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OBJECTIVES: The goal of this systemic review and meta-analysis was to compare the longevity of direct and indirect composite restorations in posterior teeth. DATA: Randomized controlled trials (RCT) investigating direct and indirect composite restorations in permanent posterior teeth. SOURCES: Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6. RESULTS: A total of 3056 articles were found by electronic databases. Finally, five RCTs were selected. Overall, 627 restorations of which 323 were direct and 304 indirect composite restorations have been placed in 279 patients (age: 28-81 years). The highest annual failure rates (AFR) were found for indirect restorations ranging from 0 % to 15.5 %. Lower AFR were found for direct restorations ranging from 0 % to 5.4 %. The most frequent failures were found to be chipping and fracture of the restoration followed by caries. Meta-analysis revealed that the failure rate for direct restorations was significantly lower than for indirect restorations (Risk Ratio (RR) [95 %CI] = 0.61 [0.47; 0.79]; very low level of evidence). Furthermore, all studies showed a high risk of bias. CONCLUSION: Direct and indirect composite restorations can be recommended for large class II cavities including cusp coverage in posterior teeth for single tooth restoration. Meta-analysis revealed significantly lower relative risk to fail for direct composite restorations than for indirect restorations but results are with high risk of basis.

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OBJECTIVE: This study aimed to assess the different pathways between predictor factors such as zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding related to anterior open bite (AOB) in twins. METHODS: The study was conducted in monozygotic (MZ) and dizygotic (DZ) twin children aged 3-15 years. AOB, atypical swallowing, mouth breathing, feeding type, duration of bottle use, and mouth opening status during sleep were recorded during oral examination. Partial least squares structural equation model (PLS-SEM) and sobel tests were performed to assess the total and indirect effects among the variables on AOB. RESULTS: A total of 404 children (29.2% MZ;70.8% DZ) participated in this study. The effect of zygosity on mouth breathing in the PLS-SEM model was statistically significant. Conversely, it was determined that mouth breathing effected that atypical swallowing (p = 0.001). Atypical swallowing triggered AOB (p = 0.001). The atypical swallowing has a mediation effect between AOB and mouth breathing (p = 0.020). Mouth breathing causes atypical swallowing and therefore indirectly increases the likelihood of AOB. While breastfeeding decreases AOB incidence (p = 0.023), bottle feeding increases AOB incidence (p = 0.046). The sobel tests show that the fully mediator variable feature of mouth breathing is statistically significant in the negative relation between zygosity and atypical swallowing. CONCLUSION: The PLS-SEM model showed that mouth breathing triggers atypical swallowing and atypical swallowing triggers AOB. As a result of this chain of relationships, an indirect effect of zygosity on AOB was observed. According to sobel tests, zygosity has an indirect effect on atypical swallowing through mouth breathing, while mouth breathing has a positive indirect effect on AOB through atypical swallowing. CLINICAL RELEVANCE: This study identified the relationships between different factors and the presence of AOB. The findings of this study demonstrate in detail the relationships between AOB and zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding. Brestfeeding has a reducing effect on the frequency of AOB. Among the nutritional forms, breastfeeding ensures the proper development of the stomatognathic system by working the oro-facial muscles.

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OBJECTIVES: This study aimed to evaluate the effects of the cushioned grind-out technique transcrestal sinus floor elevation for simultaneous implant placement with ≤4 mm of residual bone height (RBH). MATERIALS AND METHODS: This was a retrospective propensity score matching (PSM) study. Five PSM analyses included the confounding variables of Schneiderian membrane perforation, early and late implant failure, and peri-implant apical and marginal bone resorption. After PSM, we compared the difference in five aspects between the RBH ≤ 4 and >4 mm groups. RESULTS: A total of 214 patients with 306 implants were included in this study. After PSM, the generalized linear mixed model (GLMM) indicated that RBH ≤ 4 mm had no significantly higher risk of Schneiderian membrane perforation and early and late implant failure (p = .897, p = .140, p = .991, respectively). The implant cumulative 7-year survival rate of the RBH ≤ 4 and >4 mm groups was 95.5% and 93.9%, respectively (log-rank test: p = .900). Within at least 40 cases per group after PSM, two multivariate GLMMs indicated that RBH ≤ 4 mm could not be identified as the promotive factor of bone resorption of either endo-sinus bone gain or crest bone level (RBH × time interaction p = .850, p = .698, respectively). CONCLUSIONS: Within the limitations, 3 months to 7 years of post-prosthetic restoration review data indicated an acceptable mid-term survival and success rate of applying the cushioned grind-out technique in RBH ≤ 4 mm cases.

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The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.

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BACKGROUND: Evaluation of a new vertical dimension of occlusion (VDO) in complex restorative treatments is considered a necessary step prior to placement of restorations. OBJECTIVES: This randomised controlled trial (RCT) aimed to assess the effects of using an evaluation of a VDO increase before restorative treatment in patients with moderate-to-severe tooth wear, on OHRQoL, freeway space (FWS) and interventions to restorations. METHODS: Forty-two patients with tooth wear were included and randomly allocated to either a test phase with a Removable Appliance (RA) or no test phase. Restorative treatment consisted of restoration of all teeth using composite restorations in an increased VDO. OHIP-score, freeway space (FWS) and clinical acceptability of restorations were assessed at baseline and at recall appointments (1 month and 1 year). Intervention to restoration was scored in case of material chipping or when the abutment tooth had increased sensitivity that could be linked to occlusal overloading. ANCOVA analyses, Univariate Cox regression, t-tests and descriptive analyses were performed (p < .05). RESULTS: Clinical follow-up after 1 year was completed for 41 patients. No significant effect of testing the VDO with a RA could be found on the OHIP-score (p = .14). Reduction of FWS in the RA group, compared to the control group, was significantly lower at 1 year (p = .01, 95% CI -1.09 to -0.15). No effect on early interventions to restorations was found (p = .94). CONCLUSION: This RCT showed that a removable appliance is not indicated to functionally test the increased VDO prior to restorative treatment in patients with tooth wear.

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OBJECTIVES: The goal of this systemic review and meta-analysis was to evaluate the longevity of indirect adhesively-luted ceramic compared to conventionally cemented metal single tooth restorations. DATA: Randomized controlled trials (RCT) investigating indirect adhesively-luted ceramic restorations compared to metal or metal-based cemented restorations in permanent posterior teeth. SOURCES: Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of Bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6. RESULTS: A total of 3056 articles were found by electronic databases. Finally, four RCTs were selected. Overall, 443 restorations of which 212 were adhesively-luted ceramic restorations and 231 conventionally cemented metal restorations have been placed in 314 patients (age: 22-72 years). The highest annual failure rates were found for ceramic restorations ranging from 2.1% to 5.6%. Lower annual failure rates were found for metal (gold) restorations ranging from 0% to 2.1%. Meta-analysis could be performed for adhesively-luted ceramic vs. conventionally cemented metal restorations. Conventionally cemented metal restoration showed a significantly lower failure rate than adhesively-luted ceramic ones (visual-tactile assessment: Risk Ratio (RR)[95%CI]=0.31[0.16,0.57], low level of evidence). Furthermore, all studies showed a high risk of bias. CONCLUSION: Conventionally cemented metal restorations revealed significantly lower failure rates compared to adhesively-luted ceramic ones, although the selected sample was small and with medium follow-up periods with high risks of bias.

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Background: This randomized clinical trial was conducted to assess whether sleep bruxism (SB) is associated with an increased rate of technical complications (ceramic defects) in lithium disilicate (LiDi) or zirconia (Z) molar single crowns (SCs). Methods: Adult patients were classified as affected or unaffected by SB based on structured questionnaires, clinical signs, and overnight portable electromyography (BruxOff) and block randomized into four groups according to SB status and crown material (LiDi or Z): LiDi-SB (n = 29), LiDi-no SB (n = 24), Z-SB (n = 23), and Z-no SB (n = 27). Differences in technical complications (main outcome) and survival and success rates (secondary outcomes) one year after crown cementation were assessed using Fisher's exact test with significance level α = 0.05. Results: No technical complications occurred. Restoration survival rates were 100% in the LiDi-SB and LiDi-no SB groups, 95.7% in the Z-SB group, and 96.3% in the Z-no SB group (p > 0.999). Success rates were 96.6% in the LiDi-SB group, 95.8% in the LiDi-no SB group (p > 0.999), 91.3% in the Z-SB group, and 96.3% in the Z-no SB group (p ≥ 0.588). Conclusions: With a limited observation time and sample size, no effect of SB on technical complication, survival, and success rates of molar LiDi and Z SCs was detected.

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Data are a key resource for modern societies and expected to improve quality, accessibility, affordability, safety, and equity of health care. Dental care and research are currently transforming into what we term data dentistry, with 3 main applications: 1) medical data analysis uses deep learning, allowing one to master unprecedented amounts of data (language, speech, imagery) and put them to productive use. 2) Data-enriched clinical care integrates data from individual (e.g., demographic, social, clinical and omics data, consumer data), setting (e.g., geospatial, environmental, provider-related data), and systems level (payer or regulatory data to characterize input, throughput, output, and outcomes of health care) to provide a comprehensive and continuous real-time assessment of biologic perturbations, individual behaviors, and context. Such care may contribute to a deeper understanding of health and disease and a more precise, personalized, predictive, and preventive care. 3) Data for research include open research data and data sharing, allowing one to appraise, benchmark, pool, replicate, and reuse data. Concerns and confidence into data-driven applications, stakeholders' and system's capabilities, and lack of data standardization and harmonization currently limit the development and implementation of data dentistry. Aspects of bias and data-user interaction require attention. Action items for the dental community circle around increasing data availability, refinement, and usage; demonstrating safety, value, and usefulness of applications; educating the dental workforce and consumers; providing performant and standardized infrastructure and processes; and incentivizing and adopting open data and data sharing.

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Attention and awareness towards musculoskeletal disorders (MSDs) in the dental profession has increased considerably in the last few years. From recent literature reviews, it appears that the prevalence of MSDs in dentists concerns between 64 and 93%. In our clinical trial, we have assessed the dentist posture during the extraction of 90 third lower molars depending on whether the operator performs the intervention by the use of the operating microscope, surgical loupes, or with the naked eye. In particular, we analyzed the evolution of the body posture during different interventions evaluating the impact of visual aids with respect to naked eye interventions. The presented posture assessment approach is based on 3D acquisitions of the upper body, based on planar markers, which allows us to discriminate spatial displacements up to 2 mm in translation and 1 degree in rotation. We found a significant reduction of neck bending in interventions using visual aids, in particular for those performed with the microscope. We further investigated the impact of different postures on MSD risk using a widely adopted evaluation tool for ergonomic investigations of workplaces, named (RULA) Rapid Upper Limb Assessment. The analysis performed in this clinical trial is based on a 3D marker tracker that is able to follow a surgeon's upper limbs during interventions. The method highlighted pros and cons of different approaches.

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OBJECTIVES: We aimed to assess the impact of an artificial intelligence (AI)-based diagnostic-support software for proximal caries detection on bitewing radiographs. METHODS: A cluster-randomized cross-over controlled trial was conducted. A commercially available software employing a fully convolutional neural network for caries detection (dentalXrai Pro, dentalXrai Ltd.) was randomly employed by 22 dentists, supporting their caries detection on 20 bitewings randomly chosen from a pool of 140 bitewings, with 10 bitewings randomly being supported by AI and 10 not. The reference test had been established by 4 + 1 independent experts in a pixelwise fashion. Caries was subgrouped as enamel, early dentin and advanced dentin caries, and accuracy and treatment decisions for each caries lesion assessed. RESULTS: Dentists with AI showed a significantly higher mean (95% CI) area under the Receiver-Operating-Characteristics curve (0.89; 0.87-0.90) than those without AI (0.85; 0.83-0.86; p<0.05), mainly as their sensitivity was significantly higher (0.81; 0.74-0.87 compared with 0.72; 0.64-0.79; p<0.05) while the specificity was not significantly affected (p>0.05). This increase in sensitivity was found for enamel, but not early or advanced dentin lesions. Higher sensitivity came with an increase in non-invasive, but also invasive treatment decisions (p<0.05). CONCLUSION: AI can increase dentists' diagnostic accuracy but may also increase invasive treatment decisions. CLINICAL SIGNIFICANCE: AI can increase dentists' diagnostic accuracy, mainly via increasing their sensitivity for detecting enamel lesions, but may also increase invasive therapy decisions. Differences in the effects of AI for different dentists should be explored, and dentists should be guided as to which therapy to choose when detecting caries lesions using AI support.

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An increasing number of studies on artificial intelligence (AI) are published in the dental and oral sciences. The reporting, but also further aspects of these studies, suffer from a range of limitations. Standards towards reporting, like the recently published Consolidated Standards of Reporting Trials (CONSORT)-AI extension can help to improve studies in this emerging field, and the Journal of Dental Research (JDR) encourages authors, reviewers, and readers to adhere to these standards. Notably, though, a wide range of aspects beyond reporting, located along various steps of the AI lifecycle, should be considered when conceiving, conducting, reporting, or evaluating studies on AI in dentistry.

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Background and Objectives An accurate determination of the pulp status is relevant for a proper endodontic diagnosis. Objectives: The aim was to develop a universal pulse oximeter probe holder for measuring the oxygen saturation and to evaluate the use of pulse oximetry as a test for pulp vitality, by comparing the levels of oxygen saturation in the index finger and in the healthy dental pulp. Materials and Methods The universal holder was designed with software and printed with a 3D printer. The study was carried out on 128 healthy teeth. They were divided into eight groups according to tooth type. Ten root canal treated teeth served as a negative control group. For each patient, a pulse oximeter was first applied on the tooth followed by the index finger. The significance level (α) was set at 0.05. Results: The developed and manufactured universal pulse oximeter probe holder was suitable to measure the pulp vitality of all types of teeth. The handle allowed for holding the pulse oximeter on the tooth in parallel, firmly and securely. Significantly higher oxygen saturation was observed in the index finger (97.22%) compared to the dental pulp (93.17%) (p < 0.001). No correlation was observed between the maxillary teeth and index finger oxygen saturation values (r = 0.05, p = 0.72), whereas, between the mandibular teeth and index finger, a positive correlation was detected (r = 0.29, p = 0.02). There were no significant differences in the pulp oxygen saturation values between different teeth groups. Conclusion: The newly developed universal pulse oximeter probe holder is an effective device for pulp vitality testing.

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BACKGROUND: The aim of this longitudinal, one-year cohort study was to explore the hypothesis that fluorescence sampling of the root canal space prior to obturation could predict the outcome of root canal treatment (RCT). METHODS: Sixty-five teeth underwent primary RCT and were followed up clinically and radiographically. The outcome was determined radiographically with periapical radiographs (PR) and cone beam computed tomography (CBCT) scans. RESULTS: Success at 12 months was predictable based on the fluorescence score. When the fluorescence score (defined as the percentage of signal over total signal including background) was lower than 67, there was a 4.5 times (Odds ratio (OR) = 0.028; 95% confidence interval (CI): 0.003, 0.291, p = 0.001) greater chance of success (90% overall). When the readings were above this threshold, the success rate was 20%. CONCLUSION: A chairside sampling method is able to predict the outcome of RCT, through the use of paper point sampling and fluorescence staining. This has reduced the prevalence of persistent infections by guiding the optimum time for obturation. ClinicalTrials.gov trial NCT03660163.

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BACKGROUND: The best treatment option for large caries in permanent posterior teeth is still a matter of uncertainty in dental literature. The authors conducted a network meta-analysis to address the challenges related to rehabilitation of these teeth. TYPES OF STUDIES REVIEWED: The authors selected prospective and retrospective studies that compared at least 2 different treatment alternatives for permanent teeth with a minimum of 5 years of follow-up. The authors searched databases from MEDLINE, Scopus, Cochrane Library, and Web of Science in October 2019 without language or year of publication restrictions. RESULTS: From 11,263 studies identified, 43 studies fulfilled the eligibility criteria and were included in the final review. Only 13 studies were randomized controlled trials and were classified as low risk of bias. Gold (annual failure rate of 0.29%) and metal ceramic (annual failure rate of 0.52%) crowns performed better for indirect restorations and direct resin composite performed better for direct restorations (annual failure rate of 2.19%). The most substantial comparisons were between feldspathic and glass ceramics, followed by direct resin composite and amalgam; there were no statistically significant differences between these interventions. Results of the pairwise meta-analysis showed mainly glass ionomer as significantly more prone to failure than amalgam and direct composite resin. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Reference standard direct and indirect materials except for glass ionomer can be used for restorations of large posterior caries.

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OBJECTIVE: This study aimed to assess the survival and success of glass fiber posts compared to cast metal posts in teeth without ferrule. MATERIAL AND METHODS: An equivalency, prospective, double-blind (patient and outcome evaluator) randomized controlled trial (RCT) with parallel groups was designed to compare the clinical performance of cast metal and glass fiber posts cemented in endodontically treated teeth without ferrule (NCT01461239). Teeth were randomly allocated to the glass fiber or cast-metal post groups. All teeth were restored with single metal-ceramic crowns. Kaplan-Meier analysis with the log-rank test was used to test the success and survival between glass fiber and cast metal posts considering a cut-off value of P = 0.05. The annual failure rates were calculated considering the survival data for all restorations and separated by type of post after five years. RESULTS: A hundred and nineteen patients and 183 posts (72 cast metal posts and 111 glass fiber posts) were analyzed. The median follow-up was 62 months (IQR 37-81). The log-rank test for success (P = 0.26) and survival (P = 0.63) analyses did not present statistically significant differences. The AFR of both posts after 5 years was 1.5%. Considering the posts separately and after 5 years, cast metal posts presented AFR of 1.2% and glass fiber posts AFR of 1.7%. Most failures were in posterior teeth (16/23), 10 failures were classified as root fractures and 5 as post debonding. The follow-up rate was 95.3%. CONCLUSIONS: Glass fiber and cast metal posts showed good and similar clinical performance. CLINICAL SIGNIFICANCE: Results of this randomized controlled trial can help dentists to answer how the best technique to rehabilitate endodontically treated teeth with no remaining coronal wall.

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BACKGROUND: A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). METHODS: Data on costs were collected via case report forms completed by clinical staff at every visit. The co-primary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. RESULTS: A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (- 0.06; 97.5% CI: - 0.14 to 0.02) and fewer episodes of dental pain and/or infection (- 0.14; 97.5% CI: - 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. CONCLUSIONS: The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. TRIAL REGISTRATION: The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047).

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Alveolar ridge preservation (ARP) therapy is indicated to attenuate the physiologic resorptive events that occur as a consequence of tooth extraction with the purpose of facilitating tooth replacement therapy. This randomized controlled trial was primarily aimed at testing the efficacy of ARP as compared with unassisted socket healing. A secondary objective was to evaluate the effect that local phenotypic factors play in the volumetric reduction of the alveolar bone. A total of 53 subjects completed the study. Subjects were randomized into either the control group, which involved only tooth extraction (EXT n = 27), or the experimental group, which received ARP using a combination of socket grafting with a particulate bone allograft and socket sealing with a nonabsorbable membrane (dPTFE) following tooth extraction (ARP n = 26). A set of clinical, linear, volumetric, implant-related, and patient-reported outcomes were assessed during a 14-wk healing period. All linear bone assessments (horizontal, midbuccal, and midlingual reduction) revealed that ARP is superior to EXT. Likewise, volumetric bone resorption was significantly higher in the control group (mean ± SD: EXT = -15.83% ± 4.48%, ARP = -8.36% ± 3.81%, P < 0.0001). Linear regression analyses revealed that baseline buccal bone thickness is a strong predictor of alveolar bone resorption in both groups. Interestingly, no significant differences in terms of soft tissue contour change were observed between groups. Additional bone augmentation to facilitate implant placement in a prosthetically acceptable position was deemed necessary in 48.1% of the EXT sites and only 11.5% of the ARP sites (P < 0.004). Assessment of perceived postoperative discomfort at each follow-up visit revealed a progressive decrease over time, which was comparable between groups. Although some extent of alveolar ridge remodeling occurred in both groups, ARP therapy was superior to EXT as it was more efficacious in the maintenance of alveolar bone and reduced the estimated need for additional bone augmentation at the time of implant placement (ClinicalTrials.gov NCT01794806).

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The purpose of this study was to determine the efficacy of a dental nurse-delivered intervention-the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)-in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children (n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents (n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child's general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention (n = 122) was a parent-nurse conversation about child's future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group's mean dmft was 6.8, and the control group's was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction (P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing-informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).

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INTRODUCTION: Dental anxiety is common and causes symptomatic use of oral health services. OBJECTIVES: The aim was to study if a short-term virtual reality intervention reduced preoperative dental anxiety. METHODS: A randomized controlled single-center trial was conducted with 2 parallel arms in a public oral health care unit: virtual reality relaxation (VRR) and treatment as usual (TAU). The VRR group received a 1- to 3.5-min 360° immersion video of a peaceful virtual landscape with audio features and sound supporting the experience. TAU groups remained seated for 3 min. Of the powered sample of 280 participants, 255 consented and had complete data. Total and secondary sex-specific mixed effects linear regression models were completed for posttest dental anxiety (Modified Dental Anxiety Scale [MDAS] total score) and its 2 factors (anticipatory and treatment-related dental anxiety) adjusted for baseline (pretest) MDAS total and factor scores and age, taking into account the effect of blocking. RESULTS: Total and anticipatory dental anxiety decreased more in the VRR group than the TAU group (ß = -0.75, P < .001, for MDAS total score; ß = -0.43, P < .001, for anticipatory anxiety score) in patients of a primary dental care clinic. In women, dental anxiety decreased more in VRR than TAU for total MDAS score (ß = -1.08, P < .001) and treatment-related dental anxiety (ß = -0.597, P = .011). Anticipatory dental anxiety decreased more in VRR than TAU in both men (ß = -0.217, P < .026) and women (ß = -0.498, P < .001). CONCLUSION: Short application of VRR is both feasible and effective to reduce preoperative dental anxiety in public dental care settings (ClinicalTrials.gov NCT03993080). KNOWLEDGE TRANSFER STATEMENT: Dental anxiety, which is a common problem, can be reduced with short application of virtual reality relaxation applied preoperatively in the waiting room. Findings of this study indicate that it is a feasible and effective procedure to help patients with dental anxiety in normal public dental care settings.

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