Glass Ionomer Cement in Pediatric Dentistry: Benefits, Uses, and Step-by-Step Application Guide

Glass ionomer cement (GIC) is a widely used dental material in pediatric dentistry due to its strong adhesion, fluoride release, and biocompatibility.

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This article explores its characteristics, advantages, disadvantages, clinical applications, and a step-by-step guide for proper use.

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Characteristics of Glass Ionomer Cement
Glass ionomer cement consists of a powder and a liquid that, when mixed, form a rigid, adhesive matrix. The powder contains fluoroaluminosilicate glass, while the liquid consists of polyalkenoic acids in an aqueous solution. This composition enables chemical bonding to the tooth structure and sustained fluoride release, aiding in enamel remineralization and cavity prevention.

Benefits of Glass Ionomer Cement in Pediatric Dentistry
1. Fluoride Release: Provides long-term fluoride release, strengthening enamel and reducing the risk of cavities.
2. Chemical Adhesion: Bonds directly to enamel and dentin without the need for acid etching, simplifying clinical procedures.
3. Biocompatibility: Well-tolerated by dental and soft tissues, minimizing adverse reactions.
4. Thermal Expansion Similar to Natural Teeth: Reduces the risk of marginal leakage and ensures long-lasting adaptation.

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Disadvantages of Glass Ionomer Cement
1. Lower Mechanical Strength: Less resistant to wear and occlusal forces compared to composite resins.
2. Aesthetic Limitations: While improved, its translucency and color range may not fully match natural tooth appearance.
3. Moisture Sensitivity During Placement: Requires proper moisture control to prevent property alterations.

Uses of Glass Ionomer Cement in Pediatric Dentistry
° Restorations for Primary Teeth: Ideal for Class I, II, and V cavities in deciduous teeth due to its adhesion and fluoride release.
° Pit and Fissure Sealants: Used as a sealant in newly erupted permanent molars to prevent cavities.
° Liners and Bases: Serves as a protective base under restorations, providing thermal and chemical insulation.
° Cementation of Pediatric Crowns: Used for cementing stainless steel crowns on primary teeth.

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Step-by-Step Application of Glass Ionomer Cement
1. Cavity Preparation: Remove decayed tissue and clean the cavity without overextending margins.
2. Conditioning: Apply 10% polyacrylic acid for 10-15 seconds to enhance adhesion, then rinse and gently dry without dehydrating.
3. Mixing the Material: Follow the manufacturer’s recommended powder-to-liquid ratio, mixing until a homogeneous consistency is achieved.
4. Placement: Apply the glass ionomer cement into the prepared cavity, ensuring proper adaptation and avoiding air bubbles.
5. Initial Setting: Allow the material to set according to manufacturer instructions while protecting it from moisture and desiccation.
6. Finishing and Polishing: Once set, refine the restoration, adjust occlusion, and polish for improved aesthetics and longevity.

Conclusion
Glass ionomer cement is a valuable material in pediatric dentistry due to its adhesive properties, fluoride release, and biocompatibility. While it has some limitations in mechanical strength and aesthetics, its benefits for cavity prevention and ease of use make it a preferred choice for various pediatric dental applications.

References
1. Croll, T. P., & Nicholson, J. W. (2002). Glass ionomer cements in pediatric dentistry: Review of the literature. Pediatric Dentistry, 24(5), 423-429. Recuperado de
2. Berg, J. H. (2002). Glass ionomer cements. Pediatric Dentistry, 24(5), 430-438. Recuperado de
3. Sikka, N., & Brizuela, M. (2024). Glass Ionomer Cement. En StatPearls. StatPearls Publishing

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Management of Severe Acute Dental Infections

Severe acute dental infections are a critical concern in dentistry, as they can progress rapidly, causing systemic complications and posing a life-threatening risk if not managed promptly.

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A. Etiology and Pathogenesis
Severe dental infections are often caused by bacterial invasion into the dental pulp or surrounding structures. Common sources include:
° Untreated dental caries: Progression into pulpitis and periapical abscess.
° Periodontal infections: Spread to adjacent tissues.
° Traumatic injuries: Leading to necrosis of the pulp.
° Post-surgical complications: Including infections after extractions or implant placement.
The most frequently implicated bacteria are anaerobic organisms such as Prevotella and Fusobacterium, often in polymicrobial infections.

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B. Clinical Presentation
Patients with severe dental infections typically present with:
° Localized swelling: Often associated with pain and erythema.
° Fever and malaise: Indicating systemic involvement.
° Trismus and dysphagia: In cases of space infections such as Ludwig’s angina.
° Fluctuant abscesses or purulent drainage.
In advanced cases, airway compromise may occur, necessitating emergency intervention.

C. Management Strategies
1. Early Diagnosis
Timely identification of infection severity is crucial. Clinical examination, imaging (e.g., periapical radiographs, CT scans), and laboratory tests (e.g., white blood cell count) help guide diagnosis.
2. Drainage and Debridement
The cornerstone of treatment is surgical drainage to evacuate pus and relieve pressure. This may involve:
° Incision and drainage (I&D) of abscesses.
° Endodontic therapy: For infections localized to the pulp.
° Tooth extraction: For non-restorable teeth.
3. Antibiotic Therapy
Antibiotics are essential when systemic involvement is evident. Empiric therapy targets anaerobes and includes:
° Amoxicillin-clavulanate.
° Clindamycin (for penicillin-allergic patients).
°Metronidazole, in combination with penicillin or other broad-spectrum antibiotics.
Antibiotics should be adjusted based on culture and sensitivity results if available.
4. Supportive Care
° Analgesics: Non-steroidal anti-inflammatory drugs (NSAIDs) for pain control.
° Hydration and nutrition: To prevent systemic deterioration.
° Hospitalization: In cases of airway compromise, systemic sepsis, or failure of outpatient management.
5. Referral to Specialists
Complex infections, such as those involving the deep cervical spaces or spreading to the mediastinum, require multidisciplinary management by oral and maxillofacial surgeons, otolaryngologists, or infectious disease specialists.

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D. Prevention
Preventive strategies include regular dental check-ups, patient education on oral hygiene, and prompt treatment of early dental caries or periodontal disease.

E. Conclusion
Severe acute dental infections demand swift and comprehensive management to prevent serious complications. Clinicians should focus on early diagnosis, appropriate surgical intervention, effective antimicrobial therapy, and interdisciplinary care in complex cases.

References
1. Flynn, T. R. (2006). Oral and maxillofacial infections: Current therapy. Oral and Maxillofacial Surgery Clinics of North America, 18(4), 493-511.
2. Brook, I. (2011). *Microbiology and management of endodontic infections in children. Journal of Clinical Pediatric Dentistry, 36(2), 189-193.
3. Kuriyama, T., et al. (2000). *Factors affecting the clinical outcome of odontogenic infections. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 90(1), 95-100.

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