Advances in Pediatric Endodontics: Bioceramic Sealers for Primary Teeth

Bioceramic sealers are among the most important innovations in pediatric endodontics. They are designed to seal root canals more effectively while being highly compatible with the body's natural tissues.

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In primary (baby) teeth, these materials may improve treatment outcomes by reducing bacterial leakage and supporting healing around the roots.

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Although traditional materials such as zinc oxide-eugenol remain widely used, bioceramic sealers are gaining attention because of their excellent biological properties and sealing ability. However, their use in primary teeth should be based on scientific evidence and careful case selection.

✅ What Are Bioceramic Sealers?
Bioceramic sealers are calcium silicate-based materials developed to seal the root canal after cleaning and shaping. Unlike conventional sealers, they interact with body fluids and can form hydroxyapatite, a mineral naturally found in teeth and bone.

Their main characteristics include:
▪️ Excellent biocompatibility
▪️ Strong sealing ability
▪️ High antibacterial environment due to alkaline pH
▪️ Low shrinkage during setting
▪️ Ability to support tissue healing
These properties make them attractive for both permanent and primary teeth.

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✅ Why Are They Important in Primary Teeth?
Primary teeth have unique characteristics:
▪️ Thin dentin walls
▪️ Complex root canal anatomy
▪️ Physiological root resorption before tooth exfoliation
▪️ Close relationship with the developing permanent tooth

Because of these factors, the ideal filling material should:
▪️ Seal the canal effectively
▪️ Be gentle to surrounding tissues
▪️ Not interfere with normal root resorption
▪️ Reduce the risk of reinfection
Bioceramic sealers aim to meet many of these requirements.

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✅ Main Advantages

1. Excellent Biocompatibility
One of the greatest advantages is that bioceramic sealers are well tolerated by surrounding tissues, reducing inflammation if small amounts extend beyond the root.

2. Superior Sealing Ability
A tight seal prevents bacteria from re-entering the canal system.
A better seal increases the likelihood of long-term treatment success.

3. Antibacterial Properties
Their naturally high pH creates an unfavorable environment for many bacteria responsible for endodontic infections.
Although they do not replace proper canal cleaning, they provide an additional level of protection.

4. Bioactivity
Unlike conventional sealers, bioceramic materials actively interact with surrounding tissues.
They can stimulate mineral deposition and support natural healing.

5. Moisture-Friendly Setting
Primary teeth are often difficult to keep completely dry.
Many bioceramic sealers actually benefit from moisture during their setting reaction, making clinical handling easier.

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✅ Current Limitations
Despite their advantages, several limitations remain.

▪️ Higher cost than traditional materials.
▪️ Limited long-term clinical evidence in primary teeth compared with permanent teeth.
▪️ Some products may not resorb at the same rate as primary tooth roots, an important consideration before widespread use.
▪️ Clinical performance varies depending on the specific formulation.
Therefore, not every bioceramic sealer should automatically replace conventional pediatric materials.

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✅ Current Clinical Applications
Bioceramic sealers are being investigated for:

▪️ Pulpectomy in primary teeth
▪️ Management of infected root canals
▪️ Cases requiring excellent apical sealing
▪️ Teeth with periapical inflammation
Most specialists recommend using them when the clinical situation is appropriate and after considering current scientific evidence.

✅ How Do They Compare with Zinc Oxide-Eugenol?

Feature	Bioceramic Sealers	Zinc Oxide-Eugenol
Biocompatibility	Excellent	Good
Sealing Ability	Very High	Moderate
Bioactivity	Yes	No
Antibacterial Environment	High pH	Moderate
Clinical History	Emerging	Extensive
Cost	Higher	Lower
Long-Term Evidence in Primary Teeth	Growing	Extensive

✅ What Does Current Research Say?
Recent studies suggest that bioceramic sealers provide promising biological and sealing properties in pediatric endodontics. Laboratory and early clinical evidence indicates favorable tissue compatibility and reduced bacterial leakage.
However, researchers consistently emphasize that high-quality long-term clinical trials in primary teeth remain limited. Additional evidence is needed before these materials can be considered the universal first choice for every pulpectomy.

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💬 Discussion
The development of bioceramic sealers represents a significant step forward in pediatric endodontics. Their biological compatibility, sealing capacity, and bioactive behavior offer advantages over many traditional materials.
Nevertheless, primary teeth have unique biological characteristics, particularly physiological root resorption. For this reason, clinicians should evaluate whether a specific bioceramic product is suitable for each case rather than assuming that all formulations behave similarly. Current evidence supports their potential, but continued research is essential to define their long-term role.

🎯 Recommendations
▪️ Select bioceramic sealers according to the clinical indication and manufacturer recommendations.
▪️ Maintain thorough canal cleaning and disinfection, as no sealer can compensate for inadequate treatment.
▪️ Consider the expected root resorption pattern when treating primary teeth.
▪️ Stay updated with new clinical studies as evidence continues to evolve.
▪️ Explain treatment options and expected outcomes clearly to parents or caregivers.

✍️ Conclusion
Bioceramic sealers are an important advancement in pediatric endodontics, offering excellent biocompatibility, superior sealing ability, and bioactive properties that may improve the success of pulpectomy in primary teeth.
While early evidence is encouraging, long-term clinical research is still developing. At present, these materials should be viewed as a valuable option within evidence-based pediatric dentistry rather than a complete replacement for established filling materials.

📚 References

✔ Coll, J. A., Dhar, V., Vargas, K., Chen, C. Y., Crystal, Y. O., & Alvares, O. (2020). Use of non-vital pulp therapies in primary teeth. Pediatric Dentistry, 42(6), 337–349.
✔ Donnermeyer, D., Bürklein, S., Dammaschke, T., & Schäfer, E. (2019). Endodontic sealers based on calcium silicates: A systematic review. Odontology, 107(4), 421–436. https://doi.org/10.1007/s10266-018-0400-3
✔ European Society of Endodontology. (2021). European Society of Endodontology position statement: Management of deep caries and the exposed pulp. International Endodontic Journal, 54(7), 923–934.
✔ Moinzadeh, A. T., Zerbst, W., Boutsioukis, C., Shemesh, H., & Zaslansky, P. (2021). Outcome of bioceramic sealers in endodontic treatment: A review of current evidence. International Endodontic Journal, 54(11), 1977–1994.
✔ Nagendrababu, V., Duncan, H. F., Fouad, A. F., Kirkevang, L. L., Parashos, P., Priya, E., Jayaraman, J., Siqueira, J. F., Jr., & Dummer, P. M. H. (2023). PRILE 2021 guidelines for reporting laboratory studies in Endodontology: Explanation and elaboration. International Endodontic Journal, 56(Suppl. 2), 3–64.
✔ Taha, N. A., Abdulkhader, S. Z., & Al-Qudah, A. A. (2022). Calcium silicate–based root canal sealers: A review of biological and clinical properties. Journal of Clinical Medicine, 11(17), 5067. https://doi.org/10.3390/jcm11175067

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NSAIDs in Pediatric Dentistry: Benefits, Risks, and Updated Clinical Protocols

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications in pediatric dentistry. They help reduce pain, inflammation, and fever, making children more comfortable after dental procedures or during certain oral infections.

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When used correctly, NSAIDs are safe and effective for most healthy children. However, they are not appropriate for every patient. Dentists must carefully consider the child's age, weight, medical history, allergies, and underlying health conditions before prescribing them.

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This guide explains how NSAIDs work, when they are recommended, their benefits, possible risks, and the latest evidence-based clinical protocols in clear and simple language.

✅ What Are NSAIDs?
NSAIDs (Nonsteroidal Anti-inflammatory Drugs) are medications that reduce:
▪️ Pain
▪️ Inflammation (swelling)
▪️ Fever
They work by blocking enzymes called cyclooxygenases (COX-1 and COX-2), which are responsible for producing prostaglandins—substances involved in pain and inflammation.
Unlike antibiotics, NSAIDs do not treat infections. Instead, they help relieve the symptoms while the underlying dental condition is managed.

✅ Common NSAIDs Used in Pediatric Dentistry
The most frequently used NSAIDs include:

▪️ Ibuprofen (first-choice NSAID for most children)
▪️ Naproxen (less commonly used)
▪️ Ketorolac (reserved for selected short-term situations under professional supervision)
Among these, ibuprofen remains the preferred medication because it has an excellent balance between effectiveness and safety when used at the recommended dose.

✅ Clinical Indications
Dentists may recommend NSAIDs for:

▪️ Postoperative pain after tooth extraction
▪️ Pain following pulpotomy or pulpectomy
▪️ Minor oral surgery
▪️ Dental trauma
▪️ Orthodontic discomfort (selected cases)
▪️ Pain associated with irreversible pulpitis before treatment
▪️ Inflammatory oral conditions causing discomfort
NSAIDs should be used only when clinically indicated, not routinely after every dental procedure.

✅ Benefits of NSAIDs in Children
The main advantages include:

▪️ Excellent pain relief
▪️ Reduction of swelling
▪️ Lower fever when present
▪️ Fast onset of action
▪️ Improved comfort after dental treatment
▪️ Reduced need for opioid medications
Current evidence shows that ibuprofen often provides better pain control than acetaminophen alone for inflammatory dental pain.

✅ Updated Clinical Protocols
Current pediatric dental guidelines recommend:

1. Ibuprofen is the first-line medication
For most healthy children with inflammatory dental pain, ibuprofen is considered the first-choice analgesic, provided there are no contraindications.
Typical pediatric dosage:
▪️ 5–10 mg/kg every 6–8 hours
▪️ Maximum daily dose should never exceed the recommended limit based on the child's weight and age.

2. Weight-Based Dosing Is Essential
Children should never receive adult doses.
Medication should always be prescribed according to:
Body weight
Age
Medical condition
Kidney function
Other medications

3. Use the Lowest Effective Dose
Current recommendations emphasize:
▪️ Use the smallest effective dose
▪️ Treat for the shortest necessary duration
▪️ Reassess persistent pain rather than simply extending medication use.

4. Combining Medications
For moderate or severe pain, dentists may recommend alternating or combining ibuprofen and acetaminophen in selected patients.
Parents should follow professional instructions carefully to avoid dosing errors.

5. Antibiotics Are Not a Substitute
NSAIDs relieve symptoms but do not eliminate the cause of a dental infection.
When infection requires treatment, the child still needs appropriate dental care and, when indicated, antibiotics.

✅ Possible Risks and Side Effects
Although generally safe, NSAIDs may cause:

▪️ Upset stomach
▪️ Nausea
▪️ Vomiting
▪️ Heartburn
▪️ Mild abdominal discomfort

Less common but more serious complications include:
▪️ Gastrointestinal bleeding
▪️ Kidney injury (especially with dehydration)
▪️ Allergic reactions
▪️ Worsening asthma in susceptible children
These complications are uncommon when medications are used appropriately.

✅ Who Should Avoid NSAIDs?
NSAIDs may not be suitable for children with:

▪️ Known NSAID allergy
▪️ Previous severe asthma triggered by NSAIDs
▪️ Active stomach ulcers
▪️ Significant kidney disease
▪️ Severe dehydration
▪️ Certain bleeding disorders
The dentist should always review the child's complete medical history before prescribing any medication.

✅ Tips for Parents
Parents can improve medication safety by:

▪️ Giving the correct dose based on weight
▪️ Using a proper dosing syringe or measuring device
▪️ Avoiding duplicate medications containing NSAIDs
▪️ Encouraging adequate hydration
▪️ Following the prescribed treatment duration
▪️ Contacting the dentist if pain persists beyond the expected recovery period
Never increase the dose without professional advice.
💬 Discussion
Recent clinical guidelines continue to support ibuprofen as the preferred NSAID for managing inflammatory dental pain in children, thanks to its proven effectiveness and favorable safety profile. Modern pain management also emphasizes a multimodal approach, where medication is combined with prompt dental treatment and careful follow-up rather than relying on pain relievers alone.
Healthcare professionals are encouraged to prescribe NSAIDs only when necessary, calculate doses based on body weight, and educate caregivers about proper administration. This approach improves pain control while minimizing the risk of adverse effects.

🎯 Recommendations
▪️ Use ibuprofen as the first-choice NSAID when appropriate.
▪️ Always calculate doses according to the child's weight.
▪️ Prescribe the lowest effective dose for the shortest possible time.
▪️ Do not use NSAIDs to delay necessary dental treatment.
▪️ Review the child's medical history before prescribing.
▪️ Advise parents to seek professional evaluation if pain worsens, swelling increases, or fever persists.
▪️ Encourage regular dental checkups to prevent painful conditions that may require medication.

✍️ Conclusion
NSAIDs remain one of the safest and most effective options for managing pain and inflammation in pediatric dentistry when used correctly. Among them, ibuprofen is the preferred first-line medication for most healthy children because of its strong evidence for effectiveness and safety. Careful weight-based dosing, appropriate patient selection, and adherence to updated clinical protocols help maximize benefits while reducing the risk of complications.

📚 References

✔ American Academy of Pediatric Dentistry. (2024). Policy on pediatric dental pain management. In The Reference Manual of Pediatric Dentistry (2024–2025 ed.). American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2024). Useful medications for oral conditions. In The Reference Manual of Pediatric Dentistry (2024–2025 ed.). American Academy of Pediatric Dentistry.
✔ American Dental Association. (2024). Clinical practice guideline on acute pain management in adolescents, adults, and older adults undergoing dental procedures. The Journal of the American Dental Association, 155(2), 102–117. https://doi.org/10.1016/j.adaj.2023.11.009
✔ Cooper, T. E., Heathcote, L. C., Clinch, J., Gold, J. I., Howard, R., Lord, S. M., Schechter, N., Wood, C., Wiffen, P. J., & Eccleston, C. (2017). Antipyretic analgesics for acute pain in children: An overview of systematic reviews. Pain, 158(5), 789–796. https://doi.org/10.1097/j.pain.0000000000000842
✔ World Health Organization. (2023). WHO Model List of Essential Medicines for Children (9th ed.). World Health Organization.

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Dental Sealants: How They Protect Children's Teeth

Dental sealants are one of the most effective ways to prevent cavities in children. Even with good brushing habits, the deep grooves on the chewing surfaces of molars can trap food and bacteria, making them difficult to clean.

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Sealants act as a protective barrier that helps keep these vulnerable areas free from decay.

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This simple, painless, and non-invasive treatment has been recommended by major dental organizations because it significantly reduces the risk of cavities during childhood.

✅ What Are Dental Sealants?
Dental sealants are thin protective coatings made from dental resin or glass ionomer materials. They are applied to the chewing surfaces of the permanent molars and premolars, where cavities most often begin.

Once the sealant hardens, it creates a smooth barrier that:
▪️ Blocks food and bacteria from entering deep grooves.
▪️ Makes teeth easier to clean.
▪️ Helps prevent cavities before they start.
Sealants are preventive—they do not treat existing cavities, but they help stop healthy teeth from becoming decayed.

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✅ How Do Dental Sealants Protect Children's Teeth?
The chewing surfaces of molars naturally have tiny pits and grooves.

These narrow spaces can:
Hold food particles.
Collect dental plaque.
Be difficult for toothbrush bristles to reach.
Dental sealants fill these grooves, preventing bacteria and sugars from remaining trapped. This greatly lowers the chance that acids produced by bacteria will damage the tooth enamel.
Research shows that sealants can reduce the risk of cavities in permanent molars by up to 80% during the first years after placement, making them one of the most effective preventive treatments available.

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✅ Who Should Receive Dental Sealants?
Dentists usually recommend sealants for:

▪️ Children when the first permanent molars erupt (around ages 6–7).
▪️ Children when the second permanent molars erupt (around ages 11–13).
▪️ Children with deep grooves or a high risk of tooth decay.
▪️ Some adolescents and adults without cavities on their molars may also benefit.
Applying sealants soon after permanent molars erupt offers the greatest protection because the teeth have not yet been exposed to years of cavity-causing bacteria.

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✅ Benefits of Dental Sealants
Some of the most important advantages include:

▪️ Significantly reduce the risk of cavities.
▪️ Completely painless treatment.
▪️ No drilling or injections needed.
▪️ Long-lasting protection with regular dental checkups.
▪️ Cost-effective compared with treating cavities.
▪️ Preserve healthy tooth structure.
▪️ Easy to repair or replace if worn over time.

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✅ Are Dental Sealants Safe?
Yes. Dental sealants are considered safe and effective by leading public health organizations.
Resin-based sealants contain extremely small amounts of BPA-related compounds, but scientific studies have found that the exposure is very low and well below levels considered harmful. The preventive benefits of sealants greatly outweigh this minimal exposure.
Parents who have concerns can discuss material options with their dentist, including glass ionomer sealants for specific situations.

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✅ How Long Do Dental Sealants Last?
With proper care, dental sealants can last between 5 and 10 years, although some may last even longer.
During routine dental visits, the dentist checks whether the sealant is still intact and can easily repair or replace it if necessary.
Regular brushing, flossing, fluoride use, and healthy eating remain essential because sealants only protect the chewing surfaces of teeth.

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✅ Can Teeth Still Get Cavities After Sealants?
Yes, although the risk is much lower.

Sealants protect only the chewing surfaces. Cavities can still develop:
▪️ Between the teeth.
▪️ Near the gumline.
▪️ On unsealed teeth.
▪️ If oral hygiene is poor or sugar intake is excessive.

For this reason, sealants should be combined with:
▪️ Twice-daily brushing with fluoride toothpaste.
▪️ Daily flossing.
▪️ Healthy eating habits.
▪️ Regular dental checkups.

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💬 Discussion
Current scientific evidence consistently shows that dental sealants are among the most effective preventive treatments in pediatric dentistry. Their greatest benefit occurs when they are placed soon after permanent molars erupt, before cavities have time to develop.
Although sealants are highly effective, they should be viewed as one part of a complete cavity prevention strategy that also includes fluoride exposure, good oral hygiene, balanced nutrition, and regular dental visits. When these measures are combined, children have a much greater chance of maintaining healthy permanent teeth throughout adolescence.

🎯 Recommendations
▪️ Ask your dentist about sealants when your child's first permanent molars appear.
▪️ Do not wait until cavities develop.
▪️ Maintain regular dental checkups every six months or as recommended.
▪️ Encourage daily brushing with fluoride toothpaste and flossing.
▪️ Limit frequent sugary snacks and drinks.
▪️ Have sealants checked periodically to ensure they remain intact.

✍️ Conclusion
Dental sealants are a safe, simple, and highly effective way to protect children's permanent molars from cavities. Applied at the right time, they provide years of protection while preserving healthy tooth structure. Combined with fluoride, proper oral hygiene, and regular dental care, sealants play a key role in helping children maintain healthy smiles throughout childhood and beyond.

📚 References

✔ American Academy of Pediatric Dentistry. (2024). Use of pit-and-fissure sealants. The Reference Manual of Pediatric Dentistry, 455–461.
✔ Centers for Disease Control and Prevention. (2024). Dental sealants prevent cavities. https://www.cdc.gov/oralhealth/prevention/dental-sealants.html
✔ Wright, J. T., Crall, J. J., Fontana, M., Gillette, E. J., Nový, B. B., Dhar, V., Donly, K., Hewlett, E. R., Quinonez, R. B., Chaffin, J., Crespin, M., Iafolla, T., Siegal, M. D., Tampi, M. P., Graham, L., & Estrich, C. (2016). Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. The Journal of the American Dental Association, 147(8), 672–682.e12. https://doi.org/10.1016/j.adaj.2016.06.001
✔ Urquhart, O., Tampi, M. P., Pilcher, L., Slayton, R. L., Araujo, M. W. B., Fontana, M., Guzmán-Armstrong, S., Nascimento, M. M., Nový, B. B., Tinanoff, N., Weyant, R. J., Wolff, M. S., Young, D. A., & Carrasco-Labra, A. (2024). Nonrestorative treatments for carious lesions: Systematic review and network meta-analysis supporting the American Dental Association clinical practice guideline. The Journal of the American Dental Association, 155(1), 27–44.

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Hidden Risks of Dexamethasone in Dental Patients You Should Know

Dexamethasone is a powerful corticosteroid frequently used in dentistry to reduce swelling, pain, and inflammation, especially after tooth extractions, dental implant surgery, and wisdom tooth removal. When prescribed appropriately, it can improve comfort and speed recovery.

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However, many patients are unaware that dexamethasone is not risk-free. While a single short-term dose is generally considered safe for healthy individuals, certain medical conditions, medications, and repeated use can increase the risk of complications.

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This guide explains the hidden risks of dexamethasone in dental patients, who should use it with caution, and how dentists minimize potential side effects while preserving its clinical benefits.

✅ What Is Dexamethasone?
Dexamethasone is a synthetic corticosteroid that reduces the body's inflammatory response by decreasing the production of substances involved in swelling and pain.

In dentistry, it is commonly prescribed to:
▪️ Reduce facial swelling after oral surgery
▪️ Control postoperative inflammation
▪️ Decrease jaw stiffness (trismus)
▪️ Improve patient comfort after difficult extractions
▪️ Reduce nausea associated with some surgical procedures
Unlike pain relievers, dexamethasone mainly controls inflammation, which is one of the main causes of discomfort after surgery.

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✅ Why Do Dentists Prescribe It?
Scientific studies have shown that a single low dose of dexamethasone can significantly reduce:

▪️ Postoperative swelling
▪️ Pain intensity
▪️ Difficulty opening the mouth
▪️ Recovery time after third molar surgery
For most healthy adults, the benefits outweigh the risks when used correctly.

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✅ Hidden Risks You Should Know
Although dexamethasone is effective, certain risks are often overlooked.

1. Temporary Increase in Blood Sugar
One of the most important concerns is that dexamethasone can temporarily raise blood glucose levels.
This is especially important for patients with:
▪️ Diabetes
▪️ Prediabetes
▪️ Poorly controlled blood sugar
Dentists may adjust treatment plans or recommend closer glucose monitoring after surgery.

2. Reduced Immune Response
Because corticosteroids suppress parts of the immune system, dexamethasone may slightly reduce the body's ability to fight infection.

A single perioperative dose has not been shown to substantially increase infection risk in healthy individuals, but caution is warranted in patients with:
▪️ Active infections
▪️ Weakened immune systems
▪️ Long-term corticosteroid therapy

3. Delayed Wound Healing (Mainly With Repeated Use)
Short-term use generally does not impair healing significantly.

However, repeated or prolonged corticosteroid therapy may:
▪️ Slow tissue repair
▪️ Delay collagen formation
▪️ Increase the risk of wound complications
This concern is more relevant for patients taking corticosteroids regularly rather than those receiving a single dental dose.

4. Medication Interactions
Dexamethasone may interact with several medications, including:

▪️ Blood thinners (such as warfarin)
▪️ Certain antifungal drugs
▪️ Some antibiotics
▪️ Diabetes medications
▪️ Antiepileptic medications
▪️ Other corticosteroids
Patients should always provide a complete medication list before treatment.

5. Stomach Irritation
Although uncommon after a single dose, dexamethasone may contribute to:

▪️ Heartburn
▪️ Stomach irritation
▪️ Gastric ulcers (mainly with repeated use)
The risk increases when combined with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, particularly in susceptible individuals.

6. Mood and Sleep Changes
Some people experience temporary:

▪️ Difficulty sleeping
▪️ Nervousness
▪️ Mood swings
▪️ Increased energy
▪️ Anxiety

These effects are usually mild and resolve within a day or two after a single dose.

7. Adrenal Suppression With Long-Term Use
The body naturally produces cortisol, an essential hormone.
Long-term corticosteroid use can reduce natural cortisol production, a condition called adrenal suppression.
Fortunately, this is extremely unlikely after a single dental dose, but it is an important consideration for patients already taking corticosteroids for chronic medical conditions.

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✅ Who Should Be Extra Careful?
Patients should inform their dentist if they have:

▪️ Diabetes
▪️ High blood pressure
▪️ Stomach ulcers
▪️ Osteoporosis
▪️ Kidney disease
▪️ Liver disease
▪️ Glaucoma
▪️ Active infections
▪️ Pregnancy or breastfeeding
▪️ Long-term corticosteroid treatment
▪️ Organ transplantation
▪️ Autoimmune diseases
A complete medical history helps determine whether dexamethasone is appropriate.

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✅ When Is Dexamethasone Considered Safe?
Current evidence indicates that a single low-dose administration before or after dental surgery is generally safe for healthy patients.

Safety depends on:
▪️ Proper patient evaluation
▪️ Appropriate dosage
▪️ Correct timing
▪️ Review of medications
▪️ Assessment of systemic health
Dentists carefully balance the expected benefits against potential risks for each individual.

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✅ How Dentists Reduce the Risks
Dental professionals improve safety by:

▪️ Reviewing medical history thoroughly
▪️ Checking current medications
▪️ Assessing diabetes control
▪️ Using the lowest effective dose
▪️ Avoiding unnecessary repeated prescriptions
▪️ Providing postoperative instructions
▪️ Referring medically complex patients when necessary
These measures help maximize benefits while minimizing complications.

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💬 Discussion
Dexamethasone remains one of the most valuable anti-inflammatory medications in oral surgery, supported by numerous clinical trials and systematic reviews. Its ability to reduce postoperative swelling, pain, and limited mouth opening improves recovery and patient satisfaction.
Nevertheless, its use should always be individualized. Most concerns associated with dexamethasone—such as adrenal suppression, delayed healing, or significant immune suppression—are linked to long-term or repeated corticosteroid therapy, not to the single perioperative doses commonly used in dentistry. Clear communication between patients and dental professionals is essential to identify underlying medical conditions and avoid preventable adverse effects.

🎯 Recommendations
▪️ Always inform your dentist about your complete medical history.
▪️ Tell your dentist about every medication and supplement you take.
▪️ Patients with diabetes should monitor blood glucose as recommended after treatment.
▪️ Never take leftover corticosteroids without professional advice.
▪️ Use dexamethasone only as prescribed and avoid self-medication.
▪️ Contact your dentist or physician if you experience unusual swelling, fever, allergic reactions, or persistent symptoms after treatment.

✍️ Conclusion
Dexamethasone is an effective and generally safe medication for reducing inflammation and improving comfort after many dental procedures. For most healthy adults, a single prescribed dose carries a low risk of serious side effects. However, patients with chronic medical conditions, diabetes, active infections, or those taking multiple medications require careful evaluation before treatment. Understanding both the benefits and hidden risks of dexamethasone helps patients make informed decisions and supports safer, more personalized dental care.

📚 References

✔ American Dental Association. (2024). Management of acute dental pain in adults. American Dental Association. https://www.ada.org
✔ de Oliveira, G. S., Almeida, M. D., Benzon, H. T., & McCarthy, R. J. (2011). Perioperative single-dose systemic dexamethasone for postoperative pain: A meta-analysis of randomized controlled trials. Anesthesiology, 115(3), 575–588. https://doi.org/10.1097/ALN.0b013e31822a24c2
✔ Faria, F. A. C., Gallas-Torreira, M., & Crespo-Torres, A. (2023). Corticosteroids in oral and maxillofacial surgery: A review of current evidence and clinical applications. Journal of Clinical Medicine, 12(15), 5008. https://doi.org/10.3390/jcm12155008
✔ Larsen, P. E. (2022). Corticosteroids in oral and maxillofacial surgery. In J. R. Hupp, E. Ellis III, & M. R. Tucker (Eds.), Contemporary Oral and Maxillofacial Surgery (8th ed., pp. 58–66). Elsevier.
✔ National Institute for Health and Care Excellence. (2020). Corticosteroids - oral. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk

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Sedation Dentistry for Adults: Safety and Effectiveness

Sedation dentistry for adults helps patients feel relaxed and comfortable during dental procedures. It is especially helpful for people with dental anxiety, a strong gag reflex, difficulty sitting still, or those undergoing lengthy or complex treatments.

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PDF 🔽 Local anesthesia calculations: How to avoid overdose and toxicity in pediatric patients? ... We share an article that teaches us what are the symptoms of local anesthetic systemic toxicity in pediatric patients, and also how to properly calculate local anesthetics.

Modern sedation techniques have been extensively studied and are considered safe and effective when provided by trained dental professionals using appropriate patient evaluation and monitoring.

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This guide explains how sedation works, who may benefit from it, its safety profile, potential risks, and what patients should expect before, during, and after treatment.

✅ What Is Sedation Dentistry?
Sedation dentistry uses medications to reduce anxiety, increase comfort, and help patients remain calm during dental treatment. Unlike general anesthesia, most sedation methods allow patients to remain conscious and able to respond to simple instructions.
The main goal is to improve the dental experience while maintaining patient safety throughout the procedure.

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✅ Levels of Dental Sedation
Different levels of sedation are selected based on the patient's medical condition, anxiety level, and the complexity of the procedure.

Minimal Sedation
▪️ Patient is awake and relaxed.
▪️ Anxiety is reduced.
▪️ Normal communication is maintained.
▪️ Suitable for mild dental anxiety.

Moderate Sedation (Conscious Sedation)
▪️ Patient feels very relaxed and may remember little of the procedure.
▪️ Protective reflexes remain intact.
▪️ Used for moderate anxiety and longer procedures.

Deep Sedation
▪️ Patient is close to sleep but can usually be awakened.
▪️ Requires advanced monitoring.
▪️ Reserved for selected patients and procedures.

General Anesthesia
▪️ Patient is completely unconscious.
▪️ Used only when medically necessary or for highly complex cases.
▪️ Requires specialized facilities and trained anesthesia providers.

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✅ Common Types of Sedation

Nitrous Oxide (Laughing Gas)
▪️ Inhaled through a small nasal mask.
▪️ Begins working within minutes.
▪️ Recovery is rapid.
▪️ Patients can usually drive themselves home afterward unless another sedative is also used.

Best for:
▪️ Mild anxiety
▪️ Short dental appointments

Oral Sedation
A prescribed medication is taken before the appointment.

Benefits include:
▪️ Reduced anxiety
▪️ Increased relaxation
▪️ Partial memory loss of the procedure in some patients
Because drowsiness may continue after treatment, patients need someone to drive them home.

Intravenous (IV) Sedation
Medication is delivered through a vein, allowing rapid onset and precise adjustment throughout treatment.

Advantages include:
▪️ Fast effect
▪️ Deasily adjustable sedation level
▪️ Excellent comfort during lengthy procedures
Continuous monitoring is required during treatment.

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✅ Who Can Benefit from Sedation Dentistry?
Adults who may benefit include those with:

▪️ Severe dental anxiety or dental phobia
▪️ Strong gag reflex
▪️ Difficulty remaining still
▪️ Previous traumatic dental experiences
▪️ Extensive restorative treatment
▪️ Multiple procedures in one visit
▪️ Certain physical or developmental conditions that make treatment difficult

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✅ Is Sedation Dentistry Safe?
Yes. Sedation dentistry is considered very safe when appropriate protocols are followed.

Safety depends on several important factors:
▪️ Complete medical history review
▪️ Evaluation of medications and allergies
▪️ Assessment of heart and lung health
▪️ Selection of the appropriate sedation level
▪️ Continuous monitoring of vital signs
▪️ Proper training of the dental team
▪️ Availability of emergency equipment and medications
Serious complications are uncommon when these standards are followed.

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✅ Possible Side Effects
Most side effects are mild and temporary.

Common effects include:
▪️ Sleepiness
▪️ Dizziness
▪️ Dry mouth
▪️ Mild nausea
▪️ Temporary confusion
▪️ Reduced coordination for several hours
Patients should follow all postoperative instructions carefully.

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✅ Who May Need Additional Evaluation?
Some patients require extra assessment before sedation, including those with:

▪️ Obstructive sleep apnea
▪️ Severe obesity
▪️ Advanced heart disease
▪️ Significant lung disease
▪️ Pregnancy
▪️ Liver disease
▪️ Kidney disease
▪️ History of adverse reactions to sedative medications
In some situations, consultation with the patient's physician may be recommended.

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✅ Preparing for Sedation Dentistry
Patients should:

▪️ Provide a complete medical history.
▪️ List all medications and supplements.
▪️ Follow fasting instructions if required.
▪️ Avoid alcohol before treatment.
▪️ Arrange transportation home when receiving oral or IV sedation.
▪️ Wear comfortable clothing.
▪️ Ask questions about the procedure before treatment begins.
Good communication between the patient and dental team is essential for safe care.

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✅ Recovery After Sedation
Recovery varies depending on the sedation technique.

Most patients should:
▪️ Rest for the remainder of the day.
▪️ Avoid driving if instructed.
▪️ Avoid alcohol and important decisions for 24 hours after oral or IV sedation.
▪️ Drink plenty of fluids.
▪️ Resume normal activities only when fully alert.
Most people recover without complications.

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✅ Benefits of Sedation Dentistry
Sedation dentistry offers several important advantages:

▪️ Reduces fear and anxiety
▪️ Improves patient comfort
▪️ Allows longer procedures in fewer appointments
▪️ Decreases gag reflex
▪️ Helps patients complete needed dental treatment
▪️ Improves overall treatment experience
▪️ Increases satisfaction with dental care

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✅ Are There Any Risks?
Although complications are uncommon, potential risks include:

▪️ Excessive sedation
▪️ Breathing difficulties
▪️ Allergic reactions
▪️ Changes in blood pressure or heart rate
▪️ Medication interactions
These risks are minimized through careful patient selection, professional training, and continuous monitoring.

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💬 Discussion
Current scientific evidence supports sedation dentistry for adults as a safe and effective option for reducing anxiety and improving access to dental care. Advances in monitoring technology, standardized sedation guidelines, and improved professional training have significantly enhanced patient safety over the past two decades.
However, sedation should not be viewed as a substitute for proper communication or preventive dental care. Instead, it should be integrated into a comprehensive treatment plan tailored to each patient's medical history, anxiety level, and treatment needs. Individualized assessment remains essential, as patients with complex medical conditions may require additional evaluation or referral to specialized care settings.

🎯 Recommendations
▪️ Choose a dentist trained in sedation techniques and emergency management.
▪️ Provide a complete and accurate medical history before treatment.
▪️ Inform the dentist about all medications, supplements, and allergies.
▪️ Follow fasting and medication instructions carefully.
▪️ Arrange transportation home after oral or IV sedation.
▪️ Follow all postoperative instructions until fully recovered.
▪️ Maintain regular dental visits to reduce the need for extensive treatment in the future.

✍️ Conclusion
Sedation dentistry for adults is a safe, effective, and evidence-based approach that helps many people receive dental care comfortably. When performed by qualified professionals using appropriate patient assessment and monitoring, sedation significantly reduces anxiety while maintaining a high level of safety. Patients who understand their sedation options and actively communicate with their dental team can make informed decisions and experience more positive dental visits.

📚 References

✔ American Dental Association. (2016). Guidelines for the use of sedation and general anesthesia by dentists. American Dental Association. https://www.ada.org
✔ American Society of Anesthesiologists. (2018). Practice guidelines for moderate procedural sedation and analgesia 2018. Anesthesiology, 128(3), 437–479. https://doi.org/10.1097/ALN.0000000000002043
✔ Coulthard, P., Bailey, E., Patel, N., Coulthard, F. P., & Bailey, E. (2014). Conscious sedation guidance. British Dental Journal, 216(6), 295–296. https://doi.org/10.1038/sj.bdj.2014.197
✔ Green, S. M., Roback, M. G., Krauss, B., Brown, L., McGlone, R. G., & Agrawal, D. (2019). Clinical practice guideline for emergency department procedural sedation with ketamine. Annals of Emergency Medicine, 73(5), e51–e65. https://doi.org/10.1016/j.annemergmed.2018.12.018
✔ Wilson, K. E., Girdler, N. M., & Welbury, R. R. (2019). A practical guide to conscious sedation in dentistry (2nd ed.). Wiley-Blackwell.

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Transverse Malocclusions in Primary, Mixed, and Permanent Dentition

Transverse malocclusions are bite problems that occur when the upper and lower dental arches do not fit properly in width. Instead of the upper teeth slightly overlapping the lower teeth, one or more teeth may bite inside or outside their normal position.

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These conditions can affect children, adolescents, and adults, influencing chewing, speech, facial growth, and long-term oral health.

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Early recognition is important because many transverse discrepancies become more difficult to correct as facial growth slows. A proper diagnosis allows clinicians to determine whether the problem is caused by the teeth, the jawbones, or a combination of both.

🔹 What Is a Transverse Malocclusion?
A transverse malocclusion is an abnormal relationship between the maxillary and mandibular arches in the horizontal (width) dimension.

The condition may involve:
▪️ Dental problems, where only tooth position is affected.
▪️ Skeletal problems, where the maxilla or mandible has an abnormal width.
▪️ Combined dental and skeletal discrepancies, which are common in clinical practice.

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🔹 Common Types of Transverse Malocclusions
1. Posterior Crossbite
The upper posterior teeth bite inside the lower posterior teeth instead of outside them.

It may be:
▪️ Unilateral
▪️ Bilateral
▪️ Dental
▪️ Skeletal
▪️ Functional, caused by mandibular displacement during closure.
Posterior crossbite is one of the most common transverse malocclusions in children.

2. Scissor Bite (Brodie Bite)
A scissor bite occurs when the upper posterior teeth are positioned excessively toward the cheek, causing little or no contact with the lower teeth.
Although uncommon, it can interfere with mastication and occlusal stability.

3. Maxillary Constriction
A narrow upper jaw often results in:

▪️ Posterior crossbite
▪️ High-arched palate
▪️ Dental crowding
▪️ Functional mandibular shift
Maxillary constriction may be dental or skeletal and is frequently associated with mouth breathing.

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🔹 Transverse Malocclusions by Dentition Stage

Primary Dentition
During the primary dentition, transverse discrepancies are often associated with:

▪️ Non-nutritive sucking habits
▪️ Mouth breathing
▪️ Premature tooth loss
▪️ Genetic skeletal patterns
Early treatment may eliminate functional shifts and improve normal craniofacial development.

Mixed Dentition
This is considered the ideal stage for interceptive orthodontics because the maxillary sutures remain responsive to orthopedic expansion.

Treatment options may include:
▪️ Rapid Maxillary Expansion (RME)
▪️ Slow Maxillary Expansion (SME)
▪️ Habit elimination
▪️ Space maintenance when indicated
Early intervention generally provides more stable skeletal correction.

Permanent Dentition
In adolescents and adults, treatment depends on skeletal maturity.

Options include:
▪️ Orthodontic expansion
▪️ Skeletal expansion using MARPE
▪️ Surgically Assisted Rapid Palatal Expansion (SARPE) in selected adults
▪️ Orthognathic surgery for severe skeletal discrepancies
The treatment approach becomes more individualized after growth has ended.

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🔹 Main Causes
Several factors may contribute to transverse malocclusions:

▪️ Genetic craniofacial growth patterns
▪️ Narrow maxillary arch
▪️ Mouth breathing
▪️ Thumb sucking or prolonged pacifier use
▪️ Tongue posture abnormalities
▪️ Premature loss of primary teeth
▪️ Trauma
▪️ Cleft lip and palate
Usually, multiple factors are involved.

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🔹 Clinical Signs
Patients may present with:

▪️ Posterior crossbite
▪️ Facial asymmetry
▪️ Mandibular deviation during closure
▪️ High and narrow palate
▪️ Dental crowding
▪️ Difficulty chewing
▪️ Uneven tooth wear
Some patients remain asymptomatic, making routine dental examinations essential.

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🔹 Diagnosis
Diagnosis should combine clinical examination with imaging.

The evaluation includes:
▪️ Facial symmetry
▪️ Occlusal analysis
▪️ Functional mandibular shift
▪️ Arch width measurements
▪️ Digital models or study casts
▪️ Intraoral photographs
▪️ CBCT, when clinically justified for skeletal assessment
Accurate diagnosis distinguishes dental crossbite from skeletal transverse deficiency, which directly influences treatment planning.

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🔹 Treatment Overview
Treatment depends on:

▪️ Patient age
▪️ Dentition stage
▪️ Growth potential
▪️ Severity
▪️ Dental or skeletal origin

Common approaches include:

Condition	Preferred Management
Dental Crossbite	Limited orthodontic correction using appliances such as cross elastics or removable/fixed expansion devices, depending on the case.
Functional Crossbite	Early interceptive treatment to eliminate the functional shift and promote normal jaw development.
Skeletal Maxillary Constriction (Children)	Rapid Maxillary Expansion (RME) or Slow Maxillary Expansion (SME) to correct the transverse skeletal deficiency.
Skeletal Maxillary Deficiency (Adolescents/Adults)	MARPE (Miniscrew-Assisted Rapid Palatal Expansion), SARPE (Surgically Assisted Rapid Palatal Expansion), or orthognathic surgery for severe skeletal discrepancies.

🔹 Possible Consequences if Untreated
Untreated transverse malocclusions may lead to:

▪️ Progressive facial asymmetry
▪️ Abnormal tooth wear
▪️ Periodontal overload
▪️ Occlusal instability
▪️ Temporomandibular dysfunction in susceptible individuals
▪️ Persistent chewing difficulties
Early correction often reduces these risks.

💬 Discussion
Current orthodontic evidence supports early diagnosis of transverse discrepancies, especially during the mixed dentition, when orthopedic correction is most effective. Not every posterior crossbite requires aggressive treatment, but functional shifts and skeletal maxillary constriction should be identified promptly. Modern imaging and individualized treatment planning allow clinicians to distinguish dental from skeletal problems, improving treatment outcomes while minimizing unnecessary procedures.

🎯 Recommendations
▪️ Screen children for transverse discrepancies during routine dental visits.
▪️ Identify functional shifts as early as possible.
▪️ Address oral habits that contribute to maxillary constriction.
▪️ Refer patients for orthodontic evaluation when posterior crossbite is detected.
▪️ Use CBCT only when additional three-dimensional information is clinically necessary.
▪️ Develop treatment plans based on growth stage rather than chronological age alone.

✍️ Conclusion
Transverse malocclusions are common developmental problems that can affect patients from primary through permanent dentition. Their severity ranges from simple dental crossbites to complex skeletal discrepancies. Early diagnosis, especially during the mixed dentition, allows clinicians to take advantage of facial growth and achieve more predictable outcomes. Accurate differentiation between dental and skeletal causes remains essential for selecting the most appropriate treatment and promoting long-term occlusal stability.

📊 Summary Table

Aspect	Key Information
Definition	Abnormal width relationship between the upper and lower dental arches.
Main Types	Posterior crossbite, scissor bite, maxillary constriction.
Primary Dentition	Often related to oral habits, mouth breathing, and genetics.
Mixed Dentition	Best period for interceptive orthodontic treatment and maxillary expansion.
Permanent Dentition	Treatment may include orthodontic expansion, MARPE, or surgery.
Main Causes	Genetics, mouth breathing, thumb sucking, premature tooth loss, tongue posture.
Diagnosis	Clinical examination, occlusal analysis, dental models, imaging, and CBCT when indicated.
Importance of Early Treatment	Improves skeletal correction, facial symmetry, and long-term occlusal stability.

📚 References

✔ Baccetti, T., Franchi, L., Cameron, C. G., & McNamara, J. A. (2001). Treatment timing for rapid maxillary expansion. The Angle Orthodontist, 71(5), 343–350.
✔ Graber, L. W., Vanarsdall, R. L., Vig, K. W. L., & Huang, G. J. (2023). Orthodontics: Current principles and techniques (7th ed.). Elsevier.
✔ Proffit, W. R., Fields, H. W., Larson, B. E., & Sarver, D. M. (2023). Contemporary Orthodontics (7th ed.). Elsevier.
✔ Tsarapatsani, P., Tullberg, M., Lindner, A., Huggare, J., & Tsarapatsani, P. (2000). Long-term follow-up of early treatment of unilateral posterior crossbite. The Angle Orthodontist, 70(4), 319–324.
✔ American Association of Orthodontists. Clinical Practice Resources (current guidance on early orthodontic evaluation and transverse discrepancies).

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Dental Fistulas in Primary Teeth: Diagnosis & Treatment

A dental fistula is a small channel that develops when an infection inside a tooth or around its root needs a way to drain.

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In children, dental fistulas are most often associated with untreated dental caries that have progressed to pulp necrosis and a chronic dental abscess.

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Although the fistula itself is usually painless, it is an important warning sign that the underlying tooth is infected and requires dental treatment.
Early diagnosis is essential because untreated infections in primary teeth may affect the child's comfort, chewing, speech, and even the development of the permanent successor tooth.

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✅ What Is a Dental Fistula?
A dental fistula (also called a sinus tract) is a narrow pathway that allows pus from a chronic dental infection to drain from the bone toward the oral mucosa or, less commonly, the skin.
Because the infection can drain continuously, the pressure inside the tissues decreases, which explains why many children do not complain of severe pain, despite having an infected tooth.

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✅ Why Do Dental Fistulas Develop?
The most common causes include:

▪️ Deep untreated dental caries
▪️ Pulp necrosis (death of the dental pulp)
▪️ Chronic periapical infection
▪️ Dental trauma causing pulp damage
▪️ Failed pulp therapy in a primary tooth
▪️ Among these, dental caries remains by far the leading cause.

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✅ Clinical Signs and Symptoms
Children with a dental fistula may present with:

▪️ Small pimple-like lesion on the gum
▪️ Yellow or white drainage point
▪️ Intermittent discharge of pus
▪️ Mild swelling around the affected area
▪️ History of previous toothache
▪️ Tooth discoloration
▪️ Little or no pain after the fistula forms
▪️ Occasionally tenderness when chewing
The fistula often appears near the root of the infected primary tooth.

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✅ How Is a Dental Fistula Diagnosed?
Diagnosis is based on clinical examination combined with radiographic evaluation.
The dentist typically performs:

Clinical Examination
▪️ Identification of the draining sinus tract
▪️ Evaluation of dental caries
▪️ Percussion and palpation tests
▪️ Assessment of tooth mobility
▪️ Examination of soft tissues

Radiographic Examination
▪️ Periapical or bitewing radiographs help detect:
▪️ Periapical radiolucency
▪️ Bone destruction
▪️ Root resorption
▪️ Relationship with the permanent tooth germ
When the origin of the fistula is uncertain, a gutta-percha cone may be gently inserted into the sinus tract before taking a radiograph to trace its source.

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✅ Differential Diagnosis
A dental fistula should be differentiated from:

▪️ Parulis
▪️ Periodontal abscess
▪️ Gingival abscess
▪️ Eruption cyst
▪️ Mucocele
▪️ Pyogenic granuloma
▪️ Traumatic ulcers with secondary infection
Accurate diagnosis ensures the correct treatment is provided.

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✅ Treatment
The primary goal is to eliminate the source of infection rather than simply treating the fistula.
Treatment depends on the condition of the tooth.

Pulpectomy
Recommended when:
The primary tooth is restorable.
Adequate root structure remains.
There is no excessive pathological root resorption.
Pulpectomy removes infected pulp tissue and fills the canals with a resorbable material appropriate for primary teeth.

Extraction
▪️ Extraction is indicated when:
▪️ The tooth cannot be restored.
▪️ There is extensive root resorption.
▪️ The infection is severe.
▪️ The permanent successor is close to eruption.
▪️ The tooth has a poor prognosis.
If extraction is performed prematurely, a space maintainer may be required.

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✅ Are Antibiotics Necessary?
Routine antibiotics are not recommended for localized dental fistulas.
Systemic antibiotics should only be considered when there are signs of:
▪️ Facial cellulitis
▪️ Diffuse swelling
▪️ Fever
▪️ Systemic illness
▪️ Spread of infection
▪️ Immunocompromised patients
In most cases, definitive dental treatment is sufficient.

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✅ Possible Complications
Without treatment, a dental fistula may lead to:

▪️ Persistent chronic infection
▪️ Facial swelling
▪️ Pain recurrence
▪️ Bone destruction
▪️ Premature loss of the primary tooth
▪️ Damage to the developing permanent tooth
▪️ Space loss and future malocclusion

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💬 Discussion
A dental fistula is not the disease itself but a sign of chronic dental infection. Because the lesion often drains continuously, many parents mistakenly believe the problem has resolved when the child no longer experiences pain. In reality, the infection persists until the source is eliminated.
Current pediatric dentistry guidelines emphasize preserving primary teeth whenever possible through appropriate pulp therapy. However, when the tooth has a poor prognosis, extraction is the safest option to prevent further complications and protect the developing permanent dentition.

🎯 Recommendations
▪️ Never ignore a gum "pimple" in a child.
▪️ Seek prompt dental evaluation if drainage is observed.
▪️ Treat the infected tooth rather than the fistula alone.
▪️ Avoid self-medicating with antibiotics unless prescribed.
▪️ Maintain regular preventive dental visits every six months.

✍️ Conclusion
Dental fistulas in primary teeth are a common consequence of untreated pulp infection and should never be considered harmless. Although they are frequently painless, they indicate the presence of chronic infection that requires professional treatment. Early diagnosis, appropriate radiographic assessment, and timely management through pulpectomy or extraction help preserve oral health, prevent complications, and protect the normal development of the permanent dentition.

📚 References

✔ American Academy of Pediatric Dentistry. (2024). Use of non-vital pulp therapies in primary teeth. In The Reference Manual of Pediatric Dentistry (2024–2025 ed.). American Academy of Pediatric Dentistry.
✔ American Academy of Pediatric Dentistry. (2024). Best practices: Pulp therapy for primary and immature permanent teeth. In The Reference Manual of Pediatric Dentistry (2024–2025 ed.). American Academy of Pediatric Dentistry.
✔ Coll, J. A., Vargas, K., Marghalani, A. A., Chen, C. Y., Al Shamali, S., Dhar, V., ... & Seale, N. S. (2020). A systematic review and meta-analysis of nonvital pulp therapy for primary teeth. Pediatric Dentistry, 42(4), 256–461.
✔ Day, P. F., Flores, M. T., O'Connell, A. C., Abbott, P. V., Tsilingaridis, G., Fouad, A. F., ... & Levin, L. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: Injuries in the primary dentition. Dental Traumatology, 36(4), 343–359. https://doi.org/10.1111/edt.12576
✔ Schwendicke, F., Frencken, J. E., Bjørndal, L., Maltz, M., Manton, D. J., Ricketts, D., ... & Paris, S. (2021). Managing carious lesions: Consensus recommendations on carious tissue removal. Advances in Dental Research, 33(1), 12–18.

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