An oral hygiene instruction program for orthodontic patients

Introduction. Protocols which contribute to the long-term success of orthodontic treatment, in both adult and young patients, and which establish a proper routine for oral hygiene at home, must be personalized and followed strictly. Materials and methods. Our protocol includes the following steps: before orthodontic treatment (initial examination, initial preparation and reassessment); during orthodontic treatment (first session, treatment session in association with oral hygiene check-ups, recall, if oral hygiene is insufficient); after orthodontic treatment (postreatment support). The differences in treatment and approach necessary when dealing with adults or children and with removable appliance or fixed appliance are also highlighted

Shwachman–Diamond syndrome

Shwachman-Diamond syndrome (SDS) is a rare autosomal recessive disorder with exocrine pancreatic insufficiency, bone marrow failure and skeletal abnormalities. Patients frequently present failure to thrive, susceptibility to infections and short stature. A persistent or intermittent neutropenia occurs in 88-100% of patients. Bone marrow biopsy usually reveals a hypoplastic specimen with varying degrees of hypoplasia and fat infiltration. Some patients may develop myeloblastic syndrome and acute myeloblastic leukemia. The genetic defect in SDS has been identified in 2002. The osteoporosis is increased in patients with SDS, and also, bone malformations are included among the primary characteristics of the syndrome. The severity and location change with age and sexes. The typical characteristics include the following: secondary ossification centers delayed appearance, metaphysis enlargement and irregularity (very common in childhood, particularly in coastal and femur), growth cartilage progressive thinning and irregularity (possibly asymmetric growth), generalized osteopenia with cortical thinning. We describe a clinical case regarding an SDS patient with severe bone abnormalities and treated surgically for corrective osteotomy. The persistent or intermittent neutropenia that characterized this disease and the consequent risk of infection is a contraindication for short stature correction and limbs lengthening