Children's rights and dental care treatment.

Dentists, especially paediatric dentists, should inform their young patients of the treatment to be undertaken in an appropriate and comprehensive manner. In 1989, the UN Convention on the Rights of the Child (United Nations Convention on the Rights of the Child - UNCRC - https://www.unicef. org/child-rights-convention/convention-text) was adopted, comprising of 54 articles concerning every aspect of a child's life, notably health, including oral health. More than 30 years after the Declaration of the Rights of the Child, both health professionals and parents still struggle to grasp this subject, resulting in its scarce application in daily practice. Children's rights have also been mentioned several times in medical and dental literature, reminding health professionals that the approach to young patients must be age-appropriate. The clinician must learn to consider children as the main protagonists in the choices concerning their health, and they must be aware of their rights from an early age. Particularly in the field of dentistry, it is a matter of guaranteeing the best dental care for every child with particular attention to the indigent or disabled (Article 23). In addition to this, the most effective and up-to-date treatment must be proposed, avoiding unnecessary extractions and favouring conservative therapy that can guarantee a better quality of life in the future, while reducing treatment under general anaesthesia. In current practice, consent to treatment is often demanded from the parents, without involving the child. However, every child has the right to freely express their opinion and be actively involved in any matter that concerns them. This opinion is expressed in different ways according to age and stage of maturity. Pictures, drawings, cartoons and videos can help the healthcare provider when explaining procedures to the young patient, thus allowing them to obtain consent and cooperation. In individual countries, it would be advisable to have guidelines that facilitate the child's active consent to health treatments. So, what happens in your country?

Caries prevalence and molar incisor hypomineralisation (MIH) in children. Is there an association? A systematic review.

AIM: Molar incisor hypomeralisation (MIH) is a dental condition clinically characterised by the presence of morphological and qualitative enamel defects involving the occlusal and/or incisal third of one or more permanent molars or incisors. Its worldwide prevalence ranges between 2.4 and 40%. Several harmful conditions, such as genetic or medical problems during pregnancy, may act together and increase the risk of MIH. The main objective of this systematic review is to assess whether there is a correlation between MIH and dental caries in mixed or permanent dentition. METHODS: An electronic search was performed on PubMed (Medline), Scopus and Cochrane Library for articles published from August 2022 to April 2023. Cohort, cross-sectional, retrospective and prospective studies were included. In vitro and animal studies, as well as clinical cases and systematic reviews, were excluded. Studies not differentiating between mixed and permanent dentition were excluded. The observed variables were DMFT (Decayed Missed Filled Teeth) score, DMFS (Decayed Missed Filled Surface) and DMF scores related to FPM (First Permanent Molar) and the clinical prevalence of MIH. CONCLUSION: DMFT, DMFS and DMFT on FPM scores are significantly different between the group of patients with MIH and the control group. The available evidence supports a correlation between MIH lesions and caries. Caries indexes scores increase proportionally to the severity of MIH.

Aligners, can my child use them too?

This is a frequently asked question. The answer depends on various factors, with cooperation being among the most essential. As a parent, you must ask yourself if you can rely on your child to wear aligners correctly for most of the day. If the answer to this question is yes, then clear aligners may be a better choice than traditional braces. There are three major benefits of clear aligners in children: 1. Greater comfort, aligners are less voluminous than traditional braces and more likely to prevent irritation, mouth ulcers and other discomfort that derives from the movement of the orthodontic wire or braces. 2. Better hygiene, as their removal during meals and tooth cleaning manoeuvres makes home oral hygiene easier. 3. Better aesthetics, thanks to the transparency of the plastic replacing the metal. However, a certain degree of caution is advised to those who are considering this treatment option. Although aligners allow us to start resolving certain tooth malpositions (which can cause periodontal and aesthetic problems or increase the severity of damage in the event of trauma), and to improve alignment and minor crowding at an early age, it must not be forgotten that the intervening period for changing the definitive position of individual teeth is still the period of permanent teeth. It is important to consider whether a child has a dental or skeletal problem. In cases where a child's problem is exclusively dental, the aligner may be one of the tools used. In cases of skeletal problems, the literature advises against the aligner, as it is not the right instrument at this stage of development. The literature in some cases refers to aligners as the universal remedy, valid for every malocclusion, presenting them as a panacea for all orthodontic problems of very young patients. It is necessary to remain open to the innovations that the market offers us and that can improve our daily clinic, and aligners can be a valid support in this regard, but, as dentists, we should always keep a critical and open eye on treatments with an evidence-based rationale. As with all other orthodontic appliances, aligners must be evaluated on a case-by-case basis, keeping in mind that they are one of the tools in the hands of the clinician. When the clinical situation makes it possible and when both the child's requirements and the parent's expectations are fulfilled, it is certainly worth considering clear aligners as a viable route in the family-child's orthodontic treatment, making it as simple and convenient as possible. Lastly, we should remember the concept of efficiency regarding an orthodontic treatment, which depends on its cost/benefit ratio, with the former being understood in a biological sense and in terms of its impact on the life of the patient and their family with respect to duration, cooperation required, discomfort induced by the equipment used and frequency of check-ups. The latter should obviously be considered in terms of results obtained in relation to the pre-established treatment goals. A consideration that we should always keep in mind: let us never forget that is the orthodontist who treats the patient, not the appliance!

Protecting children from the harmful impact of food marketing.

A healthy and balanced diet should be promoted already in childhood, a crucial period for the psychophysical development of the individual. In particular, the consumption of free sugars and soft drinks in children and adolescents should not exceed the current WHO recommendations. This trend is very difficult to counter as the preference for sweet flavours is innate and often further reinforced by pre- and post-natal exposure and aggressive marketing. Unfortunately, sugar consumption continues to grow alarmingly due in part to the easy availability of foods and drinks rich in added sugars from vending machines, supermarkets and fast-food restaurants. Recently, the WHO (with the recommendations included in the QR Code below and in the following link: WHO recommends stronger policies to protect children from the harmful impact of food marketing) pointed out how exposure to food marketing affects children's health, eating behaviours and beliefs about food, thus becoming a real threat to public health. Among the proposals made, it is interesting to note the need for national governments to "curb the persuasive power of food marketing" by limiting the use of cartoons and other techniques that appeal to children, such as the inclusion of toys in packaging or advertisements with songs and celebrity endorsements. It is already evident in the literature that an excessive intake of sugar predisposes children to a number of pathological conditions that in the long term may favour the onset not only of carious disease but also obesity, type 2 diabetes mellitus, liver disease, cardiovascular and dysmetabolic diseases. As paediatric dentists, sugar-related dietary excesses are already very obvious to us since it is mainly these that drive young patients to our clinics. In our privileged position, we should therefore increasingly promote knowledge on the possible correlations between excessive sugar consumption and the onset of these diseases, drawing the attention of parents of young patients to all foods that are harmful to their growing children. Therefore, let us welcome these new guidelines promoted by the WHO to protect children and adolescents from the harmful impact of food marketing; and may we not miss the opportunity to share and promote this important battle for future generations!

Fake academic writing: ethics during chatbot era.

"Professor, have you ever seen anything like this?". Few weeks ago I was asked this question by two young and esteemed specialist in orthodontics of my research group, actually PhD students, who showed me a laptop screen. "No, I have never seen anything so potentially extraordinary. But doubts arise: is this legal? Or rather, is it ethical for us to use it in the field of research?" So I asked the questioners, Dr. Serafin and Dr. Bocchieri, to write a short essay on this new form of artificial intelligence, the chatbots, to give me an idea of what they are, what their potential is, and how they can change the veracity of data when an artificial mind replaces a human one. After "letterally" 5 minutes, they returned to me and let me read the following: The rapid advancement of artificial intelligence (AI) technology has led to a proliferation of AI-powered tools that are having a significant impact in the realm of academic writing to automate various aspects of the editorial process, from research to proofreading and even generating complete high-quality scientific articles. Chatbots are AI-virtual assistants that offer significant benefits but there are also important ethical considerations that must be considered. One concern is related to the accuracy and reliability of AI-generated content, particularly in scientific writing where accuracy is of utmost importance. There are also concerns about the potential for AI to be used to produce plagiarized or fraudulent content, which could undermine the credibility of scientific soundness. To mitigate this risk, it is crucial to establish clear guidelines and regulations for their use. Additionally, academic institutions and publishers should take steps to verify the authenticity of authors and promote transparency and accountability in the publishing process. The use of chatbots in academic writing has the potential to revolutionize the way in which research is conducted and written. However, it is important to ensure that the ethical implications of this technology are carefully considered and addressed. This includes ensuring that AI-generated content is accurate, reliable, and trustworthy and that the use of AI does not result in the displacement of human imagination. To address these ethical considerations, it is recommended that academic institutions and scientific journals work together to establish clear guidelines and regulations for the use of AI in academic writing, ensuring that AI-powered tools are ethical. By taking a responsible approach, we can ensure that the benefits of this technology are realized while minimizing any potential negative consequences. Finally, the most important but missing information is that this editorial is fully written by a chatbot. Therefore, pay attention: the search for health for our patients must go through scientific honesty that produces data and analyzes them "humanly". I share my amazement, but also my concern. As a university professor, as a clinician, as a researcher, but also as a "father" of future orthodontists, I always have doubts about the message we want to leave, and in this editorial I would like to reproduce an excerpt from a conversation with Marco and Salvo, as if we were discussing the legitimacy of cheating in a card game.

Effects of an Educational Book on Paediatric Oral Health knowledge in a sample of Italian women.

AIM: Parents and caregivers, particularly in Italy, often have limited knowledge about their children's oral health. The primary objective of the study is to evaluate the educational effectiveness of a book on nutrition and prevention of oral diseases entitled "Oral health of mother and child in the first 1000 days of life". MATERIALS: The sample for this study was composed of 103 adult Italian women who were potential caregivers of one or more children (e.g., mothers, grandmothers, babysitters, and educators). The enrolled women completed a preliminary online survey which included questions about their socio-demographic characteristics and their knowledge on oral health in the first 1000 days of life of newborns (30 questions). Following the survey, they received the educational book. After reading it, the participants completed a second online survey with the same 30 questions, to measure any improvement in their knowledge. CONCLUSION: It appears that our educational book about nutrition and prevention of oral diseases was effective in enhancing knowledge among the participants in our study. These findings suggest that this educational resource has the potential to be a valuable tool in preventing oral diseases in paediatric populations. However, further confirmation of these results should be obtained through randomised controlled trials.

Interceptive orthodontics: awareness and prevention is the first cure.

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.

Is CBCT a must for the dental office?

The question is whether a CBCT machine is necessary in the dental office. Setting aside the important aspect of the financial resources of both the dentist and the patient, there is still doubt about the need for a cone-beam CT system within the practice. The possibility to perform an immediate second-level radiological examination is an unquestionable benefit for both the dentist and the patient, but it's also a luxury that (at least in Italy) obligates compliance with provisions, national and regional laws, as well as circulars and regulations. It's here, in the seemingly endless authorization requirements, training, continued education, informed consent and competence limits, that the average Italian dentist loses his way, as the path is not straightforward. The quest for the perfect CBCT protocol requires dental professionals to go back to square one, which is the question: "To have or not to have?". In the case of young patients, protection from unnecessary radiation is even more important. In Italy, this complex matter is regulated by the Ministry of Health through special guidelines aimed at growing subjects [2017]. These guidelines require adaptation of work practices and retention of documents (such as internal processes, patient information notes, informed consent, technical documentation, etc.), in addition to the ability to show documentary evidence of appropriate, complementary, contextual, integrated and undeferrable diligent application of the above. I do believe in the importance of reflecting on the cost-benefit aspect in order to decide whether having CT Cone Beam Scanning capabilities in the dental office is worth the trouble! In conclusion: yes or no to CBCT? To each his own opinion. In this respect, I'd like to ask my colleagues what the status is in their countries regarding this important topic. Is the CBCT use widespread in dental practices, are there any guidelines in place for each country? I'll look forward to your input and insights, which we will gladly publish in our journal! Reference Ministry of Health. National Guidelines for Dental Diagnostic Imaging in the Developmental Age. 2017. https://www.salute.gov.it/imgs/C_17_pubblicazioni_2690_ulterioriallegati_ulterioreallegato_0_alleg.pdf https://www.salute.gov.it/imgs/C_17_pubblicazioni_2690_allegato.pdf.

Comparison of knowledge between Italian and Spanish parents about the oral health of their preschool children.

AIM: To evaluate and compare baseline knowledge between Italian and Spanish parents with regards to the oral and dental health of their preschool children. METHODS: Study design epidemiological descriptive observational cross-sectional study. The research data was collected through an anonymous bilingual survey, generated through Google Forms and distributed either in paper form or through several digital channels together with a QR code to drive the participants to the questionnaire. In order to assess the differences between Italy and Spain, t-Student (with confidence interval) or Mann-Whitney tests were used to compare the independent numerical variables, and the Chi-Square test was used to compare the independent categorical variables. CONCLUSION: Independently of the differences identified among the two countries, the results show that parents from both nationalities have limited knowledge about their preschool children's oral health and are not fully informed about child's oral hygiene practices.

Bibliometrics to improve our patients' care!

Bibliometrics is the statistical analysis of scientific publications and trends on a given topic. The use of bibliometric indicators is based on the fact that academic publishing is an essential outcome of research activity, as advancement of science and treatments increases with dissemination of knowledge. Therefore, investigation in our specific field is obligatory, as learning what the current lines of research are can help us to properly orient our research in the coming years. A soon-to-be-published paper analyses 3,027 articles that have appeared in the leading journals of Paediatric Dentistry included in the Journal Citation Reports (JCR): Pediatric Dentistry, the International Journal of Pediatric Dentistry, the European Journal of Paediatric Dentistry and the Journal of Clinical Pediatric Dentistry considering all issues and all articles published from 2008 to 2020. The most frequently addressed topic is surgery (23.4%), which more generally includes pulp treatment, conservative treatments and the use of dental materials (operative dentistry), while the second most discussed topic is prevention (13.2%), followed by oral pathology (10.6%). Subject matters covered less frequently include early childhood caries (ECC) (2.5%) and occlusion (2.7%). In terms of study types, research articles are the most frequently published (74.2%). Among them, the most common study design is observational studies (61.1%), followed by cross-sectional studies (36.9%) and case-control studies (11.9%). With regard to experimental studies, randomised controlled trials (RCTs) are the most common type (11.6%). The number of case series has fallen sharply over time, from 20% 10 years ago to 5% today. Another striking point is that two journals, the International Journal of Pediatric Dentistry and the European Journal of Paediatric Dentistry, have published more than half of the world's output. By looking at the nationality of the authors, it is apparent that research frequently takes place within limited geographical areas, a sign that collaboration between different countries is struggling to take off. Despite the fact that prevention is the second most common topic among the articles analysed in the study-both in absolute terms and also taking into account dental journals focused on different specialties-it still does not play the prominent role it deserves. It is important to emphasise the need for further investigation into the prevention of dental diseases in young patients, as the desired oral health objectives have not yet been achieved. The early identification of risk indicators and the implementation of preventive oral health campaigns aimed at the paediatric population can reduce or prevent the progression of caries, and related expenditures for the replacement of missing teeth at a later age. A final consideration is how interesting it would be to analyse how many of the paediatric medical journals publish papers and articles on paediatric dentistry, as this is in fact another crucial step towards ensuring good oral health for all our young patients!

The first thousand days of mother and child: a lifelong investment in oral health!

Obstetricians, gynaecologists, paediatricians, pharmacists, paediatric dentists and hygienists are all health professionals that women encounter during the perinatal period. Today we know that during pregnancy and even earlier-at a pregnancy planning phase-the factors that will influence the future of the child's oral health are established. These are the 1,000 days stretching from conception to the child's second year of life, a time that will influence the health of oral cavity for life, and the foundations for the overall health are laid. In fact, oral health is the result of the ongoing prevention carried out by all the above-mentioned health professionals and operators. Often, dental diseases result from misinformation, mistakes and carelessness that begin in pregnancy and continue for the first few years of life. During pregnancy there is an increased risk for and/or worsening of periodontal diseases and a higher incidence of dental erosion and caries for the mother-to -be. In turn, this can even lead to an increase in pregnancy-related diseases such as premature births and miscarriages. Maternal nutrition, oral hygiene and lifestyle choices are the main elements influencing the health of both the mother and the child. Adequate nutrient levels during crucial periods of fetal development can lead to optimal fetal tissue programming and confer the child a greater protection against chronic diseases later in life. It is therefore imperative to promote information campaigns on these topics to prepare caregivers and women for the perinatal period. A survey carried out in Italy on a sample of women of childbearing age shows widespread misinformation about the oral health of mothers and children. The knowledge of health providers is also unsatisfactory: while most respondents recognise the importance of care during pregnancy, they do not advise patients to have dental check-ups or ask them if they have underwent dental care in the previous 12 months. We are carrying out a similar project with the University of Barcelona and it would be interesting to have data from other countries: we will consider them for immediate publication in our journal. Only by improving our knowledge of different realities we will achieve an effective dissemination of information and reduce the incidence of both pregnancy-related pathologies and those affecting childhood. We are looking forward to your contributions!

Cone Beam Computed Tomography evaluation of midpalatal suture maturation according to age and sex: A systematic review.

AIM: To systematically review and analyse the available evidence and assess if a correlation exists in children and young adults between the chronological age and the degree of midpalatal suture maturation as assessed according to the method proposed by Angelieri et al. [2013]. METHODS: A search was performed in Medline/Pubmed, Scopus, and Web of Science during October 2020 for published studies analysing midpalatal suture maturation through cone beam tomography according to the method proposed by Angelieri et al. [2013]. The review was performed according to the PRISMA protocol and the articles were selected according to the established inclusion and exclusion criteria. To assess the quality of reporting, the STROBE checklist was applied. CONCLUSION: The high variability of the maturational stages in the studied cohorts, highlights the poor correlation between suture maturation and chronological age in both genders, especially in young adults. According to our findings until the age of 14, the high prevalence of stages related to sutural opening does not justify CBCT assessment of the MPS and supports the use of a conventional protocol for maxillary expansion.

Otodental syndrome: Case report and differential diagnosis with Treacher Collins syndrome.

BACKGROUND: Otodental syndrome and Treacher Collins syndrome are rare diseases that have similar clinical features, which can complicate the diagnostic process. These syndromes cause skeletal and dental abnormalities, the differential diagnosis can be based on clinical signs but only the genetic analysis can confirm it. The aim of this case report is to describe and compare clinical signs of these syndromes. CASE REPORT: A 7-year-old patient came to our department: he presented abnormal tooth shapes and sizes, delayed teeth replacement and micrognathia. After extra- and intra-oral examination and radiographic exams, a clinical diagnosis of otodental syndrome was made, and a genetic testing was requested to confirm the diagnosis. CONCLUSION: Dental management of patients with otodental syndrome is challenging due to agenesis, teeth malformation, lack of space for permanent dentition. Proper treatment decision is crucial to obtain the best result for the patient.

Maternal and Child Dentistry: A fascinating new perspective!

Through the pages of EJPD we wish to propose a new concept of preventive dentistry. The idea is that every little patient should begin his or her preventive and therapeutic journey when they are very, very small... and therefore from when they are still in the womb! We believe that true prevention begins with the mothers-to-be and involves the child already during foetal life. For this reason the very first years of life, during which the rapid growth is associated with the establishment of lifestyles, eating and oral hygiene habits that will affect forever the health of the child- and future adult-are extremely important. Our goal as clinicians is therefore apparently simple: to increase the knowledge and improve the general well-being of mothers, infants and children. We believe that this goal can be achieved with a widespread information campaign, the multidisciplinary sharing of common goals, and the fundamental support of dental and paediatric professionals who can help us turn this dream into reality. Therefore, starting from this issue of the European Journal of Paediatric Dentistry, we will try to foster a dialogue between paediatric dentists and all physicians who provide specialty care to mothers and children in order to promote an early oral and general health with increasingly solid basis, by entering the fascinating field of Maternal and Child Dentistry!!

From native core micriobiome to milk-oriented microbiome.

The human microbiome is the full set of microorganisms (microbiota) present on and in our body. Its importance is such that the human being has been defined as a holobiont, that is, a superorganism made up of human eukaryotic cells and microbial cells. A balanced microbiota (eubiosis) is a prerequisite for health and well-being; on the contrary, an altered microbiota (dysbiosis) is the cause of pathological conditions. This concept is the cornerstone of the "microbiota revolution": Currently there is no disease that cannot be re- interpreted as a function of microbiome. While all human beings have similar DNA, it is the microbiome that make every person genetically unique; therefore the microbiome is the variable component of the genome which characterises each one of us. About one third of the microbiome is common to all individuals, while two thirds are specific to each subject and constitute a sort of fingerprint that forms and stabilises in the first 2-3 years of life. This timeframe is extremely important since it has been shown that the structure of the microbiome is already acquired in the embryonic-fetal period, it is completed within 3 years and lasts a lifetime. The native core microbiome is the first microbiota and characterises individuals for their whole life. It is affected by four main variables: The quality of family and social life of the mother-to-be, the intake of drugs during pregnancy, as well as the type of birth and breastfeeding. It is renowned that breast milk is a complex, unique and essential food for the growth of the child, but one of its functions - which is still under investigation today - is to feed and guide the formation of the microbiome of the newborn even after the introduction of solid foods, during the first 3 years of life. This function is carried out by the over one hundred different types of oligosaccharides that are present in breast milk, which is why these days we talk about the so-called MOM (milk-oriented microbiome). The correct formation of the microbiome affects the entire life of an individual. This is a more than valid reason to promote breastfeeding even after eruption of baby teeth and throughout the weaning period. The role of pediatric dentists, together with hygienists and pediatricians, is to spread and stress out the importance of oral hygiene so that breastfeeding can only bring benefits and not carious lesions!

Myofunctional therapy Part 2: Prevention of dentofacial disorders.

AirwayCentric approach to prevention of dentofacial disorders. The correct development of functions is important for the prevention of dentofacial disorders from the first days of life. The first and foremost function, to which all others are adapting, is nasal breathing. The AirwayCentric® method focuses on nasal breathing during early development and throughout childhood to promote: Neurobehavioural development and the brain, development of the craniofacial and respiratory complex, correct dental occlusion, proper and restful sleep and to improve performance and life overall. By working at the same time on orofacial functions and structures, many dentofacial disorders can be prevented.

Healthcare providers and the oral health of the mother and the unborn child.

One of the main information channels on oral health during pregnancy is direct and regular contact with obstetricians and gynecologists, who are the health professionals that future mothers consult most often during pregnancy. Thus, it would be desirable to promote information campaigns on dental topics aimed at women, starting with pre- and post-partum courses, to prepare them for the changes of the perinatal period. In recent years, health professionals have increasingly focused on maternal health during pregnancy. In a survey conducted in the United States just over ten years ago on a large sample of obstetrician-gynecologists, most respondents recognised the importance of pregnancy care. However, 77% of respondents had not advised the patients to undergo dental checkups, and 73% seldom asked the patients whether they had seen a dentist in the past 12 months [Morgan, 2009]. In light of these discouraging findings, in 2012 the American College of Obstetricians and Gynecologists and the American Dental Academy devised appropriate guidelines [OHRC, 2012]: It would be desirable to promote similar initiatives globally, and we ask our readers to report to us the current status in their own country. Regarding Italy, the recent partnership between the European Federation of Periodontology and the Italian Society of Periodontology has made it possible to offer a wealth of useful information, accessible online, aimed at professionals and expectant mothers as an aid to achieve optimal oral health in pregnancy [EFP and SIdP, 2017]. Thanks to the compliance and the positive attitude of future mothers, as a result of the support of healthcare professionals and widespread dissemination, it is now possible to reduce the incidence of both pregnancy-related and childhood diseases. We are well aware that the paediatric dentist is often consulted too late, in the presence, for instance, of advanced carious lesions. Therefore it is crucial for general and paediatric dentists to inform future mothers on the critical issues that may arise during pregnancy and the first years of their child's life, and to provide them a set of instructions, starting with basic notions such as the recommended frequency of brushing and the correct use of fluorinated toothpastes. Finally, it would be useful to promote programmes that are aimed at evaluating the patients' knowledge about aspects such as prevention and oral health. This would aid in identifying any weaknesses in the current prevention strategies, and help health professionals implement targeted projects supported by both the private sector and the national health system in order to include all the information required to achieve true primary prevention.

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.

Get healthy from an early age to gain years (and quality) of life!

As it is well known, in the 2000s the average lifespan reached unhoped-for values compared to those of the early 20th century. This incredible achievement was the combined result of improved living conditions and constant medical advancements, which together have contributed to a significant reduction in mortality. The sharp decline in infant mortality led to a general aging of the population and consequently to the great challenge of keeping the elderly healthy and self-sufficient for as long as possible. In Italy, 30% of the over-65s are not affected by any major condition and 20% have a chronic disease with no particular effects on their physical and cognitive functions, while 50% have multiple chronic morbidities that - in at least 40% of cases -result in consequent mobility problems or difficulties in performing everyday activities. The Italian data presented here do not differ much from those of other industrialised countries in Europe and North America. Studies show that every one out of two elderly people is at risk for "frailty", which is regression to a weak, childlike state, exhibiting behaviours such as communication difficulties, lack of self-sufficiency, crying, incontinence, frequent falls. An important aspect of becoming a healthier elderly person is the attention to the care and feeding of children. In fact, it has been hypothesised that poor nutrition of the fetus and infant could be the cause of permanent changes in specific organs and tissues. For example, in a clinical trial, the altered development of pancreas due to inadequate early feeding resulted in increased susceptibility to type 2 diabetes and related metabolic complications, with health impacts for the patient and economic consequences for the community at large. In conclusion, these two ages, normally viewed as opposites, prove to be similar enough to the point where a strong connection can be made between paediatrics and geriatrics. The above lays the groundwork for addressing issues related to the aging process through the consideration of an individual's life as a whole, abandoning the previous method of dividing life into stages with the aim of developing increasingly personalised and biologically-driven health care.

Paediatric dentistry and Covid-19: What's next?

Students are back to school, however this year will bring more than just math tests and oral examinations. The toughest test is the one that scientists will have to face to prevent virus transmission within schools. Data collected in Italy show that of the diagnosed cases of COVID-19, 2.1% involved children aged 0-9 years and 4.0% children aged 10-19 years, with a mortality rate close to zero. In recent weeks, however, there has been a considerable increase in cases in the paediatric and adolescent population-many of which are asymptomatic-and 16% of the cases reported to the health surveillance system were of subjects under the age of 19. Schools account for 2.5% of new outbreaks, therefore the focus must be shifted to prevention measures such as daily temperature checks, management of suspicious cases at school, and the possibility of using rapid tests at school, due to the high frequency of febrile episodes during winter, in order to distinguish suspected Covid cases from the seasonal flu. Data at hand, scientific studies confirm that children of all ages can be infected with the coronavirus and spread it to others and that in the school environment the spread of the virus can become critical especially in the presence of "super-spreaders". In fact, it has recently been shown that the majority of patients (70%) with Covid-19 have never infected anyone else, while only 8% of patients are linked to 60% of new infections. Prevention is crucial and it represents the only way to win the fight against coronavirus, a fight that will also be fought in the classroom during fall. Paediatric dentists, who come into contact with a large number of children and are aware of their health status, are once again called to give their contribution to help safeguard the health of young patients, their parents, their classmates and the community as a whole.