Guidelines for promotion of oral health in children in remission from malignant disease.

Obiettivi: Descrivere lo stato di salute orale e le anomalie dentali attese in un gruppo di pazienti in età evolutiva in remissione da patologie oncologiche, per individuare linee guida di prevenzione e di terapia mirate. Materiali e Metodi: in 50 pazienti in età evolutiva in remissione da patologie tumorali sottoposti a terapie oncologiche prima dei 10 anni (gruppo studio) e in 50 pazienti in età evolutiva con anamnesi medica negativa (gruppo controllo) è stata valutata la prevalenza di carie e di difetti dello smalto. Per valutare anomalie dentali e correlazione tra età cronologica ed età dentale, è stata eseguita in ogni soggetto una ortopantomografia. Al fine di valutare l’influenza dell’età sullo sviluppo di anomalie dentali, il gruppo di studio è stato suddiviso in tre sottogruppi per età all’epoca delle terapie: 5,1 anni. Risultati: per quanto concerne la prevalenza di carie, non è emersa una differenza statisticamente significativa tra i due gruppi. Per quanto concerne la prevalenza di difetti dello smalto, anomalie dello sviluppo dentale e la correlazione tra età cronologica ed età dentale è emersa una differenza statisticamente significativa tra i due gruppi. E’ emersa una correlazione tra età all’epoca delle terapie e presenza di anomalie dentarie: il rischio di sviluppare anomalie diminuisce all’aumentare dell’età del paziente al momento della terapia, risultando a più alto rischio i bambini sottoposti a terapie ad un’età inferiore ai 5 anni. Conclusioni: nell’ambito del follow-up medico previsto al termine delle terapie, in considerazione del fatto che le alterazioni patologiche correlate alla citotossicità dei farmaci si manifestano a lungo termine, risulta evidente la necessità di uno stretto monitoraggio del cavo orale e dell’evoluzione della dentizione del paziente prolungato nel tempo, che includa una attenta valutazione ortodontica in previsione di una eventuale riabilitazione protesica a fine crescita.Aim: to investigate the oral features in Italian patients in remission from cancer, highlighting the relationship with age at cancer therapy and to compare the data with healthy controls. Materials and methods: fifty childhood cancer survivors treated under the age of 10 years with chemotherapy, haemopoietic stem cell transplantation and/or head-neck Radiotherapy, in remission from cancer for at least 3 years, were examined for dental caries and enamel defects. For each patient a panoramic radiograph was taken to assess dental age and dental abnormalities. Patients were grouped according to age at cancer therapy (5 years: subgroup O). A control group of 50 healthy children was included. Results: There was not a statistically significant difference in caries prevalence between the two groups. A statistically significant difference was found for enamel defects, dental abnormalities and dental age. The chi-squared test revealed a relationship between age at cancer therapy and specific dental abnormalities. Conclusion: The risk of developing dental abnormalities decreases with the patient’s age at the beginning of therapy: the highest risk was for children treated before 5 years-old. A oral follow-up is needed do diagnose and treat dental late adverse effects

Role of dental training and distance of the observer on the perception of apically shifted gingival margin with increased vertical tooth size in the esthetic zone

Objectives: To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated. Materials and Methods: Two groups were identified: 33 first‐year dental students (inexperienced) and 40 last‐year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an “ideal” female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected. Results: Considering a score >6 for a “pleasant smile,” only one 4mm single alteration at the canine gingival contour obtained an insufficient score. “Observa- tional distance” and “clinical training” did not influence the final score, while size and symmetry of alterations displayed a significant role. Conclusions: The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations

Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: LaMPO RCT

OBJECTIVES: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects. METHODS: One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment. RESULTS: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded. CONCLUSIONS: PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain

UTILIZZO DI BANDE ORTODONTICHE PER LA PREVENZIONE DEL BREAKDOWN POST-ERUTTIVO IN MOLARI AFFETTI DA IPOMINERALIZZAZIONE DELLO SMALTO

Background: First Permanent Molars affected by extensive forms of Molar Incisor Hypomineralization (MIH-FPMs) are susceptible to post-eruptive breakdown (PEB) and caries from the early stages of eruption. Aim:This retrospective cohort study evaluated the effectiveness of orthodontic bands luted with glass-ionomer cement (GIC) in preventing dental caries and PEB in extensively yellow-brown defective MIH-FPMs. Design: Records of 11 children, with 22 MIH-FPMs treated using GIC bands, and 22 controls with 22 MIH-FPMs treated exclusively through mineralization protocols, were examined by two calibrated evaluators. Selection of teeth relied on intraoral photographs, excluding incomplete records. Included FPMs had extensive yellow-brown defects and were devoid of caries, dentin breakdown (DB), and prior restorations. Kaplan-Meier analysis established survival probabilities at 6 months, 1 year, and 18 months. The primary outcome was the absence of restoration requirement due to caries or DB. Secondary outcomes encompassed PEB prevention and reduction in the plaque index. Results: At 6 months, study/control survival rates were 100%/94%, and between 6 and 18 months, 98%/73%. The difference was significant (p<0.001; Log Rank test). The control group had a higher enamel breakdown frequency. The study group showed a reduced plaque index (p: 0.010; Friedman test). In the study group, the average number of orthodontic band retention losses was 0.1 ± 0.3, and the mean number of GIC reapplications was 1.9 ± 1.0. Conclusions: Orthodontic bands with GIC and stringent preventive measures can effectively maintain MIH-FPMs for at least 18 months. Orthodontic bands may allow the postponement of more comprehensive restorative approaches

La promozione della salute orale in et\ue0 evolutiva: competenze e attitudini dei pediatri

OBJECTIVES. The purpose of this study is to determine how pediatricians consider their expertise in terms of oral health and if they intend or feel in a position to improve their knowledge and competences in this area.MATERIALS AND METHODS. 126 pediatricians were invited by e-mail to fill in an anonymous questionnaire developed by the American Academy of Pediatrics. For statistical analysis Chi-square test was used.RESULTS. The response rate was 56.3%; 75% of responders received an oral health training; of these, 72% had 3 hours training or less and 91% did not complete a clinical internship with a dentist.CONCLUSIONS. Pediatricians are aware of their role in the promotion of oral health, but most of them consider the training received as insufficient

Dental Trauma Epidemiology in Primary Dentition: A Cross-Sectional Retrospective Study

Our aim was to investigate the epidemiology of dental trauma (DT) injuries in primary teeth, a health hazard issue that is often neglected by the public health care system. The records of 298 children who attended the Unit of Dental Care for Special Needs Patients and Pediatric Dentistry, University of Bologna, Bologna, Italy and had suffered a DT between January 2011 and December 2021 were examined to assess age, gender, cause and place of the DT, type of lesion and teeth involved. The chi-squared test was used to compare categorical variables. A total of 265 children (89%) suffered a single trauma, and 33 (11%) suffered from repeated DT. A total of 511 teeth (mean 1.7 ± 0.5) experienced dental trauma. Most of the trauma occurred in the 2–3 years range (153 DT, 30%). The most affected teeth were the upper central incisors (n = 388; 76%). The DT involved periodontal tissue in 316 teeth (62%) and hard dental tissue in 262 cases (51%). DT in primary teeth is commonly caused by accidental falls at home, occurs most frequently to toddlers’ upper central incisors, and usually affects tooth-supporting structures. Clinicians should be aware of the most frequent DT and be updated concerning treatment guidelines

Effects of audiovisual distraction in children with special healthcare needs during dental restorations: a randomized crossover clinical trial

Background: Audiovisual distraction using video eyeglasses is useful in managing distress and reducing fear and anxiety in healthy children during dental treatments. Aim: To evaluate the effect of audiovisual distraction on behavior and self-reported pain of children with special healthcare needs (SHCN) without intellectual disability during dental restorations and its influence on the operator stress and the time of the appointment. Material and methods: This randomized controlled crossover trial comprised 48 children with SHCN requiring at least two dental restorations. One restoration was done wearing the video eyeglasses and one wearing conventional behavior management techniques. Subjective and objective pain was evaluated using the Faces Pain Scale \ue2\u80\u93 Revised (FPS-R) and the revised Face, Leg, Activity, Cry, and Consolability scale (r-FLACC). The operator stress using a VAS, the time of the appointment, and the child satisfaction were recorded. Results: The use of video eyeglasses significantly reduced the operator stress. The bivariate analysis showed that the mean FPS-R score and the mean r-FLACC score were significantly lower using the video eyeglasses only during the second clinical session. Conclusion: Audiovisual distraction could be useful in managing distress in SHCN children without intellectual disability but cannot replace the conventional behavior management techniques

Dental Trauma Epidemiology in Primary Dentition: A Cross-Sectional Retrospective Study

Our aim was to investigate the epidemiology of dental trauma (DT) injuries in primary teeth, a health hazard issue that is often neglected by the public health care system. The records of 298 children who attended the Unit of Dental Care for Special Needs Patients and Pediatric Dentistry, University of Bologna, Bologna, Italy and had suffered a DT between January 2011 and December 2021 were examined to assess age, gender, cause and place of the DT, type of lesion and teeth involved. The chi-squared test was used to compare categorical variables. A total of 265 children (89%) suffered a single trauma, and 33 (11%) suffered from repeated DT. A total of 511 teeth (mean 1.7 &plusmn; 0.5) experienced dental trauma. Most of the trauma occurred in the 2&ndash;3 years range (153 DT, 30%). The most affected teeth were the upper central incisors (n = 388; 76%). The DT involved periodontal tissue in 316 teeth (62%) and hard dental tissue in 262 cases (51%). DT in primary teeth is commonly caused by accidental falls at home, occurs most frequently to toddlers&rsquo; upper central incisors, and usually affects tooth-supporting structures. Clinicians should be aware of the most frequent DT and be updated concerning treatment guidelines

cap 1: Controllo del dolore e dell'ansia

L\u2019esperienza clinica evidenzia che il successo di un intervento terapeutico dipende non solo dalle ca- pacit\ue0 tecniche dell\u2019operatore ma anche dal livello di collaborazione del paziente. Numerose ricerche si sono occupate dell\u2019argomento nell\u2019obiettivo di individuare tecniche di tipo farmacologico e/o psi- cologico in grado di migliorare la collaborazione del paziente. In campo odontoiatrico un\u2019analgesia efficace, in grado di garantire una terapia senza do- lore, abbassa i livelli di ansia e di paura del paziente e risulta di fondamentale importanza per creare un legame positivo tra l\u2019odontoiatra e il paziente. Nel paziente in et\ue0 evolutiva e/o scarsamente colla- borante e/o affetto da patologie sistemiche la scelta della tecnica di controllo del dolore necessita di una valutazione globale delle condizioni mediche e psichiche, nell\u2019obiettivo di individuare la necessit\ue0 di tecniche analgesiche alternative all\u2019anestesia lo- cale e la loro effettiva possibilit\ue0 di applicazione. In considerazione dei minori rischi medici, dei mino- ri costi sociali e individuali e del valore educativo insito in una seduta odontoiatrica senza dolore ma con il paziente vigile, \ue8 sempre preferibile il tratta- mento in anestesia locale, limitando la sedazione cosciente e l\u2019anestesia generale ai casi in cui la col- laborazione sia assente o scarsissima. L\u2019esperienza clinica dimostra come nella maggior parte dei bambini con disabilit\ue0 di tipo psichico e/o fisico e/o medico sia possibile ottenere la colla- borazione necessaria per lo svolgimento di una se- duta odontoiatrica utilizzando tecniche di approc- cio psicologico (tell-show-do, desensibilizzazione, rinforzi positivi, ...) unite ad un\u2019efficace analgesia ottenuta con anestetici locali. Solo nel caso in cui il livello collaborativo del soggetto renda non at- tuabile il trattamento in anestesia locale, si ricorre a tecniche alternative (sedazione cosciente o pro- fonda, anestesia generale) che necessitano dell\u2019in- tervento dell\u2019anestesista