The scope of Acta Odontologica Scandinavica is to convey new knowledge within all areas of oral health and oral disease sciences, except dental biomaterials. Acta Odontologica Scandinavica has been published since 1939 and is owned by Acta Odontologica Scandinavica Society, which was established by the Dental Associations and Dental Schools in Denmark, Finland, Iceland, Norway and Sweden. The society includes members from the Nordic countries, and the editorial team includes scientists from these countries.
Increased risk of periodontal disease and poor oral-related quality of life in fibromyalgia
Objective: (1) To survey oral health in fibromyalgia (FM) and compare with population controls and (2) to assess whether patterns of contact allergy are related to oral status in FM. Materials and methods: Participants: 60 females with FM who had previously received contact allergy testing. Controls: 120 age- and gender-matched individuals. Questionnaire on aspects of oral health and symptoms and Oral Health Impact Profile-14. Clinical and radiological examination regarding oral health status. Results: The degree of periodontal disease differed significantly between the FM and control groups (p = 0.017), with the difference most marked in younger patients. No difference was seen regarding dental caries and filled surfaces. FM patients had a higher prevalence of oral lesions than control patients (30.0% vs. 10.1%, p < 0.001). Younger FM patients had a poorer oral health-related quality of life than older patients. There was no relationship between oral symptoms or oral lesions and contact allergy. Conclusions: Patients with FM have a poorer oral status than controls, particularly concerning periodontitis and oral lesions. Further work is required to assess whether contact allergy may play a role in poorer oral status and systemic inflammation in FM.
Copyright (c) 2026 Katharine Hopkins, Camilla Ahlgren, Åsa Wahlin, Annarita Antelmi, Magnus Bruze, Cecilia Svedman https://creativecommons.org/licenses/by/4.0
Impact of the 2018 periodontal classification on diagnosis, treatment strategies, and assessment of prognosis by dental hygienists in Swedish general dental care
treatment strategies, and prognostic assessments made by dental hygienists in general dentistry, compared with the 1999 classification. Materials and Methods: A questionnaire comprising five patient cases was administered to dental hygienists in Sweden on two separate occasions. For each case, diagnoses, treatment plans, and prognostic assessments were proposed, first using the 1999 and subsequently the 2018 classification. Cases ranged from no marginal bone loss attributed to periodontitis and few (<10%) bleeding sites to marginal bone loss >30% and generalized inflammation (>30%). Answers from the two occasions were compared. Results: A total of 142 dental hygienists completed both questionnaires. Diagnostic assessments changed significantly in three of the five cases when using the 2018 classification (p < 0.05). In four cases, fewer treatment sessions were recommended, and more optimistic prognostic assessments were made when using the 2018 classification (p < 0.05). Conclusion: The 2018 classification resulted in greater variation in proposed diagnoses in cases without clear attachment loss and was associated with fewer recommended treatment sessions and more optimistic prognostic assessments. However, it appeared at least as effective as the 1999 classification in identifying cases with periodontitis.
Copyright (c) 2026 Emelie Stenberg, Nina Lundegren, Bengt Götrick, Aleksandar Milosavljevic https://creativecommons.org/licenses/by/4.0
Periodontitis and all-cause mortality in 60- and 66-year-old individuals: a 23-year prospective cohort study
Objective: The present study aimed to investigate the association between baseline moderate-to-severe periodontitis and all-cause mortality over a 23-year follow-up among individuals aged 60 and 66 years. Materials and methods: This longitudinal study was based on data from the Swedish National Study on Aging and Care in Karlskrona, Blekinge, Sweden. A total of 340 participants aged 60 and 66 years old at baseline (2001–2003) who underwent periodontal and radiographic examination were included. Baseline data on age, sex, number of medications, smoking status, cash margin, and education were collected. Results: At baseline, 16.2% of participants had moderate-to-severe periodontitis. During the 23-year follow-up, 52.7% of participants with moderate-to-severe periodontitis died. In the adjusted survival analysis, moderate-to-severe periodontitis was associated with an increased risk of all-cause mortality (hazard ratio = 1.56; 95% confidence interval [CI] = 1.00–2.44, p = 0.050). Conclusions: Over 23-year follow-up, baseline moderate-to-severe periodontitis was associated with a higher risk of all-cause mortality among individuals aged 60 and 66 years. However, although the association was statistically significant, any sex-specific findings should be considered exploratory due to the limited number of events and the resulting wide CIs.
Copyright (c) 2026 Sladjana Critén, Pia Andersson, Stefan Renvert, Johan Sanmartin Berglund, Bengt Götrick, Viveca Wallin Bengtsson https://creativecommons.org/licenses/by/4.0
Predicting gingival embrasure risk after invisible orthodontics using multimodal data and machine learning
Objective: To develop and validate a risk prediction model for gingival embrasures after clear aligner therapy using multimodal oral data. Methods: A retrospective study of 340 patients (December 2022–June 2025) was randomly divided into training (n = 238) and validation (n = 102) sets (7:3). Univariate analysis, multivariate logistic regression, and least absolute shrinkage and selection operator regression were applied to identify independent risk factors. Three machine learning models – random forest (RF), logistic regression, and support vector machine – were constructed based on seven core variables. Model performance was assessed using area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis, and Shapley Additive Explanations (SHAP) values for interpretability. Results: No significant baseline differences existed between sets (p > 0.05). Seven indicators were identified (p < 0.05). Multivariate analysis confirmed percentage of bleeding on probing-positive sites, interproximal alveolar bone height, and relative movement of adjacent teeth at target site as independent risk factors, while gingival thickness, proximal contact area, interdental papilla height, and buccal/lingual bone plate thickness were protective factors (p < 0.05). The RF model performed best: training AUC = 0.849 (95% CI: 0.786–0.912), validation AUC = 0.815 (95% CI: 0.720–0.910), with good calibration and net benefit. SHAP analysis highlighted gingival thickness and interproximal alveolar bone height as key predictors. Conclusion: A risk prediction model for post-clear aligner gingival embrasures was successfully developed and validated using multimodal oral data, with RF as the optimal algorithm. The model exhibits good discrimination, calibration, and clinical utility, which can be used as an objective auxiliary tool for individualized risk prediction following clear aligner therapy and supplement traditional clinical empirical judgment.
Copyright (c) 2026 Haiyan Wang, Hanfei Shi, Liping Fan, Zhang Sun, Xuelian Xiu, Hui Yuan https://creativecommons.org/licenses/by/4.0
Comparison of the ultrasonic, Masserann, and BTR-pen techniques for removing fractured instruments with dental microscope: a CBCT-based in vitro study
Objective: This in vitro study compared the efficacy, dentin loss, and outcomes of ultrasonic, Masserann, and Broken Tool Remover Pen (BTR-Pen) techniques for removing fractured endodontic instruments using cone-beam computed tomography (CBCT) analysis. Materials and methods: Ninety extracted single-rooted teeth were randomly allocated into three groups (n = 30). ProTaper F2 instruments were intentionally fractured in the middle third of each canal, creating 3–4 mm fragments. Removal was performed using ultrasonic tips, Masserann trephine burs, or the BTR-Pen loop system. CBCT scans quantified dentin loss. Success rates, removal times, and complications were analyzed using one-way analysis of variance, Tukey honestly significant difference, chi-square, and likelihood-ratio chi-square tests (p < 0.05). Results: Ultrasonic removal showed the highest success rate (90.0%), followed by BTR-Pen (86.7%) and Masserann (70.0%). Pairwise likelihood-ratio chi-square analysis showed lower success for Masserann than ultrasonic removal (p = 0.049). Masserann caused significantly greater canal volume increase (4.50 ± 0.50 mm³) than ultrasonic (0.75 ± 0.30 mm³) and BTR-Pen (0.93 ± 0.40 mm³) techniques (p < 0.001). Ultrasonic removal required the shortest time (110.0 ± 35.0 s), followed by BTR-Pen (213.4 ± 40.0 s) and Masserann (240.0 ± 50.0 s). Conclusions: Ultrasonic and BTR-Pen techniques achieved high success with better dentin preservation than Masserann. When retrieval is indicated, techniques that maximize dentin preservation should be preferred to reduce the risk of root weakening and procedural complications.
Copyright (c) 2026 Esra Balkanlıoğlu, Aliye Kamalak, Berkcan Güner https://creativecommons.org/licenses/by/4.0
Frequency of salivary flow rate measurements in Sweden 2008–2024
Objective: Saliva flow rate measurement (SFRM) is a prerequisite for accurate diagnosis of hyposalivation, but national data about the frequency of SFRM conducted in the Swedish population are lacking. The objective was to describe performed SFRMs in the population via registration in the Swedish dental financial system and compare with the earlier reported prevalence of hyposalivation. Material and Methods: A descriptive retrospective registry-based study was completed. Dental care registry data from 2008 to 2024 were investigated to determine the proportion of individuals > 25 years of age who had undergone SFRM. Results: During 2008–2024, 70,390 SFRMs were conducted in Sweden. SFRMs began to increase in 2013. SFRMs were performed more than twice as often for females than males. Measurements increased by age up to a peak at 65–69 years of age (1.7%) and decreased thereafter. The frequency of SFRM amounted to approximately 0.9% of the total Swedish population. Conclusions: The number of SFRMs performed in the Swedish population is low overall, with increased numbers in women and in older ages. The findings support that an increased use of SFRM to improve diagnosis of hyposalivation could be beneficial to understand more about the prevalence of hyposalivation and support for preventive caries treatment.
Copyright (c) 2026 Håkan Flink, Anders Hedenbjörk-Lager, Eva Nohlert, Åke Tegelberg https://creativecommons.org/licenses/by/4.0
Association of periodontal condition with insulin sensitivity – results of the Oulu1935 cohort study
Objective: To investigate whether baseline periodontal condition predicts reduced insulin sensitivity (RIS) over a follow-up period of about 15 years among participants with baseline euglycemia. Material and methods: A subpopulation (n = 224) of the Oulu1935 cohort was studied. Periodontal condition was defined by the presence and number of sites with periodontal pockets (probing pocket depth ≥ 4 mm) or by the participant being edentulous. Insulin sensitivity was measured using the Quantitative Insulin Sensitivity Check Index, with the lowest tertile indicating RIS. Rate ratios (RRs) with 95% confidence intervals (CI) were estimated using Poisson regression models with a robust error variance. Results: RIS was observed in 21.3% of the dentate participants without periodontal pockets, 32.8% of those with 1–6 sites with pockets, 33.3% of those with ≥ 7 sites with pockets, and 40.8% of the edentulous participants. Furthermore, adjusted RRs with 95% CIs (in parentheses) for the association of periodontal condition with RIS (reference: dentate participants without periodontal pockets) were 1.4 (0.8–2.6), 1.1 (0.6–2.1), and 1.4 (0.8–2.7), respectively. Conclusions: Poor periodontal condition and edentulousness predicted RIS. A healthy periodontium appears to support normal insulin function, but further studies are needed.
Copyright (c) 2026 Ville Myllymäki, Pekka Ylöstalo, Anna Liisa Suominen, Matti Knuuttila, Ulla Rajala, Sirkka Keinänen-Kiukaanniemi, Sirpa Anttila, Tuomas Saxlin https://creativecommons.org/licenses/by/4.0
The effects of headgear treatment timing on costs and orthodontic outcome: a follow-up study
Objective: To analyze the effects of cervical headgear (CHG) timing on costs and orthodontic outcome. Material and methods: Sixty-seven participants with Class II malocclusion were randomized into two groups. In the early group (EG, n = 33), CHG treatment began after the eruption of first upper molars. In the later-timed group (LG, n = 34), CHG treatment began nearly 2 years later. Orthodontic outcome was evaluated when CHG ended and at the end of follow-up using the Peer Assessment Rating (PAR) index and Little’s Irregularity Index (LII). Costs were calculated using medical records, estimated chairside times and average personnel and material costs. Results: The mean total costs including personnel and material costs during the follow-up were higher in the EG (€416) compared with the LG (€364) (p = 0.043). No statistically significant differences between the groups were found in the PAR and in the LII scores at the end of follow-up. The number of visits during CHG treatment was higher in the EG (13.3) compared with the LG (10.4) (p = 0.01). Conclusions: Earlier initiation of CHG treatment increased the personnel and material costs, number of appointments, and chairside time. Based on the PAR and in the LII scores, the orthodontic outcome of CHG treatment was equal regardless of the timing of the treatment. If orthodontic treatment during mixed-dentition stage is considered, it would be justified from an economic perspective to favor treatment during late mixed-dentition.
Copyright (c) 2026 Matti Hannula, Mimmi Tolvanen, Pertti Pirttiniemi, Kirsi Pirilä-Parkkinen, Anna-Sofia Silvola, Johanna Julku https://creativecommons.org/licenses/by/4.0
Tissue response in hemisectioned primary mandibular second molars
Objective: Congenital absence of mandibular second premolars occur in 2.91–3.22% of individuals, with nearly half of cases being bilateral. Interceptive hemisection of primary second molars promotes mesial drift but exposes the pulp for an extended period. This study investigates histopathological responses of pulp and associated mineralized tissues. Material and methods: Children aged 7–12 in Skaraborg region, Sweden, were screened for over-retained primary mandibular second molars as part of a single-center, blinded, prospective split-mouth randomized controlled clinical trial comparing hemisection with extraction. Mesial roots of 21 hemisected teeth were collected for histopathological analysis of inflammatory infiltrate, pulpal necrosis, fibrosis, and hard tissue formation. Results: Mean interval between distal and mesial root extraction was 11.54 ± 4.3 months. Histopathological analysis revealed no pulpal inflammation in 14% of specimens, acute/subacute inflammation in 38%, chronic inflammation in 48%, and necrosis in 24%. Reparative tertiary dentin with capping occurred in 48% and without capping in 33%. Necrotic mineralized tissue appeared in one specimen. Three patients reported symptoms during follow-up. Conclusion: Prolonged pulp exposure following hemisection induced tertiary dentinogenesis, maintaining pulp vitality for up to 17 months. Despite histological evidence of inflammation or necrosis, most cases remained asymptomatic, indicating remarkable regenerative capacity of primary pulp–dentin complex.
Copyright (c) 2026 Jenny Öhman, Vini Rughwani, Julia Naoumova https://creativecommons.org/licenses/by/4.0
Complications of dermal filler treatments – a registry-based study from Finland
The popularity of dermal filler treatments is increasing in the Nordic countries. In Finland, legislation does not mandate healthcare training for those performing dermal filler treatments, potentially leading to increased complications. This registry-based study aimed to characterize complaints on dermal filler treatments received by Finnish Authorities, using data from (1) Finnish Safety and Chemicals Agency (TUKES), (2) the National Supervisory Authority for Welfare and Health (Valvira), (3) the Finnish Competition and Consumer Authority (KKV), and (4) Regional State Administrative Agency (AVI). From January 1, 2017, to December 31, 2024, 19 complaints were received by KKV, unsuccessful lip filler treatments being the most common issue (59%). No life-threatening complications were reported. Most cases (56%) occurred in beauty salons, with treatments primarily performed by beauty salon employees (44%), followed by registered nurses (24%), and only 8% by medical doctors. Notably, 72% of the complications occurred in the last 3 years. The study underscores the need for regulatory oversight and advanced medical expertise in administering dermal filler treatments due to the increasing complications and the involvement of non-medical personnel. Complications may require immediate medical first aid and should be classified as procedures requiring advanced medical expertise.
Copyright (c) 2026 Vilma Koivisto, Jaana Rautava, Hanna K. Laine https://creativecommons.org/licenses/by/4.0
Erosive tooth wear – knowledge and treatment preferences among dental hygienists
Objective: Erosive tooth wear (ETW) is generally recognized as a widespread condition and a rising concern within the oral healthcare system. This study aimed to investigate dental hygienists` experiences and treatment methods regarding ETW in young adults. Material and methods: A questionnaire was sent to 1,084 Norwegian dental hygienists working in both public and private dental services. In total, 313 responded (response rate 28.9%). After excluding 47 respondents who did not meet the inclusion criteria of working with young adults (15–30 years), 266 dental hygienists were included in the final analyses (24.5% of those invited). Results: In total, 96% of the study population of 266 dental hygienists reported recording ETW in the register, with the public dental service doing so more frequently than the private sector. Sports drinks, energy drinks and soft drinks were believed to be the primary risk indicators of ETW, analogously across groups. Furthermore, there was consensus that the most frequently performed preventive measures were dietary guidance and self-administration of fluoride rinse and/or tablets. Conclusions: Overall, this study suggests that, in our sample, dental hygienists possess substantial knowledge of ETW and hold strong views on potential improvements in their work as healthcare professionals.
Copyright (c) 2026 Julie Marie Haabeth Brox, Amela Tulek, Qalbi Khan, Amer Sehic, Linda Stein, Anne Breivik, Tor Paaske Utheim, Aida Mulic https://creativecommons.org/licenses/by/4.0
Incidence of sinus membrane perforation in transcrestal graftless maxillary sinus augmentation: a meta-analysis
Objectives: This meta-analysis aimed to evaluate Schneiderian membrane perforation incidence and complications in graftless transcrestal sinus floor elevation. Materials and methods: Several databases (PubMed, Embase, Cochrane Library, Web of Science and Scopus) were searched for studies reporting perforation rates, early implant failure (≤12 months) and postoperative complications. Two reviewers independently selected studies, extracted data and assessed bias. Random-effects meta-analysis was performed. Evidence certainty was graded using the GRADE system. Results: Among 14 studies comprising 2119 sinus-lift sites, the pooled incidence of Schneiderian membrane perforation was 1% (95% CI: 0% (95% CI: 0% the pooled incidence of Schneiderian membrane perforation was 1% (95% CI: 0% months) and postoperative failure (≤12 months) was also 1% (95% CI: 0–6%) based on 711 evaluated implants, showing no heterogeneity (I² = 0%). No postoperative complications (acute sinusitis or epistaxis) were reported in the included literature. Subgroup analysis revealed that motor-driven techniques were associated with a significantly higher perforation rate (34%) compared to conventional osteotome methods (0%). The certainty of evidence was rated as very low for all outcomes, including membrane perforation and secondary indicators. Conclusions: Graftless transcrestal sinus elevation is associated with low Schneiderian membrane perforation rates, favourable implant survival and minimal postoperative complications. Despite methodological heterogeneity, current evidence supports the clinical safety of graftless techniques. Clinical relevance: Clinicians can confidently utilise graftless sinus floor elevation approaches with appropriate patient selection and careful surgical techniques to minimise complications.
Copyright (c) 2026 Zhi-Cheng Huang, Xiao-Ling Wang, Qi-Qi Jin, Meng-Li Chen, Ya-Qin Zhao https://creativecommons.org/licenses/by/4.0
Evaluation of the accuracy, consistency, and scientific reliability of AI-powered Chatbots in endodontic practice
Objective: This study aimed to evaluate the accuracy, consistency, and scientific reliability of two AI-powered chatbots—ChatGPT-3.5 and ChatGPT-4o—in clinical endodontic decision-making, using the recently published European Society of Endodontology (ESE) S3-level Clinical Practice Guideline as the gold standard reference. Material and Methods: Twenty-five dichotomous (yes/no) questions were developed based on the ESE guideline and presented to both chatbots across three time intervals, yielding 300 total responses. Each response was evaluated for accuracy and consistency, and the quality of the supporting references was assessed according to their journal ranking (Q1, Q2, others). Results: Both ChatGPT versions demonstrated high internal consistency across repeated measurements. ChatGPT-3.5 showed 94.4% agreement (κ = 0.824; 95% confidence interval [CI]: 0.786–0.898; p < 0.001), whereas ChatGPT-4o demonstrated 98.9% agreement (κ = 0.937; 95% CI: 0.893–0.965; p < 0.001). The accuracy of ChatGPT-3.5 relative to the guideline-based answers was 81.4%, 88.9%, and 82.2% in the morning, afternoon, and evening sessions, respectively, while ChatGPT-4o achieved 82.9%, 83.3%, and 85.4%, respectively. No statistically significant differences were observed between the models across the three time intervals (p > 0.05). The proportion of Q1/Q2-ranked references was high and comparable between ChatGPT-3.5 (74–82%) and ChatGPT-4o (76–84%). Conclusion: Both ChatGPT-3.5 and ChatGPT-4o demonstrated substantial alignment with the ESE S3-level clinical practice guideline. However, these findings should not be interpreted as definitive assessments of current clinical conversational AI systems, and further evaluation of evolving models is required.
Copyright (c) 2026 Saba Kilimci, Elif Delve Başer Can, Jale Tanalp https://creativecommons.org/licenses/by/4.0
Impact of miR-146a-3p rs2910164 polymorphism on peri-implantitis susceptibility and target gene-mediated inflammatory responses
Objectives: This study investigated the association between miR-146a-3p rs2910164 polymorphism and peri-implantitis (PI) susceptibility in the Han Chinese population, as well as the potential mechanisms underlying PI progression. Material and Methods: 183 PI patients and 219 individuals with healthy implants were enrolled. Quantitative polymerase chain reaction was used to detect miR-146a-3p expression levels and analyze the impact of rs2910164 genotypes on these levels. The study compared the association between rs2910164 polymorphism and PI susceptibility, evaluated participants’ periodontal health status, and predicted miR-146a-3p target genes via bioinformatics methods, followed by Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Protein-Protein Interaction (PPI) enrichment analyses. The regulatory relationship between miR-146a-3p and ITBG7 was validated by dual luciferase assays. Results: miR-146a-3p expression was elevated in PI patients, with significantly higher levels in those carrying the CG/GG genotypes of rs2910164. Additionally, the GG genotype and G allele of rs2910164 were more prevalent in PI patients, who also exhibited poorer periodontal status. The GG genotype and G allele were identified as risk factors for PI. miR-146a-3p may contribute to PI progression by regulating inflammation-related signaling pathways. The existence of miR-146a-3p and ITBG7 had a negative regulatory relationship. Conclusion: The miR-146a-3p rs2910164 polymorphism holds promise as a potential biomarker for predicting PI occurrence. miR-146a-3p might modulate inflammation-related signaling pathways via ITBG7 and may play a role in the regulation of PI progression.
Copyright (c) 2026 Yajun Zhang, Shaofan Wang, Zeneng Xie, Yinhua Jiang, Tianyi Li https://creativecommons.org/licenses/by/4.0
Gestational diabetes alters subgingival pathobiont composition
Objective: This cross-sectional study assesses the relationship between gestational diabetes mellitus (GDM) and periodontal dysbiosis by evaluating specific periodontal pathobionts (Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola), clinical periodontal parameters, and periodontal inflamed surface area (PISA). Materials and methods: 101 GDM and 98 non-GDM women of 16–36 weeks gestation were included. Clinical periodontal parameters were measured, and PISA values calculated. Subgingival plaque samples, collected from the deepest pockets, were analyzed, to assess the amount of periodontopathogens. Associations were assessed using binary logistic regression and path analysis. Results: The GDM group showed higher clinical parameters and PISA values (p < 0.001). While P. gingivalis levels were similar in both groups (p = 0.924) and unrelated to the presence of GDM in path analysis (p = 0.055), P. intermedia and T. denticola levels were found higher in the non-GDM group (p < 0.05, p < 0.001) and negatively associated with the presence of GDM (p < 0.001, p = 0.002). P. intermedia increased with gestation week (p = 0.044). Elevated T. forsythia levels were observed to increase GDM risk 1.208-fold in regression analysis (p = 0.002). Conclusion: Increasing sex hormone levels accompanied by the presence of GDM may alter subgingival pathobiont composition. In patients with GDM, there is a heightened burden of T. forsythia in subgingival zones, where P. intermedia finds less favorable conditions.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
Use of a handheld communication tool for children and youths during dental procedures: a two-site controlled intervention study
Background: Effective communication between dental professionals and patients is essential for quality care. We aimed to evaluate whether Grasp, a novel handheld squeezable device providing real-time visual and auditory feedback to signal discomfort, improved communication between patients and their dentists during dental procedures. Materials and methods: Patients aged 6–25 years were recruited from two dental clinics in Norway. Participants were divided into two groups: One received standard care, the other used Grasp in addition to standard care. All patients – and additionally caregivers of those under 16 – completed pre- and post-treatment questionnaires, rating communication on a 1–10 scale. Multiple linear regression analyses were conducted to evaluate the intervention’s effect, adjusting for baseline scores. Results: A total of 121 patients (58% females; median age 16 years) participated, with 60 using Grasp. Patients using Grasp reported greater confidence that the dentist understood their feelings, recognized when they wanted to stop, and found it easier to speak up during treatment (β = 2.10–2.54, p < 0.05). The effect of Grasp was more pronounced for participants reporting lower baseline confidence in communication with their dentist. Conclusions: Grasp appeared to improve communication regarding discomfort during dental procedures, particularly for those who initially reported lower levels of communication confidence.
Copyright (c) 2026 Elisabeth Ørskov Rotevatn, Emilie Stensaker Paz, Louise Sandal Løkeland, Frode Guribye, Grete Olin Engan, Cecilie Gudveig Gjerde, Torgils Lægreid, David N. Breidablik Vatne, Unnur Bergmann, Lars Jørgen Rygh, Mette Engan https://creativecommons.org/licenses/by/4.0
Artificial intelligence in endodontic decision-making: hallucinations and emerging challenges for clinical practice
Copyright (c) 2026 Carlos Wesley Lopes Brasil da Silva, Mariana Souza D’Afonseca, Ana Luiza Gonzaga Zonca, Jardel Francisco Mazzi Chaves, Fabiane Carneiro Lopes Olhê, Henrico Badaoui Strazzi-Sahyon, Gustavo Sivieri-Araujo https://creativecommons.org/licenses/by/4.0
Comments on ‘Bisphosphonate and statin: adverse effects of co-medication on wound healing in in vitro models of periodontal tissues’
This is a comment on the article ‘Bisphosphonate and statin: adverse effects of co-medication on wound healing in in vitro models of periodontal tissues’ https://doi.org/10.2340/aos.v85.45585
Copyright (c) 2026 David Szaraz, Vojtech Perina, Petra Borilova Linhartova https://creativecommons.org/licenses/by/4.0
Response to the Letter to the Editor by Prof. Dr. Aydin Gülses regarding our article ‘The effect of age on third molar extraction difficulty: A retrospective cross-sectional cohort study’
This is a response to the article "Comments on ´'The effect of age on third molar extraction difficulty: a retrospective cross-sectional cohort study' – Danger in describing ‘simplicity’ in third molar surgery" https://doi.org/10.2340/aos.v85.45933
Copyright (c) 2026 Abiel Noro, Johanna Snäll, Irja Ventä https://creativecommons.org/licenses/by/4.0
Comments on “The effect of age on third molar extraction difficulty: a retrospective cross-sectional cohort study” – Danger in describing ‘simplicity’ in third molar surgery
This is a comment on the article "The effect of age on third molar extraction difficulty: a retrospective cross-sectional cohort study" https://doi.org/10.2340/aos.v85.45308
Copyright (c) 2026 Aydin Gülses https://creativecommons.org/licenses/by/4.0
Subject: evaluation of mandibular bone abnormalities in CKD patients using CBCT
Copyright (c) 2026 Suhani Ghai, Ankit Grover, Kailash N. Singh https://creativecommons.org/licenses/by/4.0
Nutraceuticals for oral health: scientific rationale and clinical potential in endodontics
Copyright (c) 2026 Romulo de Oliveria Sales-Junior, Renan Dal-Fabbro, Luciano Tavares Ângelo Cintra, João Eduardo Gomes-Filho https://creativecommons.org/licenses/by/4.0
Obstructive sleep apnea and periodontitis: a systematic review with considerations on CPAP therapy
Objective: To evaluate the association between obstructive sleep apnoea (OSA) and periodontitis and to assess the available evidence on the effects of continuous positive airway pressure (CPAP) therapy on periodontal status. Materials and methods: This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Comprehensive literature searches were performed in Cochrane, PubMed, Scopus, and Web of Science. Study selection and data extraction were carried out independently by two reviewers. A total of 20 original studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. Results: Fourteen of the 20 studies (70%) reported a significant association between OSA and periodontitis. However, only two studies fulfilled all methodological quality criteria, indicating an overall moderate to low quality of evidence. Data on the effects of CPAP therapy on periodontal outcomes were limited, and the available studies generally showed no significant impact. Conclusions: Current evidence supports an association between OSA and periodontitis, suggesting that OSA may contribute to periodontitis. Robust, well-designed studies with larger sample sizes and rigorous methodology are needed to clarify the nature of this relationship and to determine whether CPAP therapy influences periodontal health.
Copyright (c) 2026 Aida Kukila, Muhammed Manzoor, Aino Salminen, Päivi Mäntylä, Pirkko Pussinen https://creativecommons.org/licenses/by/4.0
Association of Crohn’s disease with periodontal disease risk and severity: a meta-analytic study
Background: Crohn’s disease (CD) is a chronic inflammatory disorder with systemic manifestations, including potential effects on oral health. Evidence regarding its association with periodontal disease remains inconsistent. Methods: We systematically searched PubMed, Embase, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang Data up to August 28, 2025, for observational studies comparing periodontal ­outcomes in adults with CD and non-inflammatory bowel diseases controls. Random-effects meta-­analyses were ­performed to estimate pooled odds ratios (ORs) for prevalence and standardized mean differences (SMDs) for clinical parameters. Subgroup and sensitivity analyses were conducted. Results: Thirty-four studies, including 6482 CD patients and 9137 controls, were analyzed. CD was ­associated with a higher risk of periodontitis (OR = 2.14, 95% confidence interval [CI]: 1.65–2.77). Clinical periodontal parameters were also significantly worse in CD patients: probing depth (SMD = 0.42), clinical attachment loss (CAL) (SMD = 0.50), bleeding on probing (SMD = 0.47), plaque index (SMD = 0.39), and gingival index (SMD = 0.31). Associations were stronger in European populations and in studies using CAL criteria. Sensitivity analyses confirmed the robustness of results. Conclusions: CD is associated with increased prevalence and severity of periodontal disease. These ­findings support routine periodontal screening and integrated multidisciplinary management for CD patients, highlighting shared inflammatory pathways as potential therapeutic targets.
Copyright (c) 2026 Yanyan Jin, Songhai Duan, Weidong Chu, Weijia Shen https://creativecommons.org/licenses/by/4.0
Diagnostic performance of swept-source optical coherence tomography in the detection of tooth cracks: a narrative review
Objectives: Tooth cracks are among the most common clinical findings that can affect the prognosis of the tooth. The swept-source optical coherence tomography (SS-OCT) is a non-invasive technique that was developed to identify cracks or fractures. Even though the diagnostic value of SS-OCT has been studied by several researchers, the available evidence is still inconclusive. This review aims to evaluate the reported performance of SS-OCT in detecting tooth cracks and to identify factors described in the literature that may affect it. Materials and methods: An electronic search was conducted on PubMed, Scopus, Web of Science, and Google Scholar to extract and review the English articles published between January 2012 and December 2024. The keywords were optical coherence tomography, swept-source OCT, SS-OCT, tooth crack, dental crack, enamel crack, dentin crack, and fracture detection. Studies published in English that investigated SS-OCT for the detection of enamel, dentin, or root cracks were included, whereas review articles, non-​dental OCT studies, and studies focusing solely on other diagnostic methods were excluded. Results: The literature search identified 121 articles; 14 of them met the criteria and were included. Out of the 14 included articles, only one clinical article was included. Conclusions: The SS-OCT is a non-invasive and radiation-free imaging method for detecting tooth cracks, with higher diagnostic performance reported for enamel cracks. However, its performance in deeper dentin and root cracks appears to be affected by light penetration limitations and light scattering. Further technological development and well-designed clinical studies are needed to clarify its clinical utility.
Swedish smokeless tobacco and its impact on oral health: a systematic review
Objective: Swedish smokeless tobacco, or ‘snus’, has a long history of use and has undergone significant transformations, including the introduction of portion-packed snus and tobacco-free nicotine pouches. This systematic review evaluates the impact of Swedish snus on oral health, focusing on gingivitis, gingival recession, periodontitis, caries, tooth wear, and oral cleft malformations. Material and methods: The databases PubMed, Scopus, and EMBASE were used, terminating the searches on 11th June 2025. Original scientific articles written in the English or Scandinavian languages were screened by two independent researchers, finally including 26 out of 2,176 articles. The included articles were exported to the Elicit Pro library for quality assessment performed using the Joanna Briggs Institute’s Critical Appraisal Tool for Systematic Reviews. Premalignant and malignant changes were excluded from the search. Results and conclusion: The findings indicate that Swedish snus is associated with gingival recession, particularly among users of loose snus, with mechanical pressure and cytotoxic effects contributing to these lesions. Gingivitis was more prevalent among snus users, even after controlling for plaque levels, though no significant association with periodontitis was observed. Evidence regarding caries risk was inconsistent, with some studies reporting higher caries indices values among snus users, while others found no correlation. Additionally, maternal use during pregnancy was linked to a 48% increased risk of oral cleft malformations in offspring. Tooth wear and self-reported temporomandibular disorder (TMD) symptoms were also associated with snus use. These findings underscore the importance of public health measures to regulate snus use, particularly among populations such as pregnant women and adolescents, where they have increased in popularity.
Copyright (c) 2026 Mats Jontell, Maria Bankvall https://creativecommons.org/licenses/by/4.0
Use of bmps as a treatment for medication-related maxillary osteonecrosis (mronj): a systematic review
Background: Medication-related osteonecrosis of the jaw (MRONJ) is an adverse condition in patients receiving antiresorptive or antiangiogenic therapies. Standard treatments, including surgical debridement, often yield suboptimal outcomes. In this context, bone morphogenetic proteins (BMPs), have been explored for their ability to stimulate osteogenesis and enhance bone repair. Materials and methods: A systematic review of the literature was conducted, focusing on studies that applied rh-BMPs during surgeries to treat MRONJ. Databases were searched for relevant articles from inception to the present, using keywords such as ‘MRONJ’, ‘BMP’, and ‘bone regeneration’. Inclusion criteria involved studies with human participants who had been treated with rh-BMPs, along with the surgical elimination of bone sequestrum, MRONJ stages 2 and 3 according to the AAOMS staging system and a minimum follow-up period of 6 months. Two independent reviewers (L.H.C. and C.C.V.) systematically selected the articles independently. Results: The review included nine studies with a total of 217 patients treated with rh-BMP. Bone regeneration and osteonecrosis healing was reported in all the studies included using rh-BMP. However, the measurement methods were very different between the studies, using clinical examinations, different radiological tests and biomarkers and own scales. Moreover, there were inconsistencies in treatment protocols and follow-up periods, making it difficult to standardize conclusions. Discussion: While rh-BMPs show promising results for bone regeneration in MRONJ patients, the variability in study methodologies limits definitive conclusions. The biological potential of BMPs could be beneficial, but standardized protocols and longer-term studies are needed to establish their effectiveness. Conclusions: The application of rh-BMPs may promote bone regeneration in MRONJ patients, but further research with standardized methods is required to confirm these findings.
Copyright (c) 2026 Lucía Hernando-Calzado, Aida Bauer-González, Carlos Manuel Cobo-Vázquez, Cristina Meniz-García, Juan López-Quiles, Cristina Madrigal Martínez-Pereda https://creativecommons.org/licenses/by/4.0
Orthodontic treatment need assessment and treatment timing – a questionnaire survey among specialists in Denmark and Sweden
Objective: To analyze national and regional differences in assessment of orthodontic treatment needs and timing for treatment between specialists in orthodontics in Denmark and Sweden. Additionally, to map the use of digital platforms in orthodontic referral processes. Materials and methods: A questionnaire comprising 20 items was developed to assess nine patient cases with different malocclusions and sent to nearly 500 board-certified orthodontic specialists in Denmark and Sweden. Each case was documented by clinical photos, line drawings of the head and face, and malocclusion descriptions. Before the start of the survey, the questionnaire was tested in both countries by eight experienced orthodontists. The survey was distributed between 06 November 2024 and 27 January 2025. Data were analyzed using chi-square tests with false discovery rate correction. Results: Two hundred and nineteen responses were included. Both intra-regional and cross-national differences were found in treatment need assessments. Danish respondents showed greater agreement, while Swedish assessments varied more. Digital referral systems were more common in Sweden but linked to an increased tendency to select patient observation rather than making a definitive assessment of treatment need. In Denmark, high agreement (> 80%) was found for treatment need in six of nine cases. One patient case was generally deemed not eligible, while one case demonstrated high variability. Significant regional differences were noted in both treatment need and timing. In Sweden, strong agreement was observed for five cases. One case showed wide variation. Regional differences were significant for some cases, both in need and preferred treatment timing. Conclusions: Specialists in Orthodontics in Denmark showed more consistent assessments than those in Sweden, likely due to national guidelines. Digital referrals were common in Sweden but linked to more varied evaluations, especially in borderline cases.
Copyright (c) 2026 Asta Nyvang Rank, Mikael Sonesson, Sofia Petrén, Liselotte Paulsson, Liselotte Sonnesen https://creativecommons.org/licenses/by/4.0
Analysis of prosthetic outcomes and influencing factors in patients with alveolar bone atrophy
Objective: To investigate implant-supported prosthetic outcomes and influencing factors in alveolar bone atrophy. Material and methods: One hundred and fifty patients with atrophy receiving implants (2021–2022) were followed for 2 years. Success (n = 97, 64.7%) and failure (n = 53, 35.3%) groups were compared using univariate analysis, followed by multivariate logistic regression to identify factors associated with overall failure and Cox regression to assess time to failure. Results: Univariate analysis identified age, gender, smoking, implant length, and prosthesis type as significant (p < 0.05). Multivariate logistic regression showed short implant length (< 10 mm) as the sole independent risk factor for failure (OR = 4.418, p = 0.004); age ≥ 60 years (OR = 2.560, p = 0.094) and female gender (OR = 1.127, p = 0.807) were not significant. Multivariable Cox regression revealed age ≥ 60 years as a significant predictor of earlier failure (HR = 2.558, p = 0.010), while female gender and short implants were not (p > 0.05). Kaplan–Meier curves showed significant survival differences for age (p = 0.010), gender (p = 0.023), and implant length (p = 0.021). Conclusion: Short implant independently increases failure risk; age ≥ 60 years accelerates failure. Bone augmentation is preferred. Findings need validation.
Copyright (c) 2026 Wei Zhang, Chang’ao Xue, Yan Chen https://creativecommons.org/licenses/by/4.0
Perceived importance of oral health among patients attending Katutura Hospital general outpatient department and dental clinic, Namibia
Objective: To examine determinants of oral health knowledge, perceived oral health status, perceived dental needs, and clinically assessed tooth decay among adults attending Katutura Hospital, Namibia. Material and methods: A cross-sectional hospital-based study was conducted among adults attending the dental clinic and general outpatient department. Of 660 invited participants, 639 were included in the final analysis (response rate 96.8%). Data were collected using structured questionnaires assessing socio-demographic characteristics, oral health knowledge, oral hygiene practices, perceived oral health status, and perceived dental needs. Clinical oral examinations were performed to assess tooth decay. Multivariable logistic regression analyses were conducted to identify factors independently associated with the outcomes. Results: Most participants (89.7%) demonstrated good oral health knowledge. Tertiary education was the only independent predictor of good oral health knowledge (adjusted odds ratio [AOR] = 2.47; 95% confidence interval [CI]: 1.54–3.97) and was associated with lower odds of tooth decay (AOR = 0.39; 95% CI: 0.27–0.57). Brushing twice or more daily was significantly associated with good self-rated oral health (AOR = 2.03; 95% CI: 1.45–2.84). Employment status was inversely associated with perceived dental needs (AOR = 0.71; 95% CI: 0.51–0.99). Conclusions: Education was the principal determinant of oral health knowledge and clinical tooth decay, while oral hygiene practices influenced perceived oral health. Strengthening oral health promotion and improving access to preventive services may reduce inequalities and unmet dental needs in Namibia.
Copyright (c) 2026 Juvenary John Rutabanzibwa, Andrew Ross https://creativecommons.org/licenses/by/4.0
Treatment preferences related to pulpectomy and prosthetic restorations among Lithuanian general dentists and prosthodontists
Objective: The objective of this study was to compare self-reported treatment preferences related to pulpectomy prior to prosthetic treatment, restoration selection for vital teeth, and impression-taking methods between Lithuanian general dentists (GDs) and prosthodontists (Ps). Material and methods: A questionnaire-based survey was conducted among 386 dentists in Lithuania, including GDs (62.4%) and Ps (37.6%). Data were analyzed using descriptive statistics and inferential tests (Chi-square and Fisher’s exact test), with a significance level of p < 0.05. Results: Most indications for pulpectomy were reported similarly by both groups; however, significant differences were observed for extensive coronal structure loss (> 50%) and deep caries, cervical lesions, gingival recession, short clinical crown, insufficient retention, enamel hypoplasia, and external root resorption (p < 0.05). Ps also more frequently reported using indirect restorations, including porcelain-fused-to-metal crowns, lithium disilicate ceramic inlays and onlays, and polymethyl methacrylate crowns. Conventional impressions were more common among GDs, whereas digital or combined workflows were more common among Ps. Conclusions: Lithuanian GDs and Ps reported broadly similar preferences regarding preservation of tooth vitality, but differed in selected pulpectomy indications, restorative options, and impression-taking methods. These differences may reflect variation in specialist training, clinical experience, and access to prosthetic workflows.
Copyright (c) 2026 Viktorija Ašmankevičiūtė-Lemisnkė, Gediminas Žekonis https://creativecommons.org/licenses/by/4.0
Exploring fulfillment of basic psychological needs in patients with dental anxiety: an investigation grounded in self-determination theory
Objective: This qualitative study aimed to investigate how patients with severe dental anxiety perceived cognitive behavioral therapy (CBT) delivered by interdisciplinary teams consisting of psychologists and dental personnel. Material and methods: Twelve individual semi-structured interviews were conducted at the Oral Health Center of Expertise in Eastern Norway, using an exploratory qualitative design. The analysis was guided by Braun and Clarke’s thematic analysis. Self-determination theory (SDT) was applied as the theoretical and analytical framework. Results: The qualitative analysis identified five themes shaping patients’ experiences with CBT and progress in managing dental treatment: Establishing positive relationships with the psychologist and dental personnel, Experiencing enhanced competence in managing one’s anxiety, Discovering the opportunity to use one’s own capacities, Identifying factors nurturing plans for future dental visits, and Experiencing additional effects on quality of life. These results underscore the importance of autonomy-supportive treatment that fulfills patients’ basic psychological needs (BPNs) for autonomy, competence, and relatedness, thereby fostering more autonomous motivation and desired behavioral changes. Conclusions: The findings indicate that CBT provided by interdisciplinary teams may benefit from adopting SDT as a framework, integrating autonomy-supportive principles to fulfill patients’ BPNs. This approach may enhance CBT’s patient-centered effectiveness and potentially improve patients’ quality of life.
Copyright (c) 2026 Vibeke Kranstad, Geoffrey Colin Williams, Torill Helene Tveito, Vibeke Elise Ansteinsson, Anne Elisabeth Münster Halvari https://creativecommons.org/licenses/by/4.0
Relationship between dietary diversity and periodontitis: analysis of NHANES 2003–2014
Background: Periodontitis is a common chronic oral inflammatory disease with multiple etiologies. The relationship between Dietary Diversity Score (DDS) and periodontitis prevalence remains unclear. Objective: To elucidate the DDS-periodontitis prevalence association. Methods: Logistic regression evaluated the linkage between DDS and periodontitis. Restricted cubic spline (RCS) regression assessed non-linear linkage. Interaction tests identified effect-modifying factors. Weighted quantile sum (WQS) regression identified food categories influencing associations. Mediation analysis investigated the mediating roles of body roundness index (BRI) and red blood cell distribution width (RDW). Results: In the full-adjusted model, higher DDS was linked with lower periodontitis prevalence odds (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.93–0.98; p < 0.001), with an evident dose–response relationship. RCS indicated no significant non-linear association between DDS and periodontitis (p-non- linear = 0.144). WQS showed balanced weight distribution of five main foods (all ~20%), indicating a dietary synergy effect. Subgroup analyses revealed significant interactions between DDS and periodontitis within subgroups of age, smoking, BMI, alcohol consumption, and osteoarthritis (p-interaction < 0.05). RDW (2.26%) and BRI (1.69%) partially mediated the linkage between DDS and the periodontitis prevalence. Conclusion: Higher DDS is independently associated with reduced prevalence of periodontitis, driven by the synergistic contribution of multiple food categories. Optimizing dietary breadth is important in preventing periodontitis.
Copyright (c) 2026 Qi He, Qianying Guang, Yien Xu, Jian Zhao https://creativecommons.org/licenses/by/4.0
Associations between oral microbiome diversity and rheumatoid arthritis in U.S. adults: NHANES 2009–2012
Objective: Although links exist between periodontitis and rheumatoid arthritis (RA), and the gut microbiome has been implicated in RA pathogenesis, the role of oral microbiome diversity in RA remains insufficiently characterized. This study aimed to explore the association between oral microbiome diversity (including alpha and beta diversity) and RA status through a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES). Material and Methods: This cross-sectional study analyzed data from 1,544 participants aged ≥ 20 years derived from the 2009–2012 NHANES cycles. We employed multivariate logistic regression, restricted cubic splines (RCS), receiver operating characteristic (ROC) curve analysis, SHapley Additive exPlanations (SHAP) method and beta diversity assessment (Principal Coordinate Analysis [PCoA] and Permutational Multivariate Analysis of Variance [PERMANOVA]) to examine associations between oral microbiome diversity metrics and RA. Results: After adjustments, four alpha diversity metrics (observed amplicon sequence variants [ASVs]: OR [95% CI] = 0.996 [0.992, 0.999], P = 0.043; Faith’s PD: OR [95% CI] = 0.943 [0.900, 0.988], P = 0.014; Shannon-Wiener index: OR [95% CI] = 0.786 [0.641, 0.965], P = 0.021; Simpson index: OR [95% CI] = 0.127 [0.018, 0.915], P = 0.037) were significantly inversely associated with the presence of RA. This relationship was approximately linear (P for nonlinear > 0.05) and moderated by socioeconomic factors (P for interaction < 0.05). ROC and SHAP analyses revealed that the Simpson index had the highest explanatory capacity for RA. However, beta diversity (Bray-Curtis, UniFrac distances) revealed no significant differences between RA and non-RA groups (all P > 0.05). Conclusions: Higher oral microbiome alpha diversity is significantly associated with lower prevalence of RA. Oral microbial diversity may serve as a potential indicator associated with RA status. However, given the cross-sectional nature of this study, longitudinal and interventional studies are warranted to further elucidate causal relationships.
Copyright (c) 2026 Jun-Cai Lin, Qi-Song Wang, Zhong-Min Guo, Fan Zhang, Cai-Yin Qiu https://creativecommons.org/licenses/by/4.0
Conservative versus surgical management of mandibular condylar fractures: a comparative study
Condylar process fractures are a common mandibular injury predominantly affecting males, with a male-to-female ratio of 3:1. This study examines outcomes in patients with mandibular condylar fractures treated either conservatively or surgically, comparing long-term subjective results. A total of 281 cases were reviewed (144 treated conservatively and 137 treated surgically), with symptoms and functional outcomes assessed through questionnaires. Surgical intervention was more common in complex cases (e.g. bilateral fractures or concurrent maxillofacial injuries), and the surgical treatment group had a higher proportion of male patients and trauma related to violence. Mandibular joint sounds (e.g. clicking and crepitation) were more frequent in patients treated conservatively, whereas pain both at rest and during movement was more common in women and those with interpersonal violence-related trauma. Multivariable analysis indicated the presence of concurrent fractures as a risk factor for joint sounds, and gender and trauma type influenced pain and symptom frequency. Despite these differences, both treatments achieved comparable success in maintaining stable occlusion and achieving painless jaw function. These findings suggest that both conservative and surgical treatments can be effective, although individual factors such as gender, trauma type and concurrent fractures may affect post-treatment symptomatology and choice of treatment.
Copyright (c) 2026 Hampus Eksell, Anna Jinghede Sundwall, Robin Radamson, Annika Rosén, Robert Heymann https://creativecommons.org/licenses/by/4.0
Comparative evaluation of apical root resorption in adult patients treated with clear aligners and fixed orthodontic appliances using CBCT
Background: Orthodontically induced external apical root resorption is a common iatrogenic effect of tooth movement. With the increasing use of clear aligner therapy, it is important to evaluate whether its biomechanics reduce root resorption compared with fixed orthodontic appliances. Aim: To compare apical root resorption in patients treated with clear aligners and fixed appliances using cone-beam computed tomography (CBCT). Methodology: A retrospective comparative CBCT-based analysis was conducted on 120 orthodontic patients. Root volumes and lengths were measured from the cementoenamel junction to the apex using pre- and post-treatment CBCT scans. Apical root resorption was quantified as percentage volume loss and absolute root length reduction. Primary analyses employed linear mixed-effects models adjusted for clustering of teeth within patients and for tooth type, arch, extraction status, and treatment duration. Results: Clear aligner therapy was associated with significantly lower apical root resorption than fixed appliances. Mean percentage root volume loss was lower in the aligner group (6.1 ± 4.8%) than in the fixed appliance group (8.4 ± 6.1%) (p = 0.004). Mean root length reduction was also smaller with aligners (p = 0.001). Clinically significant root resorption occurred less frequently in the aligner group (p = 0.048). Longer treatment duration increased resorption risk. Conclusion: Clear aligner therapy is associated with less apical root resorption than fixed orthodontic treatment, while treatment duration remains an independent risk factor.
Copyright (c) 2026 Rakhi Issrani, Abdullah Hammad Alshammari, Mohammad Raji Alrwuili, Mohammed Ahmed Aljabab, Nasser Attallah Alenzi, Poonam Joshi, Yousef T. Aldoseri https://creativecommons.org/licenses/by/4.0
Dental health service utilization among older adults receiving home care services in south-eastern Norway
Objective: To map dental health service utilization (DSU) and associated factors among older adults receiving home care services (HCS) in south-eastern Norway, using Andersen’s model. Materials and methods: In this cross-sectional study of older adults receiving HCS aged ≥ 65 years, data on oral health practices, general health, and predisposing, enabling, and need-based factors were collected via interviewer-administered questionnaire. Results: Of 116 participants (mean age 83, 53.6% female), 67.2% reported annual DSU, while 24.1% used dental health services only for acute problems. Although 95.6% were entitled to free dental care in the public dental service (PDS), 66 were aware of this, and 56.5% made use of their rights. Awareness of entitlements was associated with more frequent PDS use. A higher self-reported number of teeth and using private dental services were also linked to higher DSU. Conclusions: The present study showed underutilization of dental health services among older adults receiving HCS and unawareness of entitlement of their rights in PDS. However, higher self-reported number of teeth and use of private dental services were linked to more frequent DSU. To address underuse, the PDS should improve awareness of entitlements, enhance information delivery, and further investigate reasons for non-utilization.
Copyright (c) 2026 Hero Ibrahim Hassan, Vibeke Ansteinsson, Marte-Mari Uhlen-Strand, Ragnhild Hellesø, Rasa Skudutyte-Rysstad, Ewa A. Sz. Hovden https://creativecommons.org/licenses/by/4.0
Comparative efficacy and safety of bupivacaine versus articaine in third molar surgery: a systematic review and meta-analysis of randomized controlled trials
Introduction: This review systematically compares the efficacy and safety of bupivacaine and articaine in third molar surgery, with a focus on postoperative pain control, duration of analgesia, intraoperative outcomes, and hemodynamic stability. Methods: PubMed, Scopus, Web of Science, and CENTRAL were searched through December 24th, 2024, for randomized controlled trials (RCTs) comparing bupivacaine and articaine in third molar surgery. Primary outcomes included postoperative pain intensity (visual analog scale [VAS]), duration of postoperative analgesia, and need for rescue analgesia. Secondary outcomes included anesthesia onset time, intraoperative bleeding, operative time, and hemodynamic parameters. Meta-analysis was performed using a random-­effects model. Results: A total of 11 RCTs involving 749 patients (bupivacaine: 367, articaine: 382) were included. Bupivacaine significantly reduced postoperative pain scores at multiple time points, with the greatest effect observed at 4 h postoperatively (mean difference [MD] = −2.59; 95% confidence interval [CI]: −3.41, −1.77; I2 = 0%). The duration of postoperative analgesia was comparable between groups (MD = 91.22 min; 95% CI: −5.13, 187.57; I2 = 99.68%), with sensitivity analysis confirming this effect. Articaine exhibited a significantly faster onset of anesthesia (MD = 0.74 min; 95% CI: 0.36, 1.12; I2 = 81.05%), while intraoperative pain scores, surgical difficulty, and operative time were comparable between groups. No significant differences were found in hemodynamic parameters, suggesting similar safety profiles. Conclusion: Bupivacaine provides superior postoperative pain control and prolonged analgesia, making it advantageous for extended pain relief in third molar surgery. However, articaine’s faster onset may enhance surgical efficiency. Both anesthetics demonstrated comparable intraoperative efficacy and safety.
Dental healthcare utilization and mortality: a population-based prospective cohort study in southern Sweden
Objective: The aim was to investigate associations between dental healthcare utilization and all-cause, cardiovascular (CVD), cancer, and other-cause mortality. Materials and methods: A postal public health survey was distributed in the autumn of 2008 to a stratified random sample of the population aged 18–80 in Scania, southern Sweden (response rate 54.1%). Baseline survey data were linked to mortality data, creating a prospective cohort study with 8.3-year follow-up. The present study entails 26,115 respondents. Associations between dental healthcare utilization and mortality were investigated in survival analyses and analyses with a nested case–control design. Results: In all, 68.4% had visited dental healthcare <1 year ago; 19.0%, 1–2 years ago; 6.7%, 3–5 years ago; 5.5%, >5 years ago; and 0.4%, never. The groups that had visited dental healthcare 1–2 years ago, 3–5 years ago, and >5 years ago displayed increased hazard ratios of all-cause mortality throughout the multiple- adjusted survival analyses compared to the <1-year reference group. Conditional logistic regression analyses with a nested case–control design confirmed results with a clearer gradient in all-cause mortality. CVD, cancer, and other-cause mortality showed some significant associations with dental healthcare utilization. Conclusions: Dental healthcare utilization was associated with all-cause mortality, with a clear gradient in the nested case–control design.
Copyright (c) 2026 Martin Lindström, Aron Naimi-Akbar, Emma Lindström, Maria Rosvall, Mirnabi Pirnouzifard https://creativecommons.org/licenses/by/4.0
A longitudinal study on the mental health status of young and middle-aged orthodontic patients
Objectives: To assess the mental health trajectory and its influencing factors in young and middle-aged orthodontic patients. Methods: In a longitudinal study, 154 patients were recruited from Nantong Stomatological Hospital (March 2023–October 2024). A 1:1 propensity score matching (PSM) control cohort was established to balance demographic characteristics. Data on general information, social support (Social Support Rating Scale), and psychological distress (Kessler 10 scale) were collected at eight time points from treatment initiation to 15 months. Mental health trajectories were analyzed using generalized estimating equations (GEE). Results: The GEE model indicated a significant temporal trend in mental health scores (Wald χ² = 304.51, p < 0.001). Significant factors included female gender (β = 6.12, p < 0.001), student status (β = 2.18, p = 0.020), higher monthly household income (>10,000 RMB (China’s currency): β = –3.51, p < 0.001), higher education (Bachelor’s degree or above: β = –1.89, p < 0.001), unmarried status (β = 3.05, p = 0.010), severe malocclusion (Class III: β = 1.23, p = 0.018), and social support (β = –0.35, p < 0.001), which was a protective factor. Conclusions: The mental health of young and middle-aged orthodontic patients follows a dynamic trajectory, associated with a combination of sociodemographic and clinical factors. Patients who are female, students, unmarried, or have severe malocclusion are at higher risk, whereas strong social support is protective. These findings highlight the need for timely psychological monitoring and personalized interventions for at-risk individuals throughout orthodontic care.
Copyright (c) 2026 Xin-yun Miao, Ying Zhang, Bin Xiong, Meng-yao Liang https://creativecommons.org/licenses/by/4.0
Clear Aligner Treatment in Denmark – A Questionnaire Survey among Citizens and Dental Practitioners in Denmark
Objectives: This study investigates clear aligner treatment (CAT) of adult patients in private dental practice and aims to identify: 1) The awareness of and knowledge about CAT among citizens, 2) how citizens who have received CAT experience the treatment and 3) how general dentists and orthodontists assess CAT. Materials and methods: The study was based on an observational cross-sectional questionnaire investigation. Two separate online questionnaires were sent out to all private dental clinics in Denmark and to a group of 2000 citizens aged ≥18 years. Results: 217 citizens and 200 practitioners were included in the analysis. The citizens’ awareness of CAT was poor in general, and younger citizens were more aware of CAT. The citizens most often became aware of CAT through their own dentist or through friends and family. The citizens were in general satisfied with their treatments.The practitioners always/often informed about all parameters possible. The most frequent indication for CAT was cosmetics. The orthodontists more often included a lateral cephalogram in the diagnostics before CAT and more often made changes and more comprehensive changes to the digital treatment plan. The orthodontists were less satisfied with CAT compared to the general dentists. Conclusions: This study has provided valuable knowledge on the awareness and satisfaction of CAT among the citizens and indicated how practitioners assess CAT of adult patients in private dental practice in Denmark.
Copyright (c) 2026 Clara Rasborg Hartogsohn, Kasper Rosing, Liselotte Sonnesen https://creativecommons.org/licenses/by/4.0
Operator-related low diagnostic quality in bitewing examinations performed with sensors
Objective: Bitewing radiographs are essential for caries and marginal bone diagnostics. Diagnostic quality depends on operator technique. This study evaluated patient-level diagnostic quality of sensor-based bitewing examinations to identify operator-related deficiencies. Material and Methods: In this retrospective, cross-sectional study, 962 bitewing examinations from 31 Swedish public dental practices were randomly selected and evaluated for caries and marginal bone level diagnostic image quality, according to European guidelines. Available panoramic/periapical images acquired in connection with the bitewing examinations were included in a second quality assessment. Recorded deficiencies included sensor placement, collimation artifacts, and insufficient biting on the sensor holder. Associations between diagnostic quality and sensor size, number of images, age group, jaw, side, and sex were analyzed using χ2 test and logistic regression. Three calibrated examiners performed the evaluations. Results: The requirements were fulfilled in 5% and acceptable in 43% of the bitewing examinations, increasing to 7% and 45% when including panoramic/periapical images. Quality was better with larger sensor sizes (p < 0.001), more exposures (p < 0.001), panoramic/periapical images (p < 0.001), age ≥12 years (p < 0.001), and in the maxilla (p < 0.001). Common errors were incorrect sensor placement (94%), collimation artifacts (57%), and insufficient biting (15%). No differences were found between side or sex. Inter-observer agreement was substantial (Fleiss’ kappa = 0.61; Gwet’s AC1 = 0.62); intra-observer agreement was almost perfect (Cohen’s kappa = 0.88). Conclusions: Most bitewing examinations, especially in children, fail to meet diagnostic requirements due to deficient operator performance and quality assessment. Panoramic/periapical images may improve diagnostic quality but should not replace optimized bitewing examinations. Targeted continuing education is required.
Copyright (c) 2026 Daniel Olsson, Eva Levring Jäghagen, Maria Garoff https://creativecommons.org/licenses/by/4.0
Assessment of impacted canine patterns and correlations with craniofacial discrepancy
Objective: The objective of this study was to determine the prevalence, spatial patterns, and craniofacial skeletal associations of impacted maxillary canines using panoramic and cephalometric analyses in a large patient cohort. Materials and methods: This retrospective cross-sectional study evaluated 9593 panoramic radiographs of individuals aged ≥ 14 years. Cephalometric analysis was achieved on subjects aged ≥ 18 years with skeletal maturity (Cervical Vertebral Maturation Index stage ≥ 6), comparing 94 cases with maxillary impacted canines (MIC) to 100 age- and sex-matched controls. Positional measurements (sector, depth, and angulation) were compared with skeletal patterns using independent t-tests, analysis of variance, and chi-square tests (α = 0.05). Results: Analysis revealed a maxillary canine impaction prevalence of 2.02%, with a significant female predilection (54.1%) and a maxilla-to-mandible ratio of 4:1. The predominant spatial pattern was mesioangular inclination (67%) in Sector 0 (35.2%) at coronal depth (54.1%). Compared to controls, MIC cases exhibited significant maxillary skeletal deficiency (e.g., anterior nasal spine – posterior nasal spine [ANS-PNS]: 50.1 ± 5.1 mm vs. 53.1 ± 3.7 mm; p < 0.001) and vertical hyperdivergence (Sella-Nasion to Gonion-Gnathion angle [SN-GoGn]: 32.8° ± 6.2 vs. 29.8° ± 6.4; p = 0.001). Upper incisor inclination showed no intergroup difference. Conclusions: Maxillary canine impaction is strongly associated with maxillary skeletal deficiencies and vertical growth discrepancies. The common finding of mesioangular impactions in Sector 0 at coronal depth indicates a high risk for adjacent root resorption. We recommend incorporating cephalometric screening (focusing on ANS-PNS < 50 mm and SN-GoGn > 32°) into early adolescent assessments to identify at-risk patients and guide timely interceptive strategies such as maxillary expansion.
Copyright (c) 2026 Salma Abbas, Lale Taner, Orhan Özdiler, Erhan Özdiler https://creativecommons.org/licenses/by/4.0
Relationship between the efficacy of micro-implant-assisted rapid maxillary arch expansion and maturation of the midpalatal sutures
Objective: To investigate the relationship between the efficacy of micro-implant-assisted rapid palatal expansion (MARPE) and the degree of midpalatal suture (MBT) fusion. Methods: Forty patients with maxillary transverse hypoplasia from Hengshui People’s Hospital from January 2022 to August 2024 were recruited for MARPE treatment. These patients were divided into unfused (stages B and C, n = 18), initiation fusion (stage D, n = 10), and complete fusion groups (stage E, n = 12) according to the degree of MBT fusion based on the staging method for palatal sutures. Cone beam computed tomography (CT) and gypsum models were created before and on the day after arch expansion. The differences in maxilla, alveolar bone, tooth, and bony arch expansion efficiency between the three groups were measured and compared. Results: The success rates of arch expansion in the unfused, initial fusion, and complete fusion groups were 100%, 100%, and 83.3%, respectively. Expansion of the MBT in the first molar position was 4.11 ± 1.10 mm, 4.07 ± 0.42 mm, and 2.18 ± 0.66 mm in the unfused, initial fusion, and complete fusion groups, respectively (P < 0.05). The corresponding bony arch expansion efficiency was 58.82 ± 6.56%, 54.58 ± 8.65%, and 37.88 ± 4.36%, respectively, without statistical difference (P > 0.05). Conclusion: Patients with different degrees of MBT confluence and treated with MARPE had significant differences. Observation of the degree of MBT fusion before arch expansion predicts MARPE efficacy.
Copyright (c) 2026 Suna Li, Jincong Tian, Yuanyuan Li, Wenshang Song https://creativecommons.org/licenses/by/4.0
Exploring dental professionals’ experiences of interprofessional collaboration with home care services
Aim: To explore dental professionals’ experiences of interprofessional collaboration between the public dental service (PDS) and home care services (HCS) in Norway, with a focus on how structural, legal, and professional factors influence access to preventive oral health care for HCS users. Materials and methods: A qualitative design was applied, informed by phenomenological and hermeneutical approaches. Eight semi-structured interviews were conducted with dental professionals in PDS in Eastern Norway. Data were analyzed thematically using an inductive approach. Results: Three main themes were identified: (1) Systemic and practical barriers, including fragmented administrative structures, outdated legislation, and lack of shared digital infrastructure; (2) Challenges in interprofessional collaboration, such as weak institutional anchoring, unclear role expectations, and low prioritization of oral health within HCS; (3) Prevention of oral disease, wherein participants emphasized the need for early intervention, continuity, and integration of oral health into daily care routines. Joint home visits and stable interprofessional relationships were highlighted as promising. Conclusion: Despite national strategies supporting integrated care, structural fragmentation and role ambiguity hinder effective collaboration. Strengthening interprofessional frameworks, updating legislation, and improving digital systems are needed to enhance access to preventive oral health care services. Oral health must be recognized as a shared responsibility across health services.
Copyright (c) 2026 Ingrid Volden Klepaker, Lena Fauske, Marte-Mari Uhlen-Strand https://creativecommons.org/licenses/by/4.0
Prevalence of occlusal deviations and orthodontic treatment in the Northern Finland Birth Cohort of 1986
Objective: To investigate the prevalence of occlusal deviations and received orthodontic treatment in a Finnish adult population, and to assess variation by sex. Materials and methods: The data (n = 1,746) are part of the Northern Finland Birth Cohort 1986 (NFBC1986). A clinical oral examination, including 3D intraoral scanning and self-completed questionnaires was carried out when the subjects were 33–35 years old. Registration of occlusion was done in connection with clinical oral examinations and from 3D dental models. Results: Over half of the subjects (52.5%) had received orthodontic treatment, and it was more common among females compared to males. Almost half (47.5%) had at least one occlusal deviation, with the most common deviations being increased overbite ≥ 5 mm (26.3%), increased overjet ≥ 5 mm (9.2%), anterior crossbite at least in one tooth (5.0%), and lateral crossbite (4.9%). The prevalence of occlusal deviations was higher among males and subjects with orthodontic treatment history compared to females and the untreated group. Conclusions: Occlusal deviations and orthodontic treatment history were common, although severe deviations were relatively rare. Occlusal deviations were slightly more prevalent among males and in the treated group, whereas orthodontic treatment history was more common among females.
Copyright (c) 2026 Teresa Kovanen, Elisa Tervahauta, Ville Vuollo, Anna-Sofia Silvola https://creativecommons.org/licenses/by/4.0
Characterising oral microbial signatures for periodontal disease in the NHANES population
Objective: This study aims to characterise the relationship between the oral microbiota and periodontal disease (PD) by leveraging the latest and largest oral microbiota database from the US National Health and Nutrition Examination Survey (NHANES). Methods: This study represented a secondary analysis of publicly available data from the NHANES 2009–2012 cycle. Within this dataset, subjects with PD and periodontally healthy controls were identified. Oral rinse samples were collected by the original NHANES study, which also performed polymerase chain reaction (PCR) amplification targeting the V4 hypervariable region of the 16S rRNA gene, sequencing, and subsequent construction of amplicon sequence variant (ASV) tables with taxonomic classification using the SILVA reference database. Venn diagram was generated to illustrate the overlap of differentially relative abundant genera identified by the Wilcoxon test, STAMP, and Linear discriminant analysis effect size (LEfSe). These results were integrated to calculate the Microbial Dysbiosis Index (MDI). To reliably distinguish PD, four supervised machine learning (ML) algorithms were employed, SHapley Additive exPlanations (SHAP) was utilised to explain the model. Results: A Venn diagram identified 19 core genera. Subjects in the case group exhibited a significantly higher MDI compared to controls (t = 8.536, P < 0.001), with an area under the curve (AUC) of 0.595 (95% confidence interval [CI]: 0.574–0.622). ML models, particularly XGBoost, demonstrated strong predictive performance (AUC: 0.958, 95% CI: 0.950–0.966) for PD classification. SHAP analysis highlighted important microbial taxa, including Treponema_2 and Prevotella. Conclusion: This study comprehensively investigated the oral microbiota’s association with PD, identifying potential biomarkers for diagnosis and targeted interventions.
Copyright (c) 2026 Zhaocheng Zhuang, Yangjia Chen, Yongjin Wang, Donghong Wei https://creativecommons.org/licenses/by/4.0
Assessment of dental pain and its association with dental anxiety and oral health-related quality of life
Background: Dental anxiety (DA) and dental pain are closely interrelated. Anxiety often leads to an exaggerated perception of pain, while the experience of pain can further intensify anxiety, creating a vicious cycle. This cycle can significantly have an effect on individual’s oral health-related quality of life (OHRQoL). Therefore, it is essential to implement both clinical and psychological interventions to effectively manage DA. Aim: The aim of this study is to assess the level of dental pain and its association with DA and OHRQoL among patients attending dental treatment. Methodology: A cross-sectional study involving 805 participants was conducted using consecutive sampling. Data were collected on demographic characteristics, dental health status, and self-rated health. The participants’ dental pain and DA were assessed using a 100-mm Visual Analog Scale (VAS), the Dental Fear Survey (DFS), and the Dental Anxiety Scale (DAS). Descriptive analyses were performed, followed by logistic regression to identify determinants of Oral Impacts on Daily Performance (OIDP). Results: The study sample consisted of 805 participants, comprising 69.7% males and 30.3% females. Most participants were aged between 31 and 50 years (46.9%). The study’s findings revealed no significant differences in dental pain prevalence by gender, age, or education level. However, participants with dental pain reported greater difficulties in daily activities, particularly in eating and social interactions. Significant mean differences were observed in DA (P < 0.001) and DFS (P = 0.009), with individuals experiencing dental pain reporting higher mean scores for DA (7.74 vs. 7.10) and DFS (37.56 vs. 35.55). Logistic regression identified decayed teeth [OR = 1.48 (95% CI: 1.06, 2.05), p = 0.020] and higher dental pain levels [OR = 6.08 (95% CI: 4.39, 8.41), p < 0.001] as factors significantly associated with OIDP. Conclusion: The study shows a significant association between dental pain and a poor OHRQoL. These findings emphasize the importance of addressing dental health issues to improve overall well-being and quality of life among affected individuals.
Copyright (c) 2026 Azhar Iqbal, Osama Khattak, Yasir Dilshad Siddiqui, Nisreen Nabiel Hassan, Rital Jamal Alwaqid, Shahzad Ahmad, Muhammad Amber Fareed, Malik Adeel Anwar, Rakhi Issrani https://creativecommons.org/licenses/by/4.0
Attracting dentists to the Swedish public dental services through the organisations’ websites
Objective: The recruitment and retention of dentists is important for quality dental care. The Swedish public dental service (PDS) suffers from staff shortages and high turnover due to perceived unfavourable working conditions that drive dentists towards the private dental sector. Websites can be a useful recruitment tool for organisations to communicate their mission, culture, and employee benefits. Therefore, this study aimed to investigate PDS organisations’ websites to identify how they present themselves to potential employees. Material and Methods: The data were collected from the websites of the 21 Swedish PDS organisations in June 2024. A thematic analysis was conducted using qualitative content analysis. Results: The findings show that PDS organisations appealed to dentists through emphasising their commitment to (1) fostering a sense of belonging within the workplace and (2) encouraging development and career growth, which are working conditions that can persuade employees to stay at an organisation. The organisations particularly appealed to newly graduated dentists through supporting the transition to dental practice. Conclusions: The PDS organisations emphasised favourable working conditions in their presentations of themselves as employers on their websites. Further research is needed on how effective the organisations’ websites are in attracting dentists and how dentists perceive the content on the websites in relation to actual workplace realities.
Copyright (c) 2026 Cecilia Franzén https://creativecommons.org/licenses/by/4.0
Bisphosphonate and statin: adverse effects of co-medication on wound healing in in vitro models of periodontal tissues
Objective: Bisphosphonates and statins may influence wound healing and are frequently prescribed to the same patient group. Bisphosphonates may induce osteonecrosis of the jaw; however, little information is available on the cellular mechanisms and biological effects of co-medication in oral tissues. The aim was to assess the effects of alendronate and simvastatin, both alone and combined, on osteoblasts and gingival fibroblasts in vitro. Study design: Primary human gingival fibroblasts and primary human osteoblasts were incubated with alendronate (5 µM) and simvastatin (1, 5 or 10 µM), alone or combined, for up to 14 days. Cells were assessed for viability by measuring lactate dehydrogenase activity and caspase-3 concentration in the cell culture media. Migration and proliferation potential was assessed by scratch-wound assay. Secreted levels of cytokines/chemokines were measured using Luminex 200 multianalytic profiling. Results: High concentrations of simvastatin, both alone and combined with alendronate, affected the proliferation/migration potential and reduced scratch closure. The same exposure induced near abolishment of secreted levels of cytokines affecting angiogenesis, such as VEGF, IL-6, IL-8, and MCP-1, however little effect was found on cell viability. Conclusion: High concentrations of simvastatin, alone or combined with alendronate, may have a negative impact on angiogenetic markers and cell migration/proliferation, affecting wound healing and growth.
Copyright (c) 2026 Agnes Småland-Reksten, Anne E. Agger, Aina M. Lian, Janne E. Reseland, Tormod B. Krüger https://creativecommons.org/licenses/by/4.0
Erosive tooth wear and its associated factors by tooth surfaces among a group of Finnish adults: a pilot study
Objectives: This study aimed to investigate erosive tooth wear (ETW) in different teeth and tooth surfaces among a group of Finnish adults, and to investigate the association between different risk factors and the manifestation of ETW in different parts of the dentition. Materials and methods: This cross-sectional study consisted of a questionnaire and a clinical oral examination. A total of 246 participants were invited to participate in the study. Respondents were asked about their gender, age, as well as their drinking and dietary habits. The presence of ETW on the oral, occlusal, and buccal surfaces of each tooth was recorded using the basic erosive wear examination (BEWE). Results: The study population consisted of 176 participants, of which 64% were female. Of all the respondents, 98.3% had signs of ETW. ETW was most frequent on occlusal surfaces. ETW on buccal, occlusal and oral upper and lower surfaces was significantly associated with the duration of erosive drink consumption (p = 0.009), the amount of erosive food consumed (p = 0.007), and the frequency of erosive food consumption (p < 0.001). Conclusions: Among the studied Finnish adult population, ETW seems to be common. There seem to be different risk factors that affect ETW on different tooth surfaces. Clinical relevance: The association between ETW on different tooth surfaces and specific extrinsic factors provides new scientific knowledge for clinicians. When evaluating ETW, risk factors such as the frequency, duration, and amount of consumption must be taken into account.
Therapy and material choices in pulp exposure among public dentists in Norway
Objective: This study aimed to investigate the following: (1) the preferences of public dentists for procedures and materials in carious or non-carious pulp exposure of permanent teeth; (2) how factors such as clinical experience, scientific literature reading, and material availability affect their choices; (3) the self-assessed risk of root canal treatment after pulp capping. Materials and methods: An online questionnaire consisting of 20 multiple choice and open-ended questions was e-mailed to Norwegian public dental clinics. It assessed dentists’ material preferences for direct pulp capping for carious or non-carious exposures, alongside factors such as years since graduation, scientific literature engagement, availability of materials, and clinical scenario choices. Respondents were also asked to estimate and reason long-term outcomes of their chosen materials. Standardized case descriptions ensured shared clinical understanding. Data were statistically analyzed and p-values ≤ 0.05 were considered statistically significant. Results: A total of 218 (23.9%) dentists responded. Direct pulp capping was preferred by 65% of respondents, with chemically curing materials – primarily calcium hydroxide – being most used. Chi-square analyses showed that dentists with fewer years of experience and those who had read scientific literature were more likely to prefer calcium silicate materials; however, these variables were not statistically significant predictors in the logistic regression models. Material availability was the strongest predictor of preference, with significantly increased odds of selecting calcium silicates or light-curing materials when available. ‘Satisfied with clinical results for the chosen material’ was the most frequently reported reason for material selection. Conclusion: Most respondents in this study preferred calcium hydroxide for direct pulp capping in permanent teeth with closed apices, despite the superior clinical outcomes of hydraulic calcium silicates. Material availability in the clinic was the primary factor influencing dentists’ choices, surpassing clinical experience and scientific literature engagement.
Copyright (c) 2026 Bo Wold Nilsen, Nema Rashdan, Mudar Rashdan, Anca Virtej https://creativecommons.org/licenses/by/4.0
Comparison of oral health-related quality of life in a group of 19-year-old patients with or without previous orthodontic treatment
Objective: To evaluate the impact of orthodontic treatment on the oral health-related quality of life (OHRQoL) several years after orthodontic treatment. Material and methods: Thirty-two patients with previous orthodontic treatment and 31 patients without previous orthodontic treatment, aged 19 years, were included in the study. A questionnaire consisting of three parts was used: The Oral Health Impact Profile (OHIP-S14), Jaw Functional Limitation Scale (JFLS-20) and Orofacial Aesthetic Scale (OES). Previous orthodontic treatment, malocclusions and earlier dental treatment were registered. Results: There were statistical differences between the orthodontic group and the control group regarding the total OHIP-S14 (p = 0.03) and the total OES (p = 0.028), as subjects in the control group indicated less satisfaction. There were non-statistical differences between the two groups regarding the JFLS-20. When divided into the four domains of OHIP-14, only the psychosocial domain showed a statistically significant difference between the groups (p = 0.006). No association was found between the decayed, missing and filled teeth index and total OHIP, total JFSL or total OES in both groups. Conclusion: Nineteen-year-old individuals who had undergone orthodontic treatment have a significantly better OHRQoL when compared to individuals without need for orthodontic treatment, specifically in the psychosocial and aesthetic domains.
Copyright (c) 2026 Maryam Sonono, Linda Yousef, Sinan Dehrab, Marie Pegelow https://creativecommons.org/licenses/by/4.0
Permanent maxillary canine eruption in children with clefts – a retrospective study
Objective: The purpose of this study was to investigate the effect of alveolar bone grafting (ABG) on the eruption timing and the need for deliberation of the permanent maxillary canine in cleft lip and/or palate patients. Materials and methods: The study group included 45 cleft sites from a total of 39 unilateral cleft lip and alveolus (CLA, n = 5) and unilateral (n = 22) cleft lip and palate (CLP) and bilateral (n = 12) CLP patients who had undergone treatment in the Oulu Cleft Center (OCC). A split-mouth approach and linear mixed-effects regression analysis was used to compare findings between single individual grafted and non-grafted alveolar sites. Results: The maxillary canine angulation had a significant role in the timing of the canine eruption (estimate 0.06, 95% CI 0.04 to 0.08). While ABG seemed to delay the canine eruption, this result was not statistically significant. The eruption of the maxillary canine tooth on the bone grafted side was delayed compared to the eruption of the maxillary canine on the non-grafted side (estimate -0.55, 95% CI -0.99 to -0.11). Another factor affecting the canine eruption was surgical exposure of the canine, and it typically emerged about a year after it had been surgically exposed and deliberated (estimate 1.05, 95% CI 0.40 to 1.70). Conclusion: The permanent maxillary canine eruption was slightly delayed after the ABG. Also, the maxillary canine was found to typically emerge about a year after it has been deliberated. The early bone graft had no benefit in terms of the timing of canine eruption. The angulation of the maxillary canine should be taken into consideration when planning ABG to facilitate its eruption. Careful planning and timing of the ABG and multidisciplinary approach have an important role in cleft patients’ treatment.
Copyright (c) 2026 Mateusz Podleśny, Riitta Lithovius, Leena Ylikontiola, George K. Sándor, Ville Vuollo, Virpi Harila https://creativecommons.org/licenses/by/4.0
Expression of intracellular toll-like receptors in leukoplakia and oral squamous cell carcinoma
Objective: Toll-like receptors (TLRs) are a group of pathogen recognition receptors expressed not only on immune cells but also cancer cells, where TLR activation may lead to tumour progression or suppression. At present, little is known about the role of TLRs and their connection with immune responses in precancerous lesions, such as oral leukoplakia (OL). In the present study, we have explored the immune activation and the expression of the intracellular TLRs – TLR3, TLR7, TLR8, and TLR9 in OL without and with dysplasia, and in oral squamous cell carcinoma (OSCC). Patients and methods: Immunohistochemistry was performed on 19 OL patients without dysplasia (OL-no) and 13 patients with dysplasia (OL-dys) and 10 OSCC patients. On digitalised images, TLR3-, TLR7-, TLR8- and TLR9-expressing cells were semi-quantitatively assessed, while the number of CD3- and CD8-expressing cells/mm2 was registered. Results: Nuclear TLR7 appeared in 31% of OL-dys but was absent in OL-no (p = 0.03). Cytoplasmic TLR8 was higher in OL-no than OL-dys (32% vs. 8%, p = 0.02). Similarly, cytoplasmic TLR9 was also higher OL-no than OL-dys (42% vs. 23%, p = 0.01). Conclusions: TLR3, TLR7, TLR8, and TLR9 are all expressed in OL-no, OL-dys, and OSCC. Also, the study provides evidence for possible nucleocytoplasmic shuttling of TLRs.
Copyright (c) 2026 Divya Ganesh, Jonas Sundberg, Amal Dafar, Göran Kjeller, Dipak Sapkota, Jenny Öhman, Daniel Giglio, Bengt Hasséus https://creativecommons.org/licenses/by/4.0
Relationships between oral health-related self-efficacy, oral health literacy, social support, and illness perception among patients with periodontitis: a moderated mediation model
Objective: To assess oral-health literacy and test a conceptual model of the relationships among oral health-related self-efficacy, social support, illness perception, and oral-health literacy in patients with periodontitis. Materials and methods: This cross-sectional study recruited 230 eligible adult periodontitis patients by convenience sampling at the Department of Periodontology, Fourth Military Medical University (Xi’an) from March to July 2024. Participants completed validated Chinese versions of the short-form Health Literacy Dental Scale, the Self-efficacy Scale for Self-care, the Social Support Rating Scale, and the Brief Illness Perception Questionnaire. Data analysis included descriptive statistics, nonparametric tests, correlation analysis, and Hayes’s PROCESS macro (Model 4 and Model 7) to test for social support’s mediation and illness perception’s moderation. Results: The study included 230 participants (121 males, 52.6%; 109 females, 47.4%), with a mean age of 39.27 ± 11.85 years. The health literacy score for periodontitis patients was 42.00 (34.00, 52.00). The direct effect of oral health-related self-efficacy on oral-health literacy was significant (β = 0.2367, 95% CI [confidence interval] = [0.1176~0.3558]), and social support played a partial mediating role between oral health-related self-efficacy and oral-health literacy (β = 0.0526, 95% CI = [0.0153~0.0980]). Illness perception did not significantly moderate the relationship between oral health-related self-efficacy and social support (β = -0.0061, 95% CI = [-0.0133, 0.0010]). Conclusions: This study assessed oral-health literacy at a moderate level in periodontitis patients. The tested model was partially supported: self-efficacy directly improved oral-health literacy, and social support partially mediated this relationship. Illness perception did not moderate the pathway. Therefore, self-efficacy and social support are primary targets for improving oral-health literacy.
Copyright (c) 2026 Jinfeng Li, Rui Liu, Huan Zhang, Min Cao, Lei Che, Yixin Wang, Yunchao Fan https://creativecommons.org/licenses/by/4.0
Dentists’ awareness of data security and ethical issues during the transition to artificial intelligence-driven clinical practice
Objective: This study aimed to evaluate the awareness levels of actively practicing dentists in Türkiye regarding artificial intelligence (AI)-related ethical issues, data security, anonymization, and legal regulations. Materials and methods: A cross-sectional online survey (Google Forms) used a 12-item questionnaire (4 demographics; 8 awareness domains) rated on a five-point Likert scale. Participants were recruited via snowball sampling. Descriptive statistics, independent-samples t-tests, and one-way analysis of variance with Tukey post hoc tests were applied (p < 0.05). Results: A total of 257 dentists participated. Mean domain scores ranged from 2.97 to 3.13; awareness of ethical issues was highest (3.13 ± 1.44) and perception of encryption lowest (2.97 ± 1.45). No significant gender differences were observed. University hospital dentists reported significantly higher awareness of ethical issues and a greater perceived need for anonymization than other institution types (p < 0.05). For awareness of Personal Data Protection Law (KVKK), scores were higher in university hospitals and private dental polyclinics than in private practices and public hospitals (p < 0.05). Professional experience was associated with differences in perception of encryption, awareness of personal data protection law, awareness of ethical issues, and perceived AI ethical risks (p < 0.05); perception of data security and awareness of big data security did not differ significantly (p > 0.05). Conclusion: Dentists demonstrated varying levels of awareness across domains, with higher awareness reported in academic settings. Experience-related patterns differed by domain, indicating the need for focused educational strategies addressing legal and ethical aspects of AI-supported dental practice.
Copyright (c) 2026 Busra Nur Gokkurt Yilmaz, Furkan Ozbey, Birkan Eyup Yilmaz https://creativecommons.org/licenses/by/4.0
Professional quality of life among Norwegian oral health professionals working with torture and abuse survivors and patients with severe dental anxiety
Objective: To investigate the level of burnout (BO), secondary traumatic stress (STS), and compassion satisfaction (CS) among Norwegian oral health professionals who work with traumatized and vulnerable patients. Material and methods: Professional Quality of Life-5 was used to assess BO, STS, and CS. Organizational and psychosocial work factors were measured with the Nordic Questionnaire for Psychological and Social Factors at Work. Results: Participants (n = 114) reported moderate levels across all three dimensions, with 62.6% scoring in the moderate range for STS, 47.4% for BO, and 38.6% for CS. Poor work-life balance was associated with lower levels of CS and higher levels of STS and BO. Support was associated with positive outcomes of BO, STS, and CS. Conclusions: Psychosocial factors within the work environment contribute more to occupational strain than the direct challenges of working with traumatized or vulnerable patients. Involving oral health professionals in wider conversations about supporting those who care for vulnerable populations is paramount. Addressing organizational conditions alongside individual support is important to promote well-being.
Copyright (c) 2026 Hayley Manalang Ko, Ingrid Volden Klepaker, Lubomiła Korzeniewska, Marte-Mari Uhlen-Strand https://creativecommons.org/licenses/by/4.0
Microbial and periodontal shifts induced by orthodontic appliances: a comparative clinical study
Objective: This study aimed to evaluate the periodontal and microbiological alterations in oral flora associated with using removable appliances and fixed orthodontic treatments. Methods: The study materials consist of subgingival-supragingival plaque samples and periodontal measurements from 48 patients. The groups include fixed appliance users, removable appliance users, and a nontreatment control group. Periodontal measurements, including gingival index, plaque index, bleeding on probing, mobility, furcation, probing depth, and attachment level, were recorded at baseline (before treatment) and 6 months after treatment initiation. Plaque samples were collected at T0 and T1. Dental plaque samples were cultured on selective media for qualitative and quantitative microbial analysis, followed by qualitative evaluation using the VITEK 2 (Biomerieux) system. Data were analyzed using one-way one-way analysis of variance one-way analysis of variance (ANOVA), paired sample-T test, and Duncan’s multiple range test to identify and compare statistically significant differences within and between groups, while intraobserver reliability was assessed using the Kappa statistic. Results: Mobility or furcation involvement was not detected in any of the groups at either time point. At the T1 stage, a slight improvement in attachment level was observed in both the fixed and removable appliance groups compared with baseline measurements. However, during the same period, a significant increase in mean probing depth was detected only in the fixed appliance group (p = 0.003). Plaque index levels increased in both the removable appliance group (p = 0.019) and the fixed appliance group (p = 0.023). Furthermore, the bleeding on probing index also showed an increase in both groups, with p = 0.020 in the removable appliance group and p = 0.012 in the fixed appliance group. At the T1 stage, an increase in yeast counts was observed in the removable appliance group (p = 0.008), whereas decreases were detected in Lactobacillus (p = 0.004) and mutans streptococci (p = 0.026) levels. In contrast, the fixed appliance group demonstrated significant increases in Lactococcus (p = 0.042) and mutans streptococci (p = 0.037) counts. The identified microorganisms included a diverse range of bacterial species, such as Actinomyces spp., Fusobacterium spp., Lactobacillus spp., Streptococcus spp., Veillonella spp., and other clinically significant genera. Conclusions: It may be inferred that fixed orthodontic treatments create a biological environment that is more susceptible to adverse periodontal alterations and increased colonization by specific microbial species. Conversely, the potential suppressive effects of removable appliances on certain microbial groups emphasize the need to consider patients’ oral hygiene compliance, periodontal risk profile, and microbial sensitivity during treatment planning.
Copyright (c) 2026 Aybüke Asena Atasever İşler, Abdulvahit Erdem https://creativecommons.org/licenses/by/4.0
The effect of age on third molar extraction difficulty: a retrospective cross-sectional cohort study
Objective: This study aimed to clarify whether third molar extraction becomes more difficult as the patient ages. Previous research results on the topic are contradictory. Materials and methods: All 12,649 third molar extractions in Helsinki’s primary care during 2016 were retrieved from electronic records using treatment codes. The primary outcome was extraction difficulty, classified as simple (forceps) or surgical (raising a flap). The secondary outcome was an extraction labelled as demanding. Predictor variables were age, sex, and the jaw (maxilla/mandible). Statistical analyses included χ2 test and binomial logistic regression. Results: Mean age of the patients was 32.2 years (range 12–97 years). Simple extractions in the maxilla (P < 0.001) and all surgical extractions (P < 0.001) were more likely to be demanding at a higher age. In the mandible, simple extractions were easier at a higher age (odds ratio [OR] 0.971; 95% confidence interval [CI] 0.964; 0.978). Surgical extraction was 1.4 times (95% CI 1.145; 1.766) more likely to be demanding in men and twice (95% CI 1.143; 3.462) as demanding in the mandible. Conclusions: Surgical and maxillary simple extractions were more difficult at a higher age. Surprisingly, in the mandible, simple extractions were easier at a higher age.
The expression profile and clinical relevance of miR-125a-5p in individuals with chronic periodontitis
Background: Chronic periodontitis is a prevalent inflammatory disease, and miR-125a-5p’s role in its pathogenesis remains unclear. Objective: We examined the clinical significance and mechanisms of miR-125a-5p in chronic periodontitis by testing two hypotheses: (1) miR-125a-5p expression is altered in chronic periodontitis and correlates with clinical indicators; (2) miR-125a-5p regulates periodontal ligament fibroblast (PDLF) functions by targeting specific genes, contributing to disease pathogenesis. Method: Pearson correlation analysis assessed the association between miR-125a-5p expression and key clinical indicators. Receiver operating characteristic (ROC) curve analysis evaluated its diagnostic performance in chronic periodontitis. Periodontal ligament fibroblasts were treated with lipopolysaccharide (LPS) to establish an inflammatory model. miR-125a-5p and B-cell translocation gene 2 (BTG2) expression levels were measured by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Cell count kit-8 (CCK-8) assay and enzyme-linked immunosorbent assay (ELISA) assessed miR-125a-5p’s effects on cell proliferation, oxidative stress, and inflammation. The direct interaction between miR-125a-5p and BTG2 was confirmed using a dual-luciferase reporter assay. Results: The expression level of miR-125a-5p in the gingival crevicular fluid of patients with chronic periodontitis was significantly upregulated and positively correlated with the severity of periodontal tissue damage. In the LPS-induced PDLFs model, miR-125a-5p expression was upregulated, cell proliferation capacity was suppressed, oxidative stress was induced, and levels of inflammation-related factors were increased. Notably, transfection with a miR-125a-5p inhibitor effectively reversed these effects. Moreover, the study confirmed that BTG2 is a direct target gene of miR-125a-5p, and that miR-125a-5p exerts its regulatory effects on cellular functions through targeting BTG2. Conclusion: miR-125a-5p is potentially associated with chronic periodontitis, and may serve as a therapeutic target.
Copyright (c) 2026 Senqiang Li, Baoqing Fang, Qian Sun https://creativecommons.org/licenses/by/4.0
Oral health and background characteristics in a prison population: the PriOH study
Objectives: The Nordic welfare state aims for social security and equality. However, incarcerated people often face vulnerable situations impacting oral health. This study describes oral health and background characteristics of incarcerated people in Norway and explored differences between Nordic and non-Nordic origins. Material and methods: This cross-sectional study included 326 participants from four prisons in Norway. Dental personnel conducted visual oral examinations and collected questionnaire data on sociodemographic, socioeconomic and health-related background, self-reported oral health and dental anxiety. Results: The population mainly consisted of young (mean 36.9 ± 11.8) men (95.4%). Almost half had low education (46.4%), reported financial difficulties (37.8%), lacked labor market attachment (45%), and over half (54.8%) experienced physical pain. Dental services were irregularly used (56.2%), and dental anxiety was prominent (39%). Almost half reported poor oral health (46.5%) and clinical measures (mean decayed, missing and filled teeth [DMFT] 11.4 ± 7.4) revealed decayed teeth in four of 10 individuals (39.8%). Group differences showed that non-Nordic individuals had stronger labor market attachment, fewer health challenges, and less caries experience than Nordic individuals. Conclusion: Diverse socioeconomic backgrounds, untreated caries, poor self-reported oral health, dental anxiety, and irregular dental attendance were common. The group disparities challenge the equity goals of the Nordic Welfare state.
Copyright (c) 2026 Kathrine Høyvik Bergum, Emilie Bryne, Linda Maria Stein https://creativecommons.org/licenses/by/4.0
Caries experience among children and adolescents from a longitudinal Swedish national registry study over a 10-year period
Objective: To identify caries experience in two groups of children and adolescents using longitudinal data from the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa). Material and methods: Data from two groups (10- and 20-year-olds), 165,365 individuals, were observed retrospectively for 10 years. Using a three-trajectory caries model (3-TCM), individuals were assigned according to their caries development as: high (15%), moderate (45%), or low (40%). Caries experience was expressed using the decayed and filled surfaces (DFS) and dfs indices. The specific affected caries (SaC) index and a point prevalence measurement at age 6 years (PP-6) were also analyzed. Results: Over the observation period, significant differences were discovered between all three trajectories within the oldest group (20-year-olds). The mean DFS increase was significantly elevated for the high trajectory compared with the lower trajectories, 7.9 ± 10.2, 3.3 ± 2.9 and 0.2 ± 0.5 for the three trajectories respectively. In the youngest group (10-year-olds), the high trajectory combined with the SaC and PP-6 provided further information of those with the highest caries experience. Conclusions: The 3-TCM identified individuals with high caries experience in the permanent dentition; but to properly elucidate caries experience in the primary and mixed dentitions, a combination with other indices was needed.
Copyright (c) 2026 Håkan Flink, Anders Hedenbjörk-Lager, Simon Liljeström, Eva Nohlert, Åke Tegelberg https://creativecommons.org/licenses/by/4.0