Recurrent Aphthous Stomatitis in Children: Differential Diagnosis and and Modern Management

✅ Abstract
Recurrent aphthous stomatitis (RAS) is the most frequent ulcerative disorder of the oral mucosa in children.

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This article reviews its definition, etiology, clinical diagnosis, differential features, and evidence-based treatment approaches to guide pediatric dentists and clinicians in accurate management.

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✅ Introduction
Recurrent aphthous stomatitis (RAS), commonly known as canker sores, affects approximately 20–30% of children worldwide (Akintoye & Greenberg, 2021). These painful ulcers significantly impact oral comfort, nutrition, and quality of life. Understanding the pathogenesis and differentiating RAS from other ulcerative oral conditions is essential for appropriate and minimally invasive management.

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✅ Definition
Recurrent aphthous stomatitis is a chronic, relapsing condition characterized by round or oval ulcers with a yellowish fibrinous center and an erythematous halo, occurring on non-keratinized oral mucosa such as the buccal mucosa, floor of the mouth, and labial surfaces. Episodes typically recur every 1–4 months, lasting 7–14 days per episode.

✅ Etiology
The etiopathogenesis of RAS is multifactorial, involving a combination of genetic, immunologic, microbial, and environmental factors:

▪️ Genetic predisposition: Positive family history in up to 40% of cases.
▪️ Immune dysregulation: Altered T-cell response and increased TNF-α levels.
▪️ Nutritional deficiencies: Low levels of vitamin B12, folate, iron, and zinc are commonly associated.
▪️ Stress and trauma: Minor oral trauma can trigger ulcer formation.
▪️ Allergic or microbial factors: Hypersensitivity reactions to certain foods (e.g., chocolate, nuts) or bacteria.
▪️ Systemic diseases: Behçet’s disease, Crohn’s disease, and celiac disease must be ruled out.

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✅ Diagnosis
Diagnosis is clinical, based on history, lesion morphology, recurrence pattern, and exclusion of systemic conditions.
Typical RAS lesions are:

▪️ Minor aphthae: less than 10 mm, heal without scarring.
▪️ Major aphthae: more than 10 mm, last longer, may scar.
▪️ Herpetiform aphthae: Multiple pinpoint ulcers that coalesce.
Laboratory tests (CBC, ferritin, folate, vitamin B12, and celiac antibodies) are indicated when recurrent or severe ulcers are present.

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✅ Differential Diagnosis
Distinguishing RAS from other oral ulcerations is essential to avoid misdiagnosis. Common differential diagnoses include herpetic gingivostomatitis, traumatic ulcers, hand-foot-and-mouth disease, and Behçet’s disease.

📊 Comparative Table: Differential Diagnosis of Recurrent Aphthous Stomatitis in Children

Condition	Distinguishing Features	Diagnostic Clues
Herpetic Gingivostomatitis	Multiple vesicles on keratinized mucosa; painful and febrile onset	Positive HSV-1 culture or PCR; affects both attached gingiva and lips
Traumatic Ulcer	Single ulcer with history of mechanical or thermal trauma	Heals rapidly after eliminating the causative factor
Hand-Foot-and-Mouth Disease	Vesicular lesions on oral mucosa, palms, and soles	Coxsackievirus A16 or Enterovirus 71 infection confirmed by PCR
Behçet’s Disease	Oral and genital ulcers with ocular involvement	Positive pathergy test; systemic vasculitis signs

✅ Modern Management
Management focuses on symptom control, ulcer healing, and prevention of recurrence.
Current evidence-based strategies include:

1. Topical Therapies
▪️ Corticosteroids (e.g., triamcinolone acetonide 0.1%): First-line for reducing pain and inflammation.
▪️ Chlorhexidine gluconate 0.12% mouthwash: Reduces bacterial load and secondary infection.
▪️ Topical anesthetics (lidocaine gel): For pain relief prior to meals.

2. Systemic Treatments (for severe or major RAS)
▪️ Oral corticosteroids (prednisone ≤15 mg/day) for short-term control.
▪️ Colchicine or dapsone in recurrent or immune-mediated cases under specialist supervision.
▪️ Vitamin B12, folate, and iron supplementation if deficiency is detected.

3. Adjunctive and Preventive Measures
▪️ Maintain excellent oral hygiene using non-sodium lauryl sulfate toothpaste.
▪️ Avoid trigger foods (acidic, spicy, or allergenic).
▪️ Manage psychological stress through behavioral interventions.

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✅ Conclusion
Recurrent aphthous stomatitis in children remains a multifactorial condition requiring comprehensive evaluation. Early identification of underlying causes and application of evidence-based topical or systemic therapies can significantly reduce recurrence and improve quality of life.

🔎 Recommendations
1. Pediatric dentists should conduct routine screening for systemic conditions in children with frequent oral ulcers.
2. Use topical corticosteroids and chlorhexidine as first-line therapy.
3. Encourage nutritional evaluation to detect deficiencies contributing to recurrence.
4. Educate caregivers on trauma prevention and stress reduction strategies.

📚 References

✔ Akintoye, S. O., & Greenberg, M. S. (2021). Recurrent aphthous stomatitis. In M. S. Greenberg (Ed.), Burket’s Oral Medicine (13th ed., pp. 49–55). Wiley-Blackwell.
✔ 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.51395
✔ Chiang, C. P., Yu-Fong Chang, J., Wang, Y. P., & Wu, Y. H. (2022). Recurrent aphthous stomatitis – Etiology, pathogenesis, diagnosis, and ✔ management. Journal of the Formosan Medical Association, 121(6), 1073–1082. https://doi.org/10.1016/j.jfma.2021.09.012
✔ Scully, C., & Porter, S. (2008). Oral mucosal disease: Recurrent aphthous stomatitis. British Journal of Oral and Maxillofacial Surgery, 46(3), 198–206. https://doi.org/10.1016/j.bjoms.2007.07.201

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Maxillary Orthopedics vs. Interceptive Orthodontics: Understanding Their Clinical Differences

✅ Abstract
Both maxillary orthopedics and interceptive orthodontics play essential roles in early dental and facial development.

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While they share preventive and growth-modifying purposes, their focus, timing, and techniques differ. This article explores their definitions, characteristics, objectives, and the most common appliances used in each approach.

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✅ Introduction
Early orthodontic care aims to guide proper jaw growth, prevent malocclusions, and ensure harmonious facial development. The terms maxillary orthopedics and interceptive orthodontics are often confused, yet they represent distinct, though complementary, specialties within pediatric dentistry.

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✅ Definition and Characteristics

➤ Maxillary Orthopedics
Maxillary orthopedics is a preventive and corrective discipline that focuses on modifying the growth of the facial bones, especially the maxilla and mandible, during active skeletal development. It is typically indicated between 4 and 10 years old, when bone growth is most adaptable.

▪️ Characteristics include:
° Use of functional or orthopedic appliances (removable or fixed).
° Objective: guide skeletal growth and correct maxillomandibular discrepancies.
° Often part of early dentofacial orthopedic therapy.

➤ Interceptive Orthodontics
Interceptive orthodontics involves the early detection and correction of developing malocclusions, usually during the mixed dentition phase (6–11 years old).

▪️ Characteristics include:
° Focus on dental and skeletal problems in formation.
° May use orthopedic, orthodontic, or habit-breaking appliances.
° Objective: prevent or reduce the severity of future orthodontic issues.

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✅ Differences Between Maxillary Orthopedics and Interceptive Orthodontics

Aspect	Advantages	Limitations
Main Focus	Primarily addresses **skeletal (maxillomandibular) growth and balance**, enabling modification of jaw relationships and improvement of airway function.	Effectiveness is limited to **growing patients**; does not fully resolve tooth alignment problems alone.
Age of Intervention	Targets **early growth windows** (commonly 4–10 years) where skeletal changes are more easily guided, allowing prevention of severe future discrepancies.	Precise timing varies by individual and requires early diagnosis; premature or late intervention may reduce effectiveness.
Type of Appliances	Uses **functional and orthopedic devices** (e.g., expanders, face masks, Frankel) that produce skeletal effects when growth is favorable.	Appliances can be **bulky or require high patient cooperation**; some devices are uncomfortable or esthetically limiting for children.
Goal	Seeks to **modify growth** to achieve facial harmony and reduce severity of malocclusions, decreasing the need for extractions or surgery later.	May **not fully correct dental malalignment**; often requires subsequent comprehensive orthodontic treatment during adolescence.
Duration	Generally **short-term and growth-dependent**, focused on specific developmental stages, which can shorten overall treatment complexity.	Results depend on patient growth and compliance; **relapse is possible** and long-term monitoring is needed.

✅ Objectives and Functions

➤ Objectives
▪️ Maxillary Orthopedics:
° Stimulate or restrict jaw growth to achieve facial harmony.
° Correct skeletal Class II or III relationships.
° Improve airway function and posture.
▪️ Interceptive Orthodontics:
° Prevent worsening of dental malocclusions.
° Guide eruption and alignment of permanent teeth.
° Eliminate deleterious oral habits.

➤ Functions
Both disciplines serve as preventive strategies that optimize future orthodontic treatment, reduce complexity, and enhance facial aesthetics and function.

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📊 Appliances in Maxillary Orthopedics and Interceptive Orthodontics

Appliance	Primary Function	Indicated Specialty
Hyrax or Haas Expander	Expands the maxillary arch and corrects crossbites	Maxillary Orthopedics
Frankel Functional Appliance (FR)	Stimulates or restricts mandibular growth	Maxillary Orthopedics
Facial Mask (Reverse Pull Headgear)	Encourages forward growth of the maxilla in Class III	Maxillary Orthopedics
Space Maintainer	Preserves space after premature loss of primary teeth	Interceptive Orthodontics
Habit Breaker or Tongue Crib	Eliminates thumb-sucking or tongue thrust habits	Interceptive Orthodontics
Modified Hawley Plate	Corrects minor anterior crossbites or diastemas	Interceptive Orthodontics

💬 Discussion
Early interventions through both maxillary orthopedics and interceptive orthodontics have proven to be effective in reducing the severity of malocclusions and the need for extractions or complex orthodontic procedures in adolescence. The combination of orthopedic and interceptive methods ensures both skeletal balance and dental alignment, leading to better functional and aesthetic outcomes.

✍️ Conclusion
Although maxillary orthopedics and interceptive orthodontics share preventive goals, their clinical focus differs. The former primarily addresses bone growth modification, while the latter focuses on dental correction and habit management. Early assessment by a pediatric orthodontist is essential to determine which approach best suits each child’s needs.

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🔎 Recommendations

▪️ Conduct orthodontic evaluations by age 6–7.
▪️ Integrate orthopedic and interceptive strategies when skeletal discrepancies coexist with dental malpositions.
▪️ Promote parental education on early orthodontic prevention.

📚 References

✔ Graber, L. W., Vanarsdall, R. L., Vig, K. W. L., & Huang, G. J. (2022). Orthodontics: Current Principles and Techniques (7th ed.). Elsevier.
✔ Proffit, W. R., Fields, H. W., Larson, B., & Sarver, D. M. (2022). Contemporary Orthodontics (7th ed.). Elsevier.
✔ Baccetti, T., Franchi, L., & McNamara, J. A. (2011). Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. American Journal of Orthodontics and Dentofacial Orthopedics, 139(3), 343–351. https://doi.org/10.1016/j.ajodo.2009.04.028

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Modern Diagnostic and Therapeutic Approaches for Halitosis in Children and Adults

✅ Abstract
Halitosis, or oral malodor, remains a prevalent condition affecting both children and adults. Advances in diagnostic tools and modern therapeutic approaches now allow for more accurate identification and management of its multifactorial causes.

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✅ Introduction
Halitosis, commonly referred to as bad breath, is an unpleasant odor emanating from the oral cavity that can arise from intraoral or extraoral sources. It affects approximately 30–50% of the global population and has significant psychosocial implications (Murata et al., 2023). Recent studies have focused on refining diagnostic methods and developing less invasive, more effective treatments tailored to both pediatric and adult patients.

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✅ Modern Diagnostic Methods
Accurate diagnosis of halitosis requires a combination of sensory, chemical, and digital evaluations. Traditional methods such as organoleptic tests remain common, yet newer innovations—including gas chromatography, Halimeter®, and AI-based devices—are improving precision and accessibility.
Endoscopic and complementary tests have also gained clinical importance, especially in identifying extraoral origins such as Helicobacter pylori infection or gastroesophageal reflux disease (Lee et al., 2022).

📊 Comparative Table: Modern Diagnostic Methods for Halitosis

Aspect	Advantages	Limitations
Organoleptic Test	Simple, low-cost method providing direct sensory evaluation of odor intensity	Subjective results; depends on examiner’s perception and consistency
Gas Chromatography	Accurate identification and quantification of volatile sulfur compounds (VSCs)	High operational cost and requires specialized equipment and expertise
Halimeter® Device	Portable, quick results, ideal for clinical screening of sulfur compounds	Limited sensitivity; cannot detect non-sulfur gases contributing to halitosis
Microbiological Culture	Identifies specific anaerobic bacteria related to halitosis etiology	Time-consuming and requires laboratory infrastructure
Digital Sensory Evaluation (AI-based Apps)	Provides at-home monitoring using artificial intelligence and volatile gas sensors	Still under validation; results depend on sensor accuracy and calibration
Endoscopy and Complementary Tests	Detects gastrointestinal causes such as H. pylori infection or reflux-related halitosis	Invasive, costly, and requires referral to medical specialists

✅ Contemporary Therapeutic Strategies
The modern management of halitosis emphasizes both etiological control and microbiome balance. Conventional approaches include chlorhexidine or zinc-based mouthrinses, while current evidence supports additional therapies such as probiotics, laser-assisted biofilm control, and multidisciplinary management when systemic or gastrointestinal factors are present (Kozlovsky et al., 2023; Murata et al., 2023).

📊 Comparative Table: Benefits of Modern Halitosis Treatments

Aspect	Advantages	Limitations
Chlorhexidine Mouthrinses	Effective antimicrobial action reducing oral bacterial load and VSCs	Prolonged use may cause staining and taste alteration
Zinc-Based Formulations	Neutralize volatile sulfur compounds and enhance oral freshness	Requires continuous application to maintain results
Probiotic Therapy	Restores balance in oral microbiota and reduces pathogenic species	Long-term clinical efficacy still under evaluation
Laser and Photodynamic Therapy	Non-invasive bacterial reduction and biofilm elimination	Expensive and requires professional training and devices
Multidisciplinary Management (Probiotics or H. pylori Eradication)	Addresses extraoral causes of halitosis and promotes systemic-microbial balance	Requires collaboration with gastroenterologists and longer treatment periods

💬 Discussion
The integration of technology and biology has revolutionized halitosis management. AI-driven diagnostic tools and portable halimeters allow for personalized tracking, while endoscopic assessments identify systemic causes more effectively. Therapeutically, shifting toward microbiota-centered interventions like probiotics reflects a paradigm change from masking odor to restoring microbial harmony. Multidisciplinary approaches—particularly in patients with gastrointestinal involvement—ensure comprehensive and long-lasting control.

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✍️ Conclusion
Modern halitosis diagnosis and treatment now emphasize precision, accessibility, and patient-centered care. Combining digital diagnostics, microbiological insight, and multidisciplinary management provides the best outcomes in both pediatric and adult populations. Ongoing research in artificial intelligence and probiotic modulation continues to redefine the future of halitosis therapy.

🔎 Recommendations

1. Integrate AI-based halitosis monitoring in clinical and home settings for early detection.
2. Evaluate gastrointestinal conditions when halitosis persists despite oral care.
3. Promote probiotic use as a preventive and adjunctive measure.
4. Encourage collaboration between dentists, gastroenterologists, and pediatricians for systemic cases.
5. Implement photodynamic or laser therapies as safe alternatives for biofilm control in resistant cases.

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📚 References

✔ Kim, J., Lee, S., & Park, Y. (2023). Development of a portable halitosis monitoring device using artificial intelligence-based volatile gas sensors. Sensors, 23(9), 4221. https://doi.org/10.3390/s23094221
✔ Lee, J. H., Han, D. H., & Kim, Y. S. (2022). Correlation between Helicobacter pylori infection and extraoral halitosis: A cross-sectional clinical study. Journal of Breath Research, 16(2), 026001. https://doi.org/10.1088/1752-7163/ac4b90
✔ Kozlovsky, A., Houri-Haddad, Y., & Feuerstein, O. (2023). Probiotic approaches for oral malodor: Evidence-based perspectives and clinical applications. Clinical Oral Investigations, 27(3), 1167–1176. https://doi.org/10.1007/s00784-022-04685-5
✔ Murata, T., Miyazaki, H., & Sakamoto, M. (2023). Current concepts in the diagnosis and management of oral malodor: A multidisciplinary approach. International Journal of Dental Hygiene, 21(4), 565–573. https://doi.org/10.1111/idh.12693
✔ Seerangaiyan, K., Jørgensen, M. G., & Belstrøm, D. (2022). Advances in diagnostic technologies for oral malodor: From organoleptic to AI-based systems. Frontiers in Oral Health, 3, 872198. https://doi.org/10.3389/froh.2022.872198

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Dental Splinting (Ferulization) in Primary and Young Permanent Teeth: Indications and Materials

✅ Abstract
Dental splinting (ferulization) stabilizes mobile or traumatised teeth to promote healing of periodontal and pulpal tissues.

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✅ Introduction
Ferulization (tooth splinting) is the clinical procedure of joining mobile or displaced teeth to adjacent teeth to provide temporary stability during healing. The goals are to reduce pain, protect healing periodontal ligament (PDL), enable reattachment or root development, and facilitate endodontic or restorative therapy when needed. Recommendations for splint type and duration differ for primary teeth and young permanent teeth, and should follow contemporary trauma guidelines.

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✅ Indications: importance and clinical situations

➤ Primary teeth (deciduous dentition)
° Splinting is considered for selected luxation injuries or root fractures when repositioning is attempted and where stabilization will improve function or comfort. However, the decision is conservative because of risks to the developing successor tooth; therefore, non-invasive management is often preferred. Evidence supports flexible, short-term splinting in some primary tooth root fractures to improve outcomes.

➤ Young permanent teeth (immature permanent dentition)
° Splinting is important in extrusive, lateral luxation, root fractures, and avulsions to allow PDL healing and continued root development (apexogenesis). The IADT recommends passive, flexible splints (eg. 0.016" stainless steel or comparable flexible wire/fiber) for most traumatized permanent teeth, typically for 2 weeks (longer—4 weeks—if alveolar fracture or root fracture is present). Early stabilization preserves vascular and PDL healing and can improve pulpal survival in immature teeth.

➤ Why splinting matters
° Proper splinting reduces micromovement, lessens further tissue damage, and facilitates clot stabilization in replanted avulsed teeth and luxation injuries—thereby improving prognosis for both periodontal and pulpal healing.

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✅ Types of splints and choice rationale
Clinicians should prefer flexible and passive splints that allow physiologic tooth movement while providing stabilization. Rigid splints are generally avoided because they may cause ankylosis or inhibit PDL healing. Modern options include:

▪️ Wire-composite splints (stainless steel wire + composite) — traditional, widely available.
▪️ Fiber-reinforced composite (FRC) splints — superior aesthetics, less plaque retention, good strength.
▪️ Direct composite splints (wire-free) — quick application but technique-sensitive; some materials demonstrated good short-term retention in training studies.
▪️ Glass ionomer-based connectors — easier removal in some settings, but lower flexural strength.
▪️ Emerging options: 3D-printed or CAD/CAM fabricated removable splints for specific cases, an expanding field with promising early data.

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✅ Clinical protocol (practical points)

▪️ Reposition tooth carefully, then place a passive, flexible splint. Follow IADT timing recommendations (commonly 2 weeks; 4 weeks for root/alveolar fractures). Document occlusion and ensure splint does not cause premature contacts.
▪️ Combine splinting with appropriate endodontic management when indicated (eg. immature teeth with necrotic pulp require apexification/regenerative approaches).
▪️ Provide oral hygiene instructions, soft diet, and follow-up radiographs to monitor healing and detect complications (resorption, ankylosis).

💬 Discussion
Current evidence and guidelines emphasize flexibility, passivity, and short duration of splints to maximize periodontal healing and minimize adverse sequelae such as ankylosis or root resorption. Comparative studies show that fiber-reinforced composite splints may offer improved aesthetics and comparable mechanical performance to wire-composite splints, while new technologies (CAD/CAM, 3D printing) can produce customized appliances for special cases. However, heterogeneity in study designs and limited high-quality randomized trials mean clinical judgment and guideline adherence remain essential.

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✍️ Conclusion
Ferulization is a key tool in the management of dental trauma and mobility in both primary and young permanent teeth when appropriately indicated. Choosing a passive, flexible splint and limiting duration according to injury type optimizes healing while minimizing complications. Ongoing advances in materials (FRC, CAD/CAM splints) broaden clinicians’ options but should be adopted guided by evidence and practicality.

🔎 Recommendations

1. Prefer passive, flexible splints (eg. 0.016" stainless wire or FRC) and avoid rigid fixation.
2. Duration: generally 2 weeks for most luxations and avulsions; extend to 4 weeks for root or alveolar fractures as per IADT.
3. Primary teeth: be conservative—splint selectively and weigh risks to successors.
4. Combine splinting with appropriate endodontic, restorative, and follow-up care; monitor radiographically for resorption and ankylosis.
5. When available and indicated, consider fiber-reinforced or CAD/CAM solutions for improved patient comfort and aesthetics, while recognizing cost and accessibility limitations.

📊 Symptoms: Mild - Severe: Splinting Materials — Pros and Cons

Aspect	Advantages	Limitations
Wire-composite (stainless steel wire + composite)	Widely available; reliable stabilization; cost-effective; good clinical familiarity	Aesthetic concerns; plaque retention if excess resin; technique sensitivity for passive placement
Fiber-reinforced composite (FRC)	Better aesthetics; low profile; good flexural strength; reduced metal visibility	Higher material cost; requires precise technique; may need special fiber handling
Direct composite splint (wire-free)	Fast application; no metal components; comfortable for patients	May have lower long-term retention; increases polymerization shrinkage risk if bulky
Glass ionomer connectors	Easy to remove; fluoride release may benefit caries-prone patients	Lower mechanical strength; higher wear; less suitable for high-load stabilization
CAD/CAM or 3D-printed removable splints	Custom-designed fit; predictable passive support; minimal chair time for placement	Requires lab workflow or in-clinic 3D printing; higher cost; limited data in pediatric trauma

📚 References

✔ Bourguignon, C., et al. (2020). International Association of Dental Traumatology (IADT) guidelines for the management of traumatic dental injuries. Dental Traumatology. (IADT guidelines).
✔ Deery, C., et al. (2023). Should we splint traumatised primary teeth? British Dental Journal Open / Systematic Review. Retrieved from PubMed Central.
✔ Goswami, M., et al. (2020). Management of traumatic dental injuries using different splinting methods. Journal of Clinical and Experimental Dentistry.
✔ Sobczak-Zagalska, H., et al. (2020). Best splinting methods in case of dental injury. Journal of the American Academy of Pediatric Dentistry / JOCPD (article discussing splint types and techniques).
✔ Šimunović, L., et al. (2025). Three-dimensionally printed splints in dentistry: review and applications. Journal of Clinical Dentistry / MDPI Reviews.
✔ Moon, W., et al. (2022). Mechanical evaluation of dental trauma splints fabricated with various materials. Dental Materials Journal.

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Vital Pulp Therapy in Primary Teeth: Evidence-Based Approaches

Vital pulp therapy (VPT) in primary teeth aims to preserve the vitality and function of the dental pulp after carious or traumatic exposure. Its ultimate goal is to maintain primary teeth until their natural exfoliation, ensuring arch integrity, mastication, and normal development of permanent successors.

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✅ Definition of Vital Pulp Therapy Techniques

1. Indirect Pulp Treatment (IPT)
Indirect pulp treatment involves leaving a thin layer of affected but not infected dentin to avoid pulp exposure. A biocompatible liner is placed to encourage dentin remineralization and pulp healing.
➤ Current materials: calcium hydroxide, resin-modified glass ionomer, mineral trioxide aggregate (MTA), and calcium silicate-based cements.

2. Direct Pulp Capping (DPC)
Direct pulp capping is performed when a small mechanical or traumatic pulp exposure occurs. A bioactive material is applied directly over the pulp to stimulate reparative dentin formation.
➤ Current materials: MTA, calcium hydroxide, and newer bioceramics (Biodentine®).

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3. Pulpotomy
Pulpotomy is the most widely used VPT technique in primary teeth. It involves removal of the coronal pulp tissue, preserving radicular pulp vitality.
➤ Current medicaments: formocresol (historically used but controversial), ferric sulfate, MTA, Biodentine®, and sodium hypochlorite as hemostatic agents.

4. Pulpectomy (Non-Vital Alternative)
Although technically not a vital pulp therapy, pulpectomy is often considered in the treatment plan when pulp vitality cannot be preserved. It involves complete removal of pulp tissue and obturation of root canals with resorbable materials.
➤ Current medicaments: iodoform-based pastes (Vitapex®), calcium hydroxide-iodoform combinations.

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💬 Discussion
Current evidence strongly favors biocompatible and bioactive materials such as MTA and calcium silicate-based cements over traditional agents like formocresol, due to their improved outcomes in terms of pulp healing, dentin bridge formation, and biocompatibility (Farsi et al., 2023). The choice of technique depends on pulp status, extent of caries, and presence of symptoms. While IPT and DPC are conservative, pulpotomy remains the gold standard for cariously exposed but vital pulp.
Long-term clinical trials indicate that MTA and Biodentine® outperform traditional materials in terms of success rates and reduced adverse effects (Gomes et al., 2022). Nonetheless, cost and handling characteristics remain barriers in some clinical settings.

✍️ Conclusion
Vital pulp therapy in primary teeth is essential to maintain function and arch stability until natural exfoliation. Evidence-based protocols support the use of bioactive cements such as MTA and Biodentine®, which demonstrate superior clinical and histological outcomes compared to traditional agents. The clinician’s decision should integrate pulp vitality assessment, child cooperation, and material availability.

📊 Vital Pulp Therapy Techniques in Primary Teeth

Technique	Advantages	Limitations
Indirect Pulp Treatment (IPT)	Preserves pulp vitality; high success rate; conservative	Risk of residual caries; requires good sealing
Direct Pulp Capping (DPC)	Promotes reparative dentin formation; maintains pulp vitality	Lower success in carious exposures; best for mechanical exposures
Pulpotomy	Effective in symptomatic exposures; long-standing clinical success	Technique sensitive; controversy over medicaments
Pulpectomy	Option for non-vital teeth; preserves tooth until exfoliation	Not a true VPT; complex procedure; risk of failure in resorption

📚 References

✔ Farsi, N., Bawazir, O., & Al-Shahrani, A. (2023). Clinical and radiographic success of pulpotomy in primary teeth using mineral trioxide aggregate and Biodentine: A systematic review and meta-analysis. International Journal of Paediatric Dentistry, 33(1), 35–45. https://doi.org/10.1111/ipd.13013
✔ Gomes, A. C., Lima, T. F., Soares, D. G., & Hebling, J. (2022). Vital pulp therapy in primary teeth with calcium silicate-based materials: A systematic review. Journal of Dentistry, 120, 104102. https://doi.org/10.1016/j.jdent.2022.104102
✔ American Academy of Pediatric Dentistry (AAPD). (2022). Guideline on pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry, 403–412. https://www.aapd.org/research/oral-health-policies--recommendations

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Pediatric Dental Crowns: Indications, Benefits, and Long-Term Success

Pediatric dental crowns are widely used in the restoration of primary teeth with extensive decay, developmental defects, or after pulp therapy.

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This article reviews current evidence regarding their indications, benefits, and long-term success, focusing on stainless steel crowns (SSCs), zirconia crowns, and recent advances.

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✅ Introduction
Restoring severely decayed primary teeth poses a significant challenge in pediatric dentistry. Conventional fillings often fail due to limited durability and the complexity of managing caries in children. Pediatric dental crowns, particularly stainless steel and zirconia crowns, provide a reliable restorative option. Their role in maintaining arch integrity, mastication, and aesthetics has made them a cornerstone in modern pediatric restorative dentistry.

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✅ Indications

° Extensive caries affecting multiple tooth surfaces.
° After pulpotomy or pulpectomy procedures.
° Developmental anomalies such as amelogenesis imperfecta or dentinogenesis imperfecta.
° Fractured teeth requiring coverage.
° Cases where behavior management limits frequent re-interventions.

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✅ Types of Pediatric Crowns

° Stainless Steel Crowns (SSC): Gold standard for posterior teeth due to durability and cost-effectiveness.
° Zirconia Crowns: Increasingly used for anterior and posterior restorations, offering superior aesthetics.
° Resin-veneered Crowns: Intermediate option balancing aesthetics and functionality.

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✅ Benefits

° Provide full coverage protection against recurrent caries.
° High survival rates in comparison to amalgam or composite restorations.
° Improve chewing function and preserve arch length.
° Aesthetic options (zirconia) enhance parental and patient satisfaction.

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✅ Long-Term Success

° Survival rates: SSCs demonstrate over 90% success rates at 5 years (Innes et al., 2015).
° Zirconia crowns: Show comparable survival with better aesthetics but require precise tooth preparation.
° Parental satisfaction: Significantly higher for zirconia crowns due to aesthetics (Walia et al., 2014).

📊 Tabla comparativa: Pediatric Dental Crowns

Aspecto	Ventajas	Limitaciones
Stainless Steel Crowns (SSC)	High durability, cost-effective, >90% survival	Poor aesthetics, metallic appearance
Zirconia Crowns	Superior aesthetics, high parental satisfaction, biocompatible	Require extensive tooth preparation, higher cost
Resin-Veneered Crowns	Balance between cost and aesthetics	Prone to veneer fracture and wear
Long-Term Outcomes	High survival rates, preservation of arch integrity	Technique-sensitive, dependent on case selection

💬 Discussion
The literature strongly supports the use of pediatric crowns as a superior restorative option for severely compromised primary teeth. While stainless steel crowns remain the most cost-effective and durable, zirconia crowns address increasing parental demands for aesthetics. However, zirconia requires more aggressive tooth reduction, which may limit its indications in certain cases.
The long-term success of pediatric crowns is linked to proper case selection, clinical technique, and patient cooperation. Advances in adhesive dentistry and biomimetic materials may further enhance restorative outcomes, but crowns continue to hold a key role in comprehensive pediatric oral care.

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✍️ Conclusion
Pediatric dental crowns are the treatment of choice for extensively damaged primary teeth, providing excellent durability, functional preservation, and, with modern options, improved aesthetics. Both stainless steel and zirconia crowns demonstrate high long-term survival rates. Future research should focus on minimally invasive approaches that combine aesthetics with biological preservation.

📝 Reference

✔ Innes, N. P., Ricketts, D., & Evans, D. J. (2015). Preformed metal crowns for decayed primary molar teeth. Cochrane Database of Systematic Reviews, 2015(12), CD005512. https://doi.org/10.1002/14651858.CD005512.pub3
✔ Walia, T., Salami, A. A., Bashiri, R., Hamoodi, O. M., & Rashid, F. (2014). A randomized controlled trial of three aesthetic full-coronal restorations in primary maxillary teeth. European Journal of Paediatric Dentistry, 15(2), 113–118.
✔ Choi, S. C., Park, J. H., Kim, J. H., & Shin, Y. (2018). Clinical outcomes of preformed zirconia crowns in primary molars: A 24-month prospective study. Journal of Dentistry for Children, 85(3), 107–112.

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