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}{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{Niccolo Caldararo} \renewcommand\Authands{ and } \date{\small \em Received: 1 January 1970 Accepted: 1 January 1970 Published: 1 January 1970} \maketitle \begin{abstract} Introduction: Significant time and money are spent on dental visits under normal conditions. The Covid-19 pandemic has placed a stop to these regimes. The consequences of this has been shown mainly in increased emergency care, however, little is known of the effect on the general population and how well oral care and the natural ability of teeth and the immune system have worked to preserve dental health.Materials & Methods: Reference to reports in the media on oral health and dental visits are analyzed as are the dental literature for scientific foundations of treatment and pathology.Principal Results: Current reduction of visits to dental professionals by both adults and children provides a unique opportunity to study healing of teeth in a natural context. Conclusions:Research should be organized and directed to investigate the frequency of caries and natural healing in populations across socio-economic groups to determine potential changed in dental regimes of care and treatment. \end{abstract} \keywords{dental care, caries, restorations, oral health, genetics.} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \begin{textblock*}{10cm}(1.05cm,3cm) {{\textit{CrossRef DOI of original article:}} \underline{}} \end{textblock*}\let\tabcellsep& \section[{Introduction}]{Introduction}\par he Covid-19 pandemic has changed many of the daily routines of the average person. One of these is the reduction in dental care. While dentists have reported more stress related dental problems during the pandemic, the CareQuest Institute for Oral Health found that some 6 million adults had lost dental insurance, which indicates a larger number of dependents also lost covered care. More than 1 in 10 Americans surveyed had avoided getting care due to the cost, lack of insurance or fear of exposure to Covid-19 or a combination of factors. \hyperref[b0]{(Tingley, 2021)}.\par A press release by the FDI World Dental Federation dated March 18 th 2021, cited a number of dental professionals whose practice indicated an increase of dental emergencies as well as other basic dental pathologies. No scientific studies are available to support this assertion, but it does seem likely. Data collected by the AARP \hyperref[b1]{(Stepko, 2021)} suggested that cavities and periodontal gum disease was up significantly. This was partly blamed on a change in diet to sugary foods and drink and to lax dental care related to job and life changes brought on by the quarantine. One published study in Germany (Al -Masri, et al., 2021) found a 45\% increase in emergency needed care in 2020.\par With this information in mind, and no specific study data of if there has been a over all increase in cavities within the known factors of change of diet or loss of regular care (dental cleanings, scaling, fluoride etc.), it will be of interest to see if general trends can be extracted from care data after treatment resumes to normal levels. \section[{II.}]{II.} \section[{Natural Response of the Tooth}]{Natural Response of the Tooth}\par There are a number of considerations that this information could enlighten health care professionals. It is known that under normal use teeth can repair themselves under both poor care and a range of diets. It is well established that arrested caries is a fairly common phenomenon {\ref (Shafer, et al., 1969)}, the infected tooth attempts to wall off the attack and electron microscope images can show dentinal tubules filled with dead bacteria and the progress started by "pioneer bacteria" arrested at the meridian of proteolytic forms. While some absorption of bone can result from infection or trauma, the defensive capacity of the oral tissues seems to have a certain degree of success.\par There has been little research on this point and there are concerns that the lack of scientific evidence looms over dental procedures in general \hyperref[b4]{(Jabr, 2019)}. Some dentists argue that a lack of funding has stalled scientific research \hyperref[b5]{(Dhar, 2016)}. \section[{III.}]{III.} \section[{Benefits and Deficits of Interventions}]{Benefits and Deficits of Interventions}\par On the other hand, dental interventions by professionals requires the use of drills of different kinds, these generate heat which is damaging to the tissue of the teeth, and techniques of sterilization are seldom perfect leaving some microorganisms in situ. The use of a variety of materials to seal the tooth from the older Zinc Phosphate cement to newer self-polymerizing acrylic resins and recent mixtures with UV polymerization, ceramic and composites, seldom produce entirely closed joints with the enamel of the tooth and most amalgam also leaks introducing bacteria {\ref (Shafer, et al., 1969)}. One might say that modern restoration procedures are effective at removing infected tissue and bacteria, but less so at creating barriers to infection, especially given their own degradation times.\par It is generally found that most dental restorations need to be replaced every 5 years (ADACSA, 2003; \hyperref[b9]{Kingston, 2013;} {\ref Araugo, et al., 2019)}. New methods and practitioner training can increase the life of the filling according to research by {\ref Benetti, et al., 2021.} IV. \section[{Genetic Variation in Immune Response and Tooth Resistance}]{Genetic Variation in Immune Response and Tooth Resistance}\par Susceptibility to tooth decay depends also on genetics, for example by the spatial arrangement of hydroxyapatite microcrystals in the enamel {\ref (Ceve, et al., 1980)}. Genetic factors are complicated by a number of environmental factors that are difficult to control, yet twin studies have helped elucidate these variations \hyperref[b11]{(Wang, et al., 2012)}. While the ability of teeth to fight off infection and damage by bacteria of different species, there are obvious means of this process that involve the immune system \hyperref[b12]{(Athanasiadou, et al, 2018)}. Deposition of secondary dentin (sometimes called "adventitious" dentin, and dentinal sclerosis are responses of the tooth to irritation and caries {\ref (Shafer, et al., 1969)}. Success of such a response to fight off infection and repair the tooth on a population level is unknown.\par One factor here is the lack of comprehensive epidemiological studies of dental pathology and treatment outcomes. Present analysis is often based on National Center for Health {\ref Statistics (1978;}\hyperref[b14]{1979)} from the 1970s (Institute of {\ref Medicine, 1980)}. The 2011 Report of the Institute of Medicine of the National Academies characterized the information available on efficacy and treatment as: "Concerns have been expressed about the quality of care provided in alternative settings or by new types of professionals, but data on the quality of care and longterm outcomes related to the provision of care by all types of oral health care professionals are almost wholly lacking." (IM, Report, 2011, 9).\par V. \section[{Conclusion}]{Conclusion}\par A study of adults and children today after the end of regular dental regimes in the population at large in a country would provide a substantial advance in our understanding of the process and could also identify genotypes that provide greatest protection. Current conditions of Covid-19 quarantine and distance limits of contact have produced a unique opportunity to study the efficacy of dental procedures, especially regarding restorations. The outcome of such research might effect changes in practice that could be beneficial to dental science and practice and cost to patients. \backmatter \begin{bibitemlist}{1} \bibitem[Shafer et al.]{b3}\label{b3} \textit{1969) A Textbook of Oral Pathology, Philadelphia}, William G Shafer , K Maynard , Barnet M Hine , Levy . W.B. Saunders Co. \bibitem[Araujo et al. ()]{b10}\label{b10} ‘Amalgam: impact on oral health and the environment must be supported by science’. Mwb Araujo , J A Lipman , Platt . \textit{J. Am Dent Assoc., v} 2019. 150 (10) p. . \bibitem[Basic Data on Dental Examination Findings of Persons 1-74 Years, United States, 1971-1974, Health and Nutrition Examination Survey (HANES) Vital and Health Statistics ()]{b14}\label{b14} ‘Basic Data on Dental Examination Findings of Persons 1-74 Years, United States, 1971-1974, Health and Nutrition Examination Survey (HANES)’. \textit{Vital and Health Statistics} 1979. 11 (214) . National Center for Health Statistics (Series) \bibitem[Athanasiadou et al. ()]{b12}\label{b12} ‘Biological interactions of a calcium silicate based cement (Biodentine?) with stem cells from human exfoliated deciduous teeth’. E Athanasiadou , M Paschalidou , A Theocharidou , N Kontoudakis , K Arapostathis , A Bakopoulou . doi: 10.1016/ j.dental.2018.09.014. \textit{Dent. Mater} 2018. 34 p. . \bibitem[Current Estimates from the Health Interview Survey, 1977, Vital and Health Statistics Series ()]{b15}\label{b15} ‘Current Estimates from the Health Interview Survey, 1977, Vital and Health Statistics’. \textit{Series} 1978. 10 (126) . National Center for Health Statistics \bibitem[Direct and indirect restorative materials American Dental Association Council on Scientific Affairs ()]{b8}\label{b8} ‘Direct and indirect restorative materials’. \textit{American Dental Association Council on Scientific Affairs} 2003. 134 (4) p. . (J. Am Dent Assoc., v.) \bibitem[Dhar ()]{b5}\label{b5} ‘Evidence-based dentistry: an overview’. Vineet Dhar . \textit{Contemp. Clin. Dent} 2016. July-Sept, v. 7. (3) p. . \bibitem[Wang et al. ()]{b11}\label{b11} ‘Genetic and environmental factors associated with dental caries in children: The Iowa Fluoride study’. Wang , Marcia C Xiaojing , Mary L Willing , Steve Marazita , John J Wendell , Warren . \textit{Caries Res., v} 2012. 46 (3) p. . \bibitem[Stepko ()]{b1}\label{b1} ‘Get your dental care back’. Barbara Stepko . \url{https://www.aarp.org/health/healthy-living/info-2021/pandemic-impact-on-teeth.html} \textit{AARP Oct. 1} 2021. \bibitem[Al-Masri et al. ()]{b2}\label{b2} ‘How did the COVID-19 pandemic lockdown affect dental emergency care in children? Retrospective study in a specialized pedodontic center’. Al-Masri , Mohamed H Ahmad , Christian H Abudrya , Julian Splieth , Mhd Schmoeckel , Said Mourad . \textit{Quintessence Int} 2021. Sept 9. 52 p. . \bibitem[Benetti et al. ()]{b6}\label{b6} ‘How mobile are protons in the structure of dental glass ionomer cements?’. Ana R Benetti , Johan Jacobsen , Benedict Lehnhoff , C R Niels , Denis V Momsen , Okhrimenko , T F Mark , Nikolay Telling , Markus Kardjilov , Tilo Strobl , Ingo Seydel , Manke , N Heloisa , Bordallo . \xref{http://dx.doi.org/10.1038/srep08972}{10.1038/srep08972}. \textit{Scientific Reports} 2015. 5 p. 8972. \bibitem[Public Policy Options for Better Dental Health: Report of a Study ()]{b13}\label{b13} \textit{Public Policy Options for Better Dental Health: Report of a Study}, \xref{http://dx.doi.org/10.17226/9921}{10.17226/9921}. \url{https://doi.org/10.17226/9921} 1980. Washington, D.C.: The National Academies Press. Institute of Medicine (Epidemiology and Prevention of Dental Diseases) \bibitem[Cevc et al. (1980)]{b7}\label{b7} ‘The caries resistance of human teeth is determined by the spatial arrangement of hydroxyapatite microcrystals in the enamel’. G Cevc , P Cevc , M Schara , U Skaleric . \textit{Nature} 1980. July 24. 286 (5771) p. . \bibitem[Tingley (2021)]{b0}\label{b0} \textit{The New Covid-19 Quarantine and Dental Care: Patterns for Change York Times Magazine}, Kim Tingley . \url{https://www.nytimes.com/2021/05/19/magazine/the-pandemic-was-bad-for-our-teeth-will-it-change-oral-health-forever.html} 2021. May 19. (The pandemic was bad for our teeth. Will it change oral health forever?) \bibitem[Kingston ()]{b9}\label{b9} ‘The rise and fall of mercury amalgam’. G Kingston . \textit{Prim Dent J., v} 2013. 2 (3) p. . \bibitem[Jabr (2019)]{b4}\label{b4} ‘The truth about dentistry’. Ferris Jabr . \url{https://www.theatlantic.com/maga-zine/archive/2019/05/the-trouble-with-dentistry/586-039/} \textit{The Atlantic} 2019. May. \end{bibitemlist} \end{document}