Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist

Sleep disordered breathing in children designates a wide spectrum of respiratory disorders characterized by partial or complete obstruction of the upper airways. It ranges from primary snoring, its mildest clinical manifestation, to obstructive sleep apnea syndrome (OSAS): complete obstruction of the upper airways with cessation of airflow. The aim of this paper is to highlight the roles of the pediatric dentist and the orthodontist in the therapeutic approach to pediatric OSAS as a "sentinel" who can detect early signs of the disease for immediate referral to the otolaryngologist and as an active participant in therapy

Lesch-Nyhan syndrome: evaluation of a modified bite device to prevent bite injuries

Lesch-Nyhan syndrome (LNS) is a serious form of hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency, a hereditary purinemetabolismdisorder. The prevalence reported in the literature is 1/380,000 to 235,000 births. Males are affected and females are heterozygous carriers. LNS patients present a combination of hypotonia, spasticity, and neurological and behavioral disorders. They also show an obsessive-compulsive self-injurious behavior with bites and injuries to the lips, tongue, cheeks and fingers. The literature offers little scientific contribution related to the management of this problem. The authors describe their experience with a 4-year-old LNS patient and present a viable solution to control and avoid bite injuries, namely a specifically modified bite. The patient was treated at the Pediatric Dentistry Department of "Sapienza" University of Rome with a modified bite with the internal surface, in contact with the teeth, realized in 2-mm-thick soft silicone, and the exterior part consisting of a transparent resin shell with front and rear shields to separate lips and cheeks from the dental arches. At a 12-month follow-up visit, compliance was excellent: the child wore the device with regularity and without discomfort, even during soft-food feeding. No intraoral bite injuries were found, with a general improvement of the young patient's quality of life

Bond strength of self-adhesive flowable composites and glass ionomer cements to primary teeth: A systematic review and meta-analysis of in vitro studies

Background: Conventional composites are largely used in pediatric restorative dentistry and demonstrate successful clinical outcomes. However, the need for simplification of operative steps in young or uncooperative children demands reliable alternatives. Therefore, the aim of the present systematic review and meta-analysis was to evaluate the in vitro bond strength of glass ionomer cements (GICs) and self-adhesive flowable composites (SFCs) on deciduous teeth. Methods: A comprehensive literature search according to the PRISMA checklist was manually and electronically performed by two independent reviewers through the following databases: MEDLINE/PubMed, Google Scholar, Scopus, and Embase, to include in vitro studies comparing GICs and SFCs bond strength values of restorations on primary teeth. In addition, three groups of meta-analyses were conducted using random-effects models. Results: Three articles meeting the inclusion criteria were selected and subjected to both qualitative and quantitative assessment. No statistically significant difference was found between SFC versus GIC; however, both groups significantly differed with conventional flowable composites (CFs). Conclusions: Despite the absence of significant difference in bond strength values, SFCs may be considered a valid alternative to GICs in the restoration of deciduous teeth, although CFs proved better in vitro performances

Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study

Objective To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study. Methods Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth<twice daily, lowest educational level, uneven dental examination attendance). Results Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: (2)((9))=20.17 p=0.02, Z=0.02 p=0.99; FS-T: (2)((9))=25.68 p<0.01, Z=-4.31 p<0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p=0.03) and was linked to smoking (p<0.01). Conclusions The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized

Bisphosphonates therapy in children with osteogenesis imperfecta: clinical experience in oral surgery

Objectives: to define the possible complications of oral surgery in childhood in patients affected by type 1 Osteogenesis imperfecta (OI) and treated with bisphosphonates (BP). METHODS The study was conducted among 20 patients in childhood with an age range 8-14 (12 e 8 ) affected by OI. Patients were initially evaluated at the Policlinico Umberto I, University Hospital of Rome, Rare Disease Center Skeletal Dysplasia-Bone Metabolic Pathologies and after at the Policlinico Umberto I, University Hospital of Rome, Head and Neck Department, UOC Pediatric Dentistry. RESULTS From this experience, we showed that a proper patient management from the medical and dental point of view can protect these patients from the risk of post-operative problems, such as onj, soft tissue flogos, intraoral and extraoral fistulas, failure to heal the post-extractive alveolus, infections, post-operative pain and pathological fractures. The follow-up, ranging from a minimum of 2 years to a maximum of 5 years, have not demonstrated the presence of particular complications or healing defects. CONCLUSIONS The clinical experiences observed in these patients are encouraging because no postoperative complications have been observed compared to patients non-affected by OI

Salute orale e disfagia

I processi di invecchiamento del cavo orale nell'anziano hanno importanti ripercussioni sulle funzioni di masticazione e deglutizione

Diagnosis and interceptive therapy of third classes in developmental age

OBJECTIVES Provide guidelines for differential diagnosis and interceptive therapy of Classes III in developmental age. MATERIALS AND METHODS This work, as well as the presentation of the various classifications and clinical and etiopathogenetic characteristics of progeny, has the aim of analyzing the diagnostic and prognostic problems, reporting the possibility of forecasting the model and the quantity of growth of the related facial structures, in a way to establish the effectiveness of treat-ment in pediatric age and the sub-sequent eventuality of a definitive surgical therapy in adulthood. RESULTS The objectives of early therapy in Class III patients are related to the need to re-establish, in a short time, a correct occlusal and functional relationship, and a harmonious balance between hard and soft tissues; treatment prognosis is often reserved because it is strictly dependent on genetic fac-tors such as the direction and ex-tent of mandibular growth. The most recent scientific literature demonstrates how orthopedic therapy represents the gold standard in Classes III of a skeletal nature. CONCLUSIONS Interceptive orthodontic therapy is considered an early therapy in children for prevention purposes. An early intervention, in fact, can immediately eliminate an occlusal problem to favor a harmonious development of the dental arches. A therapy conducted in the prepu-bertal period allows to obtain the best and most stable results in the developmental age

A network approach to orthodontic diagnosis

Background- Network analysis, a recent advancement in complexity science, enables understanding of the properties of complex biological processes characterized by the interaction, adaptive regulation, and coordination of a large number of participating components. Objective- We applied network analysis to orthodontics to detect and visualize the most interconnected clinical, radiographic, and functional data pertaining to the orofacial system. Materials and Methods- The sample consisted of 104 individuals from 7 to 13years of age in the mixed dentition phase without previous orthodontic intervention. The subjects were divided according to skeletal class; their clinical, radiographic, and functional features were represented as vertices (nodes) and links (edges) connecting them. Results- Class II subjects exhibited few highly connected orthodontic features (hubs), while Class III patients showed a more compact network structure characterized by strong co-occurrence of normal and abnormal clinical, functional, and radiological features. Restricting our analysis to the highest correlations, we identified critical peculiarities of Class II and Class III malocclusions. Conclusions- The topology of the dentofacial system obtained by network analysis could allow orthodontists to visually evaluate and anticipate the co-occurrence of auxological anomalies during individual craniofacial growth and possibly localize reactive sites for a therapeutic approach to malocclusion. © 2011 John Wiley &amp; Sons A/S