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

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

An Innovative Approach to Treat Incisors Hypomineralization (MIH) : A Combined Use of Casein Phosphopeptide-Amorphous Calcium Phosphate and Hydrogen Peroxide—A Case Report

Molar Incisor Hypomineralization (MIH) is characterized by a developmentally derived deficiency in mineral enamel. Affected teeth present demarcated enamel opacities, ranging from white to brown; also hypoplasia can be associated. Patient frequently claims aesthetic discomfort if anterior teeth are involved. This problem leads patients to request a bleaching treatment to improve aestheticconditions.Nevertheless, hydrogen peroxide can produce serious side-effects, resulting from further mineral loss. Microabrasion and/or a composite restoration are the treatments of choice in teeth with mild/moderate MIH, but they also need enamel loss. Recently, a new remineralizing agent based on Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) has been proposed to be effective in hypomineralized enamel, improving also aesthetic conditions. The present paper presents a case report of a young man with white opacities on incisors treated with a combined use of CPP-ACP mousse and hydrogen peroxide gel to correct the aesthetic defect. The patient was instructed to use CPP-ACP for two hours per day for three months in order to obtain enamel remineralization followed by a combined use of CPP-ACP and bleaching agent for further two months. At the end of this five-month treatment, a noticeable aesthetic improvement of the opacities was observed

Carie precoce dell’infanzia e batteri cariogeni materni : quale associazione? Studio retrospettivo

Razionale - La carie rapidamente destruente dell\u2019infanzia rappresenta un grave problema di salute pubblica nella maggior parte dei Paesi industrializzati. Obiettivi - Scopo del presente lavoro \ue8 stato quello di quantificare le concentrazioni salivari degli streptococchi del gruppo mutans (sm) nelle madri nel puerperio e di associarle con la prevalenza della patologia cariosa rilevata nei bambini durante il quarto anno di et\ue0. Materiali e Metodi - Lo studio \ue8 stato di tipo retrospettivo. \uc8 stata registrata la prevalenza di carie su 494 bambini di et\ue0 media 48 mesi, calcolando l\u2019indice di carie dmfs (decayed missing, filled surface). Sono state inoltre raccolte informazioni di carattere generale dei genitori e alcune variabili correlate alla carie relative ai bambini con l\u2019ausilio di un questionario autosomministrato rivolto ai genitori. I dati clinici e quelli comportamentali/anamnestici sono stati associati con la concentrazione salivare di sm registrati nelle madri (n=489) entro il terzo giorno dal parto. Risultati - Il 31,27% delle madri (n=178) presentava una positivit\ue0 agli sm, mentre il 69,73% (n=311) \ue8 risultato negativo. L\u2019esperienza di carie registrata nei bambini non \ue8 risultata statisticamente associata alla concentrazione di sm registrati nelle mamme al puerperio (p=0,62). N\ue9 il livello di istruzione della madre, n\ue9 la lingua parlata in famiglia risultano associate alle concentrazioni degli sm in maniera statisticamente significativa (p=0,76 e 0,50 rispettivamente). Solo la frequenza di cibi dolci assunti dal bambino pi\uf9 di una volta al giorno \ue8 risultata statisticamente associata alla concentrazione di sm materni. I figli di madri con una concentrazione di sm superiore al valore soglia di 105 CFU/ml hanno un rischio di 1,61 di assumere cibi dolci pi\uf9 di una volta al giorno (p=0,01). Conclusioni - I risultati del presente studio confermano che la carie \ue8 una malattia legata ai comportamenti e come tale prevenibile con strategie preventive a carattere educativo di cui il pediatra dovrebbe farsi carico.Background - The early childhood caries is a serious public health problem in most industrialized countries. Objectives - The purpose of this study was to quantify the concentrations of salivary mutans streptococci (ms) in mothers immediately after delivery and to associate them with the prevalence of caries disease registered in children during the fourth year of age. Materials and Methods - A retrospective study was designed and performed. The caries prevalence of 494 children (mean age 48 months) was evaluated, using the caries index dmfs (decayed missing, filled surface). General information on parents and some variables related to dental caries in children were collected through a self-administered questionnaire to parents. Clinical data and behavioural/medical history were associated with the concentration of ms recorded in mothers (n = 489) in the third day after delivery. Results - 31.3% of mothers (n=178) had high concentrations of ms, while 69.7% (n=311) showed low concentrations. The children\u2019s caries experience was not statistically associated with the concentration of ms registered in mothers (p=0.62). Neither the mother\u2019s education level, nor the language spoken at home, were statistically significant associated with the concentration of ms (p = 0.76 and 0.50, respectively). Only the frequent intake of sweetened foods by children (more than once a day) was statistically associated with the concentration of maternal ms. The children from mothers with a concentration of ms higher than a threshold value of 105 CFU/ml had a risk of 1.61 to take sweet foods more than once per day (p = 0.01). Conclusion - The results of the present study confirm that caries is a disease strongly related to behaviours; prevention strategies performed by the paediatrician, such as educational intervention, are necessary to reduce the prevalence of the disease

World Café at Summer School of WHO Collaborating Centre for Epidemiology and Community Dentistry

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, \u201chabitu\ue9\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 Caf\ue8. Materials & 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 Caf\ue8. 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 Caf\ue9 experience improves learning by connection; thinking and learning become dynamic processes instead of learning outcomes

Palatal size and shape in 6-year olds affected by hypohidrotic ectodermal dysplasia

Objective: To analyze the size and shape of the hard tissue palate of Italian subjects with hypohidrotic ectodermal dysplasia (HED). Materials and Methods: The morphology and the dimensions of the hard tissue palate were analyzed in eight 6-year-old boys affected by HED. Four of the boys were completely edentulous and four partially dentate. Palatal landmarks were identified on stone casts and digitized with three-dimensional computerized electromagnetic instrumentation. Palatal length, slope, width, and maximum palatal height in both the sagittal and frontal planes were measured. From the coordinates of palatal landmarks, a mathematical equation of palatal shape was constructed, independent of size. HED palatal data were compared with reference data obtained from 12 healthy boys with a complete deciduous dentition. Results: Palatal length and height in both the sagittal and frontal planes were significantly reduced in HED as compared with control individuals. A less steep (not significant) palatal slope was found in HED than in reference subjects, whereas similar palatal width values were observed. All palatal measurements were larger in partially dentate than in edentulous patients. Both HED and edentulousness influenced palatal shape. The HED boys had a relatively lower palate than the reference boys. In the edentulous HED boys, the hard tissue palate was relatively lower than in partially dentate HED subjects. Conclusions: Palatal size and shape were significantly modified by the presence of hypohidrotic ectodermal dysplasia, and the major alterations were found in edentulous HED subjects

All-ceramic prosthetic rehabilitation of the upper incisors after removal of a periapical lesion from the lateral incisors: palatal approach

The indication of Osseointegrated implants to restore edentulous gaps or replace hopeless teeth could be assumed as a routine dental treatment; instead, if possible natural teeth should be preferred for the support of fixed prostheses. A continuous pervasive pain was referred by a 49 year-old female patient at the palatal aspect of the anterior maxillary area. Soft tissue swelling at the palatal aspect was present during the clinical intraoral examination. An extensive radiolucent area apically to the area from teeth 21 to 23 was showed by means of the X-ray examination. That teeth supported single crown fixed prostheses. A surgical entry was performed for the lesion treatment. The fixed dental prostheses were removed and root canal therapies were performed on teeth 13 and 23. After that, muco-gingival surgery was performed in order to expose the tooth root. A provisional fixed restoration on the four upper incisors was made. After the lesion resolution an all-ceramic definitive fixed prosthesis was delivered. No adverse events or prosthetic complications were detected during the two years of follow-up after prostheses cementation

Self-reported oral hygiene habits and periodontal symptoms among postpartum women

Purpose. The purpose of this study is to describe oral hygiene practices and periodontal symptoms among postpartum women and to assess whether self-reported periodontal symptoms are correlated with a clinical diagnosis of periodontal disease. Methods A self-administered questionnaire was developed to assess socio-demographic information, oral hygiene habits and frequency of dental visits among a group of 409 postpartum women. Additional questions included information on self-reported periodontal symptoms. Pregnancy information was obtained from medical charts. Results 99.3% of the participants brushed their teeth every day; 46.2 and 53.8% reported teeth brushing once a day or more, respectively. Periodontal disease was present in 61.4% of women. Patients with gum swelling and tooth mobility were almost twice as likely to have a periodontal disease (OR 1.7, CI 95% 0.9\u20132.8 and OR 1.7, CI 95%: 0.8\u20133.5, respectively). No associations were found between periodontal disease, gum swelling PTB and/or LBW. Conclusions Maternal clinical periodontal disease at delivery was related with self-perceived gum swelling and tooth mobility. Dentists and prenatal medical care providers may have the opportunity to target pregnant women that might be at higher risk for periodontal disease by asking whether they have tooth mobility and/or swollen gum

The burden of tooth loss in Italian elderly population living in nursing homes

Background: This survey aims to evaluate the prevalence and severity of tooth loss in the Italian elderly population living in nursing homes and to associate the oral data with demographic, socioeconomic factors, the Mini-Mental State Examination (MMSE), the Body Mass Index (BMI) and the Mini Nutritional Assessment (MNA) scores. Methods: A cluster sample method was performed using each nursing home as a cluster. Twenty-three nursing homes located in the five areas of the Italy (North-West, North-East, Centre, South and Islands) were selected. An informed consent to participate was distributed by the personnel of the selected nursing homes and signed directly by subjects/caregivers; 2114 forms were distributed, 1998 forms signed and finally 1976 subjects were examined. Chewing ability was scored as good ( 6510 functional units (FUs)), sufficient (7\u201310 FUs), and insufficient (< 7 FUs). The presence of prosthetic dental restorations was summarized as: absent of prosthesis, fixed prosthesis, removable prosthesis, combined prosthesis. Age, gender, socioeconomic status, MMSE, BMI and MNA were obtained from medical charts. Results: Almost three quarters of the subjects were 6580 years old (74.37%) and women (74.04%). The prevalence of edentulism was 42.10% with a large variation among the five areas of Italy (from 34.43% in Centre to 53.46% in North- West). Insufficient presence of FUs was preeminent in each age group (prevalence 42.10%) and statistically associated to age and to female gender (p< 0.01). Overweight/obese (7.47%) subjects showed the highest FUs. Area of living, MMSE (both < 0.01), BMI (p= 0.01) were statistically significant associated to the type of prosthetic dental restorations in the oldest group. Subjects with no mental impairment showed the highest percentage of prosthetic dental restorations (32.36%). Conclusions: More than half of the sample has an insufficient number of functional units for chewing and this is more pronounced in females. The presence and the type of prosthetic dental restorations are linked to cognitive impairment: the higher is the mental impairment the higher is the number of subjects with absence of prosthetic restorations. The findings of this national survey highlight the need for public health policy, aiming to increase awareness regarding oral health though health educatio

Are standardized caries risk assessment models effective in assessing actual caries status and future caries increment? A systematic review

BACKGROUND: Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment. METHODS: Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment. RESULTS: One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n\u2009=\u200916) and adults (n\u2009=\u200912) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels. CONCLUSIONS: The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited