Maternal mental health and children oral health: a literature review.

AIM: Recently, serious considerations regarding mental health conditions and their impact on the whole organism have been made. This area is still quite unknown within the dental community, despite the potential impact these conditions can have on both oral care and health. Previous studies have concluded that both pregnant women and mothers have been found to be particularly sensitive to the risk of developing mental disorders such as anxiety and major depression. There is a very high possibility for the children of these mothers to experience neglect and disregard due to of the development of these conditions, which will negatively affect their behavioural and physical growth as a result. This impact stretches into oral health as well, as these children have been reported to be more inclined to develop early childhood caries, bruxism, and after-birth enamel defects, in addition to illnesses like diabetes and disabilities. MATERIALS: A literature search was conducted in Pubmed, Medline, and Scopus for the keywords 'maternal depression', 'oral health' and 'children', combined with 'AND' or 'OR' Boolean Operators. CONCLUSION: The results of the present literature suggest a strong connection between maternal mental disorders and poor children's oral care, and as a result, dental professionals should be extremely careful when treating and communicating with these patients.

Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit.

AIM: Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children. METHODS: A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators. CONCLUSION: The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

Nasal function before and after rapid maxillary expansion in children: A randomized, prospective, controlled study.

OBJECTIVES: Children can well detect and respond to odours in order to have information about food and environment. Rapid Maxillary Expansion seems to improve dental and skeletal crossbite and increase nasal patency correcting oral respiration in children. A previous pilot study suggested that Rapid Maxillary Expansion may lead to improved N-Butanol olfactory thresholds, and peak nasal inspiratory flow values (PNIF). The aim of the present study was to prospectively evaluate olfactory threshold, nasal flows and nasal resistances in children aged from 6 to 11 years before and after Rapid Maxillary Expansion, comparing treated children with a control group of similar age, growth stage (prepubertal) and transversal skeletal deficiency. METHODS: N-butanol olfactory thresholds, anterior active rhinomanometry (AAR) and PNIF were measured in 11 children (6-11 years) before (T0), immediately and 6 months after Rapid Maxillary Expansion application (T1 and T2 respectively), and in a control group of 11 children (6-11 years) whose members remained under observation for the period of the study. RESULTS: Considering the study group, PNIF values improved at T1 respect to the T0 values (p = 0.003), while T2 values were significantly higher than T0 ones (p = 0.0002). N-Butanol Olfactory Threshold significantly improved at each control (p = 0.01, p = 0,01 and p = 0.0003, for T1 vs T0, T2 vs T1, T2 vs T0 respectively). No differences on AAR values were found during the six months follow-up in this group. Considering the control group, no significant differences were found for any of the considered variables during the time of the study. Comparing the two groups, there was a significant increase of PNIF values in the study group compared to the control group (p = 0.003) at T1, which was even more evident six months after Rapid Maxillary Expansion (p = 0.0005). This improvement was not shown by AAR values. N-Butanol Olfactory Threshold showed a significant improvement at T2 respect to T1 (p = 0.002) and T0 (p = 0.0005). CONCLUSION: Rapid Maxillary Expansion seems to significantly improve the respiratory capacity of treated patients, at least in terms of PNIF, and their olfactory function, measured by N-Butanol Olfactory Threshold Test. Further studies should be performed to evaluate if also changes in nasal resistances, measured by AAR, could occur, maybe considering a larger group of subjects and possibly using 4-phase rhinomanometry in order to evaluate the effective resistances during the entire breath.

The bone lid technique in oral surgery: a case series study.

The aim of this case series study was to illustrate the bone lid technique implemented using piezoelectric surgery to access mandibular alveolar bone diseases and to assess the clinical and radiographic outcomes. The technique was used to treat 21 consecutive patients with various conditions: cysts in six cases, impacted teeth with associated cysts in nine, keratocystic odontogenic tumours in three, impacted teeth in two, and an endodontic lesion in one. The bone lid was fashioned using piezoelectric surgery and a thin osteotomy insert. After the surgical procedure, the bone lid was replaced and fixed with miniplates. On clinical and radiological follow-up at 12 months, the outcome measures were bone lid integration and alveolar bone volume recovery. Any complications were also documented. The lesion and bone lid healed completely in 19 cases; one patient experienced permanent mild paresthesia and one experienced trauma-induced bone lid necrosis. Computed tomography volumetric analyses conducted on 11 cases indicated a mean recovery of 93.8% of the volume of bone lost. Based on healthy biological reasoning, the bone lid technique with piezoelectric surgery and rigid fixation may be considered a valid alternative to ostectomy for the purposes of bone tissue healing.

Prevalence of sleep bruxism and awake bruxism in different chronotype profiles: Hypothesis of an association.

Sleep (SB) and awake bruxism (AB) recognize a multifactorial etiology and have a relationship with several psychological factors. Psychological disorders have recently been associated also with the chronotype, which is the propensity for an individual to be especially active at a particular time during a 24-h period. Based on the chronotype, the two extreme profiles are morningness and eveningness individuals. Due to the relationship that both the chronotype and bruxism have with psychological factors and the fact that performing tasks not compatible with chronotype can trigger stress, this review presents the hypothesis that the prevalence of SB and AB can differ with the various chronotype profiles. New perspectives for the study of bruxism etiology may emerge from investigations on the topic.

Topical tocopherol for treatment of reticular oral lichen planus: a randomized, double-blind, crossover study.

OBJECTIVE: This randomized, double-blind, placebo-controlled crossover study assessed the efficacy of topical tocopherol acetate compared with placebo in easing oral discomfort in patients with reticular oral lichen planus (ROLP). MATERIALS AND METHODS: Thirty-four patients with clinically diagnosed and histologically confirmed ROLP were randomly assigned to two groups, which received first one of two treatments (treatment 1 or 2) for a month, then the other (treatment 2 or 1) for another month, with a two-week washout between them. One treatment contained tocopherol acetate and the other only liquid paraffin. The primary outcome was less discomfort, measured on a visual analog scale (VAS). Secondary outcomes were as follows: length of striae measured and photographed at each follow-up; surface area of lesions; and a modified Thongprasom score. RESULTS: No statistically significant differences emerged between the two treatments (1 vs 2) in terms of VAS scores (P > 0.05; 0.8624) or length of striae (P = 0.0883). Significant differences were seen for surface area of lesions (P < 0.05, P = 0.0045) and modified Thongprasom scores (P = 0.0052). CONCLUSION: The two treatments differed only in terms of the surface area of the lesions and Thongprasom scores, not in VAS scores for discomfort or the length of patients' striae. Topical tocopherol proved effective in the treatment of ROLP.

Prevalence of occlusal traits and orthodontic treatment need in 14 year-old adolescents in Northeast Italy.

AIM: Studies on prevalence of malocclusion support the planning and provision of public dental services. The aim of the study was to assess the prevalence of malocclusion and occlusal traits in adolescents aged 14 years from public secondary schools in the area of Health District n.15 - Veneto region, Italy. STUDY DESIGN: Cross-sectional survey. METHODS: Out of a randomly selected sample of 1187 subjects, 444 adolescents (55% males, 45% females) were evaluated in the school settings according to the criteria adopted by Brunelle et al. [1996]. Alginate impressions were then taken for 380 students together with a wax bite. The occlusal traits of the cast were analysed and IOTN was established. RESULTS: The most common occlusal traits measured on casts were overjet >3 mm (48%), overbite >3 mm (39%), midline misalignment (32%), crowding (30%), 99% of the sample showed at least one occlusal trait. Class I molar relationship prevailed (75.5%) and the prevalence of molar asymmetries was 21.9%. The prevalence of anterior and posterior crossbite and open bite was significantly higher in females, while the mean values of overjet and overbite were higher in males. The distribution of IOTN in the study population showed that only 49.5% had no or little need of treatment, and more than one third (35.8%) were assigned a 4 or 5 score. STATISTICS: Descriptive statistics are expressed as a percentage (± confidence interval) or mean ± standard deviation, according to the nature of the variable. CONCLUSIONS: These outcomes indicate a high prevalence of the aforementioned occlusal traits and also a high need for orthodontic treatment among adolescents in Northeast Italy.

Modified Dental Anxiety Scale: validation of the Italian version.

AIM: Anxiety is a relevant problem in dental practice. The Modified Dental Anxiety Scale (MDAS) is a brief, simple questionnaire consisting of five questions with a total score ranging from 5 to 25, the Italian version of which is not available yet. The aim of the study was to provide an Italian version of the MDAS and check its reliability in oral surgery, which is a major cause of dental anxiety due to the expected perception of pain and suffering. METHODS: The Italian version of the test was administered to 230 patients (98 male and 132 female patients, ages 14-88 years) undergoing oral surgery. Further recorded data were: American Society of Anaesthesiologists physical status classification (ASA-PS), frequency of visiting the dentist and any previous distressing experiences in dental or medical setting. RESULTS: The internal consistency of the test was high, with a Cronbach's alpha=0.92. The MDAS score was significantly higher in females (P<0.0001) and in patients with previous distressing experiences in medical and/or dental settings (P<0.0001); the correlation with age (P=0.01) and frequency on visiting the dentist (P=0.02) were also significant. CONCLUSIONS: The patients' selection (oral surgery only) may be a limit of the study, which might not provide an estimation of anxiety prevalence in the general dental population; however our result agree with those of studies performed in other Countries in the generic population, suggesting the absence of major differences with respect to the surgical setting and show the reliability and manageability of the Italian version of MDAS.

Modified dental anxiety scale: validation of the italian version.

AIM: Anxiety is a relevant problem in dental practice. The Modified Dental Anxiety Scale (MDAS) is a brief, simple questionnaire consisting of five questions with a total score ranging from 5 to 25, the Italian version of which is not available yet. The aim of the study was to provide an Italian version of the MDAS and check its reliability in oral surgery, which is a major cause of dental anxiety due to the expected perception of pain and suffering. METHODS: The Italian version of the test was administered to 230 patients (98 male and 132 female patients, ages 14-88 years) undergoing oral surgery. Further recorded data were: American Society of Anaesthesiologists physical status classification (ASA-PS), frequency of visiting the dentist and any previous distressing experiences in dental or medical setting. RESULTS: The internal consistency of the test was high, with a Cronbach's alpha=0.92. The MDAS score was significantly higher in females (p<0.0001) and in patients with previous distressing experiences in medical and/or dental settings (p<0.0001); the correlation with age (p=0.01) and frequency on visiting the dentist (p=0.02) were also significant. CONCLUSIONS: The patients' selection (oral surgery only) may be a limit of the study, which might not provide an estimation of anxiety prevalence in the general dental population; however our result agree with those of studies performed in other Countries in the generic population, suggesting the absence of major differences with respect to the surgical setting and show the reliability and manageability of the Italian version of MDAS.

Single- or multiple-session viscosupplementation protocols for temporomandibular joint degenerative disorders: a randomized clinical trial.

The aim of the study was to compare the effectiveness of two single-session protocols, either adopting high- (protocol A) or medium-molecular weight hyaluronic acid (protocol B), with the reference five-session protocol of temporomandibular joint (TMJ) lavage plus viscosupplementation (protocol C) in the management of chronic TMJ degenerative disorders. A randomized clinical trial (RCT) with ten participants per treatment group was designed, with multiple observation points, ending at 6 months after treatment. Pain levels on a 10-point VAS scale were selected as the primary outcome variable to rate treatment effectiveness, along with a number of secondary outcome parameters. Findings showed that Group C patients had the highest decrease in pain levels. Nonparametric permutation analyses revealed that the global effect of treatment was significantly different between the three protocols (P = 0·024). Pairwise comparisons showed that the differences of treatment effect between the two single-session interventions were negligible (global P-value = 0·93). On the contrary, the five-session protocol was significantly superior to both single-session protocols (global P-values ranging from 0·003 to 0·012). In conclusion, in a population of age-, sex-, and psychosocial aspects-matched study groups, the standard of reference five-session protocol proved to be superior at 6 months as far as the decrease in pain levels was concerned, whilst there were no differences between the two single-session interventions. The absence of differences in treatment effect as for some other secondary clinical outcome variables may suggest that there is further space for future investigations attempting to reduce the number of multiple interventions for TMJ viscosupplementation.

Evaluation of three different manual techniques of sharpening curettes through a scanning electron microscope: a randomized controlled experimental study.

OBJECTIVE: The purpose of this study was to compare the effectiveness of three different techniques for manually sharpening of periodontal curettes (PCs) by examining the blades with the aid of scanning electron microscope (SEM). METHODS: Three groups were considered based on three sharpening methods used: group A (moving a PC over a stationary stone); group B (moving a stone over a stationary PC) and group C (moving a PC over a stone fixed, placed on a 'sharpening horse'). After the sharpening, the blades were examined using SEM. The SEM images were assessed independently by five different independent observers. An evaluation board was used to assign a value to each image. A preliminary pilot study was conducted to establish the number of samples. Pearson's correlation test was used to assess the correlations between measurements. anova test with Bonferroni's post hoc test was used to compare the three groups. RESULTS: Sixty PCs (20 PCs per group) were used in this study. Statistically significant differences emerged between the three groups (P-value = 0.001). Bonferroni's test showed that the difference between groups A and B was not statistically significant (P-value = 0.80), while it was significant for the comparisons between groups A and C (P-value = 0.005) and between groups B and C (P-value = 0.001). CONCLUSIONS: The sharpening technique used in group C, which involved the use of the sharpening horse, proved the most effective.

N-butanol olfactory threshold and nasal patency before and after palatal expansion in children. A preliminary study.

OBJECTIVES: Olfaction is based on the function of the nasal olfactory receptors. Children can well detect and respond to odors in order to have information about food and environment. Rapid maxillary expansion seems to improve dental class and increase nasal patency correcting oral respiration in children. Nevertheless, there are no studies demonstrating that expansion in pediatric patients could influence olfactory sensitivity. The aim of this study was to evaluate olfactory threshold and nasal patency in children aged from 6 to 12 years before and after rapid maxillary expansion. METHOD: N-butanol olfactory thresholds, anterior active rhinomanometry, and peak nasal inspiratory flow were measured in 12 children (6-12 years) before (T0), 20 days (T1), and 6 months after rapid maxillary expansion application (T2). RESULTS: A significant lower olfactory threshold was found comparing T2 and T0 N-butanol olfactory threshold values (p=0.038). Peak nasal inspiratory flow showed a significant improvement both at T1 and T2, with respect to T0 values (p=0.043 and p=0.0001, respectively). T2 nasal resistances showed a trend towards a significant reduction when compared with T1 values (p=0.15). CONCLUSION: This pilot study suggested that rapid maxillary expansion may lead to improved N-butanol olfactory thresholds, at least 6 months after palatal expansion. Furthermore, rapid maxillary expansion seems to improve peak nasal inspiratory flow values, and finally although with lower sensitivity, reduce nasal resistances as measured by rhinomanometry.

Lateral periodontal cyst (LPC) mimicking periodontal socket in a young patient: report of a case and review of the literature.

Background: Lateral Periodontal cyst (LPC) is an uncommon development odontogenic cyst. Most papers are single case reports or series. Methods: We present a case of LPC occurred in a patient which symptoms and signs could mislead the diagnosis. A review of the literature is reported, emphasizing the clinical, radiographic and histopathological features of LPC. Results: A 28-years old female patient presented reporting pain and swelling at the lingual site of the #31.Spot lingual probing depth was 9 mm; sulcus bleeding and suppuration were found at probing. Radiographically well-defined radiolucency appeared in periodontal foramen area. The patient was treated with non-surgical and surgical therapy. Conclusions: LPC is an infrequent cystic lesion that occurs on lateral root vital tooth. In this case, the cyst mimicked a periodontal lesion. The surgical LPC excision solved the symptoms reported by the patient and improved periodontal parameters of the dental element. After 18 months since surgical treatment there aren't signs or symptoms of recurrence.

Experimental assessment of oral hygiene achieved by children wearing rapid palatal expanders, comparing manual and electric toothbrushes.

OBJECTIVES: The aim was to compare the efficacy of the electric versus the manual toothbrush in terms of the oral hygiene achieved by patients wearing rapid palatal expanders (RPEs). METHODS: Forty patients were randomly divided into two groups; one equipped with a manual toothbrush (Group A), the other with an electric toothbrush (Group B). Each child's plaque index (PI) and gingival index (GI) were calculated at banded molar level at times T0 (before banding), T1 (a month later), T2 (3 months later) and T3 (when the expander was removed). At each appointment, the PI and GI were recorded and the patient was remotivated. RESULTS: The level of oral hygiene achieved by the group using an electric toothbrush produced a greater improvement in the two indexes than in the group using the manual toothbrush that showed no statistically significant improvement (PI T0-T3: P = 0.309; GI T0-T3: P = 0.141). Both indexes dropped considerably in both groups from T0 to T2, but more so in the group B. From T2 to T3, although the electric toothbrush continued to be substantially more effective, Group B showed a statistically significant deterioration in the oral hygiene (PI +20%; GI +33%). Other assessments conducted on particular areas of the tooth showed improvements in the PI (-33%) for the vestibular region, and for the GI (-57%) in the palatal region among the patients in Group B, while there were no significant changes in these indexes in Group A. CONCLUSIONS: Our findings show that the electric toothbrush is statistically more efficient in performing an adequate level of oral hygiene in children wearing RPE.

In vitro comparison of the bond strength to the enamel of conventional and self-etching dental fissure sealants.

AIM: Dental caries in pits and fissures of molars is still very common in young people, despite a gradual reduction in their incidence and prevalence. Prevention with the aid of dental fissure sealants can help to reduce the onset of decay. In vitro tests were conducted to compare the bond strength to enamel of self-etching sealants versus those applied using the conventional procedure. METHODS: The lingual surface of 40 extracted, caries-free, mandibular third molars was milled to make them flat. The prepared teeth were randomly divided into two groups of 20 teeth each: those in Group A were treated with Clinpro (3M ESPE, St. Paul, MN, USA); those in Group B with Quick Seal (BJM Laboratories Ltd, Or-Yehuda, Israel). Cylinders of sealant were attached to the enamel of the flat surfaces of the samples using a polymerisation process treating the surfaces involved according to the type of material. All samples underwent load testing by means of a universal test machine. RESULTS: The results of the load testing, measured in MPa, were analysed using the Student's t-test for independent samples and the differences proved significant, indicating that the traditionally- applied sealant (mean strength 21.06 MPa) assured a significantly stronger bond (p <.05) than the self-etching sealant (mean strength 10.43 MPa) under our experimental conditions. CONCLUSION Conventional sealants generally provide a considerably higher bond strength than self-etching sealants.

Conscious sedation with diazepam and midazolam for dental patient: priority to diazepam.

AIM: The aim of this paper was to determine whether the use of midazolam is a better technique than the use of diazepam, in relation with the definition of conscious sedation in dentistry. METHODS: Eighty-eight patients undergoing oral surgery were divided into 2 groups in which the sedation was randomly achieved with equipotent cumulative doses of diazepam and midazolam, up to a maximum dose of 8 and 4 mg respectively. Patient's tranquillity was assessed after every dose, using a visual analogue score to ten points and the sedation was evaluated as mild, moderate or deep. Blood pressure, heart rate and SpO2 were also recorded. Psychomotor conditions, by Newman test, and the incidence of amnesia and the patient's satisfaction, by telephone interview, were both evaluated. RESULTS: The number of patients who reached maximum subjective tranquillity was greater already after the third dose of diazepam. The average scores of tranquillity were higher after diazepam. Patients treated with diazepam experienced a higher incidence of mild sedation, patients treated with midazolam a higher incidence of moderate and deep sedation. In patients treated with midazolam blood pressure, heart rate and SpO2 were lower. Postoperative recovery was similar in the 2 groups. After midazolam patients experienced greater amnesia for local anesthesia and drowsiness. Satisfaction was high with both treatments. CONCLUSION: The study shows that sedation with diazepam is more in line with the definition of conscious sedation in dentistry. Diazepam guarantees the persistence of consciousness and maximum subjective tranquillity levels. The recovery and satisfaction were comparable in the 2 groups.

Nasopalatine duct cyst as a complication of dental implant placement: a case report.

This report demonstrates the association between the development of a nasopalatine duct cyst and implant surgery, involving 2 implants positioned 4 years after teeth extraction at a site unaffected by any prior local endodontic disease or radiolucency. The cyst was removed and the residual void was filled with deproteinized bovine bone. Two-year follow-up showed no cyst recurrence, the normal anatomy was partly restored, and one of the implants showed clinical signs of re-osseointegration.

Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation.

BACKGROUND: Anxiety is a relevant but still underscored perioperative problem. The Visual Analogue Scale for Anxiety (VAS-A) seems to be effective, fast and manageable, but has not been fully validated yet. The aim of this study is to validate VAS-A comparing it to, Corah's Dental Anxiety Scale (CDAS) Spielberger's State Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). METHODS: One hundred consecutive patients (38 males and 62 females, median age 49 years) submitted to oral surgery filled out the VAS-A, CDAS, STAI forms Y1 and Y2, and BDI at preoperative examination; the order of administration of tests was randomized. RESULTS: VAS-A score was significantly correlated to CDAS (P<0.0001), STAI-Y1 (P<0.0001), STAI-Y2 (P<0.002) but not to BDI (P=0.18). ROC curve analysis suggested VAS-A equal to 46 mm as threshold for anxiety when using STAI Y1 equal to 40 as reference cutoff. CONCLUSION: Our study confirms that VAS-A is a reliable indicator of preoperative anxiety and may detect patients with depressive symptoms also. Values of VAS-A around 50 mm are a reliable threshold for a clinically meaningful level of preoperative anxiety.

Relationships between different tooth shapes and patient's periodontal phenotype.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to establish whether any correlation exists between tooth shapes and patient-related factors such as gingival and periodontal characteristics. MATERIAL AND METHODS: Clinical measurements, including the width and the height of maxillary central incisor crowns, the apico incisal height of the keratinized mucosa (KM), the buccal gingival thickness (GT), the depth of the sulcus (SD), the bone-sounding depth (BS) and the height of the interproximal maxillary central papilla (Ph), were investigated in 50 healthy individuals. These individuals were then divided into three groups based on the shape of their maxillary central incisor crowns: triangular; square; or square-tapered. The three groups were analyzed to determine any significant differences among the groups in the values obtained for clinical measurements. RESULTS: There were no significant differences among the three groups in terms of the SD (p = 0.11) or the BS (p = 0.54), whilst statistically significant differences were observed for the KM (p < 0.001), the GT (p = 0.012) and the Ph (p < 0.001). CONCLUSION: The results of this study indicate that different tooth shapes are associated with significantly different values for the extent of the KM, its bucco-lingual thickness and the height of the interproximal maxillary central papilla.