The Impact of Chronic Kidney Disease on Nutritional Status and Its Possible Relation with Oral Diseases

Several studies have demonstrated a strong relation between periodontal diseases and chronic kidney disease (CKD). The main mechanisms at the base of this link are malnutrition, vitamin dysregulation, especially of B-group vitamins and of C and D vitamins, oxidative stress, metabolic acidosis and low-grade inflammation. In particular, in hemodialysis (HD) adult patients, an impairment of nutritional status has been observed, induced not only by the HD procedures themselves, but also due to numerous CKD-related comorbidities. The alteration of nutritional assessment induces systemic manifestations that have repercussions on oral health, like oral microbiota dysbiosis, slow healing of wounds related to hypovitaminosis C, and an alteration of the supporting bone structures of the oral cavity related to metabolic acidosis and vitamin D deficiency. Low-grade inflammation has been observed to characterize periodontal diseases locally and, in a systemic manner, CKD contributes to the amplification of the pathological process, bidirectionally. Therefore, CKD and oral disease patients should be managed by a multidisciplinary professional team that can evaluate the possible co-presence of these two pathological conditions, that negatively influence each other, and set up therapeutic strategies to treat them. Once these patients have been identified, they should be included in a follow-up program, characterized by periodic checks in order to manage these pathological conditions

Cambiamenti della composizione corporea in età evolutiva: trend secolare

Scopo dello studio. Lo scopo della presente tesi è stato quello di effettuare, attraverso uno studio clinico-statistico, una valutazione antropometrica dell’accrescimento somatico su un campione di soggetti in età evolutiva, residenti in vari comuni della Regione Calabria, e di verificare se in questa Regione fosse ancora attivo il fenomeno del “secular trend”, attraverso il confronto dei risultati ottenuti nelle indagini condotte negli anni 1992, 2004 e 2007. Un ulteriore scopo è stato quello di verificare se le informazioni ottenibili dal Body Mass Index (BMI), relativamente al sovrappeso-obesità, coincidessero con quelle ricavate dalla stima della composizione corporea, effettuata attraverso due diversi metodi di valutazione (plicometria, impedenziometria). Materiali e Metodi. Il campione esaminato è composto da 641 soggetti (307 maschi e 334 femmine), di età compresa tra gli 11 ed i 14 anni. Sono stati rilevate una serie di dimensioni antropometriche e di parametri impedenziometrici; tali dati sono stati elaborati statisticamente attraverso l’analisi della varianza (ANOVA). La valutazione dell’accrescimento somatico è stata effettuata confrontando le misurazione del BMI con le tabelle di riferimento internazionali, in grado di fornire valori di cut-off del BMI per il sovrappeso e l’obesità (Cole, 2000). Inoltre, è stata calcolata la massa grassa attraverso l’utilizzo delle formule di Slaughter ed è stata confrontata con uno standard di riferimento internazionale (Deurenberg, De Lorenzo et al, 2001). Discussione e Risultati Il secular trend non sembra essere più attivo nella Regione, almeno per quanto riguarda l’accrescimento staturale, mentre si verifica un’anticipazione dei tempi di crescita. Dal confronto dei dati del BMI e della percentuale di massa grassa, si evince che il BMI, non essendo in grado di discriminare tra massa magra e massa grassa, sottostima la popolazione pediatrica in sovrappeso ed obesa. Pertanto, per effettuare uno screening attendibile nella diagnosi di sovrappeso-obesità in età pediatrica, è preferibile effettuare una valutazione della composizione corporea.Aim of the work: The aim of this work was to make, through a clinical-statistic study, an anthropometric evaluation of somatic growth on a sample of residents (11-14 years old) of the Region Calabria. We also verified if the phenomenon of "secular trend" was still active in the Region by analyzing and comparing the results obtained in the years 1992, 2004 and 2007. Another aim was to verify if the information obtained by Body Mass Index (BMI), regarding overweight-obesity, coincides with the data obtained from body composition, effected through two different methods of evaluation (plicometry, bioelectrical impedance). Materials and methods: 641 subjects were examined (307 males and 334 females), whose ages ranged from 11 to 14 years old. Anthropometric dimensions and BIA parameters were obtained and these data were elaborated statistically using the analysis of the varianza (ANOVA). The evaluation of somatic growth was performed by comparing BMI values with international tables which gave cut-off values of BMI for overweight and obesity (Cole, 2000). Besides, the Fat Mass was calculated using Slaughter's formula and it was compared with an international standard (Deurenberg, De Lorenzo et al, 2001). Results and conclusions: Secular trend seems not to be active in Region Calabria as far as height is concerned, but growth times are anticipated. By the comparison of BMI values and the percentage of Fat Mass, it is clear that BMI is not capable of disciminating between Fat Free Mass and Fat Mass and therefore it underevaluates the pediatric population which is overweight and obese. Therefore, to perform a screening for the diagnosis of overweight and obesity in pediatric age, it is preferable to evaluate body composition

Cambiamenti della composizione corporea in età evolutiva: trend secolare

Scopo dello studio. Lo scopo della presente tesi è stato quello di effettuare, attraverso uno studio clinico-statistico, una valutazione antropometrica dell’accrescimento somatico su un campione di soggetti in età evolutiva, residenti in vari comuni della Regione Calabria, e di verificare se in questa Regione fosse ancora attivo il fenomeno del “secular trend”, attraverso il confronto dei risultati ottenuti nelle indagini condotte negli anni 1992, 2004 e 2007. Un ulteriore scopo è stato quello di verificare se le informazioni ottenibili dal Body Mass Index (BMI), relativamente al sovrappeso-obesità, coincidessero con quelle ricavate dalla stima della composizione corporea, effettuata attraverso due diversi metodi di valutazione (plicometria, impedenziometria). Materiali e Metodi. Il campione esaminato è composto da 641 soggetti (307 maschi e 334 femmine), di età compresa tra gli 11 ed i 14 anni. Sono stati rilevate una serie di dimensioni antropometriche e di parametri impedenziometrici; tali dati sono stati elaborati statisticamente attraverso l’analisi della varianza (ANOVA). La valutazione dell’accrescimento somatico è stata effettuata confrontando le misurazione del BMI con le tabelle di riferimento internazionali, in grado di fornire valori di cut-off del BMI per il sovrappeso e l’obesità (Cole, 2000). Inoltre, è stata calcolata la massa grassa attraverso l’utilizzo delle formule di Slaughter ed è stata confrontata con uno standard di riferimento internazionale (Deurenberg, De Lorenzo et al, 2001). Discussione e Risultati Il secular trend non sembra essere più attivo nella Regione, almeno per quanto riguarda l’accrescimento staturale, mentre si verifica un’anticipazione dei tempi di crescita. Dal confronto dei dati del BMI e della percentuale di massa grassa, si evince che il BMI, non essendo in grado di discriminare tra massa magra e massa grassa, sottostima la popolazione pediatrica in sovrappeso ed obesa. Pertanto, per effettuare uno screening attendibile nella diagnosi di sovrappeso-obesità in età pediatrica, è preferibile effettuare una valutazione della composizione corporea.Aim of the work: The aim of this work was to make, through a clinical-statistic study, an anthropometric evaluation of somatic growth on a sample of residents (11-14 years old) of the Region Calabria. We also verified if the phenomenon of "secular trend" was still active in the Region by analyzing and comparing the results obtained in the years 1992, 2004 and 2007. Another aim was to verify if the information obtained by Body Mass Index (BMI), regarding overweight-obesity, coincides with the data obtained from body composition, effected through two different methods of evaluation (plicometry, bioelectrical impedance). Materials and methods: 641 subjects were examined (307 males and 334 females), whose ages ranged from 11 to 14 years old. Anthropometric dimensions and BIA parameters were obtained and these data were elaborated statistically using the analysis of the varianza (ANOVA). The evaluation of somatic growth was performed by comparing BMI values with international tables which gave cut-off values of BMI for overweight and obesity (Cole, 2000). Besides, the Fat Mass was calculated using Slaughter's formula and it was compared with an international standard (Deurenberg, De Lorenzo et al, 2001). Results and conclusions: Secular trend seems not to be active in Region Calabria as far as height is concerned, but growth times are anticipated. By the comparison of BMI values and the percentage of Fat Mass, it is clear that BMI is not capable of disciminating between Fat Free Mass and Fat Mass and therefore it underevaluates the pediatric population which is overweight and obese. Therefore, to perform a screening for the diagnosis of overweight and obesity in pediatric age, it is preferable to evaluate body composition

Correlation between aerosol therapy in early childhood and molar incisor hypomineralisation

AIM: To evaluate the correlation between the use of aerosol therapy in early childhood and the presence of Molar Incisor Hypomineralisation (MIH). MATERIALS AND METHODS: STUDY DESIGN: a retrospective case-control study in which a group (cases) consisted of children from 6 to 13 years with MIH visited at the unit of Pediatric Dentistry of the Policlinico Tor Vergata (Rome, Italy), and a group (controls) consisted of an equal number of children of the same age without MIH. Data about the aerosol therapy and the presence of MIH were obtained respectively by medical history and intraoral clinical examination. Collected data underwent statistical analysis using mainly non-parametric tests (p < 0.05). RESULTS: In the study were included 182 patients, of which 91 (46 males, 51%) were children with MIH (cases), and 91 (46 males, 51%) were children without MIH (controls). In the group of patients with MIH, in the early childhood, 12 (13.1%) never had aerosol therapy, 6 (6.6%) underwent aerosol therapy less than 7 days per year, 22 (24.2%) from 8 to 15 days per year, 22 (24.2%) from 16 to 45 days a year, and 29 (31.9%) more than 45 days per year. In the control group, in the early childhood, 9 (9.9%) never had aerosol therapy, 29 (31.9%) underwent aerosol therapy less than 7 days per year, 26 (28.6%) from 8 to 15 days per year, 20 (22.0%) from 16 to 45 days a year and 7 (7.6%) more than 45 days per year. STATISTICS: the risk of developing MIH in children undergoing intensive use of aerosol therapy with respect to those receiving a less intensive use resulted in an odds ratio of 3.19 (p <0.001) in the general population, 4.83 (p < 0.001) in males and was not statistically significant in females (p = 0.132). The Spearman correlation between aerosol therapy and MIH was 0.278 (p < 0.001) in the general population, 0.372 (p < 0.001) in male, and it was not statistically significant (p = 0.08) in female subjects. CONCLUSION: Aerosol therapy carried out in early childhood appears to be a risk factor for the development of MIH, particularly in male subject

Riga-fede diseade and neonatal teeth

Aim. The aim of this study is to present a case of Riga-Fede disease (RFD). RFD is a benign and uncommon mucosal disorder, characterized by an ulceration of the tongue, often caused by repetitive traumatic injuries due to backward and forward movements of the tongue over the mandibular anterior incisors. RFD is most commonly associated with the eruption of primary lower incisor in older infants or natal-neonatal teeth in newborns. Methods. A 2-month-old female infant was referred to our Paediatric Dentistry Unit for ulceration (13 mm diameter) on the ventral surface of the tongue and neonatal teeth. The extraction of neonatal teeth was selected as treatment of choice, over more conservative treatments, for the rapid resolution of the lesion and for the limited risk of inadequate nutrients intake. The extracted teeth underwent a macroscopic/ microscopic examination. The complete healing of the lesion took 4 weeks; subsequently, the infant, revised at the 1-year follow-up visit. Conclusion. Early detection of RFD is recommended because such lesions properly may induce deformity or mutilation of tongue, dehydration, inadequate nutrients intake by the infant and growth retardation

Oral manifestations in the Graft versus Host Disease in paediatric patients: case report

Graft-versus-Host Disease (GvHD) syndrome is characterized by specific pathologic and immunologic clinical manifestations, induced by the transplantation, in a body with compromised immune system, of immunologically active T lymphocytes belonging to a donor whose genome is different from the recipient. GvHD can be clinically classified into two forms: acute (aGvHD), if it is induced only by the cytotoxic effect of the donor T lymphocytes in host tissues and chronic (cGvHD), when it is caused by a cytotoxic effect associated with severe immunodeficiency.Patients affected by GvHD frequently develop a massive and progressive involvement of the oral mucosa, being so severe to impair normal feeding as well.The Authors hereby introduce a GvHD clinical case in a 12-year-old patient who underwent Hematopoietic Stem Cell Transplantation (HSCT) from a compatible donor, with odonto-stomatological diseases induced by the syndrome. Early diagnosis and a multidisciplinary treatment plan in the initial phases of this complex and dynamic syndrome are key factors to improve the quality of life in these patients

Fluoride supplements in pregnancy, effectiveness in the prevention of dental caries in a group of children

This clinical, retrospective study intends to evaluate whether the systemic administration of fluoride during pregnancy can reduce caries incidence in a group of paediatric patients, compared to a control group. 84 patients were selected out of a sample of 2000 children (3-15 years of age) and then divided in two groups: TEST Group: 34 patients (16M – 18F, mean age 9.23), whose mothers had taken fluoride during pregnancy; CONTROL Group: 50 patients (23M - 27F, mean age 9) whose mothers had not taken fluoride. Patients underwent a clinical and radiographic inspection to assess the dfs/DFS value as caries index (decayed or filled surfaces for deciduous or permanent teeth). Results: dfs/DFS value: TEST Group: 3.41, CONTROL group 2.49. The TEST group was further divided in individuals who were administered fluoride only during pregnancy (33%) with a dfs/DFS of 3.14 and individuals who were administered fluoride also after birth (67%) with a dfs/DFS of 3. Caries index (dfs/DFS) did not show any significant differences between the test and control groups. Fluoride administration during pregnancy and postpartum does not seem to have a significant impact on the reduction of caries incidence. More preventive strategies should be investigated to contrast the multifactorial etiology of children caries

Oral manifestations of coeliac disease

Aim: The aim of the clinical-statistic study was to evaluate the prevalence of the different oral manifestations in a sample of coeliac patients, in comparison with a control group of healthy subjects. Moreover, a second objective was to determine if the clinical oral examination is useful as a diagnostic tool of screening for atypical forms of coeliac disease (CD). Methods: The enrolment of 300 coeliac patients, aged between 4 and 13 years (mean age 8.16), was carried out at the Pediatric Dentistry Unit in patients sent from the Pediatric Gastroenterology Unit of the PTV Hospital, University of Rome Tor Vergata. The control group was composed of 300 healthy subjects, age-matched (mean age 8.29), enrolled from the Pediatric Dentistry Unit. The patients were examined for hard tissues (enamel hypoplasia, dental caries), soft tissues (recurrent aphthous stomatitis RAS, atrophic glossitis, geographic tongue) and delay dental eruption. Enamel defects were classified according to Aine’s criteria, while dental caries was recorded as dmft/DMFT indices. Statistical analysis was carried out by using SPSS/PC+ Software. Differences between case and control groups were tested using Paired samples T-test, and Chi-Square Test, depending on the variable considered. The minimal level of significance of the differences was fixed at p≤0.05 for all the procedures. Results: Statistical differences between groups were observed for the prevalence of enamel defects (p=0.0001), RAS (p=0.005), delay in dental eruption (p=0.0001), but not for the prevalence of atrophic glossitis (p=0.664). Differences in symmetrical distribution and a chronologic coherence of enamel defects were statistically significant between CD and control groups (p=0.0001). Regarding dental caries, the coeliac patients had higher indexes of caries than healthy subjects, both in deciduous teeth (dmft 2.31±1.84 vs 1.42±1.13; p= 0.021) and permanent teeth (DMFT 2.97±1.74 vs 1.74±1.64; p=0.0001). Conclusions: The clinical oral examination should be considered a diagnostic tool for the characterization of subjects affected by silent-atypical forms of CD

Atypical deglutition: diagnosis and interceptive treatment: clinical study

AIM: The aim of this study was to evaluate the early treatment of atypical deglutition, by analysing the efficacy of the eruptive guide appliance Habit Corrector™. MATERIALS AND METHODS: The pre- and post-treatment (T1 and T2) cephalometric data of 2 groups of patients (G1 and G2), both consisting of 25 patients each and treated with Habit Corrector™, were compared. The first group included 10 males and 15 females, aged between 4 and 7 years old, with average age 6.17 years, and therefore undergoing the last phase of primary dentition and the first phase of mixed dentition. The second group included 12 males and 13 females, aged between 8 and 12 years old, with average age 9.19 years old, undergoing the second phase of mixed dentition. The overall duration of the treatment was 12 months. RESULTS: The results showed significant differences between the two groups, with respect to overbite, overjet, molar relation, inclination of the upper and lower incisors, position of the jaw. A significant variation between the two groups at T2 was registered for the maxillomandibular relationships: the increase in the growth and degree of mandibular protrusion was of 4.66° in G1 and 2.44° in G2. Significant changes were registered for the position or growth of the upper jaw; the upper facial height almost remained unaltered, with 53.34° for G1 and with 53.96° for G2. A significant variation occurred with the increase in the sagittal relationship between the molars, improved in G1 by 3.14 mm and in G2 by 2.61 mm. A significant decrease of overjet was registered in G1 by 1.94 mm and in G2 by 0.76 m and an increase of overbite in G1 by 3.14 mm and in G2 by 0.88 mm. The inclination of the maxillary and mandibular incisors improved, with an inter-incisive angle of 123° in G1 and 124.2° in G2. CONCLUSION: The clinical results obtained suggest that early intervention in atypical deglutition with Habit Corrector™ is able to produce significant results in primary dentition and in the first phase of mixed dentition, rather than in the late phase of mixed dentitio

MTA applications in pediatric dentistry

The aim of this paper is to show and asses the clinical applications of the Mineral Trioxide Aggregate (MTA) in pediatric dentistry, either on primary teeth or on immature apex permanent teeth. We have described the primary tooth pulpotomy technique using MTA, that is characterized by a superior biocompatibility and a sealing ability that make it a more suitable compound compared to other materials in terms of result prediction on a long-term basis. We have also reported the direct capping technique using MTA on immature apex teeth; in these particular cases, MTA is undoubtedly preferable to conventional materials, especially in what its sealing characteristics concern. Furthermore, we have explained the apexogenesis clinical procedure, in which after a chamber pulpotomy on incomplete root development teeth, MTA is used in direct contact with the pulpar stump in order to save the root pulp vitality, allowing the apex and relative canal walls physiological maturation to take place. In case of necrotic teeth with immature apex, we describe the possibility of using MTA as an apical barrier making the apexification treatment faster and predictable, taking profit from its biocompatibility quality, its sealing ability and setting characteristic in humid environments. In all described applications, MTA has demonstrated to be a very versatile and extremely trustworthy material. Either literature and results obtained from the present experience, show how the use of MTA in Pediatric Dentistry, compared to commonly used materials, translates into pulp or periapical tissues being less swollen and, thus, guaranteeing a higher prediction of the therapeutic result on a short-term basis and on a long-term one