A review on the prevention of inflammatory periimplant diseases

Background: An impressive number of dental implants are inserted worldwide. Evolution in dental implants and simplification of surgical techniques allowed a significant increase in the number of dentists involved in implant surgery. Most of them are general dentists, are not always sufficiently formed and experienced, frequently use low-quality implants, do not adopt the proper patient selective criteria, do not adequately monitor and maintain the inserted implants, and do not report their own statistics to the dental community. Consequently, the incidence of inflammatory periimplant diseases (IPDs) has progressively increased to values significantly higher than those previously indicated by the scientific literature. Materials and Methods: Two main literature searches were undertaken in October 2018 in the PubMed Website database. Only articles written in English and published from 2008 onward were considered; 'Clinical Trial,' 'Meta analysis,' 'Observational study,' 'Review,' and 'Validation study' were selected as article type filters. The following keywords were used in the searches: 'Peri implantitis prevention' and 'Dental implant failure prevention.'Results: Preventive measures are analyzed according to the different factors that can favor the occurrence of an infection. The factors are divided into (i) implant dependent, (ii) patient dependent, and (iii) surgeon dependent. Conclusions: Scientific and clinical data confirm that when materials are selected with care, patients are carefully evaluated for factors of risk and attitude to adhere to the necessary maintenance program, and operative protocols and maintenance programs are respected dental implants can be attractive and effective tools for oral rehabilitation. Nevertheless, dentists and patients should have greater awareness that in many cases the decision to utilize dental implants cannot be taken lightly

Inflammatory periimplant diseases and the periodontal connection question

Implant therapy has become a widespread reality in modern dentistry. Nevertheless, dental implants can fail due to different causes, among which inflammatory peri-implant diseases (IPDs) are a major challenge, with prevalences that are much higher than previously believed. Specific searches were undertaken for each question raised between October and November 2017, in the PubMed website database (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland, United States). Only articles written in English and published from 2007 onward were considered initially. The following keywords were used in the searches periimplantitis (PI), periimplant mucositis (PM), dental implant failure, periimplant microbiota, periodontal microbiota, implant failure (no temporal limit), and foreign body reaction (no temporal limit). The selection process resulted in the selection of 239 articles that were analyzed in detail in elaborating this review. The reference list was limited to the 47 most relevant articles due to editorial limits of this Journal. Intrinsic differences between natural teeth and dental implants are able to give rise to inflammatory diseases that share only minor and scarcely relevant characters, and would consequently deserve different and specifically designed instruments and strategies, for both diagnosis and therapy

Tolerance to a new free amino acid-based formula in children with IgE or non-IgE-mediated cow's milk allergy: a randomized controlled clinical trial.

BACKGROUND: Amino acid-based formulas (Aaf) are increasingly used in children with cow's milk allergy (CMA). To be labeled hypoallergenic these formulas must demonstrate in clinical studies that they don't provoke reactions in 90% of subjects with confirmed CMA with 95% confidence when given in prospective randomized, double-blind, placebo-controlled challenge (DBPCFC) trials. The majority of available safety data on Aaf derived from patients with IgE-mediated CMA. Considering substantial differences in the immunologic mechanism and clinical presentation of non-IgE-mediated CMA it's important to investigate the hypoallergenicity of these formulas also in these patients. We prospectively assessed the tolerance to a new commercially available Aaf in children affected by IgE- or non-IgE-mediated CMA. METHODS:Consecutive patients affected by IgE- or non-IgE-mediated CMA, aged ≤ 4 years, were enrolled. DBPCFC was carried out with increasing doses of the new Aaf (Sineall, Humana, Milan, Italy), using validated Aaf as placebo. Faecal concentrations of calprotectin (FC) and eosinophilic cationic protein (ECP) were monitored. RESULTS:Sixty patients (44 male, 73.3%, median age 37, 95%CI 34.5-39.6 months, IgE-mediated CMA 29, 48.3%) were enrolled. At the diagnosis clinical symptoms were gastrointestinal (46.6%), cutaneous (36.6%), respiratory (23.3%), and systemic (10.0%). After DBPCFC with the new Aaf, no patient presented early or delayed clinical reactions. Faecal concentration of calprotectin and of ECP remained stable after the exposure to the new Aaf. CONCLUSIONS:The new Aaf is well tolerated in children with IgE- or non-IgE-mediated CMA, and it could be used as a safe dietotherapy regimen for children with this condition. TRIAL REGISTRATION:The trial was registered in the ClinicalTrials.gov Protocol Registration System (ID number: NCT01622426)

Tolerance to a new free amino acid-based formula in children with IgE or non-IgE-mediated cow's milk allergy: a randomized controlled clinical trial.

BACKGROUND: Amino acid-based formulas (Aaf) are increasingly used in children with cow's milk allergy (CMA). To be labeled hypoallergenic these formulas must demonstrate in clinical studies that they don't provoke reactions in 90% of subjects with confirmed CMA with 95% confidence when given in prospective randomized, double-blind, placebo-controlled challenge (DBPCFC) trials. The majority of available safety data on Aaf derived from patients with IgE-mediated CMA. Considering substantial differences in the immunologic mechanism and clinical presentation of non-IgE-mediated CMA it's important to investigate the hypoallergenicity of these formulas also in these patients. We prospectively assessed the tolerance to a new commercially available Aaf in children affected by IgE- or non-IgE-mediated CMA. METHODS:Consecutive patients affected by IgE- or non-IgE-mediated CMA, aged ≤ 4 years, were enrolled. DBPCFC was carried out with increasing doses of the new Aaf (Sineall, Humana, Milan, Italy), using validated Aaf as placebo. Faecal concentrations of calprotectin (FC) and eosinophilic cationic protein (ECP) were monitored. RESULTS:Sixty patients (44 male, 73.3%, median age 37, 95%CI 34.5-39.6 months, IgE-mediated CMA 29, 48.3%) were enrolled. At the diagnosis clinical symptoms were gastrointestinal (46.6%), cutaneous (36.6%), respiratory (23.3%), and systemic (10.0%). After DBPCFC with the new Aaf, no patient presented early or delayed clinical reactions. Faecal concentration of calprotectin and of ECP remained stable after the exposure to the new Aaf. CONCLUSIONS:The new Aaf is well tolerated in children with IgE- or non-IgE-mediated CMA, and it could be used as a safe dietotherapy regimen for children with this condition. TRIAL REGISTRATION:The trial was registered in the ClinicalTrials.gov Protocol Registration System (ID number: NCT01622426)

Randomised clinical trial: efficacy of a new synbiotic formulation containing Lactobacillus paracasei B21060 plus arabinogalactan and xilooligosaccharides in children with acute diarrhoea.

BACKGROUND: Acute diarrhoea is a frequent problem in children with heavy economic burden for families and society. AIM: To test the efficacy of a new synbiotic formulation containing Lactobacillus paracasei B21060, arabinogalactan and xilooligosaccharides in children with acute diarrhoea. METHODS: Double-blind, randomised, placebo-controlled trial, including children (age 3-36 m) with acute diarrhoea who were allocated to placebo or synbiotic group. Major outcome was resolution rate of diarrhoea at 72 h. Total duration of diarrhoea, daily stool outputs, stool consistency, working days lost by parents, adjunctive medications, and hospitalisation were also assessed. RESULTS: We enrolled 55 children in placebo group and 52 in synbiotic group. The two groups were similar for demographic and clinical characteristics. Resolution rate of diarrhoea at 72 h was significantly higher in synbiotic group (67%) compared to placebo group (40%, P = 0.005). Children in synbiotic group showed a significant reduction in the duration of diarrhoea (90.5 h, 78.1-102.9 vs. 109.8 h, 96.0-123.5, P = 0.040), daily stool outputs (3.3, 2.8-3.8 vs. 2.4, 1.9-2.8, P = 0.005) and stool consistency (1.3, 0.9-1.6 vs. 0.6, 0.4-0.9, P = 0.002) compared to placebo group (data expressed as mean, 95% CI). Rate of parents that missed at least one working day (41.8% vs. 15.4%, P = 0.003), rate of children that needed adjunctive medications (25.5% vs. 5.8%, P = 0.005) or hospitalisation (10.9% vs. 0%, P = 0.014) after the first 72 h of treatment, were reduced in synbiotic group. CONCLUSION: The synbiotic formulation studied is effective in children with acute diarrhoea. Australian New Zealand Clinical Trials Registry (ACTRN12611000641998)

Harnessing the power of biologic agents on the oral microbiota: a way to promote oral and systemic health?

During the long history of their evolution, higher organisms, including mammals, have learnt to take great advantage from living in close contact with selected populations of microbes.1 By living in close contact, animals and microbes underwent a progressive and mutual co-evolutive process that is believed to be a major driving force in the development of adaptive immunity of vertebrates.2 As a result of this co-evolutive process, humans and other animals are characterized by their own unique microbiomes, each consisting of many hundred species of viruses, bacteria, archaea, fungi, and protozoa, unevenly distributed to colonize the different accessible regions of the body.3 The human microbiome is believed to account for 1-3% of body weight and to comprise more than 100 trillion cells.4 The microbiota is involved in complex host-microbe and microbe-microbe interactions, thus modulating nutrient acquisition, adjusting immune system development and general homeostasis (via epigenetic modifications of host genes5), and playing the role of protective barrier to pathogens.4 When a microbiota undergoes qualitative and quantitative changes with regard to distribution in a site and metabolic activity, this condition is defined dysbiosis and is expected to be associated with local and/ or distant pathologic signs.6 Bacterial products released by a dysbiotic microbiota interact with homeostatic mechanisms of the human host and cooperate to the pathogenesis of major human diseases, including diabetes mellitus, inflammatory bowel syndrome, atherosclerosis, obesity, liver disease, and cancer.4,7 he oral microbiota is the second more abundant and one of the most diverse and unique microbial communities in the human body.8 Although many of the most relevant oral and dental diseases, including caries, periodontal and peri-implant diseases, have been long recognized as of microbial origin, only recently the application of culture independent molecular methods using 16S rRNA gene comparative analyzes enabled us to understand that they are caused by dysbiosis rather than by the action of specific pathogens.9-11 The effects of oral dysbiosis are not limited to oral tissues: periodontal diseases, for example, are among the most common human diseases and their associations with diabetes, cardiovascular disease, metabolic disease and obesity, rheumatoid arthritis, certain cancers, respiratory diseases, and cognitive disorders is now supported by increasing evidence.12 Recent molecular investigations showed that some potentially pathogenic oral bacteria (named pathobionts), as for example Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum, colonize in low numbers the oral cavity of healthy individuals, without alerting sentinel systems of mucosal defences.13,14 Conditions able to disrupt the eubiotic equilibrium promote the overgrowth of pathobionts, which suddenly become pathogens (with support from commensal

Anthropometric comparison between young Estonian and Chinese swimmers

Due to the progressive lowering of the age of peak performance among swimmers, it became important to better understand the factors influencing performance in prepuberal boys and girls. Aim of this study is to compare two different racial/ethnic groups of young swimmers, one from Nord-Europe, Estonia (Tartuma Region), and the other from China (Shanghai District) in order to assess existing differences in respect to body dimension, body fat, technical parameters of swimming performance and maximum lactate production. 26 Estonian and 7 Chinese female and 25 Estonian and 10 Chinese male, from two swimming schools, took part in the study. Anthropometric parameters were measured in accord with ISAK guidelines. BMI, Stroke Index, Stroke Length, mean velocity on a 200 m freestyle all out, and blood lactate after three minutes were measured. Significant differences exist in anthropometry between Nord-European and Asian young swimmers. These differences are more pronounced in female, with higher fat tissue in Nordic girls. Leg lengths are different between Chinese and Estonian girls having the Estonian longer legs. Hands lengths are different both in male and in female subjects. Being the Chinese groups of higher level of performance (higher mean velocity in the 200 m freestyle, such differences seems not to be as major determinants of the performance, also if they are often indicated as determinants of buoyancy and stroke efficiency

Probiotic streptococcus salivarius reduces symptoms of denture stomatitis and oral colonization by Candida Albicans

Denture stomatitis (DS) is an inflammatory status of oral mucosae frequently observed in denture wearers, and mainly associated with oral overgrowth of Candida albicans. DS is the cause of multiple visits to the dental office and is thought to enhance the risk of systemic infections. The treatment of DS mainly relies upon improvement of oral hygiene measures and prescription of topical or systemic antifungal agents, and disinfectants that, although effective, are not without drawbacks. Since, in recent years, some probiotics were investigated as a means to contrast oral colonization by Candida spp., this study was designed to preliminarily evaluate the effects of probiotic strain Streptococcus salivarius K12, in subjects affected by DS, and the duration of these effects. Fifty adult denture wearers affected by DS were enrolled and randomly divided into two groups: the experimental group was instructed to perform careful oral and denture hygiene and to assume the probiotic preparation for 30 days; the control group received only oral hygiene instructions. Patients were evaluated for signs of DS at the beginning of the study, at the end of treatment and 30 days later. Microbiological samples were obtained at the beginning of the study and at the end of treatment to quantify Candida albicans cells. Experimental treatment reduced clinical signs and symptoms of DS and the count of C. albicans. The clinical effects of experimental treatment were still evident after 30 days, suggesting that administration of probiotic strain Streptococcus salivarius K12 could be a promising approach in the treatment of DS

Investigation of chronic diarrhoea in infancy.

Diarrhoea in infants and young children is defined as >200g/day of stools, and occurs when there is an imbalance between intestinal fluids absorption and secretion. This may be caused by either a decreased absorption (osmotic diarrhoea) or an increased secretion (secretory diarrhoea). Chronic diarrhoea defines intestinal loss of water and electrolytes with increased stool frequency, reduced consistency and larger volume over more than 14days. This disorder in children shows a wide range of aetiologies depending on the age. The knowledge of common and rare aetiologies is important to optimize the diagnostic approach. A stepwise approach, starting with a comprehensive history, physical examination, inspection and collection of stool samples, helps to devise appropriate diagnostic and therapeutic management. In this article we discuss the pathophysiology, aetiology and possible approach to chronic diarrhoea in infancy

Migraine and cluster headache show impaired neurosteroids patterns

Background: Perturbation of neuronal excitability contributes to migraine. Neurosteroids modulate the activity of γ-aminobutyric acid A and N-methyl-d-aspartate receptors, and might be involved in the pathogenesis of migraine. Here, we measured plasma levels of four neurosteroids, i.e., allopregnanolone, epiallopregnanolone, dehydroepiandrosterone and deydroepiandrosterone sulfate, in patients affected by episodic migraine, chronic migraine, or cluster headache. Methods: Nineteen female patients affected by episodic migraine, 51 female patients affected by chronic migraine, and 18 male patients affected by cluster headache were recruited to the study. Sex- and age-matched healthy control subjects (31 females and 16 males) were also recruited. Patients were clinically characterized by using validated questionnaires. Plasma neurosteroid levels were measured by liquid chromatography-tandem mass spectrometry. Results: We found disease-specific changes in neurosteroid levels in our study groups. For example, allopregnanolone levels were significantly increased in episodic migraine and chronic migraine patients than in control subjects, whereas they were reduced in patients affected by cluster headache. Dehydroepiandrosterone and dehydroepiandrosterone sulfate levels were reduced in patients affected by chronic migraine, but did not change in patients affected by cluster headache. Conclusion: We have shown for the first time that large and disease-specific changes in circulating neurosteroid levels are associated with chronic headache disorders, raising the interesting possibility that fluctuations of neurosteroids at their site of action might shape the natural course of migraine and cluster headache. Whether the observed changes in neurosteroids are genetically determined or rather result from exposure to environmental or intrinsic stressors is unknown. This might also be matter for further investigation because stress is a known triggering factor for headache attacks in both migraineurs and cluster headache patients