Rischio di endocarditi infettive correlate a trattamenti odontoiatrici e di igiene orale: aspetti fisiopatologici e terapeutici (Dentistry oral hygiene and endocarditis. Pathophysiology and prophylactic therapy)

Infectious endocarditis is a cardiac pathology of bacterial, viral or more rarely mycotic origin developing on the surfaces of the endocardium or heart valves. Predisposing conditions are congenital malformations of the heart or valvular acquired alterations, as well as the presence of a valvular prosthesis. The microorganisms involved in the etiology and pathogenesis of the damage of such infection (bacterias, viruses or yeasts) determine the formation of the endocardic vegetations typical of this condition. Such lesions can be located on the valvular or the parietal endocardium and sometimes on the endothelium of a great artery. In despite of the elevated standards of instrumental investigations and therapeutic protocols, the bacterial endocarditis represents a pathology of wide interest, scientific and social, due to its high rate of incidence, morbility and mortality. Still now infectious endocarditis causes death in 20-30% of the patients. Although the significant progress on prevention of the infectious diseases and of the cross infections in dentistry practice, from the tartar ablation up to the oncologic oral surgery, still now the skills of oral hygiene and dentistry represent a potential threat for the development of an infectious endocarditis in predisposed patients. The authors, on the base of the revision of the literature and of their own clinical experience, show the etiology, pathophysiology and the clinical pictures related to such complex disease

Gastroesophageal reflux disease and dental erosion. A case report and review of the literature

The term gastroesophageal reflux refers to the regurgitation of gastric material into the oesophagus. When the reflux is accompanied by inflammation of the oesophageal mucosa and extra-oesophageal symptoms the complaint is classified as a pathological condition called gastroesophageal reflux disease (GERD). GERD is caused by backward expulsion of the gastric content into the oesophagus. It is characterized by a complex clinical picture that may include lesions of the oesophageal mucosa and lesions of a different nature and severity of the respiratory and stomatognathic apparatus. GERD is considered to be a proteiform complaint induced by many different pathogenetic mechanisms resulting in a wide spectrum of clinical and morphological manifestations secondary to the reflux. Among extra-oesophageal manifestations, those affecting the dental structures are particularly important, owing to their aesthetic and functional implications on the stomatognathic apparatus. The Authors present a recently observed and treated case of GERD with associated severe aesthetic lesions of the frontal teeth. The currently available treatment options for the primary disease are examined, as well as the possible forms of conservative treatment of the affected teeth

Experimental-numerical investigation on the biomimetic recovery of natural tooth structural response after porcelain veneer restoration

This study analyzes the effect of porcelain veneer restoration on the structural response of a maxillary incisor. Tooth deformation is evaluated, prior to and after restoration, by the synergic use of Phase-Shifting Electronic Speckle Pattern Interferometry (PSESPI) and 3D finite element (FE) analyses. The intact maxillary incisor and the porcelain veneer restored tooth are subject to flexural load. Displacement fields are measured with Phase-Shifting Electronic Speckle Pattern Interferometry. Experimental tests are simulated with 3D FE analyses tuning materials parameters via an optimisation-based inverse procedure. ESPI measurements indicate that the restoration design under study produced deformations very similar to those of the intact tooth under load. FE results show sharp changes in displacement and stress 1 mm above the cement–enamel junction on the facial side of the restored tooth. Severe stress concentration (about 50% increase with respect to natural tooth) appears at the interface between veneer restoration and intact enamel and dentine tissues. This confirms the hypothesis that veneer restorations can amplify the effect of occlusal loading on the loss of dental hard tissue in the tooth cervical regio

Our experience in Helicobacter pylori infection and gastric MALTomas

OBJECTIVE: A number of recent studies have expanded our understanding of Helicobacter pylori (Hp) infection and of the pathogenesis of MALT lymphoma. The purpose of this paper is to perform a retrospective analysis of the clinical characteristics of gastric MALT lymphoma and its relationship with H. pylori infection in authors' experience. MATERIALS AND METHODS: We report nineteen patients observed during 10 years, presenting with gastric MALTomas at any stage. The staging classification and the presence of H. pylori infection have been assessed, and the chosen therapy also. RESULTS: The most part of our patients underwent surgery, still now resulting the most effective therapy. None of the patients had eradicating therapy due to their poor compliance and because the most part of cases were observed before the time of clinical validation of such treatment. CONCLUSIONS: In our series, surgery was effective for treatment of gastric MALT lymphomas. Surgery and chemotherapy remain, in accord with literature data, the best treatment for gastric MALTomas. Hence, because Hp may play a role in the development of such pathology in certain patients, antibiotic treatment for Hp eradication should not be discouraged in these patients, especially in them with low grade gastric MALT lymphomas. In fact, the failure of this therapy will not modify either survival or later recourse to surgical and/or radio- and chemotherapy