Bruxism in children: What do we know? Narrative Review of the current evidence.

BACKGROUND: Bruxism is a repetitive masticatory muscles activity whose definition is being thoroughly reviewed in recent years. As in adults, two different forms of bruxism exist in children, namely awake and sleep bruxism. Scarcity of data, however,still persists about paediatric bruxism and no clear consensus has been developed. Therefore, the current review overviews the literature on bruxism in children tries to outline the state of art about this condition METHODS: Bruxism affects from 5% to 50% of the worldwide paediatric population. Sleep disturbances, parafunctional habits and psycho-social factors emerged to be the most likely associated factors with paediatric bruxism. Bruxism is characterised by several signs and symptoms variously combined, such as tooth wear and fractures, teeth impressions on soft tissues, temporomandibular disorders, headaches, behavioural and sleep disorders. About diagnosis, the most reliable tool in children remains the report of teeth grinding by parents or caregivers which must be accompanied by oral interview and accurate clinical examination. Electromyography and sleep polysomnography, albeit suitable in the diagnostic process, are not easy-to-use in children and are not strongly recommended. Currently, no evidence exists to support any kind of therapeutic options for bruxism in children. Management should be based on the identification of the underlying condition and conservative approaches are recommendable. CONCLUSION: Notwithstanding the high prevalence, several aspects need to be further assessed in paediatric bruxism. Parental reports are still the most suitable diagnostic tool and conservative approaches are recommended in the management. Bruxism should be considered through a biopsychosocial model, and sleep, personality traits, stress and headaches are the factors towards whom research questions must be addressed to improve diagnosis and management.

Long-term efficacy of onabotulinum toxin in treating persistent myofascial pain and masticatory muscles hypertone in an adolescent with bruxism. A 7-year follow-up case report.

BACKGROUND: Temporomandibular disorders (TMDs) represent a common chronic complaint, which includes myofascial pain (MP). Although several therapeutical options have been proposed to control bruxism-related muscle hyperactivity, there is not enough evidence to define a standard approach. The present article describes the case of a 14-year old male patient with a history of painful mandibular close lock. CASE REPORT: The patient was diagnosed with persistent myofascial pain in the left masseter, bilateral disc displacement with reduction, and retrodiscitis and capsulitis in the left temporomandibular joint. Awake and sleep bruxism were also present. Since first line treatments failed in managing the disorders, injections of onabotulinum toxin (BoNT-A ) were performed. After one month the pain decreased significantly and the jaw movements were restored. The patient was recommended to avoid hard and/or rubbery food, wide movements of the jaws and teeth clenching and to wear orthodontic appliance during the night since the joint damage was moderate. We report the 7-year follow-up demonstrating the long-term efficacy of a single injection of onabotulinum toxin in masseters and temporalis muscles in order to treat masticatory pain and dysfunctions. CONCLUSION: The authors suggest that BoNT-A could be an optimum treatment for persistent MP and bruxism in young adolescents when first-line therapies fail.

Sleep/wake rhythm modifications in the Italian population during SARS-CoV2 pandemic: a web-based cross-sectional survey.

OBJECTIVE: The study aims to investigate in a representative sample of the Italian population whether the SARS-CoV2 pandemic and the subsequent home isolation had repercussion on the daily sleep/wake cycling and habits. MATERIALS AND METHODS: A web-based cross-sectional survey consisted of various multiple-choice questions concerning demographic characteristics, sleep habits, and sleep-related problems was broadcast through mainstream social-media. Individuals were randomly allowed to participate from April 29th to May 17th, namely 50 days after the lockdown imposition and the day before its abrogation. RESULTS: 58.84% of respondents experienced a change in their sleep habits. 71% of those whose sleep changed showed a delayed sleep pattern. Overall, a two-fold risk of delayed sleep pattern without any change in total sleep time emerged during the investigation period. Females emerged almost 2 times more likely to modify their sleep habits than males. Youths were also more likely to experience modifications than old people, who conversely appeared protected. A significant improvement in daytime sleepiness occurred during the home isolation which additionally correlated with delayed bedtime and less sleep time. CONCLUSIONS: A high rate of change in sleep habits, especially among youths and females, occurred in Italian population during the home isolation to limit the SARS-CoV2 pandemic. Moreover, self-reported daytime sleepiness decreased in severity.

Breastfeeding and sleep-disordered breathing in children: systematic review and proposal of underlying interaction models.

AIM: Paediatric sleep breathing disorders represent an emerging paediatric health concern. Despite risk factors are widely discussed in literature, evidences about protective factors are lacking. The aim of this systematic review was to examine the available evidence about the effect of breastfeeding on snoring and obstructive sleep apnea in childhood, and to methodically describe the underlying mechanism of interaction. METHODS: The study protocol was registered in advance in PROSPERO (CRD42020212529). Electronic search of the literature was performed up to October 10th, 2020 using four databases: PubMed, ScienceDirect, Medline and Scopus. Two authors independently retrieved potentially relevant articles to meet eligibility criteria. PRISMA guidelines were followed. Prospective, retrospective, case-control, cohort, clinical trial and cross-sectional studies investigating the association between breastfeeding and paediatric sleep-disordered breathing were included and data were extracted. No restrictions on language or date of publication were set. Subsequently, a search in the literature was further done to investigate underlying mechanisms of interaction. CONCLUSION: This review suggests that breastfeeding can effectively protect children and adolescents from sleep-disordered breathing, especially from habitual snoring, by preventing the associated risk factors. Future prospective studies with more efficient design are required.

Temporomandibular Disorders and Juvenile Idiopathic Arthritis: Scoping review with a case report.

BACKGROUD: Juvenile Idiopathic Arthritis (JIA) encompasses a wide range of mostly idiopathic autoimmune arthritis which affect growing individuals. Temporomandibular disorders are a diffuse spectrum of diseases which involve temporomandibular joint (TMJ) and associated structures. However, much more need to be defined in order to detect and manage these conditions. Albeit satisfying evidences exist about their impact on the adult population, there is great lack of information in children. The current study has been developed in order to overview what it is known about these disorders and their mutual interactions. A case report as support to the scientific evidence has been further described. CASE REPORT: A 7-year-old patient affected by an undifferentiated form of JIA developed arthritis to TMJs, complaining pain and functional impairments. After 2 years, the follow-up with combined pharmacological therapies and a modified oral stabilisation appliance shows no objective worsening of the joints' structures. However, the more complex symptomatic management of inflammation highlights the need for further knowledge. CONCLUSION: The present study shows that both literature and clinical activity highlight a strong relationship between JIA and TMDs, that can affect the quality of life of children and adolescents. Diagnosis and management of these conditions are extremely complex, thus additional studies and evidence are needed. However, the need of an interdisciplinary approach between rheumatologists, paediatricians and dentists has been demonstrated.

Obstructive Sleep Apnea, oxidative stress, inflammation and endothelial dysfunction-An overview of predictive laboratory biomarkers.

OBJECTIVE: Obstructive Sleep Apnea (OSA) represents an emerging public health concern with great impact on cardiovascular state. Oxidative stress (OS), inflammation and altered Nitric Oxide (NO) production are recognized as prominent mechanisms of many acute and chronic diseases and even of the normal aging process. They are investigated as major pathophysiological processes in OSA through the analysis and comparison of significative and validated biomarkers. MATERIALS AND METHODS: The review is developed using as key terms "sleep apnea", "oxidative stress", "inflammation", and "endothelial dysfunction". Included studies must have followed the American Academy of Sleep Medicine guidelines according to the diagnosis and classification of OSA. Lipid, protein and DNA oxidation products, PCR, IL-6, IL-8, TNF-α, NO and nitrosative stress compounds, and endothelial functioning tests have been detected for their contribution in OSA along the last 3 decades. RESULTS: Nocturnal intermittent hypoxia has emerged to be significantly associated to oxidative/nitrosative stress, increase in pro-inflammatory markers, imbalance in NO production, and endothelium impairment. Body Mass Index (BMI) contribution needs further clarifications. Continuous Positive Airway Pressure (CPAP) therapy has demonstrated beneficial effects on vascular function and pro-inflammatory milieu in OSA. CONCLUSIONS: Oxidative stress and Inflammation significantly correlate with OSA; similarly, vascular functioning is impaired in accordance to unregulated levels of NO and derived compounds. Continuous Positive Airway Pressure markedly improves oxidative stress, inflammation and endothelial dysfunction in OSA.

Identification of ochratoxin A producing Aspergillus carbonarius and A. niger clade isolated from grapes using the loop-mediated isothermal amplification (LAMP) reaction.

AIMS: To develop two assays based on the loop-mediated isothermal amplification (LAMP) of DNA for the quick and specific identification of Aspergillus carbonarius and ochratoxigenic strains of the Aspergillus niger clade isolated from grapes. METHODS AND RESULTS: Two sets of primers were designed based on the polyketide synthase genes involved or putatively involved in ochratoxin A (OTA) biosynthesis in A. carbonarius and A. niger clade. Hydroxynaphthol blue was used as indirect method to indicate DNA amplification. The limit of detection of both assays was comparable to that of a PCR reaction. Specificities of the reactions were tested using DNA from different black aspergilli isolated from grapes. The two LAMP assays were then used to identify A. carbonarius and ochratoxigenic A. niger and A. awamori grown in pure cultures without a prior DNA extraction. CONCLUSIONS: The two LAMP assays permitted to quickly and specifically identify DNA from OTA-producing black aspergilli, as well as isolates grown in pure culture. SIGNIFICANCE AND IMPACT OF THE STUDY: Monitoring vineyards for the presence of OTA-producing strains is part of the measures to minimize the occurrence of OTA in grape products. The two LAMP assays developed here could be potentially used to speed the screening process of vineyards for the presence of OTA-producing black aspergilli.

Assessment of the ochratoxin A production ability of Aspergillus tubingensis.

Aspergillus tubingensis is a black Aspergillus frequently isolated from different agricultural products, including grapes. Conflicting results have been published in recent years about its ability to produce ochratoxin A (OTA), a potent nephrotoxic and carcinogenic mycotoxin. This study re-examined six A. tubingensis strains deposited in international culture collections for OTA production. OTA could not be detected in any A. tubingensis extract using HPLC coupled with a fluorescence detector (FLD), whereas it was easily detected in ochratoxigenic A. niger extracts used as positive control. The same outcome was obtained using LC-MS. The presence of other metabolites with retention times similar to the OTA signal in the A. tubingensis extracts or background noise of the growth media may be reasons for the misinterpretation of the chromatograms obtained by HPLC-FLD.

Highly polymorphic microsatellite loci in the rice- and maize-infecting fungal pathogen Rhizoctonia solani anastomosis group 1 IA.

Ten polymorphic microsatellite loci were isolated and characterized from the rice- and maize-infecting Basidiomycete fungus Rhizoctonia solani anastomosis group AG-1 IA. All loci were polymorphic in two populations from Louisiana in USA and Venezuela. The total number of alleles per locus ranged from four to eight. All 10 loci were also useful for genotyping soybean-infecting R. solani AG-1 isolates from Brazil and USA. One locus, TC06, amplified across two other AG groups representing different species, showing species-specific repeat length polymorphism. This marker suite will be used to determine the global population structure of this important pathogenic fungus.