Artículos (Estomatología)

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Sentinel lymph node biopsy for early-stage oral cavity cancer: analysis of diagnostic accuracy and false-negative cases
(MDPI, 2026-03-26) Lozano-Rosado, Rodrigo; De-Bonilla-Damia, A; Martin-Lozano, G; García-Perla García, Alberto; Gutiérrez Pérez, José Luis; Infante Cossío, Pedro Antonio; Cirugía; Estomatología; Instituto de Biomedicina de Sevilla (IBIS); CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial; CTS523: Innovación y Desarrollo en Técnicas y Fundamentos de Cirugía Bucal y Craneofacial
Background/Objectives: Identifying the causes of sentinel lymph node biopsy (SLNB) failure in early-stage oral cavity squamous cell carcinoma (OCSCC) is essential for refining surgical protocols and optimizing patient selection. This study aimed to evaluate the diagnostic performance, predictors of false-negative (FN) results, and long-term oncological outcomes of SLNB in patients with early-stage OCSCC. Methods: A retrospective, single-centre cohort study was conducted on 220 patients with cT1–cT2 N0 M0 OCSCC who were surgically treated between 2017 and 2024. Preoperative lymphatic mapping was performed using 99mTc-nanocolloid and SPECT/CT. All sentinel lymph nodes (SLNs) underwent an ultrastaging protocol involving serial sectioning and immunohistochemistry. Diagnostic accuracy, survival outcomes, and clinicopathological predictors of FNs were analysed. Results: The SLN identification rate was 99.1%. Metastatic involvement was detected in 49 patients (22.3%), preventing 77.7% of the cohort from undergoing unnecessary neck dissection. Bilateral lymphatic drainage was observed in 55.9% of floor of the mouth tumours. During a median follow-up of 36 months, the diagnostic performance showed a sensitivity of 81.7%, a negative predictive value of 93.6%, and an overall accuracy of 95.0%. Analysis of the 11 FN cases showed that both depth of invasion (DOI) (6.0 mm vs. 3.0 mm; p = 0.010) and maximal tumour dimension (25 mm vs. 15 mm; p = 0.0008) were significant predictors of diagnostic failure. The five-year overall survival rate was significantly superior in patients with negative SLNs compared to the SLN-positive group (82% vs. 61%; p < 0.001). Conclusions: SLNB is an accurate and reliable staging tool for early-stage OCSCC, providing personalised lymphatic mapping that harmonizes oncological efficacy with the avoidance of overtreatment. However, an increased DOI and a larger tumour size significantly raise the risk of FN events, indicating the need for close postoperative surveillance in these high-risk subgroups.
Risk factors for false-negative results in sentinel lymph node biopsy for early-stage oral cavity cancer: a scoping review
(MDPI, 2026-06-16) Lozano-Rosado, Rodrigo; Torres-Carranza, Eusebio; García-Perla García, Alberto; Gutiérrez Pérez, José Luis; Infante Cossío, Pedro Antonio; Cirugía; Estomatología; CTS142: Patología Morfolog. y Func. del Territorio Oral y Maxilofacial; CTS523: Innovación y Desarrollo en Técnicas y Fundamentos de Cirugía Bucal y Craneofacial
Background and objectives: Sentinel lymph node biopsy (SLNB) has become the standard approach for cervical staging in patients with early-stage oral cavity squamous cell carcinoma (OCSCC). Although it demonstrates diagnostic accuracy exceeding 90% in referral centres, the occurrence of false-negative (FN) results undermines oncological safety and adversely impacts patient prognosis. This scoping review aims to synthesise and evaluate the scientific evidence regarding the risk factors and technical errors that underpin FN incidence. Methods:A systematic search was conducted across MEDLINE (PubMed), Scopus and Web of Science for studies published between 2000 and 2025, adhering to PRISMA-ScR guidelines. Primary clinical and observational studies specifically addressing the variables and aetiology of diagnostic failure in SLNB for early-stage OCSCC (cT1-T2 N0) were included. Results:Twenty-seven studies were included in the final qualitative synthesis. Four critical domains characterising FN risk were elucidated, facilitating risk-stratified selection and surveillance strategies: (1) Clinical and tumour factors: Depth of invasion >4–5 mm, T3–T4 tumour size, and prior cervical anatomical disruption. (2) Surgical factors: Insufficient sentinel lymph node (SLN) harvest (≤2 SLNs), lack of exhaustive lymphatic basin exploration, the initial learning curve, and the exclusive use of non-isotopic tracers. (3) Anatomical factors: Floor of the mouth tumours and the radioactive shine-through effect. (4) Histopathological protocol: Suboptimal ultrastaging, insufficient frozen section biopsy, and limitations in rapid molecular techniques. Overall, studies using standardised protocols report a false-negative rate between 5% and 15%. Conclusions: FN events in SLNB are multifactorial and predictable phenomena, arising from cumulative vulnerabilities along the diagnostic continuum. The technique achieves an optimal diagnostic yield in cT1–T2 N0 cases without prior cervical treatment when applied under optimal conditions. However, methodological heterogeneity in the literature limits the interpretation of the results and partially constrains their clinical application.
From clinical findings to treatment willingness: self-perception of smile aesthetics among dental students—a cross-sectional study
(MDPI, 2026-10-01) Nicolas-Silvente, Ana Isabel; Jiménez Guerra, Álvaro; Carazo-Austro, Marta; Austro-Martínez, María Dolores; Estomatología; CTS618: Investigación y Clínica en Implantología Oral
Background: Objective smile characteristics do not necessarily determine how individuals perceive their own dental appearance or whether perceived concerns translate into treatment willingness. This study investigated the relationship between clinical findings, self-perception, and treatment attitude across ten smile characteristics in final-year dental students. Methods: This cross-sectional study included 116 students who underwent standardized clinical and photographic assessment and independently evaluated the same smile characteristics and their willingness to receive treatment. Clinical–perceptual agreement was examined using Cohen’s κ and Gwet’s AC1. Multivariable logistic regression assessed whether cumulative self-perceived concerns were associated with overall smile dissatisfaction. Results: Sixty-eight participants (58.6%) reported at least one concern. Clinical–perceptual correspondence was feature-dependent. Agreement was high for position/alignment (93.1%; κ = 0.852; AC1 = 0.871) but considerably lower for central-incisor proportion (64.7%; κ = 0.167; AC1 = 0.446); notably, 41 of 48 participants outside the prespecified 77–83% interval reported no concern about tooth size. Treatment willingness was high for concerns about shade and alignment but low for concerns about tooth size and shape. Each additional self-perceived concern was associated with higher odds of overall smile dissatisfaction (adjusted OR = 6.48; 95% CI, 3.13–13.41; p < 0.001). Conclusions: Clinical deviation, self-perceived concern, and treatment willingness were not interchangeable constructs. Their relationship was strongly feature-dependent, supporting smile assessment that integrates clinical findings with the individual’s perception and treatment preferences.
Human amniotic epithelial stem cells and osteoblast cells behavior on collagen membranes for bone guided regeneration
(MDPI, 2026-07-26) Pérez Pérez, Antonio; Gil, Javier; Bueno-Bianchi, Isabela; Monsalve Guil, Loreto; Ortiz García, Iván; Jiménez Guerra, Álvaro; Núñez Márquez, Enrique; Velasco-Ortega, Eugenio; Rondón Romero, José Luis; Sánchez Margalet, Víctor; Moreno Muñoz, Jesús; Bioquímica Médica y Biología Molecular e Inmunología; Estomatología; Gobierno español y Ministerio de Ciencia e Innovación de España; CTS151: Bioquímica Medica; CTS618: Investigación y Clínica en Implantología Oral
Guided bone regeneration (GBR) heavily relies on barrier membranes, with collagen being the clinical standard material. Human amniotic epithelial cells (hAECs) represent a promising, non-controversial stem cell source with substantial osteogenic and immunomodulatory potential. This study aimed to comparatively evaluate the structural characteristics of three commercial collagen membranes (Biocollagen®, Derma®, and VantyColl®) and their influence on the biological behavior, viability, and osteogenic differentiation of hAECs and hFOB 1.19 human fetal osteoblasts. The microarchitecture was assessed via scanning electron microscopy (SEM). Biological response was evaluated over 14 days, using MTT assays, calcium and phosphorus quantification, alkaline phosphatase (ALP) activity, and quantitative real-time PCR (qRT-PCR) for osteogenic markers (Runx2, Osterix, ALP, and OPN). SEM revealed a dense lamellar structure for Biocollagen®, a fibrillar and oriented architecture for Derma®, and a highly porous network for VantyColl®. Both cell types adhered to and proliferated on all membranes. Derma® provided the best long-term proliferative support for both lineages. Conversely, VantyColl® induced robust early osteoblastic differentiation, marked by exceptional upregulation of Osterix (24.93-fold) and Runx2 (2.64-fold), though it exhibited diminished long-term hAEC viability. Ultimately, collagen membrane microarchitecture dictates cell fate; dense fibrillar networks (Derma®) favor sustained growth and late matrix maturation (OPN), whereas high-porosity scaffolds (VantyColl®) amplify early osteoinductive cascades.
Influence of imaging modality on the detection of periapical lesions in root-filled teeth: a systematic review and meta-analysis
(Wiley, 2026) Segura Egea, Juan José; Segura-Raya, C; Martín González, Jenifer; Cabrera Fernández, Alberto; Areal Quecuty, Victoria; Cabanillas Balsera, Daniel; Estomatología; CTS941: Patología Dentaria, Operatoria Dental y Endodoncia
Background: Apical periodontitis is a common finding in root-filled teeth (RFT) and an important indicator of treatment outcomes. Its reported prevalence may vary depending on the imaging modality used for diagnosis. Objectives: To estimate the prevalence of periapical lesions in RFT teeth and to assess the influence of imaging modality on these estimates: METHODS: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261320661). Electronic databases (PubMed, Scopus, Web of Science and Embase) were searched up to February 2026. Studies reporting the prevalence of periapical lesions in endodontically treated permanent teeth assessed using cone-beam computed tomography (CBCT), periapical radiography or panoramic radiography were included. Random-effects meta-analyses (DerSimonian-Laird) with logit-transformed proportions were used to estimate pooled prevalence at tooth and patient levels. Subgroup analyses and meta-regression explored the impact of imaging modality. Risk of bias was assessed using an adapted prevalence tool, and certainty of evidence was evaluated using GRADE. Results: Fifty-seven studies were included, comprising 64 026 root-filled teeth and 35 569 patients. The pooled prevalence of periapical lesions was 41.3% (95% CI: 38.2%-44.6%) at the tooth level and 20.5% (95% CI: 9.3%-39.4%) at the patient level. Higher detection rates were observed in studies using CBCT compared with most two-dimensional techniques. However, meta-regression showed that combined panoramic and periapical radiography produced estimates comparable to CBCT, while each modality alone yielded significantly lower values. No significant differences were found when imaging methods were grouped as two-dimensional versus three-dimensional. Substantial heterogeneity was present (I2 = 98%-99%), and potential publication bias was suggested (Egger's test, p = 0.048). Most studies showed moderate risk of bias, with low to very low certainty of evidence. Conclusions: Periapical lesions are highly prevalent in endodontically treated teeth. Although imaging modality influences prevalence estimates, improved detection does not rely exclusively on three-dimensional imaging. Combining two-dimensional techniques may achieve comparable results to CBCT, emphasizing the importance of diagnostic strategy. Further high-quality studies with standardized criteria are needed.
Predicting return-to-work outcomes: A comparative analysis of logistic regression and machine learning in occupational mental health
(Lippincott williams & wilkins; Ovid Technologies (Wolters Kluwer Health), 2026-07-24) Dias, Adriano; Nunes, Hélio Rubens de Carvalho; Ruiz-Frutos, Carlos; Gómez-Salgado, Juan; Alonso, Melissa Spröesser; Bernardes, João Marcos; Castaño Seiquer, Antonio Luis; Ribas Pérez, David; Lacalle Remigio, Juan Ramón; Estomatología; Medicina Preventiva y Salud Pública; CTS353: Estomatología Infantil y Ortodoncia; CTS312: Análisis de la Demanda Sanitaria
This investigation compares the analytical performance of logistic regression (LR) and targeted maximum likelihood estimation (TMLE) methodologies for occupational health research using simulated workforce data. The study employs a simulation framework based on empirical observations from 738 Brazilian public university employees, generating a reference population of 10,000 cases with predetermined distributions of 2 critical exposure variables and some covariables. Through systematic sampling across multiple sample sizes (150-5000 observations), the research evaluates the comparative efficacy of traditional regression techniques versus TMLE framework. Key findings revealed important differences between the methods. For analyzing changes in diagnosis chapters, LR consistently produced more accurate estimates, with odds ratios (ORs) closer to the true population value (0.28) compared with TMLE (0.44-0.46). The precision of LR estimates, as measured by root mean squared error, was significantly better, especially in larger samples (0.02 vs 0.16 at n = 5000). The analysis of mental health conditions showed more complex results. While LR estimates were initially unstable in small samples, they converged to the true OR (27.35) as sample size increased. TMLE produced more stable but consistently conservative estimates across all sample sizes (ORs = 15-17). Notably, TMLE confidence intervals only included the true population value in the smallest sample (n = 150), suggesting potential limitations in its application for this type of analysis. These findings carry significant implications for occupational health research methodology. The results challenge prevailing assumptions about TMLE framework automatic superiority, demonstrating that conventional regression techniques can outperform more complex approaches in specific epidemiological contexts. The study highlights the continued relevance of LR for analyzing occupational health outcomes, particularly when investigating well-defined exposure-outcome relationships with adequate sample sizes. The research contributes to methodological literature by providing empirical evidence for analytical decision-making in public health research context
Independent predictors of endodontic treatment preference in a mixed NHS/private UK dental practice: a cross-sectional study
(Nature publishing group; Nature portfolio; Springer Science and Business Media LLC, 2026-09-04) Sofian-Pauliuc, Iuliana; Castaño Seiquer, Antonio Luis; Ribas Pérez, David; Barbero Navarro, Ignacio; Estomatología; CTS353: Estomatología Infantil y Ortodoncia; HUM561: Investigación Suroeste
To identify independent predictors of self-reported patient preference for Root Canal Treatment (RCT) versus tooth extraction in a mixed NHS/ private UK dental practice, using multivariable logistic regression to determine which demographic, cognitive-sensory, and economic factors remain independently associated with preference after simultaneous adjustment for all candidate predictors. A cross-sectional consecutive convenience sample of adult patients attending a mixed NHS/private dental practice in the East Midlands, UK (July–November 2025). Sample size was calculated a priori (95% confidence level, 5% margin of error, 50% conservative proportion; minimum n = 132; target n = 155). A 22-item questionnaire, assessed for face and content validity, was administered electronically via QR-linked Microsoft Forms (n = 141 valid responses; 97.3% response rate). Nine predictors were examined by multivariable binary logistic regression (IBM SPSS v31): age, gender, prior information of RCT, perceived procedural pain, dental fear, aesthetic importance, trust in the dentist, and willingness to pay for RCT. Pearson chi-square and Fisher’s Exact Test (2-sided) were used for univariable screening. Of 141 valid responses (68 males [48.2%], 73 females [51.8%]), 32.6% preferred RCT and 67.4% preferred extraction. In univariable analysis, only willingness to pay was significantly associated with treatment preference (Fisher’s exact p = 0.021). The multivariable model was statistically significant (χ² (12) = 24.564, p = 0.017) with good calibration (Hosmer-Lemeshow p = 0.605), explaining 22.3% of variance (Nagelkerke R² = 0.223) and correctly classifying 70.9% of cases. Three independent predictors emerged after full adjustment: perceived procedural pain (OR = 0.335, 95% CI 0.141–0.792, p = 0.013; deterrent), prior information of RCT (OR = 2.435, 95% CI 1.066–5.563, p = 0.035; facilitator), and age: patients aged 35–44 (OR = 0.272, 95% CI 0.084–0.882, p = 0.030), 45–54 (OR = 0.280, 95% CI 0.083–0.948, p = 0.041), and 55–65 years (OR = 0.252, 95% CI 0.071–0.895, p = 0.033) were 72–75% less likely to prefer RCT than the ≥ 65 reference group. Patients aged 18–34 did not differ from the oldest cohort (≥ 65 reference group). Willingness to pay showed a nonsignificant trend after adjustment (OR = 8.068, p = 0.056). This pilot study provides preliminary evidence that self-reported preference for RCT versus extraction in this UK setting is independently determined by perceived procedural pain, patient knowledge, and mid-adult cohort attitudinal effects. These findings are hypothesisgenerating and require replication in adequately powered multicentre samples; patient education targeting pain misconceptions and attitudinal barriers may improve tooth preservation rates in similar UK populations. These preliminary findings suggest that patient education targeting perceived procedural pain and RCT misconceptions may be particularly relevant in UK general dental practice settings. Given the exploratory nature of this pilot study and the non-significant omnibus age test, targeted age-specific clinical recommendations require confirmation in adequately powered replication studies before clinical implementation.
Radiographic Changes Following Regenerative Endodontic Treatment in Immature Permanent Teeth with Traumatic or Carious Pulp Necrosis: A Retrospective Study
(MDPI, 2026-09-03) Caleza Jiménez, Carolina; Biedma Perea, María; Arenas-González, Marcela; Curto-Aguilera, Adrián; Mendoza Mendoza, María Asunción; Rivas Pérez, David; Estomatología; CTS353: Estomatología Infantil y Ortodoncia
Objective: To compare radiographic changes following regenerative endodontic procedures in immature permanent teeth with pulp necrosis of traumatic or carious origin. Methods: A retrospective study was conducted in 20 immature permanent teeth from 20 patients (10 traumatic and 10 carious cases) treated with a standardized regenerative endodontic protocol. Root length, dentinal wall thickness, periapical status, and type of repair were assessed using standardized periapical radiographs at baseline and 12 months. Radiographs were independently evaluated by two investigators blinded to etiology, and inter-examiner agreement for type of repair was assessed using Cohen’s kappa. Results: No statistically significant differences were found in root-length change between the groups. A statistically significant greater increase in dentinal wall thickness was observed in the carious group compared with the traumatic group; however, the groups differed substantially in tooth type. No statistically significant differences were observed in Periapical Index scores after 12 months of follow-up, and periapical healing (PAI 1–2) was observed in all cases. Periodontal-associated repair was observed in all traumatic cases, whereas pulpal-associated repair was observed in all carious cases. Conclusions: Regenerative endodontic procedures were associated with favorable radiographic outcomes in immature permanent teeth with pulp necrosis of traumatic or carious origin. However, the small sample size, short follow-up, absence of a control group, and substantial differences in tooth type between etiological groups limit causal interpretation of the observed differences.
Risk of Permanent Dental Staining Following Exposure to Newer-Generation Tetracycline Derivatives in Children: A Systematic Review and Meta-Analysis
(MDPI, 2026-08-02) Machuca Portillo, María del Carmen; Suárez Marchena, Cira María; Chandler, Lucy; Barra Soto, María José; Caleza Jiménez, Carolina; López del Valle, Lydia; Segura Egea, Juan José; Estomatología; CTS941: Patología Dentaria, Operatoria Dental y Endodoncia; CTS353: Estomatología Infantil y Ortodoncia; CTS113: Investigación, Etiología y Patogenia Periodontal, Patología Oral y Enfermedades Musculares
Background/Objectives: Historical concerns regarding permanent dental staining have restricted the use of tetracycline antibiotics in children younger than 8 years. However, newer-generation tetracycline derivatives, particularly doxycycline, differ pharmacologically from first-generation tetracyclines and may present a lower risk of discoloration. This systematic review and meta-analysis evaluated the risk of dental staining associated with newer-generation tetracycline derivatives. Methods: It was conducted according to the PRISMA 2020 statement and registered in PROSPERO. PubMed/MEDLINE, Scopus, and Embase were searched. Methodological quality was assessed, and the certainty of evidence using the GRADE approach. A random-effects meta-analysis of comparative studies was performed using the risk difference (RD) as the summary effect measure. Results: Six observational studies fulfilled the eligibility criteria. Three studies reported no cases of dental staining following doxycycline exposure, whereas one study identified parent-reported discoloration in 2 of 18 evaluated children (11.1%). Dental staining was reported in 2 of 41 children (4.9%) treated with minocycline and in 2 of 12 children (16.7%) with tigecycline. Meta-analysis of the three comparative studies demonstrated no significant increase in the risk of dental staining among exposed children compared with controls (RD = 0.007; 95% CI −0.015 to 0.028; I2 = 0%). Methodological quality ranged from moderate to high. According to GRADE, the certainty of evidence was low for doxycycline/minocycline and very low for tigecycline. Conclusions: Current evidence, although limited, suggests that short-course doxycycline is associated with little or no clinically relevant risk of permanent dental staining in children younger than 8 years. In contrast, the available evidence for minocycline and tigecycline remains insufficient to establish their dental safety.
Parental acceptance of passive protective stabilization during pulp therapy in primary and young permanent dentition: a systematic review and meta-analysis
(MDPI, 2026-03-13) Caleza Jiménez, Carolina; Suárez Marchena, Cira María; Chandler, Lucy; Segura Egea, Juan José; Machuca Portillo, María del Carmen; Estomatología; CTS353: Estomatología Infantil y Ortodoncia; CTS113: Investigación Etiología y Patogenia Periodontal, Patología Oral y Enfermedades Musculares; CTS941: Patología Dentaria, Operatoria Dental y Endodoncia
Background: Passive protective stabilization (PPS) remains controversial in pediatric dentistry, particularly in invasive procedures such as pulp therapy. This systematic review and meta-analysis aimed to evaluate current parental acceptance of PPS. Methods: A systematic search of PubMed/MEDLINE, Cochrane Library, Scopus, and Embase was conducted up to 25 November 2025. Cross-sectional studies assessing parental acceptance of PPS in children aged 2-10 years were included. Studies published in English within the last 10 years and including at least 100 participants were eligible. Case reports, reviews, editorials, and studies not aligned with the objectives were excluded. Risk of bias was assessed using the Joanna Briggs Institute checklist. A random-effects meta-analysis with logit transformation was performed. Heterogeneity was quantified using I2 statistics. Certainty of evidence was evaluated using GRADE. Results: Five cross-sectional studies, including 1005 parents, were included. The pooled parental acceptance of PPS was 48.9% (95% CI: 29.0-69.2%), with substantial heterogeneity (I2 = 97%). Acceptance was consistently higher in emergency situations and among parents of children with special health care needs. Three studies showed low risk of bias and two moderate risk. The overall certainty of evidence was rated as very low due to inconsistency and imprecision. Conclusions: Parental acceptance of PPS is context-dependent and influenced by treatment urgency and patient characteristics. Given the high heterogeneity and low certainty of evidence, results should be interpreted cautiously. Further high-quality research is required.
Antibiotic prescribing patterns for pulpitis in pediatric dentistry: a systematic review and meta-analysis
(MDPI, 2026-06-26) Machuca Portillo, María del Carmen; Suárez Marchena, Cira María; Chandler, Lucy; Barra Soto, María José; López-del Valle, Lydia; Segura Egea, Juan José; Estomatología; BIO113: Mecanismos de Muerte Celular en Enfermedades Neurodegenerativas; CTS353: Estomatología Infantil y Ortodoncia; CTS941: Patología Dentaria, Operatoria Dental y Endodoncia
Background: Pulpitis is a common cause of dental pain in children and is primarily an inflammatory condition that can be effectively managed with local operative treatment. Although antibiotics are indicated only in cases of systemic involvement or infection spread, they are frequently overprescribed in dental practice. This misuse contributes to antimicrobial resistance and adverse health outcomes. This systematic review aimed to evaluate antibiotic prescribing practices for pulpitis in pediatric patients and to assess adherence to current clinical guidelines. Methods: A systematic review was conducted in accordance with the PRISMA 2020 statement and registered in PROSPERO (CRD420261342269). A comprehensive search was performed in PubMed/MEDLINE, Scopus, and Embase up to March 2026. Observational studies assessing antibiotic prescribing practices among pediatric dentists were included. A meta-analysis of proportions was conducted using a random-effects model. Risk of bias was assessed using the Joanna Briggs Institute Checklist, and certainty of evidence was evaluated using the GRADE approach. Results: Five cross-sectional studies were included. Antibiotic prescribing rates for pulpitis ranged from 0.6% to 50.0%. The pooled prevalence of antibiotic prescribing was 14.0% (95% CI: 5.0–33.5%), with high heterogeneity across studies (I2 = 95%). Amoxicillin and amoxicillin–clavulanic acid were the most commonly prescribed first-line antibiotics, while clindamycin was the most frequently reported alternative in patients with penicillin allergy. Treatment duration was generally consistent, ranging from 5 to 7 days. Conclusions: Although pediatric dentists tend to prescribe antibiotics more conservatively than general practitioners, inappropriate use remains prevalent, particularly in conditions such as pulpitis where antibiotic therapy is not indicated. These findings highlight a persistent gap between evidence-based recommendations and clinical practice and underscore the need for targeted antimicrobial stewardship strategies to optimize antibiotic use in pediatric dentistry.
Effectiveness in remineralizing white spot lesions in primary teeth with varnishes: a systematic review
(WILEY, 2026-07-08) Caleza Jiménez, Carolina; Biedma Perea, María; Ribas Pérez, David; Barra Soto, María José; Arenas-González, Marcela; Estomatología; CTS353: Estomatología Infantil y Ortodoncia
Objectives: This systematic review aims to assess the effectiveness of varnishes for the remineralization of white spot lesions in primary teeth. Methods: A database search was conducted in MEDLINE and the Cochrane Library to screen for articles relevant to the topic of the review. Risks of bias in randomized studies were assessed using the ROB2 tool and GRADE evidence levels. Results: Seven studies met all inclusion criteria and were included. Differences in varnish composition and characteristics can affect the anticaries properties. Bioactive additives had a statistically significant reduction in ICDAS scores. Conclusions: Intensive application of remineralizing varnishes demonstrated a significant effect on the remineralization and control of carious lesion activity. New‐generation fluoride appear to be more effective than conventional sodium fluoride varnishes.
Age-related differences in dynamic occlusion patterns in subjects with natural dentition
(MDPI, 2026-06-22) López Frías, Francisco Javier; Ribas Pérez, David; Barbero Navarro, Ignacio; Torrejón Martínez, Julio; El Khoury Moreno, Luis; Rosel, Eva; Castaño Seiquer, Antonio Luis; Estomatología; CTS353: Estomatología Infantil y Ortodoncia; HUM561: Investigación Suroeste
The selection of an appropriate occlusal pattern for prosthodontic and orthodontic rehabilitation remains a subject of ongoing debate within the scientific literature. A potential resolution to this controversy involves investigating the prevalence of various dynamic occlusal schemes in the natural permanent dentition. This cross-sectional study was designed to assess the typical dynamic occlusion patterns observed in both younger and older populations and to examine whether these patterns are influenced by age. The study included a total of 207 participants possessing natural dentition with no prosthetic restorations. The age of the individuals ranged from 15 to 73 years. Dynamic occlusal patterns were recorded in all participants through a clinical assessment of lateral and protrusive mandibular excursions guided by the teeth. Dynamic occlusion was categorized into five types: (O1) bilateral canine guidance, (O2) unilateral canine guidance, (O3) group function, (O4) balanced occlusion, and a category labeled “other occlusions” (O5). The overall distribution of occlusal patterns was similar between male and female participants. “The aim of this study was to evaluate the prevalence of dynamic occlusal patterns in subjects with natural dentition and to determine whether these patterns are associated with age.” Because occlusal wear accumulates throughout life, it was hypothesized that the prevalence of canine-guided occlusion would decrease with age, while group function occlusion would become more frequent. The study group consisted of 207 patients, 112 women (54.1%) and 95 men (45.9%), ranging in age from 15 to 73 years (mean = 32.79 ± 13.87). Informed consent was first explained to the participants, who then signed a consent form. We performed Pearson’s chi-square test to determine the association between demographic variables (gender and/or age) on the dynamic occlusion models (DINs) described above. The association between age groups and occlusal patterns was assessed using Pearson’s chi-squared test. The strength of the association was estimated using Cramer’s V coefficient. A p-value < 0.05 was considered statistically significant. The analysis using Pearson’s chi-squared test did not show a statistically significant association between age groups and dynamic occlusion patterns (χ2 = 15.17; df = 12; p = 0.232). The effect size, assessed using Cramer’s V coefficient, was 0.156, indicating a weak association between the two variables. Although descriptive differences were observed in the distribution of some occlusal patterns among the age groups, these differences did not reach statistical significance.
Salivary estrone and estradiol are associated with oral microbiome profiles in aging women
(Taylor & francis LTD, 2026-06-21) J. Rus, María; R. Nieto, María; Oh, Hyo Jung; Yoo, Hosuon; Areal Quecuty, Victoria; Duarte Faria, Flavio; Lendines-Cordero, Debora; Simon-Soro, Aurea; Estomatología; Centro Andaluz de Investigaciones en Biología Molecular y Medicina Regenerativa (CABIMER); Ministerio de Ciencia e Innovación de España; CTS941: Patología Dentaria, Operatoria Dental y Endodoncia
Objectives: To explore whether salivary estrogens (estrone and estradiol) are associated with oral microbiome composition in aging women, and to assess the oral cavity as a potential sentinel of systemic hormonal changes during midlife. Materials and methods: Cross-sectional study including 30 women aged 40-65 years. Saliva and microbial specimens were collected from four oral ecological niches (buccal mucosa, tongue dorsum, supragingival plaque, subgingival plaque). Microbiome composition and diversity were assessed by 16S rRNA gene sequencing, ecological indices, and co-occurrence network analysis. Salivary estrone and estradiol were quantified, and associations with oral health and microbial profiles were evaluated. Results: Estrone levels declined significantly with age and were associated with hyposalivation and lower oral health scores. Estrone was linked to increased microbial diversity on the tongue dorsum and enrichment of taxa such as Porphyromonas. In contrast, estradiol was positively associated with commensal genera (Streptococcus, Lactobacillus) and negatively with periodontal-associated taxa (Fusobacterium, Prevotella). Co-occurrence networks revealed niche-specific microbial shifts associated with estrogen levels. Conclusions: Salivary estrogens, particularly estrone, shape oral microbial communities in aging women. The oral cavity may act as a window into systemic hormonal changes, supporting its role as a non-invasive sentinel of women's health during midlife.
Actualizaciones en la detección precoz de la osteoporosis
(Ediciones Avances, S.L., 2014) Corcuera Flores, José Ramón; Manso Platero, Francisco José; Martínez Maestre, María Ángeles; Machuca-Portillo, Guillermo; Cirugía; Estomatología; CTS1000: Odontología en Pacientes Especiales, Médicamente Comprometidos y Hospitalaria
La osteoporosis es una enfermedad sistémica del esqueleto, con amplia prevalencia sobre todo en mujeres postmenopáusicas. La ortopantomografía (OPMG) es una técnica radiológica de uso generalizado en las consultas de los odontólogos. En el presente estudio se hace una revisión de trabajos en los que, utilizando una serie de índices como: Mandibular Cortical Index (MCI), Mental Index (MI), Panoramic Mandibular Index (PMI), Antegonial Index (AI), Gonial Index (GI), medidos sobre OMPG se plantea la hipótesis de poder detectar precozmente la osteoporosis por este medio. Los resultados expuestos en los diferentes estudios avalan esta hipótesis y así se podrá remitir a los pacientes al especialista para que se les haga un estudio más exhaustivo sobre dicha patología.
Association between e-cigarette use (vaping) and oral health in adolescents and young adults: a systematic review
(MDPI, 2026-05-18) Machuca Portillo, María del Carmen; Caleza Jiménez, Carolina; Suárez Marchena, Cira María; Chandler, Lucy; Relimpio-Pérez, P; Barra Soto, María José; López-del Valle, L; Segura Egea, Juan José; Estomatología; CTS113: Investigación Etiología y Patogenia Periodontal, Patología Oral y Enfermedades Musculares; CTS353: Estomatología Infantil y Ortodoncia; CTS941: Patología Dentaria, Operatoria Dental y Endodoncia
Background: Vaping has become one of the most prevalent risk behaviors among adolescents and young adults worldwide. Although electronic cigarettes (ECs) are often perceived as safer than conventional tobacco, concerns regarding their impact on oral health are increasing. This systematic review aimed to critically evaluate and synthesize the available evidence regarding the association between e-cigarette use and oral health outcomes in adolescents and young adults. Methods: A systematic search of PubMed/MEDLINE, EMBASE, Scopus, and EBSCOhost databases was conducted for observational studies published within the last ten years. Studies evaluating oral health outcomes among adolescents and young adults were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies, and certainty of evidence was graded using the GRADE approach. Results: Eight observational studies met the inclusion criteria and were included in the qualitative synthesis. E-cigarette use was associated with increased caries risk, higher prevalence of gingival inflammation, alterations in salivary flow and pH, changes in oral microbiota-including increased levels of Porphyromonas gingivalis-and elevated frequencies of micronuclei in oral mucosal cells. Four studies were rated as having low risk of bias and four as moderate risk. The overall certainty of evidence was low for all outcomes due to methodological limitations, heterogeneity in outcome assessment, and inadequate control of confounding factors, including dual use of combustible tobacco products. Conclusions: Current evidence may suggest a possible association between e-cigarette use and adverse oral health alterations in adolescents and young adults. However, given the low certainty of evidence, residual confounding, and the predominance of cross-sectional designs, causal relationships cannot be established. Well-designed longitudinal studies that clearly differentiate exclusive e-cigarette users from dual users and adequately adjust for behavioral confounders are required to clarify the independent impact of vaping on oral health in this vulnerable population.
Oral health indicators and dental care utilization patterns among adults in a context of social vulnerability (Polígono Sur, Seville)
(Frontiers media SA, 2026-06-03) Fajardo, Camila; Rodríguez Menacho, Diego; Moreno Barrera, Alejandro; Castaño Seiquer, Antonio Luis; Ribas Pérez, David; Estomatología; CTS353: Estomatología Infantil y Ortodoncia
Introduction: Access to quality dental services continues to be a challenge for individuals living in contexts of social exclusion. In the Polígono Sur area of Seville, the high socioeconomic vulnerability of the population highlights the need to identify barriers to access and to provide evidence for the development of more inclusive public policies. Objective: To describe the oral health status of a group of adults enrolled at the CEPer Polígono Sur, considering sociodemographic, clinical, and access-tocare aspects. Materials and methods: A descriptive cross-sectional study was conducted among 120 adults enrolled at the Centro de Educación Permanente (CEPer) Polígono Sur. Data were collected using an oral health survey based on the model proposed by the World Health Organization (WHO). Results: Ninety-four percent of the sample reported brushing their teeth at least once per day. Thirty percent had not visited a dentist recently, and 10% had never visited one, mainly individuals from Africa. Fifty-three percent experienced oral discomfort with varying intensity and frequency during the past year, of whom 17% reported it as “very frequent.” The overall DMFT index was 7.65. Forty-eight percent of the sample required some type of prosthetic treatment, particularly those aged 45–64 years. Conclusions: The demand for preventive education in this neighborhood is high. The overall experience of dental caries among adults is relatively low, with a high proportion of untreated dental caries (D component of DMFT) in younger individuals and extractions among older adults. Nearly half of the population experiences unmet prosthetic needs and lack of oral rehabilitation.
Effectiveness of virtual reality as a behavioural management method in children during dental visits: a systematic review
(Frontiers media SA, 2026-06-04) Ra'ed-Naser, Rand; Arenas-González, Marcela; Biedma Perea, María; Barra Soto, María José; Caleza Jiménez, Carolina; Ribas Pérez, David; Estomatología; CTS353: Estomatología Infantil y Ortodoncia
Importance: Behaviour management techniques converge on the fundamental aim of facilitating the child´s adaptation by promoting familiarity and gradual desensitisation, thereby reducing stress levels and enhancing cooperation during dental procedures. Objective: This study aimed to evaluate the use of virtual reality (VR) as a behavioural management technique to reduce anxiety in paediatric patients during dental treatments. Methods: A research strategy was conducted including articles that have been published in the past 5 years using MeSH Terms in five different databases (PubMed, Scopus, ScienceDirect, EMBASE, and Web of Science). The studies included in the review involved children under 17 years old who used virtual reality to control their anxiety in the dental clinic. Results: The use of VR in paediatric dentistry improved behaviour in children with higher positive responses in VR groups, vs. control groups. The Frankl scale showed significant improvements after the use of VR before treatment. Furthermore, audiovisual distraction with VR was the most effective technique for reducing fear and anxiety in uncooperative children. Interpretation: Virtual reality is an effective technique for managing behaviour and reducing anxiety in paediatric patients during dental treatments, often outperforming conventional techniques.
Condiciones laborales y salud psicosocial del personal sanitario en Atención Primaria
(Ministerio de Sanidad, 2026-05-28) Narbona-Gálvez, Ángela; Gómez-Salgado, Juan; Allande Cussó, Regina; Torrejón-Martínez, Julio; El Khoury Moreno, Luis; Fagundo-Rivera, Javier; Enfermería; Estomatología; CTS353: Estomatología Infantil y Ortodoncia; CTS353: Estomatología Infantil y Ortodoncia
Los riesgos psicosociales tienen un impacto importante en la salud física y mental de los profesionales sanitarios. Estos trabajadores se enfrentan a diario a una elevada carga de trabajo, la inestabilidad laboral y un notable desgaste emocional. Todo ello no solo repercute en su bienestar, sino también en la calidad de la atención que ofrecen a los pacientes. La incorporación al ejercicio profesional suele ser especialmente complicada, ya que muchos nuevos profesionales sienten que no cuentan con la preparación práctica suficiente, lo que dificulta su adaptación. A esto se suma la temporalidad de los contratos, que incrementa la sensación de incertidumbre y afecta a la continuidad de los cuidados. Por otro lado, las jornadas laborales prolongadas favorecen la fatiga, lo que puede comprometer tanto la salud de los trabajadores como la seguridad del paciente. Ante esta situación, resulta fundamental apostar por modelos laborales más flexibles, ofrecer apoyo psicológico adecuado y promover la formación continua. Estas medidas pueden contribuir a mejorar la estabilidad laboral, reducir el desgaste profesional y reforzar el liderazgo dentro de los equipos de Atención Primaria.
Co-sleeping as a contributor to early childhood caries: behavioral pathways and clinical outcomes
(Lippincott williams & wilkins; Ovid technologies (wolters kluwer health), 2026) Bayón-Hernández, Gloria; Solano-Mendoza, Patricia; Solano Mendoza, Beatriz; Gómez-Salgado, Juan; Fagundo-Rivera, Javier; El Khoury Moreno, Luis; Ribas Pérez, David; Estomatología; CTS353: Estomatología Infantil y Ortodoncia
Early childhood caries (ECC) is a multifactorial chronic disease strongly influenced by feeding behaviors and oral hygiene practices. Co-sleeping is a common caregiving practice that may increase ECC risk by facilitating nocturnal feeding and limiting adequate nighttime oral care. This study aimed to evaluate the association between co-sleeping, related behavioral factors, and the presence and severity of ECC in children aged 1 to 6 years. A retrospective observational study was conducted using clinical and radiographic records from a pediatric dentistry clinic. The sample included 150 children aged 12 to 72 months. Parents completed a validated questionnaire on feeding practices, dietary habits, oral hygiene routines, sugar intake, and co-sleeping behaviors. ECC was assessed using the decayed, missing, and filled teeth index according to World Health Organization criteria. Logistic regression analyses were performed to identify associations between co-sleeping, behavioral variables, and ECC outcomes. Co-sleeping was reported in 18.7% of children. Co-sleeping children showed significantly higher mean decayed, missing, and filled teeth index scores than non–co-sleepers (7.14 vs 3.49). Co-sleeping was significantly associated with nighttime breastfeeding on demand, higher carbohydrate consumption, and inadequate oral hygiene practices (P < .05). In most co-sleeping cases (89.3%), children fell asleep with milk remaining in the oral cavity. Co-sleeping was associated with an approximately 2-fold increase in ECC risk, and behaviors that may increase the risk and severity of ECC, particularly nocturnal feeding and insufficient oral hygiene. Targeted parental education on nighttime feeding and oral care practices may help reduce ECC risk. Prospective studies are warranted to confirm these findings.

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