Nitrous oxide and hypnotherapy in paediatric dentistry.

AIM: Patient compliance is of paramount importance for proper dental treatment, which can be difficult to achieve in children due to anxiety and fear, hindering the therapeutic procedure. In addition to well-known sedation methods (pharmacological and nitrous oxide), further methods of approach are being tested, such as hypnotherapy. MATERIALS: The sample consisted of 150 children (90 males, 60 females). Paper questionnaires, frequency meter, nitrous oxide dispenser in association with the use of the television were exploited. At the end of treatment, subjective pain was assessed using the VAS scale, while objective pain was assessed using the FLACC scale and heart rate. This made it possible to compare two experimental groups, one treated with nitrous oxide, and the other with hypnotherapy. The control group was treated with classic behavioural approach techniques. The results obtained were analysed by SPSS Software (Statistical Package for Social Science, version 27) and the inferences between the results were calculated for confirmation. CONCLUSION: Hypnotherapy can be a valid substitute for nitrous oxide in paediatric dentistry.

Effects of anti-epileptic drugs on the oral health of paediatric patients.

AIM: To evaluate the effects of epilepsy therapy on the oral health in paediatrics patients. MATERIALS: The test has involved 57 patients. The patients were stratified in three groups: monotherapy group, politherapy group and control group. They were examined and after that the test groups were compared with the control group. CONCLUSION: Paediatric epileptic patients seem to have a greater risk of having a worse oral health status compared with healthy patients. However, if the patient is well monitored and undergoes regular dental checks, the oral condition is comparable to a healthy subject.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

AIM: Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. METHODS: Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. CONCLUSION: Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Short lingual frenulum: From diagnosis to laser and speech-language therapy.

AIM: To evaluate the effects of tongue frenulectomy performed with two therapeutic approaches: Laser frenulectomy and combined laser and speech-language therapy. MATERIALS AND METHODS: The study involved 180 patients (90 males and 90 females) aged between 6 and 12 years. After examination and data collection, the patients were stratified according to three degrees of severity: mild, moderate and severe. After treatment, the test group (laser frenulectomy and combined laser and speech-language therapy) was compared with the control group (laser frenulectomy) in the pre-surgical phase, at one week, 1 month, 3 months, 6 months and 12 months after surgery. RESULTS: Statistical analysis showed statistically significant differences between the pre-surgical and post-surgical values at 3 months, 6 months and 12 months after surgery (p<0,05). CONCLUSIONS: It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech-language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.

Ponticulus posticus: clinical and CBCT analysis in a young Italian population.

AIM: To evaluate the prevalence, the morphological characteristics and any related symptoms of Ponticulus Posticus (PP) in young Italian patients by means of cone-beam computed tomography. MATERIALS ABD METHODS: A retrospective study was conducted on images derived from cone-beam CT scans of an Italian population in developmental age (mean age 12.61 ± 2.69); medical history was also evaluated from medical records. The total prevalence and morphology of PP, the prevalence by gender and according to age groups were calculated. For the statistical analysis the ?² test was used. RESULTS: Total prevalence of PP was 28.24%, the prevalence by gender was 35.27% for males and 21.42% for females, with statistically significant differences. PP was bilateral in 74.33%, and monolateral in 25.67%. As regards symptoms, the cases with headache were 32.43%, tinnitus 6.08%, migraine 3.38%. Dividing by age, patients aged ? 11 years showed headache in 25% of cases, patients aged between 12 and 14 years in 54.17% of cases and patient aged between 15 and 17 years in 20.83%. CONCLUSIONS: PP is not a rare anomaly in Italian young patients and should always be sought in the lateral cephalograms and CBCT, in patients whether or not symptomatic, irrespective of their age, for differential diagnosis and management of cranio-cervicofacial pain in developmental patients.

The use of casein in sport mouthguards: microbiological and ecological variations in oral cavity.

Sport mouthguards have the potential to become a microbial reservoir, produce oral and systemic diseases and cause negative changes in the oral cavity. The aim of this study was to monitor oral environmental changes caused by casein and sport-mouthguard in vivo, through clinical, salivary and bacterial markers of young athletes. Forty-eight active young athletes in different disciplines were selected and analysed at different times: baseline (T0); after three months of casein application on the mouthguard (T1); and after six months of application (T2). The product used was GC Tooth Mousse®. At T0, clinical monitoring was performed and the following parameters were recorded: Decay-Missing-Filled Teeth (DMFT) index, Plaque index (PL+) and Gingival Bleeding (BOP+). Saliva-Check Buffer GC® and Saliva-CheckMutans GC® salivary tests were then performed. At T0 the athletes demonstrated DMFT 0.03±0.01. PL value was positive in 100% of subjects at T0, T1, and T2. The BI value was always negative. At the three time-points, a significant change in baseline hydration values was observed; baseline viscosity was normal in 50% of cases while it increased in the remaining 50% at T0; it was normal and constant at T1 and T2. The value of the baseline pH underwent an not statistically significant increase at T1 (7.6±0.08) while remaining constant at T2. The amount of saliva produced after 5-min stimulation ranged significantly and gradually from T0 to T1 and T2, with a statistically significant difference. Plaque indicator tests highlighted that at T0 a plaque with a pH of 6.0±0.5 prevailed; at T1 it was 6.25±0.75 while at T2, pH was equal to 6. Tests for the detection of S. mutans resulted constant in all subjects at the various observation times, resulting in 67% of patients in whom S. mutans was present. The application of casein, within custom-made ethylene- vinyl acetate (EVA) mouthguards, positively influences salivary flow, the increase of pH values, the amount of stimulated saliva and the buffering capacity of the athlete, improving their state of oral health, which is negatively affected by the use of common mouthguards.

Do cancer patients change their diet in the e-health information era? A review of the literature and a survey as a proposal for the Italian population.

In recent years, there has been an explosion in the amount of available information on cancer in parallel with an ever-increasing number of cancer survivors. Cancer patients and long-term survivors are known to be more sensitive to health-related information and dietary changes could represent a potential consequence of this huge availability of messages. In our review about dietary changes after cancer diagnosis, we found that this topic is particularly investigated among the breast cancer population. The literature examined show that breast cancer patients modify their eating habits after diagnosis in a percentage that varies between approximately 30% and 60%. The most reported changes were an increased consumption of fruit and vegetables, a decrease in the consumption of red meat, fats and sugary foods. Patients who reported changes were more likely to be younger, with higher educational levels and with a longer period of time since their diagnosis of cancer. It also emerged that cancer patients are often more likely to use supplements. This topic has not been investigated in cancer patients in Italy, therefore, we propose an approach to explore it with a structured questionnaire: The "ECHO SURVEY - Eating habits CHanges in Oncologic patients".

The use of chlorhexidine in mouthguards.

Sports mouthguards have the potential to become a microbial reservoir, to produce oral and systemic diseases and cause changes in environmental oral factors, inhibiting the protective effect of saliva. The aim of this study was to monitor, in vivo, oral environmental changes caused by chlorhexidine and sports mouthguards and in vitro, the effects of microbial strains, saliva and chlorhexidine on Ethylene-Vinyl-Acetate (EVA) material. Seventy-two athletes were analyzed at different time points: before training session (T0), post-training (TA), post-training with mouthguard (TB), post-training with mouthguard and chlorhexidine (TC). At each time of observation, saliva was collected and subjected to microbiological analysis. In vitro, EVA disks were incubated with bacterial cultures, saliva and clorexidine. Culture of supernatant solution, SEM and bacterial counts of EVA disks were performed. S. mutans and Candida spp. load decreased significantly in TC. The pH value significantly decreased in TB and improved in TC. In vitro, the analyzed bacteria were organized to form a biofilm on the EVA disk surface. The addition of chlorhexidine to the bacterial culture and saliva inhibited the growth in all tested conditions. In vivo, the use of chlorhexidine associated with the sports mouthguard inhibited the growth of pathogenic microbial species, and improved pH values. In vitro, EVA stimulated biofilm formation on its surface, but this action was contrasted by chlorhexidine. The effects found in vitro encouraged the use of chlorhexidine in vivo as a valuable tool in the use of mouthguards.

Hyaluronic acid-based medical device and oral disorders: can it be used in paediatric dentistry?

Due to its physical and biological characteristics and safety profile, hyaluronic acid is very widely used in numerous clinical conditions, ranging from its best-known use in cosmetic surgery (as a filler and for its ability to promote tissue regeneration and therefore minimise scarring) to lesser-known fields such as ophthalmic surgery, major abdominal surgery (where it is used to prevent the complication of adhesion bands) and intra-articular use. Studies were recently published in which this type of device was also used in paediatric patients for the management of inflammatory disorders of the oral cavity and teething symptoms. As this is a highly topical field for dentists, we felt it would be useful to review the efficacy and safety of the device in the paediatric population treated, and analyse any discrepancies with the results obtained in the adult population. The preparations of hyaluronic acid used in pediatric dentistry, thanks to their anti-inflammatory and angiogenic properties, proved to be very effective in therapy of oral diseases in children. Further clinical research is needed to confirm the effectiveness of these products to dispel doubts about any side effects.

Clinical evaluation of salivary indices and levels of Streptococcus mutans and Lactobacillus in patients treated with Occlus-o-Guide.

AIM: The aim of this study was to assess the changes over time associated with salivary indices and the presence of Streptococcus mutans and Lactobacillus in patients treated with Occlus-o-Guide. MATERIALS AND METHODS: Two groups of patients were evaluated: a test group of 20 patients treated with Occlus-o-Guide and a control group of 20 patients not subjected to orthodontic treatment. Both groups were homogeneous for age and sex. We examined the levels of S. Mutans and Lactobacillus, the salivary flow, the buffer capacity of saliva and the Sillness and Loe plaque index (PI). The samples were taken at baseline (T0), after 3 months (T1) and after 6 months of treatment (T2). All data were compared using Student's t test. RESULTS: The percentage of patients with a level of Streptococcus mutans able to cause caries was decreased in the test group (T0 = 10%, T1 = %, T2 = 0%) compared to the control group (T0 = 0%, T1 = 5%, T2 = 35%), whereas the amount of Lactobacilli was different (test group T0 = 15%, T1 = 0%, T2 = 10%; control group T0 = 0%, T1 = 5%, T2 = 35%). The total salivary flow was increased in the test group (T0 = 47, T1 = 61, T2 = 61) compared to the control group, in which it had remained almost constant (T0 = 44, T1 = 45, T2 = 45). The buffer capacity of saliva was unchanged in both groups over time; the sum of PI-plaque indices was reduced in the test group (T0 = 3, T1 = 0, T2 = 2) compared to the control group (T0 = 0, T1 = 14, T2 = 27). CONCLUSION: Despite the presence of the Occlus-o-Guide device, patients are able to maintain a good level of oral hygiene, showing improvements of the examinated parameters at follow-ups.