Dysphagia-related mucositis in children undergoing chemotherapy: The COMEDY pattern

OBJECTIVES

Children undergoing chemotherapy can experience dysphagia due to non-erosive reflux disease (NERD). Oral mucositis (OM) associated with NERD-dysphagia in children with cancer has recently been defined with the acronym COMEDY (Clenching, Oral Mucositis, closed Eyes, DYsphagia). This study aims to identify the prevalence of the COMEDY pattern among chemotherapy-induced OM.

SUBJECTS AND METHODS

Forty-two medical records of children undergoing chemotherapy for haemato-oncologic diseases and presenting OM were reviewed. The following data were collected: age, type of haemato-oncologic disease, presence of dysphagia, type of oral mucosal lesions (i.e. traditional oral mucositis or COMEDY pattern), site of oral lesions, ear-nose-throat (ENT) assessment for the indirect signs of NERD and paediatric neuro-psychiatric (PNP) assessment.

RESULTS

Among 42 children with chemotherapy-related OM, 6 patients (14.2%) showed the COMEDY pattern. Besides the characteristic clinical aspect of the oral mucosa, initially classified as grade II OM, these children suffered from NERD-related dysphagia and PNP issues.

CONCLUSION

A COMEDY pattern can occur in a number of cases of chemotherapy-induced OM; recognizing this pattern may improve the effectiveness of treatment.

Is there any correlation between otitis media and dental malocclusion in children? A systematic review

PURPOSE

This study aims to evaluate whether there is a correlation between otitis and dental malocclusions.

METHODS

Electronic databases were searched for observational studies published until July 2021 without language or time restrictions.

PROSPERO

CRD42021270760. Observational studies on children with and without OM and/or malocclusion were included. After removing duplicates and excluding not-eligible articles, two reviewers screened relevant articles independently. Two reviewers independently extracted data and assessed data quality and validity through the Newcastle-Ottawa Scale (NOS) quality assessment tool for non-randomized studies.

RESULTS

Five studies met the selection inclusion criteria and were included in the studies for a total of 499 patients. Three studies investigated the relationship between malocclusion and otitis media, while the remaining two studies analyzed the inverse relationship and one of them considered eustachian tube dysfunction as a proxy of OM. An association between malocclusion and otitis media and vice versa emerged, although with relevant limitations.

CONCLUSION

There is some evidence that there is an association between otitis and malocclusion; however, it is not yet possible to establish a definitive correlation.

The Impact of the COVID-19 Pandemic on Pediatric Dentistry: Insights from an Italian Cross-Sectional Survey

BACKGROUND

The COVID-19 pandemic has had a significant impact on pediatric dentistry and also dental education. This study aimed to assess the observed changes in children's oral health by pediatric dentists and also served as an educational tool for dentistry students during the pandemic.

METHODS

Postgraduate students in pediatric dentistry prepared a survey addressed to Italian pediatric dentists. Over 5476 dentists were invited to participate, and collaboration among the students took place through virtual meetings and electronic platforms. The online questionnaire was composed of 29 questions focusing on the management of pediatric patients during and after the lockdown period. A descriptive statistic was used for data analysis, and chi-square tests were performed (p < 0.05).

RESULTS

A total of 1752 pediatric dentists participated in the survey. During the lockdown, 68.3% of dentists exclusively handled dental emergencies. In the subsequent semester, a significant decrease in the number of pediatric treatments was reported. Pediatric dentists also noted a decline in children's oral hygiene practices, a deterioration in dietary habits, and an increase in anxiety during dental procedures.

CONCLUSIONS

This survey shed light on the diverse effects of the pandemic on children's oral health and also provided valuable educational insights.

Evaluation of Antibacterial Activity of a Bioactive Restorative Material Versus a Glass-Ionomer Cement on Streptococcus Mutans: In-Vitro Study

BACKGROUND

Dental caries management consists of both preventive and restorative approaches. Pediatric dentists can rely on many techniques and materials to restore decayed teeth, but a high failure rate is still observed, mainly due to secondary caries. New restorative bioactive materials combine the mechanical and aesthetic characteristics of resinous materials with the capability to remineralize and the antimicrobial properties of glass ionomers, thus counteracting the occurrence of secondary caries. The aim of this study was to assess the antimicrobial activity against Streptococcus mutans of a bioactive restorative material (ACTIVA™ BioActive-Restorative™-Pulpdent©) and a glass ionomer cement with silver particles added (Ketac™ Silver-3M©), using agar diffusion assay.

METHODS

Each material was formed into disks of 4 mm in diameter, and four discs of each material were placed on nine agar plates. The analysis was repeated seven times.

RESULTS

Both materials showed statistically significant growth inhibition properties against S. mutans (p < 0.05). The difference in the effectiveness of the two materials was not statistically significant.

CONCLUSION

Both ACTIVA™ and Ketac™ Silver can be recommended since both are similarly effective against S. mutans. However ACTIVA™, given its bioactivity and better aesthetics and mechanical properties compared to GICs, may provide better clinical performance.

Photobiomodulation laser therapy in pemphigus vulgaris oral lesions: A randomized, double-blind, controlled study

OBJECTIVE

Systemic corticosteroids are the mainstay treatment for PV oral lesions; the aim of this study is to evaluate the efficacy of PBMT with a 645 nm diode laser as a supportive topical therapy in patients with PV induced erosive-ulcerative oral lesions.

MATERIALS AND METHODS

This double-blind placebo-controlled study divided patients into two groups: A, patients receiving laser therapy (Raffaello 980 Bio, Dental Medical Technologies, Italy with the following parameters: 100 mW power, 645 nm wave length, irradiation area 1 cm², application time 30 sec/cm², energy density 3 J/cm², scanning modality) and B, receiving sham therapy (placebo). All patients were being treated also with a systemic corticosteroid therapy i.e. prednisone 0.5 mg/Kg per day. Size of lesions, VAS and satisfaction were evaluated before the treatment (T0), after 4 weeks (T1) and after 8 weeks as a follow-up (T2).

RESULTS

A total of 50 lesions were evaluated. About lesions size, there was a statistical significative difference between the two groups just at T2 (p=0.0193), though VAS significantly decreased both at T1 (p=0.0198) and at T2 (p=0.0087). In general, all patients were satisfied of the treatment received.

CONCLUSION

PBMT can be considered a validate supportive therapeutic option, even if further RCTs studies with wide sample sizes and standardized management protocols are suggested.

Non-specific oral and cutaneous manifestations of Coronavirus Disease 2019 in children

BACKGROUND

Coronavirus Disease 2019 (COVID-19) seems to affect children only marginally, as a result, there is less knowledge of its manifestations in childhood. The purpose of this retrospective cross-sectional study was to investigate the oral and cutaneous manifestations in children affected by COVID-19.

MATERIAL AND METHODS

All the medical records of children with COVID-19 admitted to the Pediatric Clinic- ASST Spedali Civili of Brescia from March to April 2020 were reviewed. The following data were recorded: age, temperature, clinical presentation, oral mucosa lesions, taste alteration and cutaneous lesions.

RESULTS

The medical records of twenty-seven pediatric patients (mean age 4,2 years + 1,7) were analyzed. The clinical presentation of the disease mainly included elevated body temperature and cough. The following oral lesions were recorded: oral pseudomembranous candidiasis (7.4 %), geographic tongue (3.7%), coated tongue (7.4 %) and hyperaemic pharynx (37 %). Taste alteration was reported by 3 patients. Six patients presented cutaneous flat papular lesions.

CONCLUSIONS

As for our paediatric sample, COVID-19 resulted to be associated with non-specific oral and cutaneous manifestations.

Taste sensitivity in healthy adults: gustatory test validation and observational study

Gustatory sensitivity has important biological functions and taste disorders are generally difficult to diagnose and treat. The aim of this study was to investigate taste sensitivity on a sample of adult healthy patients through the validation and administration of a gustatory test, to describe a possible baseline of reference. A gustatory test was performed following a standardized protocol, using primary flavors solutions at 4 known increasing concentrations for a total of 16 sapid solutions. Taste sensitivity was investigated considering (a) the threshold of the flavor identification and (b) the intensity of stimulus perception. Seventy-one healthy patients were included in the study. Reliability measures were evaluated, supporting the validity of the test itself. Sweet, bitter, and salty flavors could be identified within the first concentration, sour flavor was detected within the second concentration in the majority of cases (p<0.05). Sour flavor showed the lowest value of perceived intensity for the less concentrated solution, sweet flavor showed the highest value. Regarding the most concentrated solution, bitter flavor showed the highest intensity value, while sour remained the lowest one. Both gender-based and age-based differences regarding threshold and intensity of perception were not statistically significant. However mean threshold averagely increased along with age. Within its limitations, this study validates a useful, easy-to-use tool for assessing taste function and it provides a possible baseline for perception of primary flavors in a healthy adult population, which can be used as a reference for future studies considering specific cohorts of patients.

Antibacterial activity of new hydrophilic sealants: In vitro study

BACKGROUND

Pits and fissures sealing and modulation of oral microbiota through probiotics are important preventive measures against dental decays. The aim of this study was to investigate the antibacterial activity of the Embrace™ WetBond™ Pit and Fissure Sealant (Pulpdent, USA) and UltraSeal XT® Hydro™ (Ultradent, USA) against selected oral bacteria and probiotics.

METHODS

The antibacterial effect of both sealants was tested both through planktonic growth inhibition test - 96-well microtiter plates and agar disk diffusion assay containing light-cured Embrace™ and UltraSeal XT^® against Streptococcus mutans and two oral probiotics (Streptococcus salivarius and Lactobacillus reuteri).

RESULTS

Embrace™ showed a stronger and broad activity against all the bacterial strains tested (P < 0.05) in planktonic growth inhibition test even at its lowest dose (10 μl), with inhibition rates higher than 90% in all cases. UltraSeal XT^® Hydro™ showed a mild antibacterial activity against L. reuteri, with growth inhibition rates being 19% and 23% for 20 μl and 50 μl, respectively. Regarding agar disk diffusion test, both sealants showed exclusively an antibacterial activity by contact.

CONCLUSIONS

According to these findings, it is recommended to carefully plan the timing for the administration of different preventive interventions, such as oral probiotics assumption and sealant application, to maximize their specific effectiveness. We suggest prescribing oral probiotics first and putting off the Embrace™ sealant application to the end of probiotic treatment. On the contrary, it is possible to administer L. reuteri simultaneously with the application of UltraSeal XT® since it elicits a minimal antibacterial action against this oral probiotic.

Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study

BACKGROUND

Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP.

MATERIAL AND METHODS

Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded.

RESULTS

All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant.

CONCLUSIONS

Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.

Opinions and attitudes of Italian healthcare workers towards recommended but not compulsory rotavirus vaccination

Rotaviruses (RVs) are a leading cause of viral gastroenteritis among children younger than 5. The incidence of RV disease can be reduced through the widespread use of vaccination, but coverage is low in many countries, including Italy. This fact reflects the poor consideration given to the RV vaccine, both by the population and by healthcare workers. Peoples’ opinions are strictly dependent on the attitude of doctors and nurses. The aim of this work is the evaluation of healthcare workers’ knowledge, attitudes and opinions regarding RV vaccination. The results of two surveys were compared; the first was carried out in 2017, soon after the Italian National Immunization Plan introduced the recommendation for the RV vaccine. The second was performed at the end of 2018, approximately 1 year after the adoption of a Law that introduced new compulsory vaccinations, not including the RV vaccine. In 2017, 182 questionnaires were collected, and 111 in 2018. An increase was observed in the percentage of participants who reported recommending the RV vaccine and a significant increase was found in the coverage the participants claimed to reach. Education of healthcare workers after the introduction of compulsory vaccination may prompt them to actively offer also recommended vaccines.

Photobiomodulation therapy for the management of recurrent aphthous stomatitis in children: clinical effectiveness and parental satisfaction

Background

This study aims to evaluate the effectiveness of the photobiomodulation therapy (PBMT) in the treatment of minor recurrent aphthous stomatitis (MiRAS) in children, in terms of pain relief, lesion size reduction and the parental satisfaction of the therapy.

Material and Methods

This randomized controlled study was carried out on 60 children with clinical diagnosis of MiRAS. Patients were randomized into two groups: group A receiving laser therapy and group B receiving sham therapy (placebo). Laser therapy (diode laser, λ: 645 nm) was administered on day 1 (T0) for three consecutive days. Patients were evaluated also on day 4 (T1), on day 7 (T2) and on day 10 (T3). Oral aphthous lesions size was assessed through a periodontal probe to measure the diameter length (mm); pain was evaluated through the Visual Analogue Scale (VAS); parental satisfaction was assessed through a questionnaire.

Results

The difference in the reduction of ulcers diameters between the two groups resulted statistically significant at T1 and at T2 (p<0.05). A statistically significant difference in pain reduction between two groups was found at T1 (p<0.05). No statistically significant difference between the two groups of parents was found as concerns the parental acceptance of the procedure and the discomfort for the need of multiple appointments.

Conclusions

PBMT is to be considered effective in the treatment of MiRAS in children and well- accepted by the parents of the children themselves.

Key words:Ulcers, children, lasers

Does Streptococcus Salivarius Strain M18 Assumption Make Black Stains Disappear in Children?

PURPOSE

This randomised controlled study evaluated the effectiveness of an oral probiotic, Streptococcus salivarius M18 (SsM18), in children with black stains (BSs) in order to counteract their reformation.

MATERIALS AND METHODS

Fifty-eight children (aged 4-10 years) presenting with BSs were enrolled. They were randomly divided into two groups: group A (n = 29) included children who were given the test product containing SsM18 once a day for 3 months; group B (n = 29) included children who did not receive any treatment. Before beginning the study, all the children underwent professional removal of BSs. The assessment of BSs was done after 3 months (T1) and after 6 months (T2).

RESULTS

Four patients (1 belonging to group A and 3 to group B) were excluded from the study because they started antibiotic therapy. After 3 months (T1), BSs were detected in 6 of the 28 children (21.2%) from group A and in 13 out of the 26 (50%) children from group B (p < 0.05). After 6 months (T2), BSs were detected in 9 out of the 28 (32.1%) children from group A and in 14 of the 26 (53.8%) children from group B (p > 0.05).

CONCLUSIONS

BSs formation in children could be prevented by administering S. salivarius M18.

Coronavirus Disease-2019 and dental practice: A project on the use of ozonized water in the water circuit of the dental armchair

A novel coronavirus (2019-nCoV) is associated with human-to-human transmission. From its beginning in December 2019, the coronavirus disease 2019 (COVID-19) outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization (WHO). The person-to-person transmission routes of 2019-nCoV includes direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal and eye mucous membranes. The participants in dental practice are exposed to a severe risk of 2019-nCoV infections because of the face-to-face communication and the exposure to saliva, blood, and other body fluids. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Since ozone has a proven anti-viral action, we present a project on the use of ozonized water in the water circuit of the dental armchair, in order to lower the viral load during dental practice in dental clinics and hospitals.

Efficacy of the photobiomodulation therapy in the treatment of the burning mouth syndrome

Background

This study aims to evaluate the efficacy of the photobiomodulation therapy (PBMT) - in terms of pain and of quality of life- in patients affected by burning mouth syndrome (BMS).

Material and Methods

This study was designed as a randomised double-blinded prospective study. Patients diagnosed with BMS in the period from June 2015 to June 2018 were recruited. The patients were randomised into two groups and each received treatment once a week for ten weeks: group A received laser therapy (K Laser Cube 3®) while group B was given sham therapy (placebo). Pain was evaluated through the Visual Analogue Scale (VAS) and quality of life was assessed with the short form of the Oral Health Impact Profile (OHIP-14). Assessment was done at baseline and after every therapy session. The researchers were blind to the randomised allocations.

Results

A total of 85 patients were analysed. Group A (laser treatment) was composed of 43 patients while group B (sham therapy) of 42 patients. Patients treated with PBMT showed a significant decrease in symptoms (p=0.0008) and improved quality of life related to oral health (p=0.0002).

Conclusions

PBMT has demonstrated to have a positive effect in relieving BMS symptoms and in improving a patient’s overall quality of life.

Key words:Burning mouth syndrome, oral cavity, lasers, life quality.

Effectiveness of a spray containing 1% malic acid in patients with xerostomia induced by graft-versus-host disease

Background

To evaluate the clinical effectiveness of a topical sialogogue spray (malic acid, 1%) in the treatment of xerostomia in patients with chronic Graft versus Host Disease (cGVHD).

Material and Methods

This study was designed as a randomized double-blind clinical study. Twenty-eight patients with cGVHD suffering from xerostomia were divided into 2 groups: the first group (14 patients) received a topical sialagogue spray containing malic acid 1% (SalivAktive®) whereas the second group (14 patients) received a placebo. Both groups received treatment for 2 weeks. Dry Mouth Questionnaire (DMQ) scores and unstimulated salivary flows rate were collected before and after treatment.

Results

DMQ scores increased significantly from 1.3 ± 0.4 to 3.5 ± 0.4 points (p <0.05) after two weeks of treatment with malic acid, whereas in the control group DMQ scores increased from 1.2 ± 0.7 points to 1.4 ± 0.6 (p >0.05). The unstimulated salivary flow rate in patients treated with malic acid increased significantly from 0.15 ± 0.06 mL/min to 0.24± 0.08 mL/min, while that of the patients treated with placebo went from 0.16 ± 0.07 mL/min to 0.17 ± 0.09 mL/min (p >0.05).

Conclusions

Malic acid 1% spray can be considered effective in the treatment of GVHD induced xerostomia.

Key words:Xerostomia, malic acid, transplantation.

Oral mucosal lesions in electronic cigarettes consumers versus former smokers

OBJECTIVES

Electronic cigarettes (ECs) have become very popular in recent years. However, many uncertainties remain about their side effects. This study aims to evaluate the prevalence and characteristics of oral mucosal lesions (OMLs) in former smokers compared to ECs consumers.

METHODS

A prospective case-control study was carried out. Outpatients for dental consultation were consecutively enrolled into two groups based on their habits, i.e. former smokers and ECs consumers. Each patient was examined to detect possible oral lesions and, if needed, a swab or biopsy of the lesion was taken for diagnosis. Data was entered into a spreadsheet and analyzed.

RESULTS

A total of 90 patients were examined, 45 were former smokers (group A) and 45 were ECs consumers (group B). OMLs were detected in 55 cases, of which 19/55 (34.6%) belonged to group A and 36/55 (65.4%) to group B. Nicotine stomatitis, a hairy tongue and angular cheilitis resulted to be significantly more common among EC consumers.

CONCLUSIONS

We found no statistically significant differences in terms of total prevalence of OMLs between former smokers and ECs consumers. An increased prevalence of three specific types of OMLs was detected among ECs consumers.

Oral mucosal lesions in teenagers: a cross-sectional study

Background

Adolescence is a period of transition to adulthood. Little is known about oral mucosal lesions (OMLs) in teenagers, in which the emergence of new habits, unfamiliar to children, could affect the type of lesions.

The aim of this study was to evaluate the distribution of oral mucosal lesions (OMLs) in a wide sample of adolescents.

Methods

A retrospective cross-sectional study was carried out examining all medical records of adolescents (aged 13–18 years) treated at the Dental Clinic of the University of Brescia (Italy) in the period from 2008 to 2014. Cases with OMLs were selected. Data regarding age, gender, type of OML, bad habits, systemic chronic diseases were collected.

Results

A total of 6.374 medical records (mean age 15.2 + −1.7 years) were examined. We found 1544 cases (31.7%) of oral mucosal lesions; 36 different types of mucosal alterations were detected and the most frequent were: aphthous ulcers (18%), traumatic ulcerations (14.3%), herpes simplex virus (11%), geographic tongue (9.6%), candidiasis (5.5%), and morsicatio buccarum (4.7%). Papilloma virus lesions (1.7%), piercing-related lesions (4%), multiform erythema (0.13%), oral lichen planus (0.13%) and granular cell tumour (0.06%) were also diagnosed.

Conclusions

The prevalence of OMLs in adolescents are different from those in children and, in some conditions, it could increase with age.

Dental trauma and bicycle safety: a report in Italian children and adolescents

OBJECTIVES

This retrospective study aims to analyze the pattern of oro-facial trauma from bicycle accidents in Italian children and adolescents, focusing on the safety devices used.

METHODS

The medical records of 1405 patients of the Dental Clinic of the University of Brescia, between the age of 0 to 18, who experienced a dento-facial trauma from the use of a bicycle, were analyzed. Data regarding age, gender, weight, height, dominant hand, type of bicycle, use of safety devices, location and type of dental trauma, teeth involved, bone fractures and soft tissue lesions were recorded. Statistical analysis was performed.

RESULTS

The majority of the traumatic events occurred in children within the 8-10 years of age-range; 1085 teeth were injured, of which 975 permanent teeth (89.9%) and 110 primary teeth (10.1%). The most common dental lesions were the coronal fractures (complicated and not complicated) while the most frequently involved teeth were the upper central incisors; 11% of patients were also treated for maxillo-facial fractures. A protective helmet was worn only in 3% of the cases; not one patient wore a mouth-guard. The use of helmets was more frequent in children and adolescents riding racing-bikes competitively, compared to those who were mountain bikers (p < 0.05).

CONCLUSIONS

Bicycle accidents can have serious oro-facial consequences. Therefore, national and regional efforts should be made in Italy to promote head and mouth protection in cycling.

A new emerging oral infection: Raoultella planticola in a boy with haematological malignancy

BACKGROUND

Oral mucositis is a common complication in pediatric cancer patients, affecting up to 80% of children. Due to neutropenia and disruption of the mucosal barrier, chemotherapy-induced oral mucositis is often complicated by super-infections.

CASE REPORT

A 16-years old male with stage 3 Burkitt's lymphoma developed chemotherapy induced oral mucositis grade 3 (according to WHO scale). Ulcers were quickly growing (reaching a maximum diameter of 3 cm) and became greyish in colour, resulting in dysphagia and pain. A swab of the lesions was taken and microbiological tests were performed. The sample grew for Raoultella planticola, an encapsulated Gram-negative bacterium whose full pathogenic potential still needs to be defined.

TREATMENT

The patient received antibiotic combination therapy with Amikacin and Ceftazidime for 8 days. Complete healing of the lesions and resolution of the symptoms were reached and he completed his antineoplastic therapy without further complications.

FOLLOW-UP

Twelve months after the infection, he is alive and well, with no oral complaints.

CONCLUSION

This is the first report of a Raoultella planticola infection in a patient with chemotherapy induced oral mucositis. This type of infection must be added to the list of organisms to be considered when caring for these patients.

Association between Attention and Heart Rate Fluctuations in Pathological Worriers

Recent data suggests that several psychopathological conditions are associated with alterations in the variability of behavioral and physiological responses. Pathological worry, defined as the cognitive representation of a potential threat, has been associated with reduced variability of heart beat oscillations (i.e., decreased heart rate variability; HRV) and lapses of attention indexed by reaction times (RTs). Clinical populations with attention deficit show RTs oscillation around 0.05 and 0.01 Hz when performing a sustained attention task. We tested the hypothesis that people who are prone to worry do it in a predictable oscillating pattern revealed through recurrent lapses in attention and concomitant oscillating HRV. Sixty healthy young adults (50% women) were recruited: 30 exceeded the clinical cut-off on the Penn State Worry Questionnaire (PSWQ; High-Worry, HW); the remaining 30 constituted the Low-Worry (LW) group. After a diagnostic assessment, participants performed two 15-min sustained attention tasks, interspersed by a standardized worry-induction procedure. RTs, HRV and moods were assessed. The analyses of the frequency spectrum showed that the HW group presents a significant higher and constant peak of RTs oscillation around 0.01 Hz (period 100 s) after the induction of worry, in comparison with their baseline and with the LW group that was not responsive to the induction procedure. Physiologically, the induction significantly reduced high-frequency HRV and such reduction was associated with levels of self-reported worry. Results are coherent with the oscillatory nature of the default mode network (DMN) and further confirm an association between cognitive rigidity and autonomic nervous system inflexibility.

Mutation analysis by direct and whole exome sequencing in familial and sporadic tooth agenesis

Dental agenesis is one of the most common congenital craniofacial abnormalities. Dental agenesis can be classified, relative to the number of missing teeth (excluding third molars), as hypodontia (1 to 5 missing teeth), oligodontia (6 or more missing teeth), or anodontia (lack of all teeth). Tooth agenesis may occur either in association with genetic syndromes, based on the presence of other inherited abnormalities, or as a non-syndromic trait, with both familiar and sporadic cases reported. In this study, we enrolled 16 individuals affected by tooth agenesis, prevalently hypodontia, and we carried out direct Sanger sequencing of paired box 9 (PAX9) and Msh homeobox 1 (MSX1) genes in 9 subjects. Since no mutations were identified, we performed whole exome sequencing (WES) in the members of 5 families to identify causative gene mutations either novel or previously described. Three individuals carried a known homozygous disease mutation in the Wnt family member 10A (WNT10A) gene (rs121908120). Interestingly, two of these individuals were siblings and also carried a heterozygous functional variant in EDAR-associated death domain (EDARADD) (rs114632254), another disease causing gene, generating a combination of genetic variants never described until now. The analysis of exome sequencing data in the members of other 3 families highlighted new candidate genes potentially involved in tooth agenesis and considered suitable for future studies. Overall, our study confirmed the major role played by WNT10A in tooth agenesis and the genetic heterogeneity of this disease. Moreover, as more genes are shown to be involved in tooth agenesis, WES analysis may be an effective approach to search for genetic variants in familiar or sporadic tooth agenesis, at least in more severe clinical manifestations.

Oral hygiene grade and quality of life in children with chemotherapy-related oral mucositis: a randomized study on the impact of a fluoride toothpaste with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol

AIM

The aim of this study was to assess the impact of the use of a fluoride toothpaste (Bioxtra^® , Biopharm, Milan, Italy) with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol on the oral hygiene grade and on the quality of life (QoL) of children with oral mucositis (OM) grade 1 or 2 receiving chemotherapy for Acute Lymphoblastic Leukaemia (ALL).

METHODS

Patients between 6 and 14 years with OM were randomly assigned to two groups, group A (Bioxtra^® toothpaste) and group B (fluoride toothpaste without menthol). The patients were instructed to brush their teeth at least twice a day using a soft toothbrush with a small head. Oral hygiene grade was assessed using the simplified oral hygiene index (OHI-s); quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14) questionnaires. The patients were evaluated on day 1(diagnosis of OM-T0) and on day 8 (T1). Statistical analysis was performed.

RESULTS

A total of 64 patients were enrolled. A significant difference (P < 0.001) between the mean of the OHI-s in group A (0.9 ± 1.2) and in group B (1.5 ± 1.3) was found; the overall OHIP-14 scores were not associated with the use of one or the other toothpaste (P = 0.33).

CONCLUSIONS

Although the use of Bioxtra^® toothpaste does not affect the QoL of children undergoing chemotherapy, it may be recommended as clinically effective in improving the oral hygiene grade.

Timetable for oral prevention in childhood--developing dentition and oral habits: a current opinion

As most of the etiologic factors of malocclusion are of genetic origin and thus cannot be prevented, environmental causative factors have become the focus for correction. Early interception of oral habits may be an important step in order to prevent occlusal disturbances in children. The identification of an abnormal habit and the assessment of its potential immediate and long-term effects on the dentition and potentially on the craniofacial complex should be made at an early stage. This paper focuses on the most common oral habits influencing dentofacial growth in childhood and management of these habits in the developing dentition.

Occlusal traits in children with neurofibromatosis type 1

OBJECTIVES

Literature is poor of data about the occlusion in children affected by neurofibromatosis type 1 (NF1). This case-control study investigated the occlusal traits in a group of children with NF1.

SETTING AND SAMPLE POPULATION

A hundred and fifteen children with NF1 were enrolled; non-NF1 controls were sequentially selected among subjects referred to the Pediatric Dentistry Department.

MATERIAL AND METHODS

All patients underwent a clinical dental examination and a panoramic radiography. The following orthodontic variables were considered: molar relationship, overjet, overbite, cross-bite, scissor bite, and crowding/spacing.

RESULTS

Class III molar relationship resulted significantly (p = 0.01) more common in children with NF1 than in the control group as well as the unilateral posterior cross-bite (p = 0.0017). Forty-three children with NF1 (37.3%) showed radiographic abnormalities; in one case, a plexiform neurofibroma was detected.

CONCLUSIONS

An early orthodontic evaluation might be planned in the management of children with NF1 to prevent or decrease the need for extensive orthodontic interventions.

Histopathological findings in the oral mucosa of celiac patients

BACKGROUND

Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible subjects. Although the small intestinal mucosa is the main site of the gut's involvement in CD, other mucosal surfaces belonging to the gastrointestinal tract and the gut-associated lymphoid tissue are known to be affected.

AIM

Assuming that the oral mucosa could reflect the histopathological inflammatory alterations of the intestine in CD patients, this study wishes to assess the pattern of T-cell subsets in the oral mucosa of young adults with CD.

METHODS

A group of 37 patients (age range 20-38 years; female: male ratio 28:9) with CD were enrolled. Out of 37 patients, 19 patients (group A) followed a gluten free diet (GFD) -2 patients from less than one year; 6 patients between 1 and 5 years; 11 patients more than 5 years- while 18 patients (group B) were still untreated. Fifteen healthy volunteers (age range 18-35 years, female: Male ratio 11:4) served as controls for the CD patients. Ethical approval for the research was granted by the Ethics Committee. Biopsy specimens were taken from normal looking oral mucosa. The immunohistochemical investigation was performed with monoclonal antibodies to CD3, CD4, CD8, and gamma/delta-chains T cell receptor (TCR).

RESULTS

The T-lymphocytic inflammatory infiltrate was significantly (p < 0.0001) increased in group B (both compared with group A and with the control group).

CONCLUSION

This study confirms the oral cavity to be a site of involvement of CD and its possible diagnostic potentiality in this disease.

Taste dysfunction in patients undergoing hematopoietic stem cell transplantation: Clinical evaluation in children

The aim of this study was to determine the variability of TD in children undergoing HSCT. Cases were identified as consecutively enrolled children in the period January 2011-January 2013 among patients attending the Paediatric Department of Spedali Civili of Brescia and all candidates to HSCT. The TST was conducted in two phases: identification of threshold values and identification of perceived stimulus intensity. Sixteen sapid solutions with four flavors (sucrose, sodium chloride, citric acid, and quinine hydrochloride) at four different concentrations were administered in a random sequence. The same protocol was administered at different time intervals: before starting the conditioning therapy (T0), during the conditioning therapy (T1) (two times), and every three months (two times) after engraftment post-HSCT (T2). A p-value < 0.05 was considered statistically significant. Fifty-one children (29 female and 22 male, mean age 5.2 ± 0.7 yr) were enrolled. Threshold value means for the four flavors increased during HSCT conditioning therapy (T1) (p < 0.01); intensity of perceived stimulus decreased during HSCT conditioning therapy (p < 0.01). At six months after engraftment (T2), both parameters had returned to starting values (T0). Changes in taste perception in children undergoing HSCT seem to occur especially during the conditioning therapy and resolve in about six months after engraftment post-HSCT.

Management of paediatric maxillofacial fractures: conventional methods and resorbable materials

AIM

To compare the outcomes between the use of resorbable plates and screws and the conventional methods in children with paediatric maxillofacial fractures.

STUDY DESIGN

a retrospective observational study was designed reviewing the clinical records from June 2007 and June 2011. Data collected included aepidemiological data, type of treatment, outcome and satisfaction questionnaire. Descriptive statistics and bivariate analysis were performed.

RESULTS

A total of 1122 children (0-17 years old) were studied. Children treated by conventional methods were 912, while children treated by resorbable materials were 210. The frequency of complications during recovery was similar and no statistically significant difference was noted. The satisfaction questionnaire revealed similar percentages of satisfaction, with a high degree of satisfaction.

CONCLUSION

Our experience suggests that resorbable devices should be considered as a treatment option, which avoids the need of further surgery to remove metallic fixation, limits hospital spending and increases children's quality of life.

Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study

BACKGROUND

Several maternal health determinants during the first period of life of the child, as feeding practice, smoking habit and socio-economic level, are involved in early childhood health problems, as caries development. The potential associations among early childhood caries, feeding practices, maternal and environmental smoking exposure, Socio-Economic Status (SES) and several behavioral determinants were investigated.

METHODS

Italian toddlers (n = 2395) aged 24-30 months were recruited and information on feeding practices, sweet dietary habit, maternal smoking habit, SES, and fluoride supplementation in the first year of life was obtained throughout a questionnaire administered to mothers. Caries lesions in toddlers were identified in visual/tactile examinations and classified using the International Caries Detection and Assessment System (ICDAS). Associations between toddlers' caries data and mothers' questionnaire data were assessed using chi-squared test. Ordinal logistic regression was used to analyze associations among caries severity level (ICDAS score), behavioral factors and SES (using mean housing price per square meter as a proxy).

RESULTS

Caries prevalence and severity levels were significantly lower in toddlers who were exclusively breastfed and those who received mixed feeding with a moderate-high breast milk component, compared with toddlers who received low mixed feeding and those exclusively fed with formula (p < 0.01). No moderate and high caries severity levels were observed in an exclusively breastfed children. High caries severity levels were significantly associated with sweet beverages (p < 0.04) and SES (p < 0.01). Toddlers whose mothers smoked five or more cigarettes/day during pregnancy showed a higher caries severity level (p < 0.01) respect to those whose mothers did not smoke. Environmental exposure to smoke during the first year of life was also significantly associated with caries severity (odds ratio =7.14, 95% confidence interval = 6.07-7.28). No association was observed between caries severity level and fluoride supplementation. More than 50% of toddlers belonging to families with a low SES, showed moderate or high severity caries levels (p < 0.01).

CONCLUSIONS

Higher caries severity levels were observed in toddlers fed with infant formula and exposed to smoke during pregnancy living in area with a low mean housing price per square meter.

Rare case of desmoid-type fibromatosis of the mandibular region in a child: diagnosis and surgical management

AIM

Desmoid-type fibromatosis is a broad group of rare disorders that originate from musculoaponeurotic structures. They represent less than 0,1% off all tumors and the annual incidence is 2-4 cases per million, with two peaks between 6 and 15 years of age and between puberty and age 40. They are rare in the oral and maxillofacial regions. Its pathogenesis is multifactorial. The treatment is still mainly represented, both in children and adults, by surgical excision.

CASE REPORT

A case is reported of a 8-year- old girl with desmoid fibroma in the mandible who presented at the Department of Pediatric Dentistry with a swelling measuring 4x4 cm on the lower edge of the right mandible which had appeared a few months earlier and slowly developed. The family dentist had initially diagnosed it as an odontogenic abscess from the lower right deciduous molars, but the antibiotic therapy was unsuccessful. After x-ray examination, which showed a large osteolytic lesion, mandibular CT revealed a solid expanding mass. The child was referred to the Department of Paediatric Maxillofacial Surgery where the whole mass was surgically removed. At the 2-year follow-up no relapse was noted.

CONCLUSION

This case stresses the importance, especially for paediatric dentists, of further diagnostic steps if suspect lesions do not heal after conventional treatment.

Clinicopathological features and malignant transformation of oral lichen planus: a 12-years retrospective study

OBJECTIVE

Oral lichen planus (OLP) is known to be associated with the risk of developing oral squamous cell carcinoma (OSCC). The objective of this study was to investigate the clinicopathological features of OLP and the prevalence of malignant transformation in this setting.

MATERIALS AND METHODS

This retrospective study was carried out on 204 medical records of patients with histologically proven OLP who received long-term follow-up (range 6 months-12 years). Data were entered in an informatic database. The statistical analysis, when needed, was performed with the chi-squared test for significance (p < 0.05).

RESULTS

At the moment of the diagnosis, out of 204 patients (163 female and 41 male; mean age 54.5 years), 107 patients (52.45%) suffered from systemic chronic diseases, in particular 46 (22.5%) from hepatitis C. Clinically, the reticular form of OLP was the predominant one and most patients had multiple oral sites of involvement. Fourteen patients showed extra-oral lesions. A percentage of malignant transformation less than 1% was found. In fact, two patients (0.98%) underwent a malignant transformation at a site previously diagnosed as OLP.

CONCLUSIONS

At present, OLP is accepted as being a potential malignant disorder, therefore lifelong follow-up is recommended.

Oral findings in 50 children with neurofibromatosis type 1. A case control study

AIM

The scientific literature is poor of data concerning NF1-related oral manifestations in children. The purpose of this study was to investigate the oral findings in a group of children with NF1.

MATERIALS AND METHODS

This study was designed as a clinical research. A total of 50 children affected by NF1 were enrolled. Non-NF1 controls were selected among subjects referred to the Paediatric Dentistry Department of the Dental Clinic at the University of Brescia, Italy. The craniofacial and all the dental examinations were carried out. The following parameters were investigated: dental caries, dental abnormalities, periodontal status, oral and perioral neurofibromas, orthodontic features, mandible and temporomandibular joint abnormalities. Statistics Unpaired Student's t test was calculated for Gaussian distributed variables; Fisher's test for non-Gaussian distributed binomial variables was used. The values inferior to p <0.05 (threshold) were considered significant for the study.

RESULTS

Children with NF1 showed poorer oral hygiene conditions, more frequent Class III dental malocclusions and severe alterations of the mandible and the temporal mandibular joint, if compared with the control group.

CONCLUSION

NF1 related-oral manifestations are evidenced also during childhood, even if some of the best known, like the neurofibromas, are not yet developed. It is important to keep a long-term follow-up to monitor the possible development of other oral lesions.