Effect of a daily dose of <i>Lactobacillus brevis</i> CD2 lozenges in high caries risk schoolchildren

Objectives A double-blind, randomised, placebo-controlled clinical trial was performed to validate the hypothesis that the use of lozenges containing Lactobacillus brevis CD2 (Inersan®, CD Investments srl) may reduce plaque pH, salivary mutans streptococci (ms) and bleeding on probing, during a 6-week period, in a sample of high caries risk schoolchildren. Methods A total of 191 children (aged 6–8 years), presenting two to three carious lesions and a salivary ms concentration of ≥105 CFU/ml, were enrolled and divided into two groups, an L. brevis CD2 lozenge group and a no L. brevis lozenge group, and examined at baseline (t0), after 3 weeks (t1), after 6 weeks of lozenge use (t2) and 2 weeks after the cessation of lozenge use (t3). Plaque pH was assessed using the microtouch technique following a sucrose challenge. The area under the curve (AUC5.7 and AUC6.2) was recorded. Salivary ms were counted, and bleeding on probing was assessed. Results At t0, the plaque-pH and ms concentration values were similar in both groups. Mean areas (AUC5.7 and AUC6.2) were significantly greater in the control group at t1, t2 and t3. L. brevis CD2 lozenges significantly reduced salivary ms concentrations and bleeding. The subjects from the test group showed a statistically significant decrease (p=0.01)in salivary ms concentration. At t2, a statistically significantly lower bleeding value was recorded in the test group compared with the control group (p=0.02). Conclusions Six weeks’ use of lozenges containing L. brevis CD2 had a beneficial effect on some important variables related to oral health, including a reduction in plaque acidogenicity, salivary ms and bleeding on probing.</br

Six months of high-dose xylitol in high-risk caries subjects—a 2-year randomised, clinical trial

Objectives The hypothesis was that the daily use of a high dose of a xylitol chewing gum for 6 months would reduce the increment of decayed permanent first molar surfaces (ΔD6S) in high-risk schoolchildren after 2 years. Methods In this randomised, clinical trial, 204 schoolchildren with a high caries risk were assigned to two experimental groups, xylitol and non-xylitol. Caries status, salivary mutans streptococci, and lactobacilli were re-evaluated 2 years later in 74 xylitol-treated and 83 non-xylitol-treated schoolchildren. Differences in mean ∆D6S between groups registered at baseline and at follow-up were evaluated using the nonparametric Mann–Whitney U test. Results Outcome was the development of detectable carious lesions initial (D1–D2) and manifest (D3) in the permanent first molars. In the xylitol group, the difference in proportion of children with decayed first permanent molars at baseline and follow-up was 1.43 % for manifest lesion and 2.86 % for initial lesions; while in the non-xylitol group was 10.26 % (p &lt; 0.01) and 16.66 % (p &lt; 0.01), respectively. A statistically significant difference regarding means was also observed in the non-xylitol group: the ∆D6S for manifest lesion was 0.18 (p = 0.03) and 0.67 (p = 0.02) for initial lesion. Conclusion The use of a chewing gum containing a high dose of xylitol for a period of 6 months has been shown to produce a long-term effect on caries development in high caries-risk children. Clinical relevance A school-based preventive programme based on 6 months’ administration of a high dose of xylitol via chewing gum proved to be efficacious in controlling caries increment in high-risk children

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: χ(2)(9) = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ(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

World Caf\ue9 at Summer School of WHO Collaborating Centre for Epidemiology and Community Dentistry

Objectives of the study: This study is a qualitative evaluation of a teaching method. The 2015 Summer School organized by the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan took place in Sardinia. The educational objectives of the first day included: make an informal conversation with other members of the summer school; create an interesting exchange of ideas and experiences also between new, \u201chabitue\u301\u201d and beginners with senior professionals of this event; make a group for the works in the next days. Considering the different professional roles, age and context of origin, the purpose of the Pedagogists was to create a positive, relaxed but intimate atmosphere using the pleasure of \u201cinformal\u201d conversation, through a creative and practical method: The World Cafe\u300. Materials &amp; methods: The Pedagogists\u2019 first task focused on: caring of the location and the physical setup of the table, creating relevant questions to the concerns of the group, establishing the rules, managing the process to encourage participants to have a non- formal learning experience consequently improving thinking, speaking and listening skills. Finally the participants answered self-administered questionnaire to write about their emotions and cognitive processes that went out during the World Cafe\u300. Results: The analysis of the questionnaires was carried out with Interpretative Phenomenological Analysis (IPA), The interpretative steps identified two emerging themes: \u201cdifferent vs peer\u201d and \u201cdiscovering vs practicing\u201d. Conclusions: The World Cafe\u301 experience improves learning by connection; thinking and learning become dynamic processes instead of learning outcomes

Overdentures on implants placed in bone augmented with fresh frozen bone

Introduction In the last decade several studies have been performed to evaluate the clinical outcome of one or two stage loaded implants supporting overdentures. Aim Since fresh frozen bone (FFB) has an ever-increasing number of clinical applications and few reports are available on implants inserted into FFB, we performed a retrospective study on fixtures inserted in FFB and bearing overdentures. Methods In the period between December 2003 and December 2006, 17 patients (14 females and 3 males with a median age of about 56 years) were grafted and 60 implants inserted thereafter. A total of 17 overdentures were delivered: 8 in the mandible and 9 in the maxilla. Multiple implant systems were used: 22 Double etched, 7 SLA, 9 Anodic oxidized, and 22 CaPo4 ceramic-blasted. Implant diameter ranged from 3.25 to 4.3 mm and length from 11.5 to 16.0 mm. Implants were inserted to replace 23 incisors, 9 cuspids, 20 premolars and 8 molars. Results No implants were lost (i.e. survival rate = 100%) and no differences were detected among the studied variables. Kaplan Meier algorithm and Cox regression did not reveal any statistical differences among the studied variables also as regards the success rate. Conclusion Implants inserted FFB and bearing overdentures have a high survival rate and success rates, which are comparable to those of implants inserted in non-grafted bone. FFB bone is a reliable material for alveolar ridge augmentation. No difference was detected among removable prostheses supported by 2 or more implants

Dental care protocol based on visual supports for children with autism spectrum disorders

Background : Subjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments. Material and Methods : 83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in or der to undergo: an oral examination (stage 1), a professional oral hygiene session (stage 2), sealants (stage 3), and, if necessary, a restorative treatment (stage 4). Each stage came after a visual training, performed by a psychologist (stage 1) and by parents at home (stages 2, 3 and 4). Association between acceptance rates at each stage and gender, intellectual level, verbal fluency and cooperation grade was tested with chi-square test if appropriate. Results: Seventy-seven (92.8%) subjects overcame both stage 1 and 2. Six (7.2%) refused stage 3 and among the 44 subjects who need restorative treatments, only three refused it. The acceptance rate at each stage was statistically significant associated to the verbal fluency ( p =0.02; p =0.04; p =0.01, respectively for stage 1, 3 and 4). In stage 2 all subjects accepted to move to the next stage. The verbal/intellectual/cooperation dummy variable was statistically associated to the acceptance rate ( p <0.01). Conclusions: The use of visual supports has shown to be able to facilitate children with ASDs to undergo dental treatments even in non-verbal children with a low intellectual level, underlining that behavioural approach should be used as the first strategy to treat patients with ASDs in dental setting

Caries experience among adolescents in southeast Italy

Abstract Background/purpose According to WHO recommendations, 12-year-olds are considered an important target group for evaluating the level of dental caries among children with permanent teeth, and are often chosen for international comparisons. The aim of the present study was to evaluate the current oral health status of 12-year-old children in southeast Italy, stratified by gender and residential area. Materials and methods The survey was conducted on 431 children enrolled by multistage cluster sampling. A dental caries experience index (decayed, missing, and filled permanent teeth; DMFT) was recorded at schools by a team of examiners trained at the start of the study. Statistical analyses by Chi-square, Fisher's exact, and Wilcoxon tests were performed using SAS version 9.1 software for PCs. We applied the Zero-Inflated Negative Binomial regression model in the STATA package. Results Caries prevalence was recorded in 38.3% of the sample. Estimated means and 95% confidence intervals of the DMFT index by gender were: 1.15 (0.91–1.39) for males, 1.26 (1.02–1.5) for females, and 1.21 (1.03–1.39) for the total sample. The D component of the index was dominant. The mean number of caries found in southeast Italy was significantly higher than the national mean ( t =3.125, P=0.002), but significantly lower than the mean for south Italy ( t =−2.125, P=0.03). Results of the regression model showed that only the mother and father's nationality and educational level contributed to the DMFT. Conclusions The oral health situation of 12-year-old children from southeast Italy seems to be in line with that in other Western European countries

Inequalities in caries among pre-school Italian children with different background.

BACKGROUND The study was aimed to describe caries prevalence and severity and health inequalities among Italian preschool children with European and non-European background and to explore the potential presence of a social gradient. METHODS The ICDAS (International Caries Detection and Assessment System) was recorded at school on 6,825 children (52.8% females). Caries frequency and severity was expressed as a proportion, recording the most severe ICDAS score observed. Socioeconomic status (SES) was estimated by mean a standardized self-submitted questionnaire filled-in by parents. The Slope Index of Inequality (SII) based on regression of the mid-point value of caries experiences score for each SES group was calculated and a social gradient was generated, children were stratified into four social gradient levels based on the number of worst options. Multivariate regression models (Zero-Inflated Negative Binomial logistic and logistic regression) were used to elucidate the associations between all explanatory variables and caries prevalence. RESULTS Overall, 54.4% (95%CI 46.7-58.3%) of the children were caries-free; caries prevalence was statistically significant higher in children with non-European background compared to European children (72.6% vs 41.6% p < 0.01) and to the area of living (p = 0.03). A statistically significant trend was observed for ICDAS 5/6 score and the worst social/behavioral level (Z = 5.24, p < 0.01). Children in the highest household income group had lower levels of caries. In multivariate analysis, Immigrant status, the highest parents' occupational and educational level, only one kid in the family, living in the North-Western Italian area and a high household income, were statistically significant associated (p = 0.01) to caries prevalence. The social gradient was statistically significant associated (p < 0.01) to the different caries levels and experience in children with European background. CONCLUSIONS Data show how caries in preschool children is an unsolved public health problem especially in those with a non-European background

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

Wide Diameter Implants Inserted in Jaws Grafted with Homologue Bone

Svrha rada: Posljednjih deset godina povećala se uporaba implantata širokog promjera (WDI-a), posebice u lateralnim dijelovima čeljusti, uglavnom zbog dobrih kliničkih rezultata. No, malo je opisanih postupaka te objavljenih radova i ni jedan se ne bavi WDI-ma ugrađenima u transplantate homologne svježe zamrznute kosti (FFB-e). Zato smo obavili i retrospektivno istraživanje na nizu WDI-a postavljenih u homologne FFB-e, kako bismo ispitali kliničke rezultate. Materijal i metode: Ukupnom broju od 49 pacijenata ugrađeno je 126 WDI-a. Njih 35 imalo je dvostruko jetkanu površinu, 5 SLA1 površinu, 9 je bilo poprečno pjeskareno i jetkano kiselinom, 44 anodno oksidirano, 19 pjeskareno s CaPO4, 10 SLA2 površinu, a 4 su usatka imala neku drugu površinu. Rezultati: Samo jedan implantat bio je izgubljen (tj. SVR = 99,2%), a nije bilo razlike ni u ispitivanim varijablama. S druge strane, Coxova regresija pokazala je da su vrsta implantata (tj. dvostruko jetkana površina, površina pjeskarena CaPO4 i SLA2 površina) te njegova duæina (manja od 13 mm) u statistički znatnoj korelaciji s manjim gubitkom krestalne kosti, a time se omogućuje i bolji klinički ishod. Zaključak: Upotreba WDI-a u homolognom FFB-u može biti prihvatljiv način liječenja te može osigurati i neka poboljšanja, posebice u lateralnim dijelovima čeljusti za različita protetska rješenja poduprta usadcima.Objective of work: In the last decade the use of wide diameter implants (WDI) has increased especially in posterior jaws for their good clinical outcomes. However there are few reports on this topic and none on WDI inserted in homologue fresh frozen bone (FFB) grafts. Thus we planned a retrospective study on a series of WDI placed in homologuous FFB to evaluate the clinical outcome. Materials and Methods: 49 patients were operated on and 126 WDI inserted. There were 35 Double etched, 5 SLA1, 9 Grit blasted and acid etched, 44 Anodic Oxidized, 19 CaPo4 ceramic-blasted, 10 SLA2, and 4 miscellaneous implants. Results: Only 1 over in 126 WDI was lost (i.e. SVR = 99.2%) and no differences were detected among the studied variables. On the contrary, the Cox regression showed that implant type (i.e. Double etched, CaPo4 Ceramic-blasted, and SLA2) and implant length (i.e. length < 13 mm) correlated with a statistically signifi cant lower crestal bone loss and thus a better clinical outcome. Conclusion: The use of WDI inserted in homologuous FFB can be a viable treatment option and may provide benefi ts especially in posterior regions for the maintenance of various implant-supported prosthetic rehabilitations