Obstructive Sleep Apnea Syndrome (OSAS) treated with orthodontic appliances in children : a new feasible approach

Obstructive Sleep Apnea Syndrome (OSAS) affects up to 4% of the paediatric population and, due to the high risk of cardio-vascular and neurological complications and negative outcomes on the developmental process associated, represents the most serious type of Sleep Disordered Breathing (SDB) and the most challenging for public health.Although the most common treatment for OSAS in childhood is Adenotonsillectomy (AT), this approach is limited by its surgical risks and by a high prevalence of recurrence or partial success, with persistence of signs and symptoms of obstructive apnea.The presence of cranio-facial abnormalities and malocclusion is considered an important risk factor for paediatric OSAS and its recurrence after AT. Children affected by OSAS often present specific oro-facial features such asnarrow maxilla, mandibular retrusion, anterior openbite, bilateral/ monolateral cross bite, that are frequently associated with dysfunctions such as oral breathing and atypical swallowing. Those alterations can represent an anatomical base which can contribute to the development of paediatric OSAS, especially in preschool child aged 3-6 years, when the hyperplasia of adenoids and tonsils is reported to be at its peak with a higher risk for obstruction. The purpose of the present research is to evaluate the possibility that an orthodontic treatment, primary aiming to the treatment of malocclusion and the related dysfunctions, can induce improvement or relief of respiratory nighttime distress, as a secondary effect. The sample consisted of 5 children affected by OSAS, 3 female and 2 male, average aged 4.5 years, who have never undergone AT or have had a recurrence of sign and symptoms 1 year after AT.All patients presented narrow maxilla, associated with monolateral/ bilateral crossbite and or anterior openbite. The patients underwent orthodontic treatment performed with an elastodontic appliance, which is a removable oral device made of PVC and widely used in children aged less than 6 years. The following variables were evaluated in each patient at the beginning (T0) and after 1 year (T2) of orthodontic treatment:occlusal parameters; Sleep Clinical Score (SCS); Night time poligraphic parameters: Snoring, Apnea/Hypopnea Index (AHI) andOswestry Disability Index (ODI).Four out of 5 patients showed high compliance to the orthodontic treatment and improved their occlusal relationship. In those patients also AHI and ODI index improved as well as the SCS score, revealing a reduction of sign and symptoms of OSAS. The only patient who did not improve his occlusal and respiratory findings also showed poor compliance to the orthodontic treatment. The study suggest that the treatment of malocclusion might produce improvements in sign and symptoms of OSAS in children aged 3-6 years and that preformed elastodontc appliances are a feasible therapeutic tool for this purpose

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

Generalized aggressive periodontitis in prepubertal age: description and comparison of two cases.

Aggressive periodontitis is a rare form of periodontal disease and it can involve both the deciduous dentition and the permanent one. It causes a rapid loss of periodontal attachment. The paper aims to describe two cases of severe generalized prepubertal periodontitis: the first child doesn't suffer from neither systemic diseases nor alteration of functionality of polymorphonuclear and periodontal disease involved both his deciduous dentition and the first permanent molars. The second child had a deficiency of functionality of polymorphonuclear but periodontal disease involved only primary dentition thanks to his immediate improvement of home dental hygiene. This comparison shows the importance of early diagnosis and especially of optimal dental oral hygiene. Infant healthcare professionals, as pediatric dentists and pediatricians, should have the necessary knowledge for early and correct diagnosis and clinical management of disease

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

Griebel, Rolf; Schäffler, Hildegard; Söllner, Konstanze (Hg.): Praxishandbuch Bibliotheksmanagement. 2 Bände. Berlin/München/Boston: de Gruyter Saur, 2015.

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