Background/Objectives: Deep caries lesions represent an actual concern in preserving tooth vitality and preventing irreversible pulpitis. As presently the non-selective approach is considered an overtreatment, the concept of selective caries removal is highly recommended. The goal of this narrative review is to focus on current trends in carious dentine excavation and adjunctive therapies. Methods: A keyword-based selection of scientific publications issued in the last six years, i.e., 2019–2024, was conducted with the search engine of PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: deep carious lesion; caries removal; indirect pulp capping; adjunctive antimicrobial therapy; adjunctive anti-enzymatic therapy; biomimetic restorative dentistry. Discussions: In deep caries management, the current trends of carious dentine excavation recommend preferentially partial caries removal technique as less risky to pulp exposure and more conservative compared to the stepwise technique (SW). Presently, advanced additional procedures such as antimicrobial photodynamic therapy and an anti-enzymatic approach are also considered for caries arrest. Conclusions: Selective caries removal and adjunctive photodynamic antimicrobial therapy are procedures of choice in preserving pulp vitality. Anti-enzymatic therapies impede decoupling with time of adhesive restorations from the smear layer. Biomimetic restorative dentistry and smart materials introduce the principles of artificial intelligence in the therapeutic approach of deep caries.

Background/Objectives: The aim of this narrative review is to perform an updated literature review of the root canal microbiome in secondary endodontic infections and the bacterial dynamics that govern the processes leading to the development of these persistent endodontic infections and periapical lesions. Methods: A literature search of scientific publications issued in the last 8 years, i.e., 2017–2024, was conducted in PubMed (MEDLINE) and ScienceDirect databases, using the following keywords: endodontic microbiome; endodontic pathogens; periapical lesion; primary endodontic infection; secondary/persistent endodontic infection; functional redundancy. Discussions: Secondary endodontic infections (SEIs) are a highly prevalent pathological condition affecting a minimum of one tooth in more than half of adults worldwide. The transition from primary endodontic infection (PEI) to secondary endodontic infection (SEI) is mainly governed by Enterococus faecalis (EF) that invades and dominates the previous endodontic biofilm initiated by Fusobacterium nucleatum (FN). Conclusions: The findings from different studies indicate that secondary endodontic infections are polymicrobial. In SEIs, the microbial species interactions are crucial in influencing the ecology of infected root canals. The issue of the keynote pathogen is still under debate. Both EF and FN pathogens cooperate with neighboring residents. Functional redundancy of the endodontic microbiome explains how the ecological diversity modulates its pathogenicity.

Primary root canal infection is a dynamic process. All species of oral microbiota have comparable abilities to establish in the root canals of necrotic teeth. The essential ecological factors in their biological selection are nutrient availability, anaerobic environment and bacterial interactions. In chronic apical periodontitis, all selected microflora residing in the long-term infected habitat of root canals system are synergistic, and each of them can play the role of an endodontic pathogen. Microorganisms living in the root canal system of pulpless teeth progressively reach through anatomical communications to the periodontal ligament where, sooner or later, they cause the inflammatory and immunological conflict between the infection and the host. The insight into the complexity of the root canal microbiota is improved by the current pyrosequencing and next-generation sequencing diagnostic techniques, which allow the identification of multispecies of the microbiome and their targeted treatment. The insight into the complexity of root canal microbiota is improved by present diagnostic techniques of pyrosequencing and next generation sequencing, which allow the identification of multispecies of the microbiome and their targeted treatment.

Background: Hepatitis C (HC) remains a major public health concern, affecting approximately 50 million people globally. In addition to hepatic damage, HC induces extrahepatic manifestations (EHMs), including oral conditions such as oral lichen planus (OLP), xerostomia, and Sjögren syndrome-like (SS-like), which impair quality of life. The aim of this study was to investigate the possible association between certain extrahepatic manifestations of HC and the presence of risk factors. Methods: A cross-sectional study was conducted on 38 adults (22 males and 16 females; mean age 56.5 ± 8.6 years) with inactive HC. For each patient, demographic and clinical data were collected, including the following: frequency of dental brushing, frequency of professional dental hygiene visits, smoking, alcohol consumption, the presence of xerostomia, OLP, and SS-like. Logistic regression analyses and ROC curves were performed using R software to identify independent predictors for each condition. Results: OLP was present in 39.5%, xerostomia in 47.4%, and SS-like in 15.8% of patients. Female gender significantly predicted OLP and showed a borderline association with xerostomia. Smoking was weakly associated with xerostomia. No predictors were significant for SS-like. Conclusions: Oral hygiene and smoking are risk factors for oral EHM, their good control being important for the quality of life of these patients. Gender has also been shown to be a risk factor for these manifestations.

Background/Objectives: Systemic diseases such as diabetes mellitus and hepatitis C virus infection are increasingly recognized as important modifiers of oral health. However, their combined impact, as well as the role of behavioral confounders such as smoking, remains insufficiently explored. This study aimed to evaluate oral health parameters in patients with diabetes and/or hepatitis C virus infection, to investigate the prevalence of oral mucosal conditions, and to identify independent predictors of xerostomia, with particular emphasis on glycemic control and smoking. Methods: A cross-sectional study was conducted on 66 patients, including 33 systemically affected individuals and 33 healthy controls. Clinical parameters included the number of teeth, tooth mobility, bleeding on brushing, xerostomia, and oral lichen planus. Glycemic control was defined by using glycated hemoglobin thresholds (controlled < 7%, uncontrolled ≥ 7%). Statistical analyses included non-parametric tests, Spearman correlation, and multivariate logistic regression. Results: Patients with diabetes exhibited significantly fewer teeth (p = 0.001), increased tooth mobility (p = 0.001), and a higher prevalence of gingival bleeding (p = 0.042). Hepatitis C virus infection was strongly associated with oral lichen planus (p = 0.009). Xerostomia was more prevalent in hepatitis C virus infection patients, but in multivariate analysis, smoking emerged as the only independent predictor (OR = 5.73; p = 0.014). Glycemic control was not independently associated with xerostomia after adjustment. Conclusions: Diabetes primarily influences periodontal destruction, while hepatitis C virus infection is associated with mucosal pathology. Smoking plays a dominant role in xerostomia and may confound associations attributed to systemic disease. These findings highlight the importance of integrated oral-systemic assessment and behavioral risk management.