habits, and reduce the need for complex treatments later (González & Casado, 2024; Dental Peset, 2024; Moonz, 2024).

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3. Diagnosis
Both approaches require early evaluation.

➤ Maxillary Orthopedics: Diagnoses focus on skeletal discrepancies such as posterior crossbites, asymmetries, or sagittal imbalances (Solución Dental, 2024; Acosta Cubero, 2024).
➤ Interceptive Orthodontics: Diagnosis includes early malocclusions, dentoalveolar discrepancies, deleterious oral habits (thumb sucking, mouth breathing), or abnormal eruption patterns (González & Casado, 2024; Mallorca Dental, 2024; Moonz, 2024).

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4. Characteristics and Ideal Age

5. Most Common Appliances

➤ Maxillary Orthopedics
° Palatal expansion appliances (Hyrax, Quad Helix, McNamara)
° Face mask and headgear for sagittal discrepancies (retrognathia, prognathism)
° Functional plates to redirect mandibular growth
➤ Interceptive Orthodontics
° Palatal expanders and twin block devices
° Removable plates, Bionator, chin cup, mandibular advancement devices (MADs)
° Functional appliances to stop habits (tongue thrust, thumb sucking, mouth breathing)

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6. Discussion
Both therapies share the same preventive and corrective philosophy but differ in their scope. Maxillary orthopedics directly targets skeletal growth, leveraging craniofacial plasticity. Interceptive orthodontics combines skeletal and dental guidance, addressing early malocclusions and habits.
In clinical practice, they are often sequential or combined: orthopedic treatment first to establish a stable skeletal base, followed by corrective orthodontics to align permanent dentition.
Early diagnosis (ideally around age 6) maximizes effectiveness, reducing the likelihood of surgical interventions such as orthognathic surgery later in life.

7. Conclusion
Maxillary orthopedics and interceptive orthodontics are complementary but distinct strategies. Orthopedics corrects skeletal imbalances, while interceptive orthodontics prevents and modifies both skeletal and dental malocclusions. Both require early diagnosis and proper appliance selection. When combined, they lead to more stable, functional, and esthetic long-term outcomes.

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📚 References

✔ Clínica Solución Dental. (2024, December 22). Differences between maxillary orthopedics and orthodontics. Solución Dental. https://soluciondental.pe/ortopedia-maxilar/diferencias-ortopedia-ortodoncia/

✔ TopDoctors. (2024, August 7). Difference between maxillary orthopedics and orthodontics: A complete guide. TopDoctors. https://www.topdoctors.mx/articulos-medicos/diferencia-entre-ortopedia-maxilar-y-ortodoncia-una-guia-completa/

✔ González y Casado. (2024). Interceptive orthodontics, orthopedics, and functional appliances. https://gonzalezycasado.com/tratamientos/ortodoncia-interceptiva-ortopedia-y-aparatologia-funcional

✔ Dental Peset. (2024). Differences between interceptive and corrective orthodontics. https://dentalpeset.com/ortodoncia-interceptiva/

✔ Moonz Clinics. (2024). What is interceptive orthodontics and why is it important? https://moonz.com/tratamientos/ortodoncia-interceptiva-ortopedia/

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Key Differences Between Gingivitis, Periodontitis, and Aggressive Periodontitis: Updated Clinical Review

Periodontal diseases, ranging from gingivitis to aggressive periodontitis, differ significantly in severity, progression, etiology, and treatment.

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This academic article critically examines these distinctions based on current scientific evidence and emphasizes their clinical implications for dental professionals.

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1. Definitions and Main Characteristics

1.1 Gingivitis
The mildest and most common form of periodontal disease, characterized by gum inflammation and bleeding, generally caused by plaque accumulation without loss of periodontal support tissues. Gingivitis is fully reversible with proper oral hygiene, flossing, and regular professional cleanings.
1.2 Periodontitis
Progression from untreated gingivitis, involving irreversible destruction of the periodontal ligament and alveolar bone. It results in periodontal pocket formation, gum recession, tooth mobility, and eventual tooth loss if left untreated. Management often requires deep scaling and root planing, sometimes combined with systemic antibiotics or surgical intervention.
1.3 Aggressive Periodontitis
A less common but highly destructive form of periodontitis, progressing rapidly—often in patients under 30 years old—with no apparent systemic disease. Key features include:
° Rapid attachment loss (≥ 2 mm/year) and alveolar bone destruction.
° Absence of systemic conditions explaining progression.
° Strong family history suggesting genetic predisposition.
° Hyperactive immune response with elevated mediators such as PGE₂ and IL-1β.

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2. Etiology, Risk Factors, and Microbiology

➤ Gingivitis & Chronic Periodontitis: Initiated by plaque and calculus accumulation; aggravated by smoking, diabetes, genetic factors, stress, or inadequate oral hygiene.
➤ Aggressive Periodontitis (AP):
° Involves a complex interplay of genetic predisposition and host hypersensitivity, including neutrophil and monocyte dysfunction and altered antibody responses (Benza-Bedoya, 2009).
° Smoking worsens disease progression by impairing gingival microcirculation, modulating immune response, and favoring pathogenic bacterial colonization.
° Highly virulent bacteria such as Aggregatibacter actinomycetemcomitans produce collagenases, leukotoxins, and other toxins that inhibit periodontal tissue repair.

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3. Comparative Clinical Progression

4. Diagnosis and Clinical Management
➤ Gingivitis: Clinical diagnosis; managed with improved oral hygiene, patient education, and professional cleanings.
➤ Periodontitis: Requires periodontal probing, radiographic assessment, and deep scaling and root planing; advanced cases may need surgical therapy or systemic antibiotics.
➤ Aggressive Periodontitis:
° Differential diagnosis involves detailed history, comprehensive periodontal examination, and ruling out systemic conditions.
° Treatment strategies include:

• Initial phase: Intensive plaque control, reinforcement of interdental cleaning.
• Corrective phase: Deep scaling, root planing, removal of defective restorations, and caries treatment.
• Regenerative or surgical phase: Periodontal surgery, regenerative procedures, and implant placement as needed.
• Maintenance: Highly individualized, with close monitoring due to rapid progression risk.

💬 Discussion
Gingivitis, chronic periodontitis, and aggressive periodontitis represent different points along the periodontal disease spectrum. Gingivitis is entirely reversible, while advanced forms require intensive interventions. Early detection is critical, particularly for aggressive periodontitis, which has distinct genetic, immunologic, and microbiologic profiles requiring specialized clinical management.

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✍️ Conclusion
° Gingivitis is an early, reversible, and highly manageable periodontal condition.
° Chronic periodontitis involves irreversible tissue destruction and requires professional periodontal therapy.
° Aggressive periodontitis progresses rapidly in otherwise healthy young individuals and demands prompt, specialized intervention and long-term follow-up.

📚 References

✔ Andrii Iemelyanenko. (2025, April 12). What Is the Difference Between Gingivitis and Periodontitis? Health.com. Retrieved from https://www.health.com/gingivitis-vs-periodontitis-11684200

✔ Nico De Pasquale. (2025, May 29). Healthy Gums vs. Unhealthy Gums: How To Tell the Difference. Health.com. Retrieved from https://www.health.com/healthy-vs-unhealthy-gums-11698782

✔ Benza-Bedoya, R. (2009). Periodontitis agresiva: Clasificación, características clínicas y etiopatogenia. Acta Odontológica Venezolana, 47(3). Retrieved from https://ve.scielo.org/scielo.php?pid=S0001-63652009000300020&script=sci_arttext

✔ Benza-Bedoya, R. (2009). Periodontitis agresiva: Diagnóstico y tratamiento. Acta Odontológica Venezolana, 47(4). Retrieved from https://homolog-ve.scielo.org/scielo.php?pid=S0001-63652009000400019&script=sci_arttext

✔ Medigraphic. (2018). Aggressive Periodontitis: Diagnosis and Clinical Management. Odovtos - International Journal of Dental Sciences, 20(3). Retrieved from https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=76787

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Partial Pulpotomy in Pediatric Dentistry: Technique, Benefits, and Key Differences

Modern pediatric dentistry emphasizes minimally invasive procedures that preserve pulp vitality and tooth structure.

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Partial pulpotomy offers a biologically favorable approach in cases of limited pulp inflammation, especially in traumatic pulp exposures or shallow carious lesions, promoting healing and long-term tooth survival.

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✅ Definition of Partial Pulpotomy
Also known as Cvek pulpotomy, partial pulpotomy involves the removal of 1–3 mm of inflamed coronal pulp tissue directly beneath the exposure, preserving the remaining healthy pulp and covering it with a biocompatible material that supports healing and dentin bridge formation.

✅ Differences Between Partial and Conventional Pulpotomy

✅ Biological Rationale
Partial pulpotomy is grounded in the understanding that pulp inflammation is often localized. When only the affected area is removed, the remaining pulp can regenerate and form a dentin bridge. Young permanent teeth, in particular, have a high regenerative capacity, which enhances success rates when proper isolation and materials are used.

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✅ Step-by-Step Technique

➤ Clinical and radiographic evaluation
° Indicated for recent pulp exposures (less than 24 hours for trauma)
° No signs of irreversible pulpitis or periapical pathology

➤ Anesthesia and isolation
° Use local anesthesia and rubber dam isolation to ensure an aseptic field.

➤ Partial pulp removal
° Excise 1–3 mm of inflamed pulp using a sterile diamond bur with water coolant.
° Rinse with sterile saline.

➤ Hemostasis
° Apply a moist cotton pellet for 2–5 minutes.
° Successful hemostasis confirms healthy pulp status.

➤ Placement of pulp capping material
° Apply a biocompatible material (e.g., MTA, Biodentine) directly onto the pulp.
° Cover with resin-modified glass ionomer or temporary cement.

➤ Final restoration
° Restore with composite resin or stainless steel crown depending on the tooth's condition and location.

Recommended Materials
° MTA (Mineral Trioxide Aggregate) – ProRoot® MTA (Dentsply Sirona), MTA Angelus®
° Biodentine™ (Septodont) – Bioactive dentin substitute with excellent sealing and biocompatibility
° TheraCal LC® (Bisco) – Light-cured resin-modified calcium silicate
° Vitrebond™ (3M) – Resin-modified glass ionomer for base/sealing

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💬 Discussion
Scientific literature strongly supports partial pulpotomy for managing pulp exposures in both primary and permanent teeth. It is especially effective when performed soon after trauma or in controlled carious exposures. Studies report success rates above 90% with bioceramic materials like MTA and Biodentine. Case selection, operator technique, and proper sealing are critical to achieving optimal outcomes.
Partial pulpotomy aligns with the minimally invasive dentistry philosophy, reducing the need for more extensive endodontic procedures and maintaining tooth vitality for longer periods.

💡 Conclusion
Partial pulpotomy is a reliable and conservative vital pulp therapy that supports biological healing and long-term function. When performed correctly and with appropriate materials, it offers a high success rate and preserves natural pulp defenses. It is recommended as a first-line treatment for immature permanent teeth and select primary teeth with localized inflammation.

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📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. https://www.aapd.org

✔ Aguilar, P., & Linsuwanont, P. (2019). Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. Journal of Endodontics, 45(5), 511–517. https://doi.org/10.1016/j.joen.2019.01.021

✔ Bogen, G., Kim, J. S., & Bakland, L. K. (2008). Direct pulp capping with mineral trioxide aggregate: An observational study. Journal of the American Dental Association, 139(3), 305–315. https://doi.org/10.14219/jada.archive.2008.0177

✔ Nowicka, A., Wilk, G., Lipski, M., Kołecki, J., & Buczkowska-Radlińska, J. (2015). Tomographic evaluation of reparative dentin formation after direct pulp capping with Ca(OH)₂, MTA, Biodentine, and dentin bonding system in human teeth. Journal of Endodontics, 41(8), 1234–1240. https://doi.org/10.1016/j.joen.2015.03.017

✔ Chisini, L. A., Collares, K., Cademartori, M. G., et al. (2022). Vital pulp therapy for primary teeth: A systematic review and meta-analysis. Clinical Oral Investigations, 26(1), 91–106. https://doi.org/10.1007/s00784-021-04076-9

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Calcium Hydroxide in Pediatric Dentistry: Updated Uses, Benefits, and Clinical Evidence

Preserving pulp vitality and supporting dental development are key goals in pediatric dentistry.

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Calcium hydroxide (Ca(OH)₂) has been widely used for decades, especially in pulp therapy procedures, thanks to its outstanding biocompatibility and ability to stimulate dentin bridge formation.

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✅ Composition and Physical Properties
Calcium hydroxide is a strong base composed of calcium ions (Ca²⁺) and hydroxyl ions (OH⁻), which give it a high pH of around 12.5. This alkalinity plays a central role in its biological effects.

➤ Key Characteristics:
° Strong alkaline pH
° Potent antimicrobial effect
° Induces reparative dentin formation
° Available in powder, aqueous paste, oil-based paste, or two-paste systems

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✅ Mechanism of Action

° Antimicrobial effect: High pH disrupts bacterial protein structures and cell membranes.
° Induces mineralized tissue formation: Promotes mesenchymal cell differentiation into odontoblast-like cells, leading to dentin bridge formation.
° Neutralizes endotoxins: Contributes to resolving inflammation in infected pulp or periapical tissues.

✅ Clinical Applications in Pediatric Dentistry

✅ Advantages of Calcium Hydroxide

° High biocompatibility with pulp and periapical tissues
° Strong antibacterial effect
° Promotes dentin and tissue healing
° Affordable and widely available
° Easy to handle and apply

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✅ Limitations and Disadvantages

° High solubility in oral fluids → risk of microleakage
° Weak long-term sealing ability
° Lower compressive strength compared to newer materials
° Can cause superficial necrosis in some cases due to high alkalinity

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✅ Recommended U.S. Commercial Brands

° UltraCal™ XS (Ultradent Products Inc.) – Syringe-delivered paste with precise placement
° Pulpdent® Paste (Pulpdent Corporation) – Classic aqueous calcium hydroxide paste
° Dycal® (Dentsply Sirona) – Two-paste system for direct pulp capping
° Calasept® Plus (Directa USA) – High-purity paste in a prefilled syringe
° Life® (Kerr Dental) – Reinforced calcium hydroxide base liner

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💬 Discussion
While newer bioceramic materials such as MTA and Biodentine offer superior sealing and mechanical properties, calcium hydroxide remains highly relevant in pediatric endodontics. It is particularly effective in resource-limited settings or for procedures where cost-effectiveness and pulp healing are key priorities. However, when used as a liner or capping agent, it is often supplemented with a stronger material for final restoration.

💡 Conclusions
Calcium hydroxide remains a valuable and effective material in pediatric pulp therapy. Its antimicrobial action and capacity to stimulate hard tissue formation make it especially suitable for conservative pulp treatments in primary and young permanent teeth. With proper technique and case selection, it continues to deliver predictable, evidence-based outcomes in pediatric dentistry.

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📚 References

✔ American Academy of Pediatric Dentistry (AAPD). (2023). Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. https://www.aapd.org

✔ Schwendicke, F., Brouwer, F., Paris, S., Stolpe, M., & Tu, Y. K. (2019). Effects of calcium hydroxide liners on outcome of direct pulp capping: Systematic review and meta-analysis. Clinical Oral Investigations, 23(3), 1181–1191. https://doi.org/10.1007/s00784-018-2523-9

✔ Tavares, W. L. F., de Oliveira, A. M. T., & da Silva, R. A. B. (2021). Calcium hydroxide and its therapeutic use in pediatric endodontics: A literature review. European Archives of Paediatric Dentistry, 22(4), 551–560. https://doi.org/10.1007/s40368-020-00557-4

✔ Holland, R., de Souza, V., Nery, M. J., Otoboni Filho, J. A., Bernabé, P. F., & Dezan Junior, E. (2020). Reaction of rat connective tissue to implanted dentin tubes filled with calcium hydroxide pastes. Brazilian Dental Journal, 31(1), 55–62. https://doi.org/10.1590/0103-6440201902933

✔ Estrela, C., et al. (2019). Mechanism of action of calcium and hydroxyl ions of calcium hydroxide on tissue and bacteria. Brazilian Dental Journal, 30(6), 536–541. https://doi.org/10.1590/0103-6440201902936

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