Objective: To train and validate a deep learning-based diagnostic tool capable of accurately segmenting the alveolar cleft region and automatically estimating the required bone graft volume using cone-beam computed tomography (CBCT) imaging.

Study Design: Eighty-eight CBCT scans from patients with non-syndromic unilateral clefts were divided into training (n = 45), validation (n = 10), and test (n = 33) sets. Two annotators performed manual segmentations, and the intersection of these served as the ground truth for training 3D U-Net models. The Dice Similarity Coefficient (DSC) was calculated to validate the tool by comparing manual and automated segmentations. Three observers evaluated the resulting deep learning model using 33 CBCT scans and performing subjective assessments in terms of shape and size.

Results: The DSC between the two annotators was 0.66, and between the automated and manual segmentations, 0.78. The observers considered the automated segmentations acceptable in 82%–94% of the cases. The deep learning-based tool took approximately 7 seconds to perform an automated segmentation, while manual segmentation by the annotators required 14 and 6.5 minutes.

Conclusion: The deep learning-based tool that was developed in the present study can accurately perform automated segmentations of unilateral alveolar clefts and estimate the required bone graft volume.

INTRODUCTION: This study is a part of a series of studies on a health and social care home-visit program in Sweden called Grow Safely. The program aimed to reduce health disparities in underprivileged areas. The current study evaluated home visits from Child Health Care and dental services that took place when the children were 8 months old and illuminated their parents' experiences of the home visits from both pediatric nurses and dental nurses.

METHODS: Interviews were conducted with 18 first-time families after they received the home visits. The interviews were analyzed using Burnard's approach to content analysis. Ethical approval from the Regional Ethical Committee in Lund, Sweden, was obtained before the study was conducted.

RESULTS: The results included three categories. The parents appreciated the home visits since both they and their baby felt comfortable and secure during the visits. They found the information about their child's development and the advice on good oral health valuable. They also valued the tailored information on how to ensure that their home was safe and secure for the child.

CONCLUSION: The first-time parents appreciated the extended home visits when the baby was 8 months old. Further studies are needed in order to evaluate the effect of these visits on oral health.

OBJECTIVES: The aim of this study was to investigate whether a low-dose cone-beam computed tomography (CBCT) protocol provides diagnostically acceptable image quality for assessing bone healing after alveolar bone grafting.

MATERIAL AND METHODS: The study cohort comprised 11 patients (aged 7-14 years) with orofacial clefts who had undergone alveolar bone grafting at Skåne University Hospital in Malmö, Sweden. During the postsurgical follow-up at 6 months, each patient was assessed twice: once with a standard-dose CBCT protocol and once with a low-dose CBCT protocol, which in total corresponds to one CBCT examination made with the exposure settings recommended by the manufacturer. Among others, the assessed parameters included subjective image quality, as well as bone graft height, thickness, and integration.

RESULTS: No significant differences were found between the standard- and low-dose protocols for most parameters (p > 0.05). Exceptions included subjective image quality (one observer, p = 0.05) and confidence levels during the assessment (three observers, p = 0.01, 0.01, 0.02).

CONCLUSIONS: The low-dose protocol yielded adequate image quality for postoperative CBCT healing assessment in patients who have undergone alveolar bone grafting. However, the confidence level of observers during the assessment with the low-dose protocol was reduced. This study is registered on ClinicalTrials.gov (NCT06395077).

CLINICAL TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT06395077).

Introduction: During development of dental caries, oral biofilms undergo changes in microbial composition and phenotypical traits. The aim of this study was to compare the acid tolerance (AT) of plaque from two groups of children: one with severe caries (CA) and one with no caries experience (CF) and to correlate this to the microbial composition and metabolic profile of the biofilms.

Methods: Dental plaque samples from 20 children (2–5 years) in each group were studied. The AT was analyzed by viability assessment after exposure to an acid challenge (pH 3.5), using LIVE/DEAD® BacLight™ stain and confocal microscopy. Levels of acid tolerance (AT) were evaluated using a scoring system ranging from 1 (no/low AT), to 5 (high/all AT). Metabolic profiles were investigated following a 20 mM glucose pulse for one hour through Nuclear Magnetic Resonance (NMR). Microbial composition was characterized by 16S rRNA Illumina sequencing.

Results: The mean AT score of the CA group (4.1) was significantly higher than that of the CF group (2.6, p < 0.05). When comparing the end-products of glucose metabolism detected after a glucose-pulse, the CA samples showed a significantly higher lactate to acetate, lactate to formate, lactate to succinate and lactate to ethanol ratio than the CF samples (p < 0.05). The bacterial characterization of the samples revealed 25 species significantly more abundant in the CA samples, including species of Streptococcus, Prevotella, Leptotrichia and Veillonella (p < 0.05).

Discussion: Our results show that AT in pooled plaque from the oral cavity of children with severe caries is increased compared to that in healthy subjects and that this can be related to differences in the metabolic activity and microbial composition of the biofilms. Thus, the overall phenotype of dental plaque appears to be a promising indicator of the caries status of individuals. However, longitudinal studies investigating how the AT changes over time in relation to caries development are needed before plaque AT could be considered as a prediction method for the development of dental caries.

Objectives: To determine pre-operative cleft volume and evaluate cleft´s impact on surrounding anatomical structures in children and adolescents with orofacial clefts using cone bean computed tomography (CBCT) imaging.

Methods: The present retrospective study retrieved CBCT examinations of 68 patients from a previous study. The examinations had been exposed either before (n = 53) or after (n = 15) alveolar bone grafting. Pre-operative volume of cleft was determined, and type and location were evaluated. Morphological changes on the adjacent anatomical structures, including the incisive foramen, the nasal septum and floor, and the inferior turbinate, were assessed.

Results: Mean bilateral cleft volume was 0.76 cm3, while mean unilateral cleft volume was 1.08 cm3; the difference was significant (p < 0.001). Variation in cleft volume, however, was large. The incisive foramen was not visible in the majority of cases with bilateral clefts (71%); the difference was significant (p = 0.001). In cases with unilateral clefts, the nasal septum in 87% was curved towards the cleft or graft side. Also, the mean size of the widest part of the inferior turbinate was 8.8 mm on the cleft or graft side and 10.4 mm on the non-cleft side. The difference was significant (p < 0.001).

Conclusions: When required, CBCT is a feasible method for quantitatively illustrating alveolar clefts and their impact on the morphological development of surrounding structures. Variation in cleft volume was large.

BACKGROUND: Preterm birth has been shown to cause various long-term health issues. Children who were born preterm have also been observed to have more dental behaviour management problems (DBMP) during dental examinations and treatment than children born full term. It is known that dental radiographic examinations can be uncomfortable and cause anxiety in paediatric patients. Thus, our aims were to retrospectively compare dental care related examinations and treatments carried out in three different age intervals (3-6 years, 7-12 years, and 13-19 years) among preterm- and full-term born children and adolescents.

METHODS: The present study included 311 patient files: 122 very preterm-born and 33 extremely preterm-born children and adolescents (&lt; 32 gestational weeks). A matched control group of 156 full term-born children and adolescents (≥ 37 gestational weeks) was analysed for comparison. Various factors, including DBMP, missed appointments, dental caries, and radiographic examinations, were retrieved from the dental records for three age intervals: 3-6 years, 7-12 years, and 13-19 years.

RESULTS: Extremely preterm-born children missed significantly more dental appointments and presented with more DBMP during dental examinations and treatment than full term-born children in the 3-6-year age group; the same was observed for the very preterm-born in the 7-12-year age group. No significant differences in DBMP during bitewing and periapical examinations or in number of bitewing, periapical and panoramic radiographs occurred between the groups in any age interval.

CONCLUSION: Preterm-born children and adolescents may need more flexibility in booking and receive reminders for scheduled visits with the general dental team. Due to the non-significant differences in dental care related oral examinations and treatments, the same dental care service may be applied to the preterm- and full-term born children and adolescents.

BACKGROUND: To evaluate oral health-related quality of life (OHRQoL) over a period of five years using the Oral Health Impact Profile (OHIP-14) questionnaire in a population of Swedish adolescents born preterm and full term.

METHODS: In a longitudinal study of adolescents aged 12-14 and 17-19, changes over time in OHRQoL were measured by using OHIP-14. The OHIP-14 score, self-reported chronic illness, temporomandibular disorder (TMD pain) and subjective orthodontic treatment need were compared between 98 extremely and very preterm born (< 32 gestational week) and 93 full-term controls (≥ 37 gestational week) at two ages. The chi-square test was used for comparisons within the extremely-, very-, and full-term control groups, and to contrast the differences of mean scores of OHIP-14, the ANOVA test was used for comparisons within the study groups of extremely preterm, very preterm and full term-born adolescents.

RESULTS: All adolescents reported a good self-perceived OHRQoL. No significant differences in the comparisons of the total mean scores were revealed between the groups, between gender or in domain-specific scores over the 5-year period. Very preterm adolescents with reported chronic illness at 12-14 years of age showed significantly higher mean scores of OHIP-14 compared with those without chronic illness (p = 0.015). At age 17-19, significantly higher mean scores of OHIP-14 were reported by very preterm adolescents with TMD pain compared to those without TMD pain (p = 0.024). Significantly higher mean scores of OHIP-14 were found among the extremely preterm (p = 0.011) and very preterm born adolescents (p = 0.031) with a subjective need of orthodontic treatment compared with those without orthodontic treatment need.

CONCLUSIONS: Poor OHRQoL measured with OHIP-14 in very preterm adolescents aged 12-14 was related to chronic illness and aged 17-19 to TMD pain. In addition, extremely and very preterm-born adolescents with subjective orthodontic treatment need at 17-19 years of age also reported poor OHRQoL. To improve the dentist-patient relationship and achieve more successful treatment results, it is important for dental clinicians to understand the impact that chronic illness, TMD pain and orthodontic treatment need has on OHRQoL in preterm-born adolescents.

This retrospective study investigated requests and indications for cone-beam computed tomography (CBCT) in children and adolescents over a 3-year period at one oral and maxillofacial radiology department. Specific aims were to determine what technical settings were used, which caregivers write the referrals, and how often and for what reasons re-exposure was necessary. Patients

OBJECTIVES: Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.

SETTING: The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.

PARTICIPANTS: Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.

RESULTS: Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.

CONCLUSIONS: The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.