Use of Edibles as Effective Tools in Myofunctional Therapy: A Pilot Study

AIM

The aim of this retrospective study is to explore the introduction of edible spread cream and small candies as tools to improve motivation and compliance in young children undergoing myofunctional therapy, with the purpose of optimizing oral functions, including swallowing.

METHODS

Six patients, one female and five males, between the ages of 7 and 14 years, presenting with atypical swallowing, were evaluated and treated at the clinic of the University of L'Aquila. The patients included in the study were randomly divided into two groups and were treated with two different treatment protocols: Group A: traditional myofunctional therapy and traditional tools; Group B: same exercises as group A, but with edible tools (spreadable cream and small candies).

RESULTS

As expected, the two patients who used edible tools demonstrated increased motivation and collaboration during myofunctional therapy.

CONCLUSIONS

Patient compliance, especially in very young patients, limits the effectiveness of myofunctional therapy; therefore, creative solutions are needed to achieve greater cooperation, and edible tools can play a significant part in retraining correct swallowing. Although the sample of this pilot study is small, the results suggest that using actual edible tools in myofunctional therapy could increase compliance and provide better results in myofunctional therapy.

Analysis of General Knowledge on Obstructive Sleep Apnea Syndrome (OSAS) among Italian Pediatricians

INTRODUCTION

Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by partial or total airway obstruction during sleep. Studies have shown variability in the level of knowledge and awareness about OSAS among pediatricians. The management of childhood obstructive sleep apnea syndrome (OSAS) depends on the severity of the disease, the presence of comorbidities, and the child's age. The American Pediatric Academy recommends a multidisciplinary approach involving a pediatrician, a sleep specialist, and an otolaryngologist to provide comprehensive care for children with OSAS. The aim of this cross-sectional study is to evaluate the level of knowledge among pediatricians in Italy regarding the diagnosis of pediatric OSAS.

MATERIAL AND METHODS

An anonymized survey was conducted among Italian pediatricians. The survey was administered electronically using Google Forms, and a total of 350 pediatricians were invited to participate. Out of the 350 invitations, 299 pediatricians responded to the survey. The statistical analysis performed consisted of descriptive analysis. The study included 297 pediatricians.

RESULTS

Pediatricians demonstrated proficiency in identifying common nocturnal and day symptoms of OSAS. A majority (68.9%) considered the oral and otorhinolaryngologist areas during checkups. Approximately 70.6% took patient weight into account, and 62.8% were aware of the regional diagnostic-therapeutic-assistance pathway.

CONCLUSIONS

According to the results of this manuscript, there is evidence of a good level of knowledge about OSAS, but disseminating more information about OSAS and all the health issues associated with this syndrome is suggested. This study also has limitations caused by the complexity of the pathology.

Temporomandibular disorders: the most common diagnostic approaches

BACKGROUND

Temporomandibular disorders (TMDs) are a heterogeneous group of conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. They are a multifactorial disease that can be determined by organic, genetic aspects, oral parafunctional habits, and psychological stress. They have an annual incidence of more than 5% of the population and about 6% to 12% of the population is affected by symptoms. The diagnostic criteria (DC), introduced by Dworkin, is considered the standard system to diagnose this disease in a specific way. Imaging can support the diagnosis of TMD when history and physical examination findings are equivocal. The aim of the study was to evaluate instrumental examinations and therapies, clinicians prefer to use in different cases of TMDs.

METHODS

An anonymized survey, available in two languages (Italian and English), was given to 450 patients, 398 (120 males, 274 females and 4 who did not answer) of different private dental practices were considered, using Google Form (Google LLC, Mountain View, CA, USA) and used an electronic platform, from September 2021 to February 2022. There was no reminder sent to patients to let them feel free to answer.

RESULTS

We performed binary regression for oral bite prescription considering common symptoms and found that the most representative is jaw block (P=0.007, exponential value [EXP]=0.509), followed by TMJ noises (P=0.01, EXP=0.503) and feeling stressed (P=0.04, EXP=1.125) while headache and tinnitus resulted not significant.

CONCLUSIONS

The study highlighted that magnetic resonance imaging (MRI) is the most instrumental examination adopted by the clinicians and the oral splint(bite) is the therapy most widespread nowadays, even if TMDs are a multifactorial disease that is not, probably, only linked to an alteration of dental occlusion.

Risk factors and prevention of choking

Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances).  The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%)  and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.

Evaluation of the Loss of Strength, Resistance, and Elasticity in the Different Types of Intraoral Orthodontic Elastics (IOE): A Systematic Review of the Literature of In Vitro Studies

BACKGROUND

Intraoral orthodontic elastics (IOE), typically referred to as rubber bands, are important tools for correcting malocclusion, and they are classified into latex and synthetic (elastomeric-based) elastics. They have different strengths and sizes, depending on their intended use, that provide clinicians with the ability to correct both anteroposterior and vertical discrepancies. Clinical use, together with saliva, alters the physical characteristics of both latex and synthetic elastics, causing declines in strength over time.

AIM

The aim of the study was to assess, through a systematic review of in vitro studies, the properties of intraoral elastics. The primary goal was to evaluate how IOEs behave in terms of tension strength and duration. The secondary goal was to investigate the force loss during the first hours of wear. The tertiary goal was to assess how these forces decayed.

MATERIALS AND METHODS

The following electronic databases were searched from December 2020 to April 2021: Medline Full Text, PubMed, Cochrane Clinical Trials Register, Science Direct, and Literature Review. Out of 8505 initial articles, 10 were selected for the systematic review.

RESULTS

The force-degradation property was found in all types of IOEs. The loss of strength was directly proportional to time, with the highest value during the first 3 h after extension, regardless of the elastic band size and manufacturer. The forces generated by the latex bands were higher than in those of the elastomeric-based elastics, but they did not consistently correspond to the loads specified by the manufacturers. The retention forces in the latex IOEs were significantly higher than those in the nonlatex bands, suggesting that elastomeric-based bands need to be changed more frequently and at regular intervals throughout a 24 h period.

CONCLUSION

This systematic review indicates that intraoral orthodontic elastics have the greatest loss of force during the first 3 h, that latex rubber bands have the highest strength during the first hour, that the forces generated are not always consistent with the manufacturer's specifications, and that nonlatex (elastomeric-based) IOEs need to be changed frequently and regularly during a 24-h cycle.

Malocclusion and Scoliosis: Is There a Correlation?

INTRODUCTION

Scoliosis is a complex three-dimensional malformation of the spine. Although its etiology is still being investigated, it is clear that a number of factors can influence this syndrome. The spinal deformity of idiopathic scoliosis can be viewed from an etiopathogenetic perspective as a symptom of a complicated condition with a multifactorial etiology. Numerous studies have established its relationship with malocclusion, but it is still unclear how these factors interact. Malocclusion is a change in the physiological alignment of the upper and lower teeth that can be either dental or skeletal in origin. This study's objective is to assess the relationship between scoliosis and malocclusion.

MATERIAL AND METHODS

A total of 646 patients were enrolled (554 females and 92 males), 447 with scoliosis and 199 without, from private dental and orthopedic practices, to answer an anonymous questionnaire. They were selected in private dental and orthopedic practices where they had dental and orthopedic examinations. Twenty-two patients were excluded because of a lack of answers. Participants were given a bilingual survey, in English and Italian, composed of 13 questions formulated specifically for this study, using Google Forms (Google LLC, Mountain View, CA, USA).

RESULTS

Univariate analysis of the question "Do you have scoliosis?" shows a significant correlation with the following questions: "Was scoliosis a family issue?" (p < 0.05 OR 7.30 IC: 3.05-17.46) "Do you have malocclusion?" (p < 0.05, OR: 1.19 IC:1.0-1.34) and "Was mal-occlusion a family issue?" (p < 0.01, OR: 1.39 IC 1.10-1.77). Performing a multivariate analysis for the same variables, the best predictors of scoliosis were "Was scoliosis a family issue?" (p < 0.001) and "Was malocclusion a family issue?" (p < 0.05), while the question "Do you have malocclusion" lost significance.

CONCLUSION

This study adds further confirmation that there might be an important connection between malocclusion and scoliosis; it suggests that dentists and orthopedists have to check, as early as possible, for the probable presence of both pathologies to avoid a severe progression which, in most cases, may require significant therapy and even surgery.

Upper Airway Changes and OSAS Risk in Patients after Mandibular Setback Surgery to Treat III Class Skeletal Malocclusion

INTRODUCTION

Mandibular setback surgery (MSS) is one of the treatment options to resolve mandibular prognathism in patients suffering from skeletal class III malocclusion, which cannot be treated with simple orthodontic treatment. The mandibular setback surgical operation can involve changes in the pharyngeal morphology, resulting in a narrowing of the posterior airway space (PAS). This aspect is associated with an increase in airflow resistance, which increases the risk of developing snoring or obstructive sleep apnea syndrome (OSAS). The aim of this study is to evaluate the medium- and long-term effects of mandibular setback surgery on the upper airways and its possible association with OSAS in patients suffering from class III skeletal malocclusion.

MATERIAL AND METHODS

A total of 12 patients (5 males and 7 females) were enrolled in this study. The statistical tests highlighted a significant change in the PAS and BMI values in relation to T0, before surgery (PAS: 12.7 SD: 1.2; BMI: 21.7 SD: 1.2), and T1, after surgery (PAS: 10.3 SD: 0.6, p < 0.01; BMI: 23.8 SD: 1.2, p < 0.05). Sample size was calculated to detect an effect size of 0.9, with statistical power set at 0.8 and the significance level set at 0.05.

RESULTS

No statistically significant correlation was found between the extent of mandibular setback, PAS and BMI change.

CONCLUSION

This study confirms the effects of mandibular setback surgery on the upper airways, reporting a statistically significant PAS reduction in the medium- and long-term follow-up. On the other hand, no direct correlation was identified with OSAS risk, at least for the small mandibular setback (<8 mm), despite the statistically significant increase in BMI.

The importance of promoting oral health in schools: a pilot study

Promotion of oral health has an essential role in the maintenance of teeth in adults. However, health education must start from an early age, in order to monitor the child's growth and prevent pathologies. Schools are in charge of the overall education of children and of guidance to parents but could also be engaged in the promotion of oral health, supported and counseled by pediatricians and dentists. The purpose of this pilot study is to evaluate whether school age children could be taught, successfully, basic oral sciences and dental hygiene, by a professional, during school hours. In this pilot study, an anonymized test was administered to 45 children of age between 8 and 10, both before and after an interactive lecture on oral health, to assess the effectiveness of the lesson and acquisition by the children of knowledge on oral health. After the presentation, the majority of the children were able to answer correctly to the questionnaire that was given to them (test, retest) which was related to dental anatomy and pathology (number of teeth, cavities, halitosis), and dental hygiene tools and practices (brushes, floss, mouth wash, tongue scrapers). The children seemed to be receptive to learning while in school, and a specific educational session of dental hygiene and oral health seems to be the right approach to ensure children can identify dental hygiene tools and use them appropriately.

Prevention of malocclusion and the importance of early diagnosis in the Italian young population

AIM

Malocclusion is an alteration of the normal relationships between skeletal, muscle and dental structures that can lead to impaired functionality as well as aesthetic alteration of the stomatognathic system. Functional alteration can affect various aspects, ranging from chewing ability to respiratory disorders. Paediatricians and dentists are called to prevent and diagnose these conditions as early as possible in order to preserve the patient's health. The purpose of this research is to study the incidence of malocclusion and its relationship with Obstructive Sleep Apnea Syndrome (OSAS) in a young population. Also, the role of paediatricians and dentists in prevention and early diagnosis of this condition was evaluated METHODS: An anonymous survey was given through Google form to 300 Italian children (139 males and 161 females) from different private dental practices in Italy. No personal information that identifies the individuals was collected, and the data was analysed in aggregate form only. All data was collected and statistically analysed.

CONCLUSION

The data highlight the patients' good attitude towards dental check-ups, which help to intercept malocclusions. Unlike the past, the knowledge of the importance of oral health and dental occlusion is high among young patients, parents and paediatricians. This study underlines the role of paediatricians as key players in the prevention of dental health problems.

The Potential of Digital Impression in Orthodontics

Background: Over the past 20 years, there have been many innovations in orthodontic diagnosis and therapy. Among the innovations, there is the taking of dental impressions (DIs). Dental impressions are the negative imprint of hard and soft tissues of one or both arches, and they allow a plaster model to be formed, i.e., a positive reproduction. Traditional dental impressions can be made of different materials, such as alginate, while digital impression is captured by an intra-oral scanner. Digital impression, despite the evident advantages, has not yet replaced the conventional impression. The aim of this study is to evaluate which dental impressions are the most used by dentists. For this purpose, we considered 120 questionnaires sent electronically to patients of different dental private practices from different countries, where the dentists can use both techniques. The results highlighted that the kind of impression adopted is very much influenced by the type of therapy and orthodontic devices used in the treatment. We can conclude that, despite the advent of digital technology, conventional impressions are still used for fixed devices, while digital impressions are more adopted for orthodontic customized devices and therapies with clear aligners, that are very widespread among adult patients.

Utility of Teleorthodontics in Orthodontic Emergencies during the COVID-19 Pandemic: A Systematic Review

Background. Coronavirus disease has subjected the whole of humanity to two years of social isolation and a series of restrictions. These circumstances have led to the use of information technology in an increasingly widespread manner. Even in the dental field, telematic means have been used to respond to emergencies. The aim of this systematic review of the literature is to evaluate the types of orthodontic emergency that occurred most often and how they were managed by teleorthodontics during the COVID-19 pandemic. The secondary aim is that clinicians will use teleorthodontics not only during pandemics but as an additional tool to manage orthodontics. Materials and Methods. Out of 1695 articles available on PubMed, Science Direct, Cochrane and SciELO, eight articles were selected for this systematic literature review. Google Scholar was used as a secondary source to confirm that there were no additional articles. The screened papers comprised editorials, clinical studies, cross-sectional studies and retrospective studies in Italian, English or Spanish language. Results. The articles showed that the means by which patients most often communicated with their orthodontists were voice calls and smartphone applications such as WhatsApp^® Messenger. Through these media, patients communicated their orthodontic emergencies. These mainly involved fixed multibracket appliances and the most common issues were discomfort and pain, fracture or loss of the appliance, protruding distal ends of archwires, brackets, tubes and bands or retainer detachment. Through teleorthodontics, patients could solve these issues by using orthodontic relief wax, cutting the protruding distal ends of the archwire with a nail clipper or a stronger cutter and removing or replacing detached bands, brackets, tubes or metallic ligature with a clean tweezer. Conclusions. In situations where personal contact is limited, teleorthodontics represents a valuable aid for professionals and patients facing orthodontic emergencies. The hope is that it may continue to represent a valuable aid for patients with difficulties in planning an in-office visit.

The Influence of SARS-CoV-2 Pandemic on TMJ Disorders, OSAS and BMI

The pandemic of the 21st century had a significant influence on the lives of the world population in a negative way. This situation determined a change of lifestyle; it caused the necessity of social isolation for a great number of people. In fact, people tended to avoid crowded environments, social events, to reduce medical checks and sports activities, favoring sedentary life because of fear of the virus. This social attitude brought a high level of stress that worsened many health conditions. This study has the aim of evaluating the possible influence of the pandemic on temporomandibular joint (TMJ) disorders, obstructive sleep apnea syndrome (OSAS) and body mass index (BMI). An anonymized survey, available in two languages (Italian and English), was given to 208 patients from different private dental practices. In this questionnaire, the patients shared experiences about their life during the pandemic. The article highlighted that during this health emergency, there was an increase in body weight in the considered sample. This brought a worsening of OSAS in 65% of patients with a previous diagnosis. Eventually, an increase in TMJ disorders and orofacial pain was reported.

Evaluation of the effects on SpO2 of N95 mask (FFP2) on dental health care providers: a cross-sectional observational study

Objective

The purpose of this cross-sectional observational study was to evaluate the effects of SpO2 in a sample of dental health care providers who wear a N95 mask or Filtering Face Piece (FFP2) for four consecutive hours, measured by a pulse oximeter before donning the mask and again after four hours of work and to offer some strategies to minimize discomfort and improve communication with their patients while wearing the mask.

Materials and methods

A 17-item questionnaire was sent via Google Drive to various practitioners in Italy and the USA. A sample of 162 questionnaires were returned from dentists, orthodontists, dental hygienists and dental assistants who committed to wearing a FFP2 for 4 consecutive hours during a work day and then measuring the oxygen saturation by way of a pulse oximeter before and after the 4 working hours. The final analysis was performer on 147 viable questionnaires returned. The sample was composed of 62 males and 85 females with an average age of 42.9 ± 12.0 years.

Results

For the entire sample population, the baseline saturation was 98.6 ± 1.2 and, after four hours of mask wearing, there was a significant decrease in oxygen saturation to 97.0 ± 2.9 (p < 0.01). No statistical differences in SpO² were found across specialties or across types of procedures performed during the 4 h. Heart rates were not significantly different before and after the 4 h in all categories. The 3 most frequent reported complaints were: fatigue (64%), headache (36%) and external ear pain (31%). The most common additional personal protective equipment (PPE) was a mask shield (78%) and those who wore the mask continuously reported more communication difficulty with patients, compared with those who took the mask off more often, in fact, 64% of the subjects reported that using the mask influenced their communication with their patients. Based on the results of the questionnaire, a list of breathing and vocal folds health strategies was devised and proposed, along with strategies to augment communication with patients.

Conclusions

This study highlights a significant decrease in oxygen saturation after only 4 h of work (except for smokers) while wearing a FFP2, and confirms the widespread symptoms of fatigue, headache and pain behind the ears that dental professionals experience. But it also highlighted how mask wearing impaired communication with patients and wearing additional masks and a facial shield may add to those communications difficulties. This aspect and the need for better communication can lead the operators to remove the mask to improve breathing and communication, thus putting themselves at a risk of infection. Of all the aspects explored in this study, the most interesting was indeed the impact on fatigue and communication and the strategies proposed in this article can easily be implemented to reduce headache and fatigue by improving breathing efficiency and by aiding communication while donning a mask by improving voice quality and by using augmentative communication tools.

Maldevelopment of the cranio-facial-respiratory complex: A Darwinian perspective

AIM

The mammalian Cranio-Facial-Respiratory Complex (CFRC) comprises several different biological tissues that collectively function under coordination from the central nervous and cardiorespiratory systems, primarily to breathe, eat and drink as well as integrating the sensory and motor systems for speech, communication and protective mechanisms. Anthropologists have long recognised that lifelong exposure to modern feeding regimens of readily available and highly processed foods, changes in breastfeeding and weaning, can impact expression of various phenotypic traits affecting the CFRC quite differently than does lifelong exposure to more traditional ancestral feeding regimens, typical of hunter-gather/foraging in non-Western-exposed cultures. The aim of this study is to highlight the role of the paediatric dentist in a multidisciplinary approach in which professionals working in and around the CFRC can actively prevent tooth decay and skeletal-dental malocclusion in the light of evolutionary oral medicine.

RESULTS

As a result of changes in the environment, in the food quality, in eating and feeding practices starting from day one, two oral diseases of civilisation, tooth decay and skeletal-dental malocclusion, have both relatively recently reached worldwide epidemic proportions and afflict people of all ages.

CONCLUSION

A multidisciplinary approach in which professionals working in and around the CFRC can actively promote prevention or reversal of dento-skeletal and myofunctional disorders, diagnose them when present and coordinate the appropriate therapy and life long maintenance programme.

Myofunctional therapy Part 3: Tongue function and breastfeeding as precursor of oronasal functions

Breastfeeding is the best practice to ensure proper nutrition, correct growth of the craniofacial complex and overall health of the baby with optimal breathing, feeding and sleeping functions. Many mothers face breastfeeding problems due to the baby's difficulty in latching, especially if the lingual frenum is restricted. Early detection and understanding of some of the root causes of those difficulties will lead to an early intervention, thus getting the babies on the right tract of their full potential of growth and development.

Proposal of use of the autotransplantation of the third molar as space maintainer in growing patients: a review of literature and a clinical case

The review of literature shows that 48,22% of the autotranspated teeth were orthodontically treated. A 13-year-old male patient presented a destructive decay in the element 3.6, which was underoccluded. To maintain the arch space and the quantity of bone necessary for a potential implant, it was decided to perform an autotransplantation of the impacted element 3.8. Tooth autotransplantation is a valid and durable alternative to the prosthetic and the implant solutions with high success rate.

Complications of oral piercing: a review of the literature and two case reports

The practice of piercing has been used since ancient times, and nowadays is coming back in fashion among adolescents and young adults. Teenagers wearing oral piercings are frequently observed during routine examination, and there are, also, recurrent harmful consequences attributed to the devices. Unfortunately, piercings are usually placed by unlicensed individuals, lacking the appropriate anatomical knowledge, and therefore unable to provide sufficient information regarding the potential risks, especially when compared to the ones known by the patients. In this regard, the relevant legislation is frayed both vertically (that is within the framework of State and Regional competences), and horizontally (within the competences between the various regions). With the present study, through an accurate review of the literature and the description of two case reports, we underline the importance of informing both the patients and the dental professionals about the dental consequences undergoing the application of piercing. Both patients examined presented the common complications related to the application of piercing. The aim of this study is to underline the importance of being informed for both the dental professional and the person who undergoes piercing about its consequences for the whole oral system as well as the possible risks of infections and complications. We want to underline the key role of the dentist as a promoter of prevention of oral disorders as well as being able to deal with the possible complications which may occur.

A new factor involved during childbirth labor: the importance of having a good dental occlusion

It is widely recognized that the physiology of childbirth labor largely depends on the interaction between three factors: a) the force generated by uterine contractions; b) the structure and characteristics of the birth canal and c) the fetus. Harmony between these three variables determines the initiation of maternal dynamic phenomena and the establishment of an optimal maternal-fetal balance in which both warrant for a correct delivery timing. The present study considered the above known factors and assessed if any other factor, still not recognized, could also play a role, and eventually modify the timing of delivery during the expulsive period. In particular, we focused our attention on the role played by the temporomandibular joint and dental occlusion on maternal body balance and on the stability of muscular reflected forces. The importance of assessing the temporomandibular function and the dental occlusion lies in the fact that any alteration in chewing or in temporomandibular joint (TMJ) mobility and occlusion brings to relevant modifications on the vertebral column and pelvic girdle. Our hypothesis is based on the evidence that those women who have any kind of alteration in their dental occlusion, can have an altered capability of pushing during the expulsive period, as the force applied on the pelvic floor is not expressed. Moreover, recent studies have highlighted a relationship between temporomandibular dysfunctions and sleep apnea syndrome and between sleep apnea syndromes and pregnancy. These relationships are explored in this study.

The relationship between TMJ symptoms and orthodontic treatments: a survey on 236 orthodontic patients

The study analyzes how and if temporomandibular joint symptoms are influenced by different types of orthodontic therapy. Two-hundred-and-thirty-six adult orthodontic patients treated by different clinicians, were asked to complete a survey in which factors as the age, the gender and the type of device were considered. The questions were about the typical symptoms of temporomandibular disorders, in particular headache, bruxism, clenching, pain while opening the mouth and joint's noise. It was highlighted if these symptoms changed during the therapy and if they increased or decreased. The answers to our questionnaire revealed that the only statistically significative difference was related to bruxism, because we found a higher rate in patients treated with aligners than patients treated with metal braces, so we can suggest the fixed technique in the orthodontic patient who suffers of bruxism, even if further studies are required.

Does a short lingual frenulum affect body posture? Assessment of posture in the sagittal plane before and after laser frenulotomy: a pilot study

The factors that characterize posture are neurophysiological, biomechanical, psychoemotional. Neurophysiological factors concern the modulation of tone, muscle tone is the result of a series of neuropsychological processes within the tonic-postural system. The tonic-postural system can become unbalanced for various reasons, including a tight lingual frenum. The aim of this pilot study was to evaluate the benefits of frenulectomy by laser on body posture and on the scapular (shoulders) anteroposterior movement. Twenty-four healthy subjects were selected, between the ages of 10 and 26 years (mean age 15.22) who presented a short lingual frenum and a low posture of the tongue and jaw. They were examined using the Marchesan Protocol for Lingual Frenum and the Spinometry® Formetric and underwent laser frenectomy by diode laser (Siro Laser Blu. 660 nm) without any post-surgery complications. The release of the frenulum immediately brought benefits to patients, reorganizing the physiological modulation, and the movement of the tongue within the normal parameters of temporomandibular kinematics which were within physiological parameters. Frenectomy improved the anterior-posterior flexion of the scapulas (shoulders) in the sagittal plane but a larger sample is required to have statistically significant results.

Myofunctional therapy Part 2: Prevention of dentofacial disorders

AirwayCentric approach to prevention of dentofacial disorders. The correct development of functions is important for the prevention of dentofacial disorders from the first days of life. The first and foremost function, to which all others are adapting, is nasal breathing. The AirwayCentric® method focuses on nasal breathing during early development and throughout childhood to promote: Neurobehavioural development and the brain, development of the craniofacial and respiratory complex, correct dental occlusion, proper and restful sleep and to improve performance and life overall. By working at the same time on orofacial functions and structures, many dentofacial disorders can be prevented.

Myofunctional therapy. Part 1: Culture, industrialisation and the shrinking human face

Culture, industrialisation and the shrinking human face: Why is it important? Over the past 300,000 years, not only has the way we consume food from birth through our lifetime changed, there have also been changes related to the methods of food preparation, availability, processing, and storage. These diet-related factors, along with other epigenetic factors, have led to a widespread increase in orofacial myofunctional disorders (OMDs) and resultant human malocclusion phenotypes (HMPs) worldwide. Currently there is an increasing need for resolution of HMPs in early childhood and associated OMDs. This review will include reports of cases and describe the nature of the problem and strategies for effective solutions.

Telemedicine for a Multidisciplinary Assessment of Orofacial Pain in a Patient Affected by Eagle’s Syndrome: A Clinical Case Report

Background:

Orofacial pain has a broad range of origins and a multidisciplinary approach occupies a relevant role.

Objective:

The aim of this study was to review the literature regarding the evolution of telemedicine and orofacial pain related to a case report of a patient affected by Eagle's syndrome.

Materials and Methods:

Two authors (RJM and SG) independently reviewed the literature up to March 2020. A case report was developed by including the interdisciplinary assessment and initial treatment of orofacial pain in a 38-year-old female patient affected by Eagle’s syndrome. The patient was interviewed by two different specialists (from Rome, Italy and Los Angeles, California) through an online meeting platform in order to evaluate her complex situation, demonstrating the possibilities that telemedicine offered during the COVID-19 pandemic.

Conclusion:

An interdisciplinary approach can be performed for future follow ups on patients as various advantages were found by the patient and by the clinicians themselves.

The Digital Diagnostic Approach to Stafne’s Bone Cavity (SBC): From a Review of the Literature to the Description of a Clinical Case

Introduction:

Stafne’s Bone Cavity [SBC] is a rare, well-defined, mandibular bone lesion, which was first discovered by Edward C. Stafne in 1942.

Objective:

The purpose of this article is to evaluate a digital diagnostic approach to Stafne’s Bone Cavity (SBC) through a review and description of some clinical cases.

Methods:

The review was conducted through an analysis of the literature of all articles published on Stafne’s Bone Cavity.

We report the case of a 55-year-old male patient who needed tooth implant rehabilitation, and therefore, a panoramic radiograph was taken as part of the routine evaluation and plan of care. After the diagnosis, the focus was on more precise imaging and the merits of choosing Computerized Tomography or Magnetic Resonance Imaging were compared.

Results:

According to our review of the literature, the prevalence of these cavities was found to be 0.14%, while 8% of them were found in male patients and 72% of them were found in male patients older than 44 years of age.

The patient’s panoramic radiograph revealed the presence of an SBC in his left posterior side of the mandible. In order to confirm and improve the diagnosis, the patient underwent a Computer Tomography exam, chosen for its benefits outweighing those of an MRI.

Conclusion:

Stafne’s bone cavity (SBC) is indeed an uncommon finding as it is asymptomatic and is identified only through panoramic imaging, CT scans or MRIs. However, it can pose some logistical problems in the application of dental implants. The typology of this case study confirmed the findings of the systematic review; the patient, being a middle aged male, presented a mandibular SBC, which was discovered only during a routine panoramic x-ray to plan the fitting of dental implants. The use of tomography confirmed the diagnosis of SBC and detailed the anatomical structure, thus guiding the restoration process.

Study of cellular toxicity in vitro of two resins for orthodontic use

OBJECTIVE

The objective of this work is to compare cellular toxicity in vitro of two resins for orthodontic use: an auto-polymerizable composite and a photo-polymerizable composite.

MATERIALS AND METHODS

Samples were obtained by joining a couple of steel orthodontic brackets by using auto-polymerizing or photo-polymerizing resin. We used a halogen lamp, a mini LED lamp and a fast LED lamp used for orthodontics cure for 40 seconds. The 3T3 Swiss cellular line of fibroblasts was used. The samples obtained were used to determine the cellular toxicity in vitro using the Neutral Red Up-take (NRU) and the 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

RESULTS

Toxicity of the extract appraised at a low level at MTT and NRU assays. There were statistically relevant differences between the toxicity induced by the auto-polymerizing material and the toxicity induced by the photo-polymerizing composite material, polymerized with the blue-light lamp (p < 0.001) and with the mini LED lamp (p < 0.05).

CONCLUSIONS

From the data collected in this study, we can conclude that both resins show a low level of cytotoxicity that, in the case of photochemical polymerizing resin, depends on the characteristics of the lamp.

Coronavirus Lockdown as a Major Life Stressor: Does It Affect TMD Symptoms?

Temporomandibular disorders are multi-factorial conditions that are caused by both physical and psychological factors. It has been well established that stress triggers or worsens TMDs. This paper looks to present early research, still unfolding, on the relationship between COVID-19 as a major life stressor and TMDs. The main aims of this study were to: investigate the presence of symptoms related to TMDs and the time of onset and the worsening of painful symptoms in relation to the changes in social life imposed by the coronavirus pandemic; and to evaluate the perception of COVID-19 as a major stressful event in subjects who report worsening of painful TMD symptoms. One hundred and eighty-two subjects answered questionnaires—Axis II of the RDC/TMD, the PSS, and specific items about coronavirus as a stressful event—during the lockdown period for COVID-19 in Italy to evaluate the presence of reported symptoms of TMD and the level of depression, somatization, and stress perceived. The results showed that 40.7% of subjects complained about TMD symptoms in the past month. Regarding the time of onset, 60.8% of them reported that facial pain started in the last three months, while 51.4% of these subjects reported that their symptoms worsened in the last month and were related to the aggravation of pain due to the coronavirus lockdown as a major life event and to the stress experienced. The results of this study seem to support the hypothesis that stress during the pandemic lockdown influenced the onset of temporomandibular joint disorders and facial pain, albeit with individual responses.

Short-Term Effects of a Myofunctional Appliance on Atypical Swallowing and Lip Strength: A Prospective Study

Atypical swallowing needs treatment in order to eliminate harmful interferences of the tongue, which prevent the harmonious growth of the stomatognathic system. The purpose of this study was to assess the effects of a functional appliance on the presence of atypical swallowing, analyzing the lip strength and the altered facial mimics. The effects of a myofunctional appliance (the Froggy Mouth) were evaluated on 40 children (6 males; 24 females; mean age 9.6 ± 2.17) with atypical swallowing—with tongue thrust diagnosed by an expert orthodontist—before and during a 6 month treatment. Data were analyzed over time with a paired samples t-test for normally distributed data. After 6 months of treatment, 33 children out of 40 achieved clinical correction of atypical swallowing due to their good compliance, even at an early stage. Seven children showed low compliance and did not obtain any result. Lip strength in compliant subjects went from 190.30 ± 86.04 cN to 489.39 ± 123.36 cN (t = p < 0.001). Facial mimics improved in 28 out of 33 compliant subjects, and four children with the initial diagnosis of labial incompetence achieved correction. This observational study demonstrates the short-term efficacy of this myofunctional appliance in the treatment of atypical swallowing, achieving correction of the facial mimics and labial incompetence with a significant improvement of the lip strength.

Perspectives of tele-orthodontics in the COVID-19 emergency and as a future tool in daily practice

AIM

The aim of our study was to explain how tele-orthodontics represents the only way to perform orthodontics during a period of restriction as the one subsequent to COVID-19 emergencies: To do this, we report a case study and explore the proposal of a model of tele-orthodontics, considering the advantages of this modality in the immediate post-emergency phase and in the future daily practice.

MATERIALS AND METHODS

Study design: Our study involves 30 patients, who had undergone different orthodontic therapies in a traditional way, and that the clinician continued to follow by means of tele-orthodontics. Given the obvious limitations of tele-practice, a comparison with patients who did not undergo any follow-up or underwent only in-office follow-ups could not be possible. The communication tools used in our study and proposed in our model of tele-orthodontics are videocalls, dedicated applications, intraoral and extraoral photos taken by the patients and instant messaging.

RESULTS

Tele-orthodontics allowed to perform some orthodontic follow-ups with less chairside time, reduced time spent by the patients in the dental office from up to 45 min, less risk of infection, fewer to no missed appointments, specific troubleshooting solutions, and more follow-ups with odontophobic patients. Overall, tele-orthodontics balanced the disadvantages of less personal contacts and in-office visits.

CONCLUSIONS

The need to respect safety distance and the fears patients have about the risk of infection make tele-orthodontics a fundamental tool during a pandemic lockdown and in its immediate post-emergency phase. Tele-orthodontics demonstrated to be a viable tool to continue at least some orthodontic care in times of emergency, but it may be considered an appropriate solution and addition even in normal times to ease therapy demands for both the orthodontist and the patient, while reducing time and money spent, without an excessive decrease in orthodontic quality.

Association between oral habits, mouth breathing and malocclusion in Italian preschoolers

AIM

This cross-sectional study was carried out to evaluate the prevalence of malocclusion and associated factors in preschoolers with the aim of assessing the existence of an association between bad habits and mouth breathing with the most severe malocclusions.

MATERIALS AND METHODS

A sample of 1616 children aged 3-6 years was visited by applying the Baby ROMA index, an orthodontic treatment need index for preschool age. The following were searched: the prevalence of malocclusion, the association of bad habits and mouth breathing with malocclusion, how often are found in association and how this association is statistically significant. Chi-square and Fischer test were applied to verify the statistical significance of the association between the variables.

RESULTS

The data show that 38% of the sample need orthodontic treatment and 46% have signs of malocclusion of less severe degree that require a close monitoring and the elimination of risk factors so that they can improve spontaneously with growth. Moreover the prevalence of bad habits and oral breathing increases with increasing severity of the malocclusion, and sucking habits and oral breathing are both closely related to anterior open bite, posterior crossbite and increased overjet.

CONCLUSIONS

In the context of prevention and early treatment of disorders of the craniofacial growth, bad habits and mouth breathing, being risk factors of malocclusion, should be intercepted and corrected early on to prevent the development of malocclusion, or the worsening of existing ones. From this point of view it is important to follow the patients with a multidisciplinary approach.

The validity of panoramic radiograph as a diagnostic method for elongated styloid process: A systematic review

Objective: To evaluate the validity of panoramic radiograph as a radiographic method for the diagnosis of an elongated styloid process (ESP) in the general population. Methods: An electronic search of available articles about ESP was conducted on PubMed. Sequential screenings based on previously defined exclusion and inclusion criteria were performed. Results: Eight studies were included in the systematic review. Prevalence of ESP and mean radiological length of the styloid process (SP) increased with age, which might be due to a chronic calcification development of the SP. Most of the included studies also asserted that there was no statistically significant correlation between ESP and the gender. Discussion: Panoramic radiograph is easy to perform and interpret, so it can be defined as being useful for diagnosis of ESP in the general population. In symptomatic patients, it can help in the differential diagnosis with other conditions associated with orofacial and neck pain.

Proposal for a myofunctional therapy protocol in case of altered lingual frenulum. A pilot study

In this article, the authors propose a specific Myofunctional Therapy Protocol for patients with altered lingual frenulum. In such cases tongue muscles are hypofunctioning and their range of motion is reduced. To compensate for this limitation, dysfunctional lingual motor patterns are established, such as the use of some muscles at the expense of others; this negatively affects the development and functions of the stomatognathic system. The Myofunctional Therapy Protocol presented in this pilot study was developed with the aim of making the muscles of the tongue, the floor of the mouth and the soft palate more coordinated, and increasing muscle contraction strength, in order to produce improvements on the muscle tone, on orofacial and nasal functions and a better wound healing and functional recovery in the case of surgical therapy (frenulotomy).

A specific protocol of myo-functional therapy in children with Down syndrome. A pilot study

In this article the authors propose a specific myofunctional therapy protocol for children with Down syndrome. For these patients, who usually present with atypical swallowing problems, mouth breathing and lip incompetence, the use of a myofunctional therapy protocol with specific exercises has been shown to improve orofacial and nasal functions. In addition to the functional results, such as the correction of the atypical swallowing, restoration of lip competence, breathing improvement and reduction of nasal rhinorrhea, there were also aesthetic results. This protocol can be useful to improve the quality of life of these patients.

Retrospective epidemiological study of mandibular rotational types in patients with orthodontical malocclusion

SUMMARY

The primary aim of this study was to illustrate the prevalence of facial skeletal discrepancy in an Italian sample. Another aim was to evaluate the effectiveness of the sagittal skeletal discrepancy classification in order to establish a morphologic pattern of growth useful for diagnosis and prediction of therapeutic results. The authors considered a sample of 732 patients (426 females and 306 males) aged between 6 and 17 years old. Cephalometric parameters were evaluated in order to establish a relationship between sagittal skeletal discrepancy and the classification of facial rotations (Lavergne and Petrovic). Facial types with neutral mandibular growth direction were the most prevalent, and were most observed in classes I and II; the latter was more represented than others in our sample. Facial types with posterior mandibular growth direction were the most prevalent in class III. Sagittal skeletal discrepancy classification is not able to establish a specific facial type or predict an individual responsiveness to treatment.

Cancer of the Pancreas: Clinical Outcome in 76 Cases

A final diagnosis of pancreatic cancer was established in 76 consecutive patients during 4 years. The clinical outcome was evaluated retrospectively, as well as clinical presentation and its impact on the rate of resectability. Even though the diagnostic techniques showed a high sensitivity, only 18.4% of patients had a radical resection performed. In 77.6% of the cases a tissue diagnosis had been obtained. However, in only 1/5 of them was the tissue proof obtained preoperatively. This review confirms that the survival of patients with pancreatic cancer is poor, with slight advantages in the few resectable cases. Therefore, an earlier diagnosis should be attempted in high-risk symptomatic patients, selected by means of nonaggressive tests and evaluated by means of more accurate diagnostic techniques, when suitable.

Outcome of Follow-Up Programs in Patients Previously Resected for Colorectal Cancer

The survival of a group of 115 patients (group A) who entered a follow-up program after apparently « curative » surgery for colorectal cancer was compared with that of 62 similar patients (group B) who did not join such a program. No significant difference was found. Clinical benefits to single patients in group A, in terms of anticipated diagnosis and effective treatment of recurrences and of metachronous neoplasias, appeared to be, if any, extremely limited. In light of the high costs of intensive follow-up programs, it is concluded that their use can be justified only within controlled perspective trials aimed to evaluate their usefulness.

Ca 19-9 Assay in Patients with Extrahepatic Cholestatic Jaundice

Serum concentrations of the CA 19-9 tumour marker were determined in 35 patients with histologically proven bilio-pancreatic malignancies associated with obstructive jaundice and in 35 patients with benign extrahepatic jaundice due to choledocholithiasis.

At a cut-off level of 37 U/ml the sensitivity of this assay was 82.8%, but the specificity was very low (45.7%). Thus CA 19-9 can not be employed to differentiate between malignant and benign extrahepatic jaundice.

Serial samples of CA 19-9 were achieved in 7 patients with benign and in 6 patients with malignant biliary obstruction, before and after the disappearance of jaundice. Serum concentrations of this tumour-antigen returned to normal concurrently with the bilirubin values only in patients with benign obstruction, remaining unchanged in all cases of malignancies.

The data suggest that patients with extrahepatic jaundice should be evaluated by other examinations or by collecting serial samples for this assay.

Case report of patients treated with an orthodontic and myofunctional protocol

BACKGROUND

Occlusion alterations can be associated to bad habits (such as thumb sucking, oral breathing, atypical swallowing and labial interposition) which can lead to functional anomalies.

CASE REPORT

Three cases are reported with the good results of myofunctional and orthodontic therapy.

CONCLUSION

When there are bad habits, orthodontics should be combined with a myofunctional therapy.

Causal relationship between malocclusion and oral muscles dysfunction: a model of approach

AIM

Bad habits result in altered functions which with time can cause anomalies of the orofacial morphology. To solve these problems, orthodontic treatment can be supported by myofunctional therapy in order to recover the normal functionality of the oral muscles. The aim of this study is to assess the need to treat patients with neuromuscular disorders, from both the occlusion and the muscles condition approach in order to obtain the balance needed for the stability of treatment.

MATERIALS AND METHODS

A sample of 23 patients with atypical swallowing was included in this study, some of them presented thumb sucking and oral breathing. After case history collection, in order to make a correct orthodontic and functional diagnosis, correction of anomalies was carried out since they could compromise the success of the therapy (maxillary contraction, oral breathing, and short lingual fraenum). Then a different therapeutic approach was applied on the basis of the specific dental features.

RESULTS

Both from the diagnostic and therapeutic point of view, important results were achieved especially through muscle analysis with dynamometer and surface electromyography.

CONCLUSION

Orthodontic therapy, in the presence of bad habits, is not enough to solve orthodontic issues, it must be combined with a myofunctional treatment. The success of the therapy is granted only when patients and their family comply with the treatment and all factors which can prevent success of the therapy are removed.

Patients treated with orthodontic-myofunctional therapeutic protocol

The aim of this study is to report three cases that needed myofunctional and orthodontic treatment and the good results achieved after the therapy. Orthodontic treatment alone, in presence of bad habits, is not enough to solve the orthodontic issues, so it needs to be combined with myofunctional treatment.

Exendin-4, a glucagon-like peptide 1 receptor agonist, protects cholangiocytes from apoptosis

BACKGROUND AND AIMS

Progression of chronic cholestatic disorders towards ductopenia results from the dysregulation of cholangiocyte survival, with cell death by apoptosis prevailing over compensatory proliferation. Currently, no therapy is available to sustain cholangiocyte survival in the course of those disorders. It was recently shown that cholangiocytes express the glucagon-like peptide-1 receptor (GLP-1R); its activation results in enhanced proliferative reaction to cholestasis. The GLP-1R selective agonist exendin-4 sustains pancreatic beta cell proliferation and prevents cell death by apoptosis. Exendin-4 is now employed in humans as a novel therapy for diabetes. The aim of the present study was to verify whether exendin-4 is effective in preventing cholangiocyte apoptosis.

METHODS

In vitro, tests were carried out to determine if exendin-4 is able to prevent apoptosis of cholangiocytes isolated from normal rats induced by glycochenodeoxycholic acid (GCDCA); in vivo, animals subjected to 1 week of bile duct ligation and to a single intraperitoneal injection of CCl(4) were treated with exendin-4 for 3 days.

RESULTS

Exendin-4 prevented GCDCA-induced Bax mitochondrial translocation, cytochrome c release and an increase in caspase 3 activity. Phosphatidylinositol 3-kinase, but not cAMP/protein kinase A or Ca(2+)/calmodulin-dependent protein kinase inhibitors, neutralised the effects of exendin-4. In vivo, exendin-4 administration prevented the increase in TUNEL (terminal deoxynucleotidyl transferase-mediated triphosphate end-labelling)-positive cholangiocytes and the loss of bile ducts observed in bile duct-ligated rats treated with CCl(4).

CONCLUSION

Exendin-4 prevents cholangiocyte apoptosis both in vitro and in vivo; such an effect is due to the ability of exendin-4 to counteract the activation of the mitochondrial pathway of apoptosis. These findings support the hypothesis that exendin-4 may be effective in slowing down the progression of cholangiopathies to ductopenia.

Human cholangiocarcinoma development is associated with dysregulation of opioidergic modulation of cholangiocyte growth

BACKGROUND/AIMS

Incidence of cholangiocarcinoma is increasing worldwide, yet remaining highly aggressive and with poor prognosis. The mechanisms that drive cholangiocyte transition towards malignant phenotype are obscure. Cholangiocyte benign proliferation is subjected to a self-limiting mechanism based on the autocrine release of endogenous opioid peptides. Despite the presence of both, ligands interact with delta opioid receptor (OR), but not with microOR, with the consequent inhibition of cell growth. We aimed to verify whether cholangiocarcinoma growth is associated with failure of opioidergic regulation of growth control.

METHODS

We evaluated the effects of OR selective agonists on cholangiocarcinoma cell proliferation, migration and apoptosis. Intracellular signals were also characterised.

RESULTS

Activation of microOR, but not deltaOR, increases cholangiocarcinoma cell growth. Such an effect is mediated by ERK1/2, PI3K and Ca(2+)-CamKIIalpha cascades, but not by cAMP/PKA and PKCalpha. microOR activation also enhances cholangiocarcinoma cell migration and reduces death by apoptosis. The anti-apoptotic effect of microOR was PI3K dependent.

CONCLUSIONS

Our data indicate that cholangiocarcinoma growth is associated with altered opioidergic regulation of cholangiocyte biology, thus opening new scenarios for future surveillance or early diagnostic strategies for cholangiocarcinoma.

Pancreatic intraductal sampling during ERCP in patients with chronic pancreatitis and pancreatic cancer: cytologic studies and k-ras-2 codon 12 molecular analysis in 47 cases

BACKGROUND

A preoperative tissue diagnosis of pancreatic cancer is desirable but difficult to obtain.

METHODS

Pancreatic brush cytology, salvage cytology, and collection of pancreatic juice were attempted prospectively during ERCP in 34 patients with pancreatic cancer and 11 with chronic pancreatitis. K-ras-2 codon 12 was analyzed for presence and type of point mutations.

RESULTS

Brush cytology coupled with salvage cytology had a sensitivity of 74%. The addition of cytologic analysis of pancreatic juice did not substantially improve sensitivity (76%). K-ras-2 was mutated in both cancer (87%) and pancreatitis (40%). The specificity for cytology was 100% and for K-ras-2 mutations 60%. Combining cytology with mutation analysis increased sensitivity to 93% but reduced the positive predictive value. The negative predictive value never exceeded 75%. None of the patients with chronic pancreatitis had cancer develop (median follow-up 60 months).

CONCLUSIONS

Pancreatic ductal brushing with salvage cytology is useful in the diagnosis of cancer, whereas cytologic analysis of pancreatic juice can be abandoned. At present, K-ras-2 mutation is not useful for differentiating pancreatic cancer from chronic pancreatitis or the identification of patients with chronic pancreatitis at risk for malignant transformation.

Intracellular signaling pathways involved in acetaldehyde-induced collagen and fibronectin gene expression in human hepatic stellate cells

Ethanol induces liver fibrosis by several means that include, among others, the direct fibrogenic action of acetaldehyde on hepatic stellate cells (HSC). However the mechanisms responsible for this effect are not well understood. In this communication we investigated signal transduction pathways triggered by acetaldehyde leading to upregulation of alpha2(I) collagen and fibronectin gene expression in human HSC. Run-on assays showed that acetaldehyde-enhanced transcription of these 2 genes as early as 2 hours, via de novo protein synthesis-independent and -dependent mechanisms. It also stimulated a time-dependent induction in phosphorylation of pp70(S6K) and extracellular-regulated kinase (1/2) (ERK1/2). These effects were completely prevented by calphostin C, a protein kinase C inhibitor. As expected, acetaldehyde-elicited ERK1/2 phosphorylation was inhibited by PD98059, a MEK inhibitor, but not by wortmannin, a PI3K inhibitor. On the other hand, both of these inhibitors partially inhibited phosphorylation of pp70(S6K) induced by acetaldehyde suggesting that its activation is ERK1/2- and PI3K-dependent. Acetaldehyde-elicited fibronectin and alpha2(I) collagen upregulation was inhibited by calphostin C. However, while PD98059, wortmannin and rapamycin (a pp70(S6K) inhibitor) completely abrogated alpha2(I) collagen upregulation, they had no effect on fibronectin expression. Overall, these data suggest that protein kinase C is an upstream component from which acetaldehyde signals are transduced to other pathways such as PI3K and ERK1/2. In addition, differential activation of these pathways is needed for the increase in fibronectin and alpha2(I) collagen gene expression induced by acetaldehyde in human HSC.

Intracellular pH regulation and Na+/H+ exchange activity in human hepatic stellate cells: effect of platelet-derived growth factor, insulin-like growth factor 1 and insulin

BACKGROUND/AIMS

The Na+/H+ exchanger is involved in rat hepatic stellate cell (HSC) proliferation induced by platelet-derived growth factor (PDGF). We therefore evaluated in human HSC: (1) the mechanisms of intracellular pH regulation; (2) the relationship between Na+/H+ exchange activation and cell proliferation induced by PDGF, insulin-like growth factor 1 (IGF-1) and insulin.

METHODS/RESULTS

pH(i) regulation was mainly dependent on the activity of the Na+/H+ exchanger, which was evaluated by measuring pH(i) recovery from an acute acid load. PDGF (25 ng/ml) gradually increased the activity of the Na+/H+ exchanger which peaked at 18 h and remained stable until the 24th h. IGF-1 (10 nmol/l), but not insulin (100 nmol/l), slightly but significantly increased the activity of the Na+/H+ exchanger. Amiloride (100 micromol/l) and 20 micromol/l 5-N-ethyl-N-isopropyl-amiloride completely inhibited HSC proliferation (evaluated by measurement of bromodeoxyuridine incorporation) induced by PDGF and IGF-1, but did not affect proliferation of HSC induced by insulin. Finally, IGF-1 did not modify the activity of the Na+/Ca2+ exchanger.

CONCLUSIONS

The Na+/H+ exchanger is involved in HSC proliferation induced by PDGF and IGF-1, whereas the proliferative effect of insulin is mediated by intracellular pathways which are Na+/H+ exchange-independent.

Involvement of reactive oxygen species and nitric oxide radicals in activation and proliferation of rat hepatic stellate cells

BACKGROUND/AIMS

Reactive oxygen species (ROS) induce HSCs activation, proliferation and collagen gene expression in vitro. Nitric oxide (NO) represents a reactive molecule that reacts with ROS, yielding peroxynitrite. We thus verified the effect of NO on ROS-induced HSCs proliferation in vitro and correlated iNOS expression and ROS formation to HSCs activation in the early phase of liver injury leading to hepatic fibrosis in vivo.

METHODS/RESULTS

HSCs were incubated with iron ascorbate (FeAsc) in vitro, which induced ROS production, ERK1/2 phosphorylation and increased cell proliferation. This effect was significantly reduced by the presence of the NO donor S-nitroso-N-acetylpenicillamine. Liver injury was induced in vivo in rats by dimethylnitrosamine administration. HSCs activation started 6 h after DMN administration and peaked at 1 week. ROS generation and neutrophil infiltration were evident for at least 48 h after DMN treatment, showing an identical distribution pattern. Only a few inflammatory cells expressed iNOS 6 h after DMN administration.

CONCLUSIONS

we have shown that NO acts as a ROS scavenger in vitro, thus inhibiting HSCs proliferation. ROS production by infiltrating neutrophils occurs in the early phase of liver fibrosis and can represent a stimulus to HSCs activation in vivo. The reduced iNOS expression may account for the low NO levels and the inability to prevent the ROS-induced HSC activation in vivo.

Pulpo-dentin protection: the biocompatibility of materials most commonly used in restorative work. A literature review

The complexity and importance of the biological structures that form the so-called pulpal dentinal complex call for considerable accuracy during restorative procedures. In practice this means accurate techniques and appropriate dental materials, able to combine protective and restorative qualities, and above all, offering biocompatibility. In order to analyze this property, a number of international studies suggest the use of sequential tests divided into three different levels: initial tests, secondary tests and usage tests in the form of in vivo and in vitro tests to observe and simulate the biological reactions to dental materials used in particular tissues. The authors publish a review of the literature regarding the biocompatibility of intermediate materials regarded as useful aids in restorative dental practice; these include paints, liners and cavity bases made from Ca(OH)2, ZOE cements, zinc phosphate, polycarboxylic compounds, glass ionomers, bonding agents and mordents. The chemical, biological, clinical and utilization parameters are outlined for each compound, paying special attention to the problem of biocompatibility and indicating the pulpal reactions reported over the past decade in connection with their use. In conclusion, while waiting for a standard international document to codify evaluation methods and classify the results obtained, these experimental data can be used to programme a more correct and safer use of materials.

Fibrogenic effect of oxidative stress on rat hepatic stellate cells

Oxidative stress is associated with liver fibrosis and with hepatic stellate cell (HSC) activation in vivo. However, it remains controversial whether oxidative stress contributes to HSC activation either directly or through a paracrine stimulation by damaged hepatocytes. A medium containing products released from cells undergoing oxidative stress was obtained after incubation of hepatocytes with (HCM/Fe) or without (HCM) 0.1 mmol/L ferric nitrilotriacetate complex (FeNTA). Exposure of HSC to HCM/Fe for 24 hours significantly increased the number of proliferating HSC compared with HCM and to controls at all dilutions tested. The simultaneous coincubation of HSC with HCM/Fe and desferrioxamine (50 micromol/L) did not reduce the observed increase in cell proliferation, thus excluding a role for eventually contaminating iron in HCM/Fe. HCM/Fe induced also a significant increase in collagen type I accumulation in HSC culture media. To study the cellular mechanism underlying HCM/Fe effects, we evaluated the activity of the Na+/H+ exchanger, which plays a role in regulating HSC proliferation. The incubation of HSC for 24 hours with HCM/Fe significantly increased baseline intracellular pH (pHi) and Na+/H+ exchanger activity, indicating a plausible role of this antiport in mediating cell response. In conclusion, hepatocytes undergoing oxidative stress release factors which are fibrogenic for HSC, thereby, confirming what has been only hypothesized in vivo. In addition, HSC proliferation is associated with changes in the Na+/H+ exchanger activity, thus providing a useful target for the evaluation of inhibitors of this pathway for the treatment of hepatic fibrosis.