Comparison of Erythritol Air-Polishing and Conventional Polishing Following Ultrasonic Scaling on the Relapse of Chromogenic Tooth Staining in Children

Participants will:

Undergo a routine oral examination. Receive professional removal of chromogenic tooth staining using ultrasonic scaling.

Be randomly assigned to receive either conventional polishing with prophylaxis paste and a polishing brush or erythritol air-polishing using the EMS air-polishing device.

Attend follow-up visits to assess the recurrence of chromogenic tooth staining over time.

Chromogenic tooth staining will be assessed using the Qraycam.

• Guided Biofilm Therapy with erythritol (Device): Description: Participants assigned to Group 1 will receive professional removal of chromogenic tooth staining using ultrasonic scaling followed by erythritol air-polishing with the EMS air-polishing device, guided by a plaque-disclosing agent. At the end of the procedure, the investigator will record the treatment time, apply the plaque-disclosing agent, obtain intraoral photographs, and assess chromogenic tooth staining using the Qraycam.
• Conventional Polishing (Device): Participants will undergo professional tooth cleaning using the ultrasonic scaler of the EMS device. The tooth surfaces will then be polished using a polishing brush and prophylaxis paste.

Primary outcomes

• Black Stain Score [Baseline, immediately after polishing, 1 month, 2 months, 3 months, and 6 months]: Black Stain Classification (Gasparetto et al., 2003) Score Description Clinical Characteristics 0 None No black pigmentation on the tooth surface. 1. Mild Pigmented dots or thin pigmented lines parallel to the gingival margin that are not continuous. 2. Moderate Continuous pigmented lines o extending over up to one-half of the cervical third of the tooth surface. 3. Severe Pigmentation extending over more than one-half of the cervical third of the tooth surface. Black Stain Classification (Zerman et al., 2024) Score Description A Pigmented lines or dots present only on the buccal surface. B Pigmented lines or dots present on both the buccal and lingual surfaces. C Pigmented lines or dots associated with dental caries. D Recurrent pigmented lines or dots.
• Participant Feedback [Periprocedural]: Pain perception during the procedure will be assessed using the Wong-Baker FACES Pain Rating Scale. The scale ranges from 0 to 10, where 0 indicates "no pain" and 10 indicates "hurts worst." Higher scores indicate greater pain intensity (worse outcome).
• Time Session [Periprocedural]: The duration of treatment is noted and compared between groups

Sex: All, ages: 4 Years to 13 Years, accepts healthy volunteers

Inclusion Criteria:

* Children aged 4-13 years.
* Absence of oral diseases, including gingivitis and oral mucosal diseases.
* No orthodontic appliances.
* No history of iron supplementation or professional fluoride treatment within the previous 3 months.
* Systemically healthy children.

Exclusion Criteria:

* Presence of oral diseases, including periodontitis, salivary gland diseases, or oral mucosal diseases.
* History of autoimmune disease.
* Antibiotic use within the previous 3 months.
* Consumption of tannin-containing beverages (e.g., tea, coffee, or similar beverages) within the previous 1 month.