Correlation between halitosis, oral health status and salivary ß-galactosidases and time spent in physical activities in children.

AIM: The aim of this work was to evaluate the oral health status in children and to correlate it with time spent in physical activity per week. MATERIALS AND METHODS: Fifty children (mean age 9±2 years) attending the first visit at the Paediatric Dental Unit of the University of Rome "Tor Vergata" have been included in the study. The parents of all patients were interviewed about the medical history of the children and specific data, in particular, the time spent in physical activity per week. A trained dentist examined the oral cavity of the patients and the following clinical parameters were recorded: number of deciduous and permanent teeth, caries (on deciduous and permanent teeth), presence of gingivitis (0=no; 1=yes), tongue coating score (from 0=none to 3= > 2/3 tongue dorsum surface covered)", oral infections (0=no; 1=yes), oral hygiene index (0=insufficient, 1=sufficient, 2=good), presence of at least one incongruous restoration (0=no, 1=yes), oral breathing (0=no; 1=yes), fissured tongue (0=no, 1=yes), presence of aftous ulcers, herpetic lesions or candidiasis (0=no, 1=yes), food stagnation (0=no; 1=yes). The level of salivary ?-galactosidases activity was measured spectrophotometrically. The subjects were classified into "Group 0": children who did not practice any sports beside physical education class; "Group 2": 2 hours per week; "Group 3": 3 hours; and "Group 4": 4 hours. STATISTICS: Statistical analysis was performed using SPSS for Windows version 21 (IBM SPSS Inc., Chicago, IL, USA). The Pearson's correlation coefficient (P) was used to evaluate the linear relationship between continuous variables, and the Spearman's correlation coefficient (S) was calculated for ordinal variables. Analysis of variance (ANOVA) and the Fischer's Least Significant Difference (LSD) test were used to compare the parameters analysed in the study. Data were analysed using linear regression and descriptive statistics. The significance threshold was set at 0.05. RESULTS: A more physically active lifestyle was significantly associated with a better oral hygiene and a reduced level of salivary ?-galactosidases, halitosis, gingivitis and tongue coating. Results of the organoleptic evaluation of halitosis performed by the parents and sport hours/week practiced have shown that Group 0 and 2 were characterised by statistically significant higher scores with respect to the other groups (Group 0 vs. Group 3, p=0.014; Group 2 vs. Group 3, p=0.030; Group 0 vs. Group 4, p=0.001; Group 2 vs. Group 4, p=0.002) (P= -0.458). The spectrophotometric quantification of salivary ?-galactosidases has shown that increasing the hours of sports, the enzyme activity significantly decreases (S= -0,330); similar levels were found with 0 and 2 hours of sports, but an important decrease has been recorded with both 3 (Group 0 vs. Group 3, p=0,011; Group 2 vs. Group 3, p=0,006) and 4 hours of sports practiced (Group 0 vs. Group 4, p=0,014; Group 2 vs. Group 4, p=0,008). The level of significance between children who did not practice sport and those who did for 3 and 4 hours a week was 0.005 (Group 0 vs. Group 3) and 0.0018 (Group 2 vs. Group 4) with respect to tongue coating scores (P= -0,511) and 0.012 for both groups with respect to gingivitis (Group 0 vs. Group 3; Group 0 vs. Group 4) (P=-0,427). CONCLUSION: Children who practiced sport showed a better oral hygiene level and lower halitosis, with respect to those who did not.

Default mode network changes in multiple sclerosis: a link between depression and cognitive impairment?

BACKGROUND AND PURPOSE: In multiple sclerosis (MS), depression is a common disorder whose pathophysiology is still debated. To gain insights into the pathophysiology of depression in MS, resting-state (RS) functional connectivity (FC) changes of the default mode network (DMN), salience network (SN) and executive control network (ECN) were assessed in a group of depressed MS (D-MS) patients and in appropriately matched control groups. METHODS: Sixteen D-MS patients, 17 non-depressed MS (ND-MS) patients, 17 non-depressed healthy controls and 15 depressed subjects (D-S), age, sex and education matched, cognitively preserved and non-fatigued, were enrolled. All participants underwent a neuropsychological evaluation and RS functional magnetic resonance imaging study. RESULTS: Comparing D-MS patients with D-S, within the DMN, a significant RS-FC suppression was found in the posterior cingulate cortex (PCC); comparing D-MS with ND-MS, FC was significantly increased in the anterior cingulate cortex and significantly reduced in the PCC. Within the SN increased FC in the right supramarginal gyrus and right middle frontal gyrus was found in D-MS patients compared to D-S and to ND-MS; within the ECN increased FC in the right inferior parietal cortex was found in D-MS patients compared to ND-MS patients. CONCLUSIONS: In cognitively preserved D-MS patients, FC derangement occurs in the SN, ECN and DMN. In the latter, changes occurring both in the anterior cingulate cortex and PCC suggest that depression in MS may be linked to MS itself and, in particular, to a peculiar pattern of network abnormalities favored by MS pathology through disconnection mechanisms. Reduced FC in the PCC, similar to MS patients with cognitive impairment, suggests a functional link between depression and cognitive impairment in MS.

Anxiety in Multiple Sclerosis: psychometric properties of the State-Trait Anxiety Inventory.

OBJECTIVE: The aims of the present study were to examine psychometric properties of the Spielberger State-Trait Anxiety Inventory (STAI-Y-1 and STAI-Y-2, respectively) in a Multiple Sclerosis (MS) population and to identify a cut-off score to detect those MS patients with high level of state and/or trait anxiety who could be more vulnerable to development of depression and/or cognitive defects. MATERIAL AND METHODS: The STAI-Y-1 and STAI-Y-2 was completed by a group of patients (n = 175) affected by MS and a group of healthy subjects (n = 150) matched for age, educational level, and gender. In MS patients internal consistency, divergent and discriminant validities were evaluated. Construct validity was examined by exploratory factor analysis for each scale. RESULTS: There was no missing data, no floor or ceiling effects for both scales. The two scales showed high internal consistency, good divergent, and Known-groups validities. To identify high levels of state and trait anxiety in a patient with MS, we proposed three gender specific screening cut-off values (1, 1.5, 2 SD) for the STAI-Y-1 and the STAI-Y-2. CONCLUSIONS: The findings showed that the STAI-Y-1 and the STAI-Y-2 are a valid tool for clinical use in MS patients and can be useful to measure the severity of anxiety and to identify those patients with high anxiety to introduce them in specific non-pharmacological intervention.

The process of mineralisation in the development of human tooth.

AIM: Tooth development and mineralisation are processes that derive from different tissues interactions, in particular ectodermal and mesenchymal layers. These interactions are responsible for the formation of unique structures with a particular chemical composition. Despite differences, mineralised tissues are similar and they derive by highly concerted extracellular processes that involve matrix proteins, proteases, and mineral ion fluxes that collectively regulate the nucleation, growth and organisation of forming mineral crystals. This review aims at explaining mineralisation, its stages and when damage occurs and alters the hard tissues structure.

Correlation between aerosol therapy in early childhood and Molar Incisor Hypomineralisation.

AIM: To evaluate the correlation between the use of aerosol therapy in early childhood and the presence of Molar Incisor Hypomineralisation (MIH). STUDY DESIGN: a retrospective case-control study in which a group (cases) consisted of children from 6 to 13 years with MIH visited at the unit of Pediatric Dentistry of the Policlinico Tor Vergata (Rome, Italy), and a group (controls) consisted of an equal number of children of the same age without MIH. Data about the aerosol therapy and the presence of MIH were obtained respectively by medical history and intraoral clinical examination. Collected data underwent statistical analysis using mainly non-parametric tests (p < 0.05). RESULTS: In the study were included 182 patients, of which 91 (46 males, 51%) were children with MIH (cases), and 91 (46 males, 51%) were children without MIH (controls). In the group of patients with MIH, in the early childhood, 12 (13.1%) never had aerosol therapy, 6 (6.6%) underwent aerosol therapy less than 7 days per year, 22 (24.2%) from 8 to 15 days per year, 22 (24.2%) from 16 to 45 days a year, and 29 (31.9%) more than 45 days per year. In the control group, in the early childhood, 9 (9.9%) never had aerosol therapy, 29 (31.9%) underwent aerosol therapy less than 7 days per year, 26 (28.6%) from 8 to 15 days per year, 20 (22.0%) from 16 to 45 days a year and 7 (7.6%) more than 45 days per year. STATISTICS: the risk of developing MIH in children undergoing intensive use of aerosol therapy with respect to those receiving a less intensive use resulted in an odds ratio of 3.19 (p <0.001) in the general population, 4.83 (p < 0.001) in males and was not statistically significant in females (p = 0.132). The Spearman correlation between aerosol therapy and MIH was 0.278 (p < 0.001) in the general population, 0.372 (p < 0.001) in male, and it was not statistically significant (p = 0.08) in female subjects. CONCLUSION: Aerosol therapy carried out in early childhood appears to be a risk factor for the development of MIH, particularly in male subjects.

Gingival fibromatosis: a case report.

AIM: Gingival Fibromatosis is characterised by a large increase in the gingival dimension which extends above the dental crowns, covering them partially or completely. The causes of the disease may have a genetic origin, in which case gingival hyperplasia may occur in isolation or be part of a syndrome, or acquired origin, which comes from specific drugs administered systemically. A form of gingival fibromatosis of idiopathic origin has been described. The therapy involves mainly the surgical removal of the hyperplastic gingival tissue, although in these cases recurrences are frequent. CASE REPORT: A 9 years old male patient came to observation at the Clinic of Pediatric Dentistry of the Tor Vergata Polyclinic of Rome. After Primary Gingival Fibromatosis was diagnosed, the therapeutic choice was to wait and postpone gingivectomy at the end of the development phase.

The Italian perspective on fluoride intake in children and adolescents.

AIM: This paper represents the outcome of the meetings of the Committee composed by Pedodontists (SIOI - Italian Society of Paediatric Dentistry) and Paediatricians (FIMP - Italian Association of Paediatricians) with the aim to share an evidence- based common approach in caries prevention during childhood and adolescence. The most important topic was an update on fluoride administration methods in order to minimise the risk of fluorosis and maximise its caries-preventive effect. CONCLUSION: The conclusions of this work are exposed in a synoptic table.

Dental caries and childhood obesity: analysis of food intakes, lifestyle.

AIM: The aims of this cross-sectional statistical study were to evaluate the association between obesity and dental caries and to assess the impact of food intake, oral hygiene and lifestyle on the incidence of dental caries in obese paediatric patients, analysed by Dual X-ray Absorptiometry (DXA). MATERIALS AND METHODS: A sample of 96 healthy patients, aged between 6 and 11 years (mean age 8.58±1.43) was classified in relation to body composition assessment and McCarthy growth charts and cut- offs. Body composition analysis, to obtain body fat mass (FM) and body fat free mass (FFM) measurements, was determined by means of a DXA fan beam scanner. The subjects underwent dental examination to assess the dmft/DMFT, and completed a questionnaire on food intake, oral hygiene habits and lifestyle. The sample was subsequently subdivided into four groups: Group A (normal weight - caries-free), Group B (normal weight with caries), Group C (pre-obese/obese - caries-free), Group D (pre-obese/obese with caries). STATISTICS: The statistical analysis was performed using SPSS software (version 16; SPSS Inc., Chicago IL, USA). Spearman's correlation was performed to evaluate the correlation between dmft/DMFT and FM%. The chi-square test was performed to assess the categorical variables, while the non-parametric Kruskal Wallis test and the Mann Whitney test were employed for the quantitive variables. Statististical significance was set at a P-value of 0.05. RESULTS: The preobese-obese children had higher indexes of dental caries than normal weight subjects, both for deciduous teeth (dmft 2.5 ± 0.54 vs 1.4 ± 0.38; p=0.030) and permanent teeth (DMFT 2.8 ± 0.24 vs 1.93 ± 1.79; p=0.039). The correlations between dmft/DMFT indexes and body composition parameters were analysed and a significant correlation between dmft/DMFT indexes and FM% was observed (p=0.031 for dmft, p=0.022 for DMFT). According to the data recorded, there was no statistically significant difference between Groups A, B, C and D in terms of food intake between meals (p=0.436), frequency of starch intake limited to the main meals (p=0.867), home oral hygiene (p=0.905), dental hygiene performed at school (p=0.389), habit of eating after brushing teeth (p=0.196), participation in extracurricular sport activities (p=0.442) and educational level of parents: father (p=0.454), mother (p=0.978). In contrast, there was a statistically significant difference between Groups A, B, C and D in terms of intake of sugar-sweetened drinks (p=0.005), frequency of sugar intake limited to the main meals (p<0.001), frequency of food intake between meals (p=0.038) and sedentary lifestyle (p=0.012). Successive analysis revealed a statistically significant difference between Group A and D in terms of intake of sugar-sweetened drinks (p=0.001), frequency of sugar intake limited to the main meals (p=0.008), and frequency of food intake between meals (p=0.018), and between Group C and D in terms of frequency of sugar intake limited to the main meals (p<0.001), and frequency of food intake between meals (p=0.040). CONCLUSION: This study shows a direct association between dental caries and obesity evident from a correlation between prevalence of dental caries and FM%. The analysis of food intake, dmft/DMFT, FM%, measured by DXA, demonstrates that specific dietary habits (intake of sugar-sweetened drinks, frequency of sugar intake limited to main meals, frequency of food intake between meals) may be considered risk factors that are common to both dental caries and childhood obesity.

Association between the organoleptic scores, oral condition and salivary ß-galactosidases in children affected by halitosis.

OBJECTIVES: The goal of this work is to evaluate the association between organoleptic scores, oral condition and salivary ß-galactosidases, to facilitate the differential diagnosis of halitosis in children. METHODS: Fifty systemically healthy children with a primary complaint of oral malodour were included in this cross-sectional study. The organoleptic evaluation was carried out by two judges, evaluating the intensity of malodour of the air exhaled 5 s through the mouth of the patients, at a distance of approximately 10 cm from their noses; the level of salivary ß-galactosidases was quantified spectrophotometrically after a chromatic reaction between a salivary sample of each patient and a specific chromatic substrate of the enzyme. Clinical conditions, such as visible plaque and gingival bleeding index, tongue coating score, localized food stagnation and other oral parameters, were evaluated by qualified dentists through an oral check-up. RESULTS: The ß-galactosidase level was significantly related to the organoleptic scores and clinical parameters, such as the tongue coating score and the visible plaque index. Stratifying results with respect to the different phase of the day at which parents complained halitosis in their children, statistical analysis showed that the organoleptic scores and the level of ß-galactosidases were significantly higher in children who suffered of halitosis during the whole day, A = 40%, with respect to those without this problem, N = 20% (P = 0.001 and P = 0.006, respectively). CONCLUSIONS: Certain oral parameters such as halitosis during the whole day, high tongue coating score and high visible plaque index were particularly associated with an increase in the salivary ß-galactosidase level.

Humanisation and health needs in children: present or future?

AIM: For a few years, teledentistry has been an emerging innovative strategy with potential in the field of paediatric dentistry. There are still few studies in this regard, so further research is needed to verify and ensure that teledentistry is not only an accessible mode of communication, but above all effective and evidence-based. This study aimed to use a preliminary telematic approach to promote the compliance of patients in the developmental age during the first dental visit. MATERIALS: Two hundred patients were selected according to the eligibility criteria, and distributed in two groups: a study group with the preliminary telematic approach (ATP) before the first visit and a control group with traditional first visit without ATP. Through an ordinal semi-proportional regression model, the degrees of collaboration between the study and control groups were compared, correcting the estimate for age groups, the presence of systemic pathologies, disorders of cognition, attention and learning, degree of anxiety and previous medical-dental experiences. CONCLUSION: The preliminary telematic approach could be useful as a support to the traditional paediatric dental visit, to promote better management and fidelity of the patient, reducing anxiety and increasing collaboration during the first visit.

Aesthetic perception of patient in developmental age in interceptive orthodontic treatment.

AIM: Patients at development age show considerable attention to the shape of the face from both an aesthetic and relational point of view, to arouse interest from researchers. There are few studies related to profile analysis in patients of developmental age. Therefore, the objective of the present study was to analyse the importance of the aesthetic perception of the patient in development age in relation to the profile, before and after interceptive orthodontic treatment. MATERIALS: A sample of 25 patients who came to our observation for dentoskeletal malocclusions was considered. A questionnaire was proposed to each patient, before and after the interceptive orthodontic treatment (T0 and T1), to evaluate the aesthetic perception before and after the orthodontic treatment and its psychosocial impact. Profile analysis was performed using photographic documentation (at T0 and T1). The variables considered were the Ricketts line, the facial convexity angle, the nasolabial angle, and the labiomental angle. CONCLUSION: Interceptive orthodontic treatment has proven to be of valid clinical and psychological help. This result is confirmed by the complete aesthetic satisfaction of the patient in the frontal and latero-lateral planes.

Immediate dentin sealing in indirect restorations of dental fractures in paediatric dentistry.

AIM: At present, two different clinical procedures to ensure the adherence of indirect tooth restorations to the dental tissues are available: a traditional method based on a delayed dentin sealing (DDS) and an innovative approach that contemplates an immediate dentin sealing (IDS). In this study the authors highlight the advantages of the latter method (IDS), decribing the operating phases of this procedure used in paediatric dentistry to perform indirect restorations of dental fractures. MATERIALS AND METHODS: The operating phases of indirect composite restorations of dental fractures in paediatric patients are described, introducing an innovative procedure that recommends the immediate application of the dental adhesive (IDS) on the exposed dentin before the subsequent operating phases of tooth preparation, dental impression and adhesive cementation of the restoration. RESULTS: The immediate application of the dental adhesive (IDS) on the freshly cut exposed dentin, before taking the dental impression, protects the dental pulp from bacterial contamination and prevents post-operative sensitivity. At the same time, this procedure provides an ideal substrate for formation of a hybrid layer with excellent adhesion properties. CONCLUSION: Both methods (DDS and IDS) allow the formation of an adequate hybrid layer to seal the dentin in the interdiffusion area, although SEM images of samples treated with the two methods reveal clear ultrastructural differences between the different interfaces.

Atypical deglutition: diagnosis and interceptive treatment. A clinical study.

AIM: The aim of this study was to evaluate the early treatment of atypical deglutition, by analysing the efficacy of the eruptive guide appliance Habit Corrector™. MATERIALS AND METHODS: The pre- and post-treatment (T1 and T2) cephalometric data of 2 groups of patients (G1 and G2), both consisting of 25 patients each and treated with Habit Corrector™, were compared. The first group included 10 males and 15 females, aged between 4 and 7 years old, with average age 6.17 years, and therefore undergoing the last phase of primary dentition and the first phase of mixed dentition. The second group included 12 males and 13 females, aged between 8 and 12 years old, with average age 9.19 years old, undergoing the second phase of mixed dentition. The overall duration of the treatment was 12 months. RESULTS: The results showed significant differences between the two groups, with respect to overbite, overjet, molar relation, inclination of the upper and lower incisors, position of the jaw. A significant variation between the two groups at T2 was registered for the maxillomandibular relationships: the increase in the growth and degree of mandibular protrusion was of 4.66° in G1 and 2.44° in G2. Significant changes were registered for the position or growth of the upper jaw; the upper facial height almost remained unaltered, with 53.34° for G1 and with 53.96° for G2. A significant variation occurred with the increase in the sagittal relationship between the molars, improved in G1 by 3.14 mm and in G2 by 2.61 mm. A significant decrease of overjet was registered in G1 by 1.94 mm and in G2 by 0.76 m and an increase of overbite in G1 by 3.14 mm and in G2 by 0.88 mm. The inclination of the maxillary and mandibular incisors improved, with an inter-incisive angle of 123° in G1 and 124.2° in G2. CONCLUSION: The clinical results obtained suggest that early intervention in atypical deglutition with Habit Corrector™ is able to produce significant results in primary dentition and in the first phase of mixed dentition, rather than in the late phase of mixed dentition.

Childhood obesity and skeletal-dental maturity.

AIM: The aim of this cross-sectional study was to evaluate the skeletal maturation assessed through cervical vertebral maturation (CVM) and dental age, in normal weight, pre-obese and obese patients, using the Body Mass Index (BMI) and the Dual energy X-ray Absorptiometry (DXA). MATERIALS AND METHODS: A group of 107 healthy patients, aged between 6 and 12 years (mean age 8.77∓1.79), underwent anthropometric measurements, BMI calculation, and DXA exam at the Department of Neuroscience, Human Nutrition Unit, University of Rome "Tor Vergata" and the assessment of skeletal and dental age at the Paediatric Dentistry Unit of PTV Hospital, University of Rome "Tor Vergata". The subjects were classified as underweight, normal weight, pre-obese and obese according to FM% McCarthy cut-offs classification and BMI classification. STATISTICS: The analyses were performed using the SPSS software (version 16; SPSS Inc., Chicago IL, USA). The assessment of differences through the means of continuous variables among the different groups were analysed using the One-Way-Anova test. The Student's t test was also applied for each group of children (using McCarthy and BMI classifications) between chronological and skeletal-dental age; the Fisher's exact test was performed between the gender categorical variable and McCarthy cut-offs classification, and between McCarthy and BMI classifications. Besides, to evaluate the association between skeletal and dental age, a Pearson correlation coefficient was calculated. In all the assessments a significant level of alpha = 0.05 was considered. RESULTS: The comparison between BMI and DXA data shows statistically significant differences between BMI- FM% (McCarthy cut-offs) classifications (p≤0.001). According to FM% (McCarthy cut-offs) classification, from the Anova analysis among the groups a statistically significant difference between skeletal age (p=0.03) and dental age (p=0.02) was observed, while the difference related to the chronological age (p=0.22) among the groups, was not significant. The correlation between dental and skeletal age is almost the highest (Pearson correlation coefficient=0.994) and statistically significant (p=0.01). According to FM% McCarthy classification, it is observed that with an increase in the FM% , that is passing from normal weight to obese children, the skeletal-dental age always increases with respect to the chronological age. The difference between chronological and skeletal-dental age is statistically significant for pre-obese (p=0.01) and obese (p<0.001) children, while it is not significant for underweight (p=0.46) and normal weight (p=0.33) children. According to the BMI classification, from the Anova analysis no statistically significant differences were observed among the groups as for chronological, dental and skeletal age. Applying the same inferential analyses and taking into account the BMI classification, in the obese subjects were observed not statistically significant differences as for chronological and skeletal-dental age (p=0.09). CONCLUSION: The results highlighted a relation between skeletal-dental age acceleration and body fat percentage measured by DXA.

Chemotherapy-induced oral mucositis in children and adolescents: a systematic review.

PURPOSE: The present systematic review aims to describe the incidence and severity of chemotherapy-related oral mucositis in children and adolescents affected by hematologic and solid tumors. METHODS: An electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO up to the 8th November 2020. The PRISMA protocol was followed for the article selection and inclusion. The risk of bias in individual studies was evaluated through the Newcastle-Ottawa Scale. Data were summarized using mean and standard deviation for continuous variables, while categorical ones were described with frequency and percentage. RESULTS: A number of 9940 records were obtained after the electronic search. Seventeen of them were included in the qualitative analysis after the two stages of screening, while none of these articles was considered eligible for the quantitative analysis. The mean incidence of oral mucositis was 53.6% and it ranged from 16.7 to 91.5%, while severe oral mucositis accounted for the 15.8% (0.0-35.2%) among selected studies. Most of the articles included both patients with solid and hematologic tumors, while only five of them described oral mucositis in children with acute lymphoblastic leukemia. Even the kinds of chemotherapy administered were extremely variable. CONCLUSION: In conclusion, about half of the patients submitted to cancer chemotherapy developed oral mucositis with an incidence and severity that varies depending on the primary disease and the kind of drugs administered.

The dental age in the child with coeliac disease.

AIM: The coeliac disease deprives affected individual of the main nutritive factors, which are essential to promote body development: coeliac children are often subject to weight loss and have a lower somatic growth rate compared to healthy children. In addition, it is proven that prolonged malnutrition can have irreversible effects on dental eruption: teeth development also suffers a delay or it is slowed down in coeliac children. The purpose of this study was to evaluate and quantify the persistence of a delay in the dental age in children with coeliac disease and the presence of a possible constant relationship between the estimated delay in skeletal development and that referred to the dental age. MATERIALS AND METHODS: Seventy children (24 males and 46 females) were selected, all affected by coeliac disease, aged between 5.3 and 13.8 years, with a mean age of 9 years +/- 22 months SD. Through teleradiography of the skull in latero-lateral projection and orthopantomography of the dental arches, the estimate of the skeletal development and dental age was carried out for each patient, applying two specific methods extensively described in the literature. RESULTS AND CONCLUSION: The results obtained, in agreement with the literature, show how the dental age, which is delayed in children affected by coeliac disease, may be considered as a reliable indicator of somatic growth and also of biological age. Furthermore, a gluten-free diet has considerable beneficial effects on skeletal development in relation to the dental age, in agreement with the hypothesis that dental development is controlled by different regulatory mechanisms, totally independent from those that influence skeletal development and the somatic and sexual development of the individual, even if the delay of dental development decreases progressively from the time of diagnosis of coeliac disease to introduction of a gluten-free diet.

Oral lesions in paediatric patients with graft-versus-host disease.

AIM: This work aims at assessing and describing the most frequent clinical manifestations of the Graft-versus- Host Disease (GvHD) in the oral and maxillofacial region in paediatric patients affected by neoplastic or non neoplastic haematologic disorders who undergo specific haematopoietic stem cell transplantation (HSCT) protocols, with a view to detecting the potential pathological modifications that are recognised as the cause of a possible altered harmonious development of the child. MATERIALS AND METHODS: Thirty-eight paediatric patients aged between 3 and 13 years, coming from the haematological department of Tor Vergata University (Roma, Italy) and affected by GvHD, assessed on the basis of their medical history and accurate clinical and instrumental exams, after having received haematopoietic stem cell transplantation for neoplastic or non neoplastic haematologic disorders, were enrolled in this study. The aim of this work was to assess oral conditions, detect possible oral pathological manifestations and evaluate their incidence both locally and in terms of clinical severity, as well as to mitigate associated symptoms. This was done to prevent and eliminate any oral interference in the systemic treatment protocol. DISCUSSION AND CONCLUSION: In line with the data presented in the literature, clinical GvHD manifestations seem to mainly involve the oral and maxillofacial region from an early phase also in paediatric patients. As a consequence, a timely diagnosis and a multidisciplinary treatment programme are essential for the early detection of the oral signs of potential systemic complications, to improve the quality of life of these young patients, as well as to prevent any potential alterations of dentoskeletal development and growth in the child.

Obesity and dental caries in paediatric patients. A cross-sectional study.

AIM: The aim of the present cross-sectional study was to evaluate the relationship between childhood obesity and dental caries, in paediatric subjects, through the use of two methods of diagnosis of overweight-obesity: Body Mass Index (BMI), and Dual energy X-ray Absorptiometry (DXA). METHODS: A total of 107 healthy patients, aged between 6 and 12 years (53.3% females, 46.7% males) were included in the study. Each patient underwent a nutritional examination and dental check-up. The nutritional examination was performed at the Department of Neuroscience, Human Nutrition Unit, University of Rome Tor Vergata and consisted of anthropometric measurements, BMI calculation, DXA exam, body fat mass (FM) assessment. Dental examinations were performed by a trained dentist of the Paediatric Dentistry Unit of PTV Hospital, University of Rome Tor Vergata. Dental caries was assessed using visual-tactile method and X-rays (bite-wing and panoramic radiography); the dmft/DMFT index was calculated. The subjects were classified as underweight, normal weight, pre-obese, obese, according to different criteria: a) age- and sex-specific BMI according to the Cacciari growth charts and cut-offs, b) body fat mass percentage (FM%) according to the WHO cut-offs, c) body fat mass percentage (FM%) according to the McCarthy growth charts and cut-offs. STATISTICS: The statistical analysis was performed with the SPSS software (version 11.01; SPSS Inc., Chicago, IL, USA). The dmft/DMFT index was checked for normality using the Kolmogorov-Smirnov test. Independence of the dmft/DMFT distribution from sex and age was checked by using the Mann Whitney and Kruskal Wallis tests. Differences in the dmft/DMFT values between groups, according to BMI and FM% classifications, were tested using the Mann Whitney test. The minimal level of significance of the differences was fixed at p- value ≤ 0.05 for all procedures. RESULTS: The comparison between BMI and DXA data shows statistically significant differences between BMI-%FM (WHO cut-offs) classifications (p ≤ 0.001) and BMI-%FM (McCarthy cut-offs) classifications (p ≤ 0.001). According to the BMI classification, there was no significant association between increase of dmft-DMFT and pre-obesity/obesity, but according to the FM% (WHO cut-offs) classification, the pre-obese/obese children had higher caries indexes than normal weight subjects, both in deciduous teeth (p=0.003) and permanent teeth (p=0.000). Furthermore, according to the FM% (McCarthy cut-offs) classification, obese children had higher caries indexes than normal weight and pre-obese subjects, both in deciduous teeth (p=0.030, p=0.02) and permanent teeth (p=0.019, p=0.011), respectively, but they had a dmft-DMFT value comparable with underweight children. CONCLUSION: The BMI misclassified adiposity status of the paediatric population compared to DXA, which provides a reliable screening and a more specific assessment of body composition. The misclassification of childhood obesity, determined by the BMI, could be used to explain the conflicting data in the literature on the association between obesity and dental caries. Our results highlighted for the first time the relationship between dental caries prevalence and body fat percentage measured by DXA.

Oral manifestations of eating disorders in adolescent patients. A review.

AIM: Eating disorders (ED) are a group of psychopathological disorders that affect the patient's relationship with food and his own body and that are manifested mainly in adolescence and in young-adult age. ED include anorexia nervosa (AN), bulimia nervosa (BN) and other eating disorders as classified in the DMS-V. ED can result in several oral and dental manifestations that often occur in the early stages of ED and may allow early detection. The aim of the study is to describe the different oral and dental manifestations in patients with ED in order to offer a classification for their identification during an extra/intra-oral examination. METHODS: A search on PubMed, Medline and Cochrane Library data bases has been performed. RESULTS: Oral manifestations in ED patients include a variety of signs and symptoms, which involve the oral mucosa and perioral tissues (exfoliative cheilitis, labial erythema, atrophic glossitis, glossodynia, yellow-orange colouration of the soft palate, cheek/lip biting, candidiasis), the teeth (dental erosion, tooth hypersensitivity, dental caries), periodontal diseases, and salivary manifestations (sialoadenosis, alterations in salivary flow). The oral signs are caused by a number of factors, including nutritional deficiencies and consequent metabolic changes, poor personal hygiene, altered eating habits and pharmacological therapies. There is a very specific link between oral manifestations and ED in the presence of self-induced vomiting. CONCLUSION: The paediatric dentist may be the first professional to detect the clinical signs thus improving the interception, early diagnosis, characterisation and prognosis of ED. In addition, the oral manifestations of ED can cause alterations of the oral function, discomfort, oral pain, and worsen aesthetics of the face and the quality of life.