Merkel Cell Polyomavirus in the Context of Oral Squamous Cell Carcinoma and Oral Potentially Malignant Disorders

Despite recent advances in prevention, detection and treatment, oral squamous cell carcinoma (OSCC) remains a global health concern, strongly associated with environmental and lifestyle risk factors and infection with oncogenic viruses. Merkel Cell Polyomavirus (MCPyV), well known to be the causative agent of Merkel Cell Carcinoma (MCC) has been found in OSCC, suggesting its potential role as a co-factor in the development of oral cavity cancers. To improve our understanding about MCPyV in oral cavities, the detection and analysis of MCPyV DNA, transcripts and miRNA were performed on OSCCs and oral potentially malignant disorders (OPMDs). In addition, the cellular miR-375, known to be deregulated in tumors, was examined. MCPyV DNA was found in 3 out of 11 OSCC and 4 out of 12 OPMD samples, with a viral mean value of 1.49 × 102 copies/mL. Viral integration was not observed and LTAg and VP1 transcripts were detected. Viral miRNAs were not detected whereas the cellular miR-375 was found over expressed in all MCPyV positive oral specimens. Our results reported evidence of MCPyV replication in both OSCC and OPMD suggesting the oral cavity as a site of replicative MCPyV infection, therefore underscoring an active role of this virus in the occurrence of oral lesions.

The Core Curriculum in Cariology: Fiction or Reality? Challenges About Implementation

INTRODUCTION

The Core Curriculum in Cariology (CCC) was developed by ORCA and ADEE in 2010. This article summarizes challenges for the implementation of the CCC at university/country level identified at the "Education Platform" of the ORCA 2022 conference in Cagliari, Sardinia.

METHODS

Participants from Universities from 3 European (Italy, Poland, and UK), 2 Asian (India and Russia), and 3 American countries (Brazil, Colombia and USA) led the presentations, discussion, and generation of statements. Presentations were transcribed and summarized through qualitative content analysis. Key themes were identified, transformed into key topics, and sent to the panel for agreement.

RESULTS

Regardless of the wide variety of dental schools per country, from few (Poland n=10) to many (India n=318, Brazil n=563), or from country/continent itself, frequent challenges to CCC implementation were highlighted. These included: lack of agreement on a basic CCC as standard (96%), insufficient support or reimbursement for caries prevention and management (90%), separation between cariology and restorative dentistry (68%), focus on restorative/surgical management with prevention and non-operative management being disconnected (73%). The group agreed that the integration of cariology and restorative dentistry remains essential to enhancing evidence-based decision-making, resulting in a shift of emphasis from cure to care.

CONCLUSION

There is variation in the level of implementation of the CCC. A frequent challenge is the disconnect between cariology and restorative dentistry. The CCC should be disseminated and promoted as a uniform blueprint/framework to facilitate the implementation of a common cariology curriculum among universities within each country, as well as internationally.

Methods for Evaluating the Effectiveness of Home Oral Hygiene Measures-A Narrative Review of Dental Biofilm Indices

Dental plaque is a biofilm structured in an extracellular matrix of polymers of host and microbial origin; the microorganisms can coexist in harmony with the host, thus guarantying oral health. Environmental modifications can lead to dysbiosis and onset of oral diseases; in fact, plaque is the etiological agent both of periodontal disease and dental decay. The use of an effective oral hygiene index should be considered as a relevant goal for the clinicians and the researchers, and consequently, numerous plaque indices have been proposed during the years. The present literature review aims primarily to obtain a complete summary of these scores to assess plaque deposits. It is useful because the clinician/researcher will select the right scoring method for the specific situation only if he knows the available options and if he is aware of both their strengths and weaknesses. This review applies a basic classification of plaque indices that distinguishes the ones that use non-quantitative methods from the ones that use quantitative methods. Non-quantitative methods are more subjective because they are based on the ability of the clinician to point out the presence or the entity of deposits, while quantitative methods introduce objectifiable means to measure plaque deposits.

Dentine surface modification and remineralization induced by bioactive toothpastes

OBJECTIVE

In this study, dentine surface was analysed through Environmental-scanning-electron-microscopy (ESEM) with energy-dispersive-X-ray-spectrometry (EDX) and Fourier-transform-infrared-spectroscopy (FTIR) with attenuated total-reflectance (ATR) to assess the morpho-chemical changes and variations in mineralization degree after demineralizing treatment, after five toothpastes application (HA & Citrate toothpaste, Zinc-HA toothpaste, Calcium Sodium Phosphosilicate toothpaste, Arginine & Calcium carbonate toothpaste, Colgate-Triple-Action, and Control toothpaste), after soaking in artificial saliva and after citric acid attack.

METHODS

Ca/P, Ca/N and P/N ratios were calculated from EDX atomic data to evaluate the mineralization degree of dentine surface. The IR calcium phosphate (CaP)/collagen and carbonate/collagen ratios has been evaluated to assess the remineralization changes in dentine; the carbonate/collagen IR ratio was calculated to identify the nucleation of B-type-carbonated apatite and calcium carbonate.

RESULTS

ESEM-EDX and ATR-FTIR showed residuals of toothpastes after the treatments in all cases, with a general increase in the mineralization degree after soaking in artificial saliva and a decrease after acid attack. Treatment with Arginine & Calcium carbonate toothpaste showed the highest Ca/P value after treatment (Ca/P 1.62) and acid attack (Ca/P 1.5) in confirmation, IR showed the highest amount of carbonate after treatment and soaking in artificial saliva. Arginine and calcium carbonate toothpaste and HA and citrate toothpaste remained to a higher extent on the dentine surface and revealed a higher remineralization activity. These formulations showed higher resistance to demineralization attack, as demonstrated by a higher I_CaP /I_{Amide II} intensity ratio than those obtained after EDTA treatment.

CONCLUSIONS

Toothpastes that remained to a higher extent on dentine surface (arginine and calcium carbonate toothpaste in particular) were more able to promote remineralization. The formed calcium phosphate (CaPs) phase was intimately bound to dentine rather than a simple deposit.

Enamel Analysis by 3D Scanning after Three Orthodontic Clean-Up Procedures: An In-Vitro Test of a New Piezoelectric Tool

(1) Background: To assess the clinical safety and efficacy of a new piezoelectric instrument for orthodontic clean-up; (2) Methods: An in-vitro comparative study on 75 teeth extracted for orthodontic reasons compared the tested method (Treatment 1) with two other procedures: One step finisher and polisher (Inverted cone One gloss Shofu Dental, Kyoto, Japan) (Treatment 2) and twelve-fluted tungsten carbide bur (123-603-00, Dentaurum, Pforzheim, Germany) and Sof-Lex discs Pop-On XT Kit (3M ESPE) (Treatment 3), with n:25 samples in each group. Clinical safety (enamel volume loss) and effectiveness (residual adhesive volume) were assessed using the structured light 3D scanner Atos Compact Scan (GOM GmbH) together with the support of Atos Professional software. The surfaces were scanned three times to assess: (i) the volume of the residual adhesive (RAV) after bracket removal; (ii) the volume of the relative residual adhesive (dAV) after the clean-up procedure; (iii) volume of the enamel loss (EVL); (3) Results: The mean RAV (mm³) was 0.239 ± 0.337; 0.069 ± 0.124, 0.120 ± 0.193 and the mean EVL (mm³) was 0.1870 ± 0.177, 0.187 ± 0.299 and 0.290 ± 0.205, for treatment 1, 2 and 3, respectively. The distribution was asymmetrical between groups in both cases; (4) Conclusions: The tested instrument proved to be effective and safe for post-orthodontic clean-up. With the increasing use of invisible aligners, the possibility of using an ergonomic and fast instrument is of benefit to both patient and practitioner.

Quality of Life and Stress Management in Healthcare Professionals of a Dental Care Setting at a Teaching Hospital in Rome: Results of a Randomized Controlled Clinical Trial

In the healthcare environment, more and more people experience work-related stress. The Faculty of Medicine and Dentistry of Sapienza University of Rome, having observed the need to take care of healthcare professionals, has set itself the objective of providing useful tools such as additional and necessary personal protective equipment for healthcare professionals.

OBJECTIVE

To promote health through better management, skills, and the use of strategies and solutions to identify, decompress, and neutralize those responsible for work-related stress mechanisms in order to take care of those who care (CURARE CURANTES).

MATERIALS AND METHODS

A randomized controlled clinical trial was conducted. The participants were enrolled by three departments of the Department of Dental and Maxillofacial Sciences of Rome; in consideration of emotional involvement of health professionals who work there. A motivational program was offered.

RESULTS

There were 17 and 16 healthcare professionals in the intervention and control groups, respectively. Levels of the mental composite score (MCS) varied both in the pre-post phase of the intervention group (p = 0.002), and between the intervention group and control group in the post phase (p = 0.006). No significant differences were observed for the physical composite score (PCS). Similarly, there were no significant differences regarding the positivity scale (PS) and the two dimensions of work-related stress (job demand and decision latitude).

CONCLUSION

This study demonstrates the efficacy of yoga training practiced directly in the workplace and wearing work clothes, entering the work context, not weighing further on the healthcare workload, and being a way to carry out physical activity even in those cases in which professionals do not have the time to do it in their free time.

Management of transverse root fractures in dental trauma

The management of complex dental trauma can be modulated according to the emergencies that may arise over time. Clinical management of transverse root fractures may require different therapies based on situations, such as delay and error in the treatment of an avulsion trauma associated with apical third root fracture, patient's poor compliance, or external and internal root resorption. The primary aim of this article was to review studies regarding root fractures in the permanent dentition and root fracture management. The secondary aim was to present the inflammatory reaction and the complications (i.e., infections) that may occur if the International Association for Dental Traumatology (IADT) guidelines are not followed. In addition, a scenario is devised in which endodontic surgery, despite the baseline patient's conditions and negative prognosis, can help to inhibit the inflammatory root resorption and allow the preservation of soft and hard tissues within a long follow-up from the injury, for the purpose of demonstrating the next possible implant-prosthetic rehabilitation.

Student Evaluation of Distance Learning during the COVID-19 Pandemic: A Cross-Sectional Survey on Medical, Dental, and Healthcare Students at Sapienza University of Rome

The COVID-19 pandemic has had a deep impact on university education, necessitating an abrupt shift from face-to-face learning to distance learning (DL). This has created new challenges, especially for those courses in which practical activities and internships are integral parts of the education program. The aim of this study was to assess the impact of DL on the study progress of a population of pregraduate students of medicine, dentistry, and healthcare professions. The survey was administered through an anonymous questionnaire by sharing a Google Forms link. Demographic data and educational background information were collected to obtain a profile of the participants. Different aspects of DL were investigated, including availability of digital devices, quality of connection, and environmental conditions; other questions focused on the effects of DL on students' progress and professional maturation. Measures of association were also calculated using the chi-squared test, Cramer V, and Somers D. Among the 372 who participated, the results showed that students had a positive attitude toward online classroom and that DL did not substantially affect their progress. Most of the associations were statistically significant, also highlighting the effect of the degree course on the responses. Some critical issues clearly emerged, however, including the lack of adequate devices and environmental conditions due to economic disparity, poor relationships, suspension of internship programs, and clinical training. The results suggest that DL cannot be considered as a substitute for classroom-based medical education outside an emergency context.

Green dentistry: Organic toothpaste formulations. A literature review

Dentistry as a profession should take into account the goals of sustainable development in daily practice and encourage the transition to a green economy. Consumers are becoming more conscious about the impact of self-care products, including toothpastes, on the environment. Organic toothpastes are considered very safe. A broad literature review was conducted to: (i) identify the ingredients in available organic toothpastes; (ii) classify them into active and inactive; and (iii) evaluate each ingredient's purpose and the adverse events that may be associated with its use. A comprehensive list of available organic toothpastes and their ingredients was compiled based on the products from the largest Italian organic supermarket chain (NaturaSì®) that is representative of the European market. Then, PubMed, Scopus and Google Scholar databases were searched to identify, classify and evaluate each ingredient. The final sample consisted of 46 organic toothpastes that included 156 ingredients; 139 (89.1%) and 17 (10.9%) were classified as active and inactive, respectively. Overall, 32 (20.5%) ingredients were associated with known adverse events. The results of this study indicate that organic toothpastes are highly biocompatible with oral cavity tissues. Careful product selection may help consumers avoid potential adverse effects that can be caused by ingredients such as polymers (e.g., polyethylene glycol) and carbomers, detergent agents (e.g., sodium lauryl sulfate), and triclosan. The lack of clinical studies should encourage the development of sufficient evidence to provide consumers with recommendations for daily use, based on both efficacy and biocompatibility.

In-vivo colour stability of enamel after ICON® treatment at 6 years of follow-up: a prospective single center study

OBJECTIVES

This in-vivo clinical study provides subjective and objective documentation on colour stability of enamel after resin infiltration at a mean observation time of six years after treatment.

METHODS

76 teeth previously treated with ICON® due to hypomineralized lesions of enamel were recalled for a follow-up at ………(………..). Colour stability was assessed: i) subjectively by patients using FDI-colour matching criteria; ii) objectively by calculating CIEDE2000 colour differences between the affected/treated and sound enamel in each tooth at T0 (baseline), T1 (one year) and T2 (six years) based on spectrophotometric data. Analysis of correlation between FDI and CIEDE2000 data was performed.

RESULTS

Two teeth were lost to follow-up prior to 72 months. No unwanted effects were reported by patients. Number of FDI scores 1 and 2 were 13.5%, 90.6% and 93.2% at T0, T1 and T2, respectively. ΔE00 was evaluated at 6.8 (SD3.8) at T0. ΔE00 was 5.8 (SD3.1) between T0 and T1 and 1.3 (SD0.6) between T1 and T2. ΔE00 reduction (T1-T0) was significantly but only fairly correlated with FDI scores at any follow-up.

CONCLUSIONS

This study shows that caries infiltration satisfactorily masks aesthetically relevant lesions after longer follow-up. Subjective and objective outcomes showed a fair correlation mainly for the initial masking effect.

CLINICAL SIGNIFICANCE

This prospective clinical trial demonstrates the excellent subjective and objective colorimetric stability of enamel treated with ICON® 6 years after treatment.

How Did the COVID-19 Pandemic Effect Dental Patients? An Italian Observational Survey Study

The primary aim of this observational survey study was to assess patients' attitudes toward clinical dental practice during the COVID-19 pandemic; the secondary aim was to evaluate patients' attitudes towards oral health by maintaining an appropriate lifestyle and oral hygiene at home. The questionnaire was developed using Google Forms. The questionnaire consisted of three parts: Part A-geographic, demographic, and personal data; Part B-patients' attitude toward oral health selfcare and lifestyle; Part C-patients' attitude toward dental practice. This survey, conducted during the months of November and December 2020, enrolled 1135 subjects throughout Italy. All data were statistically analyzed. COVID-19 has changed patients' approach to dental procedures. Most of the people interviewed lived in families, and their greatest fear was infecting a family member. Restrictive measures forced people to stay at home, which led to an increased consumption of various types of food, including cariogenic foods. People said they felt safe when they went to the dentist, but they also paid special attention to measures to prevent contagion. Among the measures that should be introduced in similar situations in the future, people wanted telemedicine, a phone recall, and the possible use of video clips for home oral care instructions.

Risk Management for a Legally Valid Informed Consent

ABSTRACT

Gelli-Bianco law (Law no. 24/2017) intervenes both in order to divide healthcare liability between the healthcare professional and the facility in which he/she exercises and to incentivize the latter to adopt an organizational model suitable for managing the risk associated with the provision of any healthcare service, including the information for consent. In fact, the healthcare facility must guarantee clear, complete and adequate information on the specific case, which, therefore, cannot consist of standard forms to be signed by the patient, under penalty of a flawed consent to treatment and consequent healthcare liability in the event of an adverse event. The regulation mandates that safety must be guaranteed through proper prevention tools and health care risk management, in con-junction with the most effective use of structural, technological and organizational resources available. It further spells out the obligation of health care professionals to contribute to risk prevention while administering health care procedures. For this reason, the consent information constitutes a source of risk for the responsibility of the healthcare provider and the Facility and it must necessarily be managed. Risk Management is the management tool that can allow the healthcare facility to improve the quality and safety of the services provided, optimizing the risk of adverse events through proper moni-toring of the same. This paper will be published, following a special agreement, on the two journals "Igiene e Sanità Pubblica" and "La Clinica Tera-peutica", in Italian and in English, in order to increase the diffusion to a wider audience.

Long-Term Effectiveness of Treating Dentin Hypersensitivity with Bifluorid 10 and Futurabond U: A Split-Mouth Randomized Double-Blind Clinical Trial

Background: The definition of dental hypersensitivity is “pain derived from exposed dentin in response to chemical, thermal tactile or osmotic stimuli which cannot be explained as arising from any other dental defect or disease”. One of the treatments proposed is tubular occlusion. The aim of this in vivo split-mouth randomized clinical trial was to evaluate the clinical efficacy of a in-office application of a fluoride varnish (Bifluorid 10) and a bonding resin (Futurabond U) in adults with dentin hypersensitivity. Material and methods: A total of 180 teeth were treated with Bifluorid 10 and 160 with Futurabond U. Outcome measurements were taken one or two weeks before treatment, at baseline at the application days, at 1 week and at 1–6 months after first treatment. Results: Both treatments reduced pain intensity. Bifluorid 10 and Futurabond U have similar efficacy in reducing SCHIFF-measured pain reduction, while Bifluorid 10 is significantly more efficient for VAS-measured pain reduction, mainly due to long-term pain reduction. Patient age has a significant negative influence on pain reduction, while the influence of patient gender and BEWE of the tooth is insignificant. Conclusions: Bifluorid 10 and Futurabond U are effective in the treatment of dental hypersensitivity. The RCT was registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04813848.

Phototherapy and Tailored Brushing Method. Personalized Oral Care in Patients with Facial and Dental Trauma. A Report of a Case

(1) Background: Traumatic dental injuries are frequent in children and young adults. The facial structures involved in dental trauma may include soft tissues of the face and mouth, bone and dental structures. Dental trauma often results in augmented dental anxiety. Phototherapy can improve stress and pain control thereby improving compliance in young patients with the necessary dental treatments, after dental trauma has occurred. (2) Methods: Phototherapy was performed to enable soft tissue healing. The Tailored Brushing Method (TBM), a personalized approach for at-home oral hygiene procedures, was also utilized, with the aim of improving biofilm control in traumatized patients. (3) Results: The approach hereafter presented made it possible to obtain subjective control of anxiety and pain documented on a visual analog scale (VAS) due to the innovative use of photo-biomodulation. In addition, for the first time, the TBM was adapted to the needs of a patient with facial trauma and illustrated. (4) Conclusions: Phototherapy and TBM were found to be effective in the combined treatment of soft tissue wounds and in the oral care of the traumatized patient.

Risk management and Healthcare responsibility. How to guarantee legal protection in Medicine

Having regard to the increasing attention to the issue of safety and health of patients and workers by low, the hypothesis that this topic will be the growing trend in the next years does not seem to be manifestly unfounded. For this reason, it is wise for healthcare professionals to already be aware that any violation of the interests underlying the legislation in question entails a ruling on civil and/or criminal liability. It is therefore necessary to identify the most suitable means to prevent undue harm occurring, partly to exempt healthcare professionals and hospitals from compensation costs, thereby providing them with recourse to insurance coverage. Healthcare facility organisations must adopt Risk Management techniques as a tool to simultaneously guarantee the effectiveness of health services (in this case), the efficiency of the management economy, and finally compliance with all legally required precautions. This will relegate the occurrence of an adverse event to remote and unpredictable hypotheses, thus guaranteeing useful recourse to insurance coverage to compensate any harm that does occur.

Impact of Green Tea (Camellia Sinensis) on periodontitis and caries. Systematic review and meta-analysis

Background

The oral health-promoting effects of green tea are attributed to its polyphenol components. Aim of this work was to systematically review the literature in search for clinical trials assessing green tea for managing periodontitis and caries.

Methods

Randomized clinical trials comparing the efficacy of green tea versus control groups in oral hygiene and gingival health; periodontitis; caries; periodontal pathogens number; Streptococcus mutans, Lactobacillus spp. Meta-analysis and meta-regression analysis were performed.

Literature searches were carried out using MedLine (PubMed), Scopus, and the Cochrane Library. Eighteen studies (870 subjects) were included.

Results

Green tea treatment had medium positive effect size in reducing GI (SMD: 0.50; 95%CI: −0.02/1.01); PI (SMD: 0.54; 95%CI: 0.14/0.95); GBI (SMD: 0.58; 95%CI: −0.41/1.56) and BOP (SMD: 0.52; 95%CI: −0.57/1.60) in respect to the control group. Splitting to subgroups, green tea showed a small negative effect in the chlorhexidine control groups. Green tea treatment had medium positive effect size in reducing CAL (SMD 0.58; 95%CI: −0.49/1.65) and large positive effect size in reducing PPD (SMD:1.02; 95%CI: 0.45/1.59).

Conclusion

Even if the results are encouraging, there is insufficient evidence to recommend the use of green tea formulation as first choice treatment for gingivitis, periodontitis and caries.

Detecting white spot lesions on dental photography using deep learning: A pilot study

OBJECTIVES

We aimed to apply deep learning to detect white spot lesions in dental photographs.

METHODS

Using 434 photographic images of 51 patients, a dataset of 2781 cropped tooth segments was generated. Pixelwise annotations of sound enamel as well as fluorotic, carious or other types of hypomineralized lesions were generated by experts and assessed by an independent second reviewer. The union of the reviewed annotations were used to segment the hard tissues (region-of-interest, ROI) of each image. SqueezeNet was employed for modelling. We trained models to detect (1) any white spot lesions, (2) fluorotic lesions and (3) other-than-fluorotic lesions. Modeling was performed on both the cropped and the ROI images and using ten-times repeated five-fold cross-validation. Feature visualization was applied to visualize salient areas.

RESULTS

Lesion prevalence was 37 %; the majority of lesions (24 %) were fluorotic. None of the metrics differed significantly between the models trained on cropped and ROI imagery (p > 0.05/t-test). Mean accuracies ranged between 0.81-0.84, without significant differences between models trained to detect any, fluorotic or other-than-fluorotic lesions (p > 0.05). Specificities were 0.85-0.86; sensitivities were lower (0.58-0.66). Models to detect any lesions showed positive/negative predictive values (PPV/NPV) between 0.77-0.80, those to detect fluorotic lesions 0.67 (PPV) to 0.86 (NPV), and those to detect other-than-fluorotic lesions 0.46 (PPV) to 0.93 (NPV). Light reflections were the main reason for false positive detections.

CONCLUSIONS

Deep learning showed satisfying accuracy to detect white spot lesions, particularly fluorosis. Some models showed limited stability given the small sample available.

CLINICAL SIGNIFICANCE

Deep learning is suitable for automated classification of retro- or prospectively collected imagery and may assist practitioners in discriminating white spot lesions. Future studies should expand the scope into more granular multi-class detections on a larger and more generalizable dataset.

A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: "Sapienza Head and Neck Unit" Proposal

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event associated with antiresorptive and antiangiogenic drugs. The use of these drugs in the treatment of cancer patients with bone metastasis is necessary and standardized in the literature. A multidisciplinary approach for the patient’s management is strongly recommended. Therefore, it should be necessary to integrate the path of these subjects with a dedicated dental screening in order to first assess the individual risk of developing a MRONJ, and then to plan dental treatments and oral hygiene sessions, and finally to schedule a follow-up to intercept and treat early osteonecrosis. The aim of this manuscript is to propose a new simple medical report to evaluate patients affected by metastatic bone cancer in order to reduce the risk of developing MRONJ.

Antiviral Activity of Reagents in Mouth Rinses against SARS-CoV-2

The oral cavity, an essential part of the upper aerodigestive tract, is believed to play an important role in the pathogenicity and transmission of SARS-CoV-2. The identification of targeted antiviral mouth rinses to reduce salivary viral load would contribute to reducing the COVID-19 pandemic. While awaiting the results of significant clinical studies, which to date do not exist, the commercial availability of mouth rinses leads us to search among them for reagents that would have specific antiviral properties with respect to SARS-CoV-2. The challenges facing this target were examined for 7 reagents found in commercially available mouth rinses and listed on the ClinicalTrials.gov website: povidone-iodine, chlorhexidine, hydrogen peroxide, cyclodextrin, Citrox, cetylpyridinium chloride, and essential oils. Because SARS-CoV-2 is an enveloped virus, many reagents target the outer lipid membrane. Moreover, some of them can act on the capsid by denaturing proteins. Until now, there has been no scientific evidence to recommend mouth rinses with an anti-SARS-CoV-2 effect to control the viral load in the oral cavity. This critical review indicates that current knowledge of these reagents would likely improve trends in salivary viral load status. This finding is a strong sign to encourage clinical research for which quality protocols are already available in the literature.

Challenges in diagnosing and managing non-cavitated occlusal caries lesions. A Literature overview and a report of a case

AIM

Aim of this literature overview was to analyze the diagnostic procedures of hidden caries lesions and to present a restorative protocol.

METHODS

A literature overview was performed in order to evaluate hidden caries etiological hypothesis and the reported prevalence. The diagnostic procedure is performed with the aid of an intra-oral fluorescence based camera and the restorative procedure is completed with the use of a novel bisphenol-A free composite.

RESULTS

Non cavitated occlusal caries lesions prevalence is high in young adults population. Diagnosis of hidden caries requires both high sensitivity and specificity.

CONCLUSIONS

The novel diagnostic and restorative protocol showed to be highly effective in hidden caries assessment and restoration.

Correlation between Vista Cam, ICDAS-II, X-ray bitewings and cavity extent after lesion excavation: an in-vivo pilot study

BACKGROUND

To correlate fluorescence-based camera (FC), visual inspection (ICDAS-II) and radiographic examination X-rays bitewings (BW) to the extent of caries after excavation.

METHODS

The occlusal sites of 20 permanent first and second molars in 14 young adolescents (12±2 years old) were examined at 1^st Observation Unit of Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome. All the enrolled patients were asked to provide with X-rays bitewing of the studied teeth. The assessment of ICDAS-II and FC was performed by a trained operator. Then a second blind operator removed the carious lesion and evaluated the cavity extent (depth, width, length) after caries removal with a calibrated probe. To correlate FC measurements with bitewing sensitivity, 10 dentists evaluated the presence/absence of caries on the X-rays.

RESULTS

All the occlusal sites assessed by fluorescence camera, ranged from 1.7 to 2, indicating in all cases deep enamel lesions with possible extent to dentine with a mean of 1.7±0. In accordance, visual inspection by ICDAS-II showed scores of 3 and 4. By contrast, the radiographic documentation, i.e. bitewing X-rays, was evaluated in only 6 cases as presence of caries. The extent of the cavities was determined by three consecutive measurements: depth, width and length, with a mean of 3.5+1.73, 2.8+1.07 and 3.2+1.64 mm respectively. These results confirmed the agreement between FC and ICDAS-II for diagnosis of cavities with extent to enamel and dentine, while showed the low sensitivity of bitewings X-rays, in accordance with the existing evidence in Literature. Moreover, the results of this study for the first time provide information about the cavity extent after caries removal for the occlusal sites with ICDAS-II 3 and 4 scores and FC≥1.7.

CONCLUSIONS

X-rays evaluation showed diagnostic accuracy in 6% of the sample. VistaCam measurement of 1.7 was correlated to a cavity with 3.5, 2.8 and 3.2 mm of depth, width and length.

The Influence of Dental Occlusion on Spectrophotometric Tooth Color Determinations

Background:

Shade matching is a significant treatment step and a challenge for the clinical team with potentially high costs for color correction. Currently, in the United States, the majority of private dental practitioners use visual color matching, but a recent study has reported a high rate of mistakes of subjective color determination among graduate dentists.

Objective:

The aim of this retrospective study is to analyze whether a change in the oral background due to dental occlusion can influence tooth color determination.

Methods:

Volunteer dental students underwent spectrophotometric color assessment using the SpectroShade device. Two measurements were carried out (with the individuals’ occlusion closed and with the occlusion open) on 43 upper central and 58 lateral incisors. Association between colorimetric variables L*, a*, b* and ΔE00 and tooth width, length and tobacco usage were examined.

Results:

Slight changes in the CIELAB values between closed and open occlusions were found for both the gingival and the central sections as for the overall tooth area, with mean ΔL*=-1.24, Δa*=-1.77, Δb*=-1.42 and ΔE00=1,84. A larger difference was detected in the incisal area, with mean ΔL*=-2.99, Δa*=-1.76, Δb*=-2.83 and ΔE00=3.65.

Conclusion:

In conclusion, our study showed that dental occlusion does not play a significant role in tooth color matching determinations, even though attention to avoid overbite due to a maximum intercuspation should be made.

Oral health in a cohort of individuals on a plant-based diet: a pilot study

INTRODUCTION

Plant-based diets are associated with a lower: (i) body mass index, (ii) rates of death from ischemic heart disease, (iii) serum cholesterol, (iv) incidence of high blood pressure, (v) type II diabetes mellitus and cancer, with an overall longer life expectancy. However, little data concerning the oral health in individuals on a plant-based diet are available.

AIM

The aim of the present study was to investigate the general and clinical oral health status in a cohort of adults who had been following a plant-based diet for a minimum of 24 months.

MATERIAL AND METHODS

For this purpose, individuals were administered two questionnaires (a.Questionnaire investigating risk areas for oral diseases; b. Italian version of the Oral Health Impact Profile -14 (IOHIP-14)) by a dental hygienist and clinical examination of the oral cavity was carried out.

RESULTS

Seventy-seven adult individuals were enrolled. On average, they followed a plant-based diet for the last four years, had four meals a day and brushed their teeth twice a day. Fruit was the most frequently consumed food at breakfast by 48 of the participants. Thirty-four responders did not drink beer or wine, 65 did not drink spirits, 57 avoided carbonated beverages and 62 (80.5%) did not consume any highly-sugared beverages. Different dental therapies in the previous three years were reported in 36 of the responders. Overall, answers "never and almost never" to the IOHIP-14 questionnaire were observed in 87% to 100% of the individuals. Multiple logistic regression analysis revealed that fresh fruit consumption at lunch had a protective effect against caries (p<0.05).

CONCLUSIONS

In conclusion, this study showed that individuals on a plant-based diet have good overall oral health conditions. These features are in agreement with the behavior of these subjects towards an overall healthy life style.

Diagnostic Drama. Use of ICDAS II and Fluorescence-Based Intraoral Camera in Early Occlusal Caries Detection: A Clinical Study

BACKGROUND

Early diagnosis of occlusal caries is of paramount importance for a minimally invasive approach in dentistry. The aim of the present in vivo clinical prospective study was to compare the diagnostic outcomes of visual subjective evaluation between the International Caries Detection and Assessment System (ICDAS-II) and an intraoral fluorescence-based camera (VistaCam iX Proof, Dürr Dental, Bietigheim-Bissingen, Germany) for the detection of pits and fissures in early caries lesions of posterior teeth.

METHODS

The study included 1011 posterior teeth in 255 patients aged 13-20 years (mean age 16 ± 2.2 years). Two blinded operators evaluated all the occlusal surfaces and the first assigned an ICDAS-II code, while the second assessed the VistaCam score: sound enamel (score 0-1.2); initial enamel decay (score 1.2-1.5); dentine caries (score 1.5-3).

RESULTS

Some 283 (28%) of the assessed teeth were ICDAS-II code 0; 334 (33%) code 1; 189 (18.7%) code 2; 176 (17.4%) code 3; and 29 (2.9%) code 4. The level of agreement between the two procedures was expressed by using Cohen's and Fleiss' kappa statistics and performing McNemar's test. VistaCam assessed in 513 (50.7%) sound enamel; in 292 (28.9%) initial enamel decay; and in 206 (20.4%) dentine caries.

CONCLUSIONS

This comparative study showed a poor agreement between the two diagnostic methods, especially between ICDAS-II 0, 1 and 2 codes and fluorescence assessments.

Lactoferrin and oral pathologies: a therapeutic treatment

The oral cavity is a non-uniform, extraordinary environment characterized by mucosal, epithelial, abiotic surfaces and secretions as saliva. Aerobic and anaerobic commensal and pathogenic microorganisms colonize the tongue, teeth, jowl, gingiva, and periodontium. Commensals exert an important role in host defenses, while pathogenic microorganisms can nullify this protective function causing oral and systemic diseases. Every day, 750-1000 mL of saliva, containing several host defense constituents including lactoferrin (Lf), are secreted and swallowed. Lf is a multifunctional iron-chelating cationic glycoprotein of innate immunity. Depending on, or regardless of its iron-binding ability, Lf exerts bacteriostatic, bactericidal, antibiofilm, antioxidant, antiadhesive, anti-invasive, and anti-inflammatory activities. Here, we report the protective role of Lf in different oral pathologies, such as xerostomia, halitosis, alveolar or maxillary bone damage, gingivitis, periodontitis, and black stain. Unlike antibiotic therapy, which is ineffective against bacteria that are within a biofilm, adherent, or intracellular, the topical administration of Lf, through its simultaneous activity against microbial replication, biofilms, adhesion, and invasiveness, as well as inflammation, has been proven to be efficient in the treatment of all known oral pathologies without any adverse effects.

Nanoparticles as Anti-Microbial, Anti-Inflammatory, and Remineralizing Agents in Oral Care Cosmetics: A Review of the Current Situation

Many investigations have pointed out widespread use of medical nanosystems in various domains of dentistry such as prevention, prognosis, care, tissue regeneration, and restoration. The progress of oral medicine nanosystems for individual prophylaxis is significant for ensuring bacterial symbiosis and high-quality oral health. Nanomaterials in oral cosmetics are used in toothpaste and other mouthwash to improve oral healthcare performance. These processes cover nanoparticles and nanoparticle-based materials, especially domains of application related to biofilm management in cariology and periodontology. Likewise, nanoparticles have been integrated in diverse cosmetic produces for the care of enamel remineralization and dental hypersensitivity. This review summarizes the indications and applications of several widely employed nanoparticles in oral cosmetics, and describes the potential clinical implementation of nanoparticles as anti-microbial, anti-inflammatory, and remineralizing agents in the prevention of dental caries, hypersensitivity, and periodontitis.

The treatment of black stain associated with of iron metabolism disorders with lactoferrin: a litterature search and two case studies

Among the various pathologies of the oral cavity, the formation of "unsightly black spots" on the surface of the tooth, universally known as Black Stain (BS) has recently been acquiring more interest. Usually BS is typically found in individuals in prepubertal age, even though it has been identified in adults associated with microbial exchange and / or with iron metabolism disorders. Microbial exchange concerns the possible exchange of bacteria between family members which can take place directly, through effusions, or indirectly, through brushes, cutlery or glasses. For this reason, it is recommended that toothbrushes of family members not be left damp and in contact with each other. The bathroom, being a warm-humid environment, is in fact an optimal habitat for microbial proliferation. Of specific importance in BS is the accumulation of iron in tissues and secretions which, together with chromogenic bacteria, are the primary cause of this pathology. In fact, among the metabolic products synthesized by bacteria in the oral cavity, hydrogen sulfide is of considerable interest, since upon reacting with iron available in saliva, in pathological conditions (iron metabolism disorders), it forms black precipitates consisting of ferric sulfide. These precipitates bind to the surface of the teeth, tending to form a stria that usually follows the contour of the gingiva, with an unsightly and variable chromatic intensity. In physiological situations, iron homeostasis is defined as the state of equilibrium between iron present in tissues and in secretions and that which is present in the circulation. Instead, in pathological conditions, defined as iron metabolism disorders, there is an accumulation of iron in tissues and secretions and a lack of it in the circulation. It is also important to remember that subjects affected by BS are more protected from carious processes than healthy subjects, probably due to a significant predominance of chromogenic bacteria compared to those responsible for caries. It should also be remembered that in young subjects BS tends to regress with pubertal development and the transition to adult life. In any case, using common professional hygiene procedures, it is possible to remove BS as well as plaque and tartar deposits. In particular, with ultrasonic scalers, polishing pastes and powders carried by air and water jets, the surfaces of the teeth can be restored to their natural healthy state. All the techniques for removing the precipitates, are not enough however, to fix and permanently eradicate their appearance, as these precipitates last only for short periods and recur very frequently. Due to the frequent recurrences, new oral microbiota control therapies are emerging; among these the use of lactoferrin (Lf) in the dental field and particularly in the treatment of BS appears to be very promising. Taken togheter, here the effect of Lf in subjects affected by BS has been investigated.

School-age dental screening: oral health and eating habits

AIM

the study has the purpose to evaluate the association between clinical data collected from dental screening carried out on children and their eating habits. Materials and methods: The dental screening was carried out on a sample of eight-year-old children attending the third grade of the elementary schools of Gaeta (Latina). Clinical data and periodontal status indexes were recorded. The descriptive statistics (mean, standard deviation, frequency) of all data were calculated and anova analysis and chi square test have been performed.

RESULTS

On the sample of 70 children the results showed an average of 1.4 decayed teeth per child (sd ± 2.3) with a slightly higher average in females. More than 68% of the sample had poor or insufficient oral hygiene conditions with plaque presence in 64% of cases. Moreover, 57% of children had class II malocclusion with increased overjet and oral breathing respectively in 37% and 30% of cases. Only 24% were breastfed in the first months of life and more than 40% maintained a bad habit for over two years of age. About eating habits, more than 80% of the sample consumed sweets or sweet drinks every day. The analysis of the data showed as children consume several snacks throughout the day, and 47% eat them watching TV.

CONCLUSIONS

The results of this study showed how prevention program carried out through the School is more effective on children for learning of content especially when the acquisition of knowledge follows the application and verification of theoretical and practical skills in terms of oral health.

Oral health knowledge in pre-school children: A survey among parents in central Italy

Background

The aim of this survey was to evaluate the knowledge and awareness of parents about potential oral health risk factors and correct management of oral hygiene of their preschool children.

Material and Methods

The participation to the survey was proposed to all parents of 3-5 year aged children attending a kindergarten in Campobasso. A self-administered questionnaire was completed to obtain information regarding demographic and education variables, knowledge about caries and its transmission, infant feeding practice, maternal oral health during pregnancy, parents and children’s oral hygiene habits and risk behaviors (e.g., sharing cutlery, tasting of baby food, nightly using of baby bottles or pacifier), oral health prevention and role of school.

Results

Overall, the parents of 101 children consented to fill the questionnaire. Data analysis showed that only 24% of respondents was aware of the potential vertical transmissibility of cariogenic bacteria through contaminated saliva. It is still a common trend from 61% of parents tasting food of their child. On 101 children, 30% used pacifier and 17% used baby bottle with milk during night and among these children 41% for more than 2 years. Parents reported no toothbrushing for 57% of the children in their first 3 years of life.

Conclusions

From this survey, independently on parents education, it emerges as still nowadays parents are not fully trained and informed about the management of their child’s oral hygiene and as it’s necessary a parental oral health promoting program to control children oral health risk status, starting from school.

Key words:Oral health, pre-school children, dental caries, oral prevention.

Treatments of sleep bruxism in children: A systematic review and meta-analysis

Objective: Treatment of sleep bruxism (SB) in children is not well established. The aim of this study was to develop evidence-based recommendations on SB therapy in children between the ages of 2 and 17. Methods: A systematic review and meta-analysis was conducted. Literature searches were performed using MedLine (PubMed), Web of Science, Scopus, and the Cochrane Library (November 30 2017). Results: The search strategy identified 268 potential articles; 10 papers were included in the qualitative synthesis and 3 in the meta-analysis, for a total of 94 patients. Hydroxyzine therapy showed the strongest efficacy on SB (OR 10.63; CI 95%, 1.48 to 76.08). Flurazepam and Melissa officinalis therapies presented lower grades of association with decreased SB symptoms. Conclusions: Data on treatments of SB in children are limited. Future studies with a proper design, conducted on a meaningful number of patients, and based on standardized and developed diagnostic criteria are desperately needed.

The Use of Yoga to Manage Stress and Burnout in Healthcare Workers: A Systematic Review

The purpose of this systematic review is to analyze and summarize the current knowledge regarding the use of yoga to manage and prevent stress and burnout in healthcare workers. In February 2017, a literature search was conducted using the databases Medline (PubMed) and Scopus. Studies that addressed this topic were included. Eleven articles met the inclusion criteria. Seven studies were clinical trials that analyzed yoga interventions and evaluated effectiveness by gauging stress levels, sleep quality and quality of life. A study on Chinese nurses showed statistical improvement in stress levels following a six-month yoga program (χ2 = 16.449; p < 0.001). A population of medical students showed improvement in self-regulation values after an 11-week yoga program (from 3.49 to 3.58; p = 0.04) and in self-compassion values (from 2.88 to 3.25; p = 0.04). Four of the included articles were observational studies: They described the factors that cause stress in the work environment and highlighted that healthcare workers believe it is possible to benefit from improved physical, emotional and mental health related to yoga activity. According to the literature, yoga appears to be effective in the management of stress in healthcare workers, but it is necessary to implement methodologically relevant studies to attribute significance to such evidence.

Therapeutic efficacy of chlorhexidine-based mouthwashes and its adverse events: Performance-related evaluation of mouthwashes added with Anti-Discoloration System and cetylpyridinium chloride

OBJECTIVES

To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti-Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects.

METHODS

Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use).

RESULTS

Sixty-six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1-T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0-T2) was -9.82 (SD = 9.27; 95% CI -5.48 to 14.16; P = 0.000), -19.31 (SD = 11.33; 95% CI -14.15 to -24.47; P = 0.000) and -21.13 (SD = 12.56; 95% CI -15.70 to -26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106).

CONCLUSIONS

Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX.

Periodontitis and the microbiome: a systematic review and meta-analysis

INTRODUCTION

The association between the oral microbiome and periodontal diseases is still unclear. We performed a systematic review and meta-analysis to quantify the association between the specific pathogens and periodontitis.

EVIDENCE ACQUISITION

A computerized medical search was performed using MEDLINE and SCOPUS database between 1950 and May 2017 to identify all case-control studies that evaluated the association between specific pathogens and periodontitis. The pooled Odds Ratio with relative 95% confidence interval (95% CI) was calculated and plotted in the forest plot.

EVIDENCE SYNTHESIS

Eleven RCTs involving 2111 patients were included. The retrieved case-control studies evaluated the presence or absence of different targeted pathogens. Among the microrganisms evaluated Porphyromonas gengivalis (OR [95% CI] 2.93 [0.98,8.87]; P<0.0001) and Streptococcus mutans (OR [95% CI] 1.77 [0.89-3.54]; P=0.03) were found to be risk factors for the development of periodontitis, while Aggregatibacter actinomycetemcomitans (OR [95% CI] 0.52 [0.33-0.83]) played a protective role for periodontitis.

CONCLUSIONS

It seems that changes in the taxonomic composition of the microbiome rather than single targeted pathogens is the key determinant of periodontitis.

Plasma and Tissue Distribution of Adriamycin in Patients with Pelvic Cancer

The levels of adriamycin in plasma, ascitic fluid and normal and neoplastic tissues sampled during surgery of 3 patients with advanced pelvic cancer were measured by fluorimetry. The highest content of fluorescent compounds was found in tumoral masses in necrotic or scarcely viable tissue; viable and invasive tumor areas scored fluorescence levels comparable with normal adnexa. Ascitic fluid contained levels of fluorescence comparable to the last observed phase of plasma levels. Adipose and cutaneous tissue scored the lowest concentrations.

Clinical comparison between an opaque and a clear pit and fissures sealants: a 12-month split-mouth, randomized controlled study

TRIAL DESIGN

We design a clinical splith-mouth, randomized controlled study, in which the retention of an opaque and clear pit and fissures sealants were evaluated and their effectiveness compared at 6 and 12 months of follow up. A secondary aim was to evaluate the possibility of using a fluorescence based intra-oral camera through the clear sealant to monitor enamel demineralization.

METHODS

Consecutive young adolescents with at least two molars with code 0, 1, 2 caries evidenced following the International Caries Detection and Assessment System (ICDAS II) were enrolled. A split-mouth randomized allocation was carried out. One skilled operator applied the sealant under 3.5 X magnification. A second operator evaluated clinical retention and performed the intra-oral camera assessments at 6 and 12 months follow up.

RESULTS

A total of 42 patients, (20 males and 22 females, mean age 14.25) with 176 dental lesions were enrolled. Nine patients dropped out accounting for 26 teeth lost during follow up. Overall, a total of 150 sealed teeth were evaluated in the study. In 77 cases the clear sealant was used, while in 73 the opaque sealant was utilized. The opaque sealant rated 100% complete retention at 6 months, and 97.3% at 12 months, while the clear selant 91.8% and 85.9% respectively. Demineralization under clear selant was registered when sealant partial detachment occurred.

CONCLUSIONS

The overall retention rate of an opaque sealant was higher than that of a clear sealant after 12 months of follow-up. This difference may partly be due to difficulty in clinical detection of clear sealants during follow-up. Fluorescence based intra-oral camera seems useful to monitor enamel demineralization in clear sealant.

Medication-related osteonecrosis of the jaws (MRONJ) and quality of life evaluation: a pilot study

BACKGROUND

MRONJ (medication related osteonecrosis of the jaws) is a well-known side effect of certain drugs, which are used to influence bone metabolism for the cure of osteo-metabolic or cancer diseases. The aim of this study is to assess the quality of life (QOL) under a physical and mental point of view in patients affected by MRONJ compared with the general population.

METHODS

The study has been accomplished through the administration of the SF-12 questionnaire: 30 patients of the MRONJ group were evaluated.

RESULTS

Significant differences based on the level of education and age of the subjects, on the location and finally on the stage of necrosis of the jaw have been identified. In this pilot study the test sample shows how MRONJ can aggravate the conditions of patients, above all under a physical point of view.

CONCLUSIONS

Prevention of MRONJ and its symptoms as dysphagia, oral pain, immunological compromission and the need of frequent antibiotic therapies is a crucial part of modern oral pathology and dentistry, above all for oncologic patients who already have a general decrease of physical and mental activities, leading to a poor quality of life.

Objective and subjective aesthetic performance of icon® treatment for enamel hypomineralization lesions in young adolescents: A retrospective single center study

OBJECTIVES

An evaluation method is proposed to qualitatively and quantitatively evaluate the clinical outcome of the enamel hypomineralization treatment with infiltrative resin in young adolescents. The aesthetic outcome is assessed before and after treatment by visual evaluation using FDI-colour match criteria and by spectrophotometric analysis using the CIEDE2000 colour difference formula. The visual (subjective) results are compared with the spectrophotometric (objective) approach.

MATERIALS AND METHODS

76 teeth of patients of Sapienza University (Rome, Italy) presenting early caries lesions and/or developmental defect of enamel on the labial surface of clinical crown were subjected to resin infiltration. Three observers evaluated the aesthetic appearance of the teeth before and after treatment using FDI-colour match criteria. The spectrophotometric colour difference between the affected and sound enamel in each tooth was calculated before and after resin infiltration. A correlation between FDI criteria and the calculated CIEDE2000 colour difference (ΔE₀₀) was performed.

RESULTS

Mean FDI scores and ΔE₀₀, evaluated before and after treatment, were large in all sample. A clear correlation was detected between visual inspections and spectrophotometric colour difference of clinical outcomes.

CONCLUSIONS

On the basis of the present study results, the aesthetic outcome of resin infiltration proved to be highly effective, both with visual qualitative and spectrophotometric quantitative assessment.

CLINICAL RELEVANCE STATEMENT

Hypomineralized enamel colour abnormalities affect patients' quality of life, therefore tissue preservative cosmetic treatments are requested. An evaluation method of resin infiltration clinical outcome by visual evaluation and spectrophotometry is proposed.

[Knowledge, attitude and behavior towards oral health: gender differences between parents]

OBJECTIVES

The aim of this study is to compare the results of a survey carried out on a sample of mothers and fathers about the knowledge and personal attitudes towards their own oral health and in terms of attention to that of their children. Mutual analogy and cognitive and behavioral differences between parents have been evaluated; in particular as the early assumption of a healthy lifestyle can influence the proper development of their children.

MATERIALS AND METHODS

This survey was conducted using a paper questionnaire distributed to a population of parents, men and women, in several private dental practices in Rome. The study lasted about three months.

RESULTS

The results obtained from this study show that values obtained by mothers and fathers are essentially equivalent, there are no statistically significant differences (p> 0.05).

CONCLUSIONS

This study has shown that there are no significant thinking and behavioral differences between parents regarding their oral hygiene and that of their children. Both parents have been shown to recognize the importance of continuous monitoring and to be aware of techniques and oral hygiene aids suitable for adults and children, although this knowledge is not always applied in daily lifestyles and oral hygiene.

Oral health sentinel-based surveillance: a pilot study on dentinal hypersensitivity pain

Aim of the study is to assess the development of a structured sentinel system for oral health data collection at national level. Furthermore, this pilot study aims to investigate the prevalence data on dentinal sensitivity pain collected through a nationwide network of epidemiological sentinels (dental hygienists). Each sentinel was given a specific number of examinees and periodicity of data collection. Overall, 116 adults were recruited from 19 Regions, 42,24% male and 57,76% female, with a mean age of 26. DH result was consistent with literature data, being 45%. All sentinel completed the standard forms and assured a good compliance. The overall good customer satisfaction assures adhesion of the sentinels to the procedure, and the regular data collection. The pilot study proved the effectiveness of a structured nationwide network of epidemiological sentinels (dental hygienists) for oral health data collection at national level. This methodology can be an essential starting point for periodic comparative studies.

Oral Health Status and Oral Health-Related Quality of Life in Italian Deinstitutionalized Psychiatric Patients

INTRODUCTION

The aim of this study is to investigate the oral health status and Oral Health-Related Quality of Life (OHRQoL, measured with OHIP- 14) in psychiatric patients assisted by the unique Italian mental health care system, in accordance to regulatory Law 180/78.

MATERIALS AND METHODS

Demographic and medical variables were retrieved from institutional medical records. General health and oral health variables, oral health-related behavior and last dental contact were recorded. Clinical evaluation was performed on each patient. For oral health data collection, a standardized medical form was used.

RESULTS

The study involved an overall number of 67 patients. Primary diagnosis of mental illness was at mean age of 29 years. The average number of teeth per patient was 25.45 ±6,55. The overall mean value of caries experience was 9.1 decayed, missing and/or filled teeth (DMFT Index). Among affected patients (60%, n=33) the mean value of DMFT for all age groups was 11.3 (range 2-27). The present study highlighted a direct linear relationship between caries experience and OHRQoL. As the caries level increased, pain, functional and psychological discomfort scores increased.

DISCUSSION AND CONCLUSIONS

The overall caries experience value of 9.1 DMFT was lower than that reported in existing literature, which is usually related to traditionally institutionalized psychiatric patients, and most important of all, data on access to dental care is fairly good. These results, although derived from a pilot study on a limited sample, suggest that, where a psychosocial rehabilitative program is set out for psychiatric patients, as in the case of the Italian experience, the program can also determine an improvement in oral health status. It is important that programs for oral health promotion are developed in collaboration with mental health services and social measures are patient-centered as an integral part of the individual's rehabilitation program.

Infant and Child Oral Health Risk Status Correlated to Behavioral Habits of Parents or Caregivers: A Survey in Central Italy

AIM

The aim of this survey was to evaluate the knowledge and awareness of parents and caregivers about potential oral health risk factors for their children in their first months of life (3-30 months).

MATERIALS AND METHODS

The participation to the survey was proposed to all parents or caregivers of children attending the public consulting service in Latina for mandatory vaccinations during the period of June to August 2014. A self-administered questionnaire was completed to obtain information regarding demographic variables, infant feeding practice, maternal oral health during and after pregnancy, children's oral hygiene habits and risk behaviors (e.g., sharing cutlery, tasting of baby food, nightly using of baby bottles with sugared beverages, or sugared pacifier), and knowledge about caries and its transmission. The analysis of the data was performed using SPSS 14.0 for Windows (SPSS Inc., Chicago, IL, USA). The variance analysis and chi-square test were used to investigate the relationship between the variables.

RESULTS

Overall, the parents of 304 children consented to fill the questionnaire. Data analysis showed that about 50% of respondents considered dental caries an infectious disease, however, 53.6% was not aware of the potential vertical transmissibility of cariogenic bacteria through contaminated saliva. It is a common trend in the early stages of weaning to taste the baby food (53%) and sharing cutlery (38.5%). With regard to children oral health care, parents reported no toothbrushing for 53.1% of the children in their first 3 years of life. The relationship between the two variables concerning caries transmissibility and tools sharing carried out on through Pearson chi-square test identified P = 0.32.

CONCLUSIONS

From this survey, the need for parental oral health promoting program emerged to control children oral health risk status.

Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study

Objective

To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study.

Methods

Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance).

Results

Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ²₍₉₎ = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ²₍₉₎ = 25.68 p < 0.01, Z = −4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking (p < 0.01).

Conclusions

The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.

[VAP and oral hygiene.A systematic review]

Ventilator associated pneumonia (VAP) is a common nosocomial infection in intensive care units. International literature showed how the use of professional oral hygiene protocols provide an essential support in VAP prevention. The aim of this study is to provide a systematic and narrative updated review, to further demonstrate that a proper protocol of oral hygiene, in special needs patients, can reduce risk of developing VAP. In this study were analyzed 10 narrative and 3 systematic reviews. Systematic reviews were evaluated with AMSTAR checklist, INSA tool was used to analyze narrative reviews. The findings of this study suggest that the use of antimicrobials combined with tooth brushing can actively contribute to reducing the incidence of VAP.

Oral Health Literacy: How much Italian people know about the dental hygienist

BACKGROUND

People with poor OHL have the highest level of oral diseases and the worst oral treatment results. The main aim of the present study was to investigate the degree of knowledge of the role of the dental hygienist in patients who go to a public dental facility for the first time.

MATERIAL AND METHODS

A semi-structured questionnaire was administered to the patients with the "face-to-face" mode during a 12-month period. The principal component analysis, the general linear model and the chi-square test were used for the statistical analysis.

RESULTS

A total number of 900 questionnaires were completed. Sixty-seven per cent of patients know that a specific degree is needed to practice dentistry and 93.1% of them know that a specific educational qualification is required to practice the dental hygienist profession. Sixty-three per cent of the subjects were aware of dental hygienist's activities. There is no patient preference of gender as far as both dentist (84.11%) and dental hygienist (85.11%) are concerned. Seventy-five per cent of patients claimed to know what "dental hygiene" means and 65% of them believed that a good level of oral hygiene was important for oral disease prevention. Both qualification and marital status of patients are significantly associated with the patient's level of knowledge of the dental hygienist profession. Patients with "High" scholastic qualifications showed significantly higher scores than those with "Low" qualifications. Married patients have less knowledge than widows/widowers, while divorced patients have greater knowledge than widows/widowers.

CONCLUSIONS

Patients' educational qualification itself only partially justifies the apparent high level of knowledge of patients about the dental hygienist's role. Key words:Oral disease prevention, dental professional qualification, public dental knowledge, patient educational qualification, dental hygienist, oral heath literacy, public dental facility.

Correlation among periodontal health status, maternal age and pre-term low birth weight

PURPOSE

To assess correlations between periodontal status, maternal age and adverse pregnancy outcomes, such as pre-term and low birth weight in a sample of pregnant women.

METHODS

Study population was represented by outpatient pregnant women, gestational age > 26 weeks. Medical history questionnaires were administered to all participants who underwent clinical evaluation; clinical obstetric outcome records were collected after delivery. A questionnaire was administered regarding personal information, socio-economic status, oral hygiene habits, and oral health conditions. A clinical oral examination was performed to collect Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Pregnancy outcome records included: delivery week, kind and causes of delivery, any relevant complications, and birth weight. Descriptive statistics were used to depict the data from the questionnaire while the relationship between delivery week, birth weight, maternal age and periodontal status was evaluated through multivariate tests of significance.

RESULTS

88 pregnant women were enrolled in the study. The results showed a statistically significant correlation (P< 0.001) among participants older than 40 years of age, between periodontal disease and adverse pregnancy outcomes. No statistical correlation was found among pre-term and low birth weight, smoking, ethnicity and educational level of mothers. The results highlight the importance of including a routine oral and periodontal health examination in pregnant women older than 40 years of age.

CLINICAL SIGNIFICANCE

The correlation between periodontal status and adverse pregnancy outcomes in older mothers indicates the need for routine oral health examination and periodontal status assessment and care in pregnant women older than 40 years of age.

Awareness of complications and maintenance mode of oral piercing in a group of adolescents and young Italian adults with intraoral piercing

Background

The aim of the study was to focus the awareness of complications of oral piercing among a group of adolescents and young Italian adults with intraoral piercings.

Material and Methods

A total of 225 teenagers were asked to complete a questionnaire on the awareness of complications of oral piercing. An additional questionnaire was administered in case of oral piercing worn, based on site piercing, knowledge about piercer license, oral and systemic risks due to oral piercing, disinfection and sterilization of the material pierced, information by the piercer about piercing hygiene maintenance and post-piercing dentist check-up. After questionnaire all partecipants received a brochure with some information about risks and maintenance mode of piercing.

Results

Data revealed that more than 50% of teens surveyed was found to wear a piercing. Only 25.3% was aware of the risk of HCV cross-infection and only 17.3% reported of knowledge about risk of endocarditis. Only 17% checked the piercer license and only 18% sterilization and disinfection of the materials used. 53.7% did not received explanations about the risks associated with piercing. With regard to the maintenance mode of the piercing, it has been suggested to brush the piercing bar in 17% of cases. The post piercing specialist visits have been suggested only in 7% of cases.

Conclusions

The general lack of awareness of complications and maintenance mode related to oral piercing needs to be addressed by some education programs performed at school and by dentists.

Key words: Oral piercing, oral health, oral complications.

Changes in microflora in dental plaque from cancer patients undergoing chemotherapy and the relationship of these changes with mucositis: A pilot study

BACKGROUND

To assess changes in oral microflora in dental plaque from cancer patients within 7 days of the first course of chemotherapy, and the relationship of the changes with mucositis.

MATERIAL AND METHODS

Thirty cancer patients, divided into a test group undergoing chemotherapy and a control group no undergoing chemotherapy, were enrolled in this pilot study. Oral microflora were cultured from three samples of dental plaque at t0 (before chemotherapy), t1 (1 day after chemotherapy) and t2 (7 days after chemotherapy). Single and crossed descriptive analyses were used to establish prevalence, and the χ² test was used to establish the statistical significance of the differences observed in distributions (significance level: P<0.05).

RESULTS

In most patients (57%), oral microflora consisted mainly of Gram-positive cocci, while the remaining 43% of the bacterial flora also had periodontal-pathogenic species. No Porphyromonas gingivalis appeared in the test group. Actinobacillus was the least frequently found bacterium among periodontal pathogens in the test group, while Fusobacterium nucleatum was the most frequently found. No significant differences were found in quantitative bacterial changes between t0, t1 and t2 in either the test or control groups, or between the two groups. According to World Health Organization scores, oral mucositis developed in 10 patients (66.6%) in the test group.

CONCLUSIONS

The results of this pilot study indicate that there were no changes in microflora in dental plaque in cancer patients within 7 days of the first course of chemotherapy. No correlations between oral mucositis and specific microorganisms were assessed.

Awareness of risks related to oral piercing in Italian piercers. Pilot study in Lazio Region

OBJECTIVE

Specific regulations about education and training for body piercing licensure courses have to be considered due to the great increase in oral piercing practices. The aim of the present survey was to assess the local and systemic risk awareness in the practice of oral piercing and their prevention in a sample of Italian piercers.

MATERIALS AND METHODS

An anonymous 20-item questionnaire was administered to 30 body licensed piercers in a small town of central Italy. Licenses certificates were issued by Lazio Region after the completion of an approved training program for standard body piercing including 90 hours of course and a final examination as provided by regional law. The questionnaire surveyed on oral cavity anatomy, local and systemic risks as result of oral piercing, piercing maintenance and need of a dental visit.

RESULTS

Response rate was 66.6%. Only 20% of respondents was aware about oral cavity anatomy and none had knowledge about tongue and gums anatomy. Only 10% enlightened the need of a dental visit and 30% was aware about piercingrelated temporary paralysis. The piercing maintenance was habitually proposed only by 40% of respondents.

CONCLUSION

The study participants showed a low level of awareness regarding the potential health risks of oral piercing. Poor knowledge of anatomy and local and systemic risks and poor awareness of the importance of piercing maintenance explanation.