Parental perceptions and acceptance of silver diamine fluoride staining in Italy.

BACKGROUND: Parental perceptions of staining due to silver diamine fluoride (SDF) could affect its utilization in paediatric dentistry. This study represents the second part of a wider project focused on SDF esthetic acceptability among Italian parents. AIM: To evaluate parental acceptance of SDF staining in Italy and to assess whether the parent's level of acceptance depends on location, child's behavior, or demographic background. DESIGN: A cross-sectional study was conducted among Italian parents of children attending two university dental clinics. We used a validated Italian version of the questionnaire "Parental Perceptions of Silver Diamine Fluoride Dental Color Changes." RESULTS: Two hundred and thirty-four parents took part in the survey. Of parents, 65.4% considered the staining on posterior teeth esthetically "acceptable" or "somewhat acceptable," and 19.3% on anterior teeth (p = .001). In a scenario of positive cooperation, 48.5% of parents were "somewhat likely" or "very likely" to choose SDF to treat posterior teeth, and 17.6% on anterior teeth (p = .001). Level of acceptance increased as the difficulty the child would experience to receive conventional treatment increased. CONCLUSION: Staining on posterior teeth is more acceptable to parents than staining on anterior teeth. Level of acceptance on anterior teeth increases when sedation or general anesthesia is the alternative for the child.

Development and validation of the Italian version of the 'Parental Perceptions of Silver Diamine Fluoride Dental Color Changes' questionnaire.

BACKGROUND: The original English version of the questionnaire 'Parental Perceptions of SDF Dental Color Changes' was used among parents in the New York City metropolitan area. AIM: To develop an Italian version of the questionnaire and to assess its validity. DESIGN: The construct validity and the internal consistency were assessed in a convenience sample of Italian parents of 251 young healthy children seen at the University of Bologna and Pisa. Forward-backward technique was carried out for the translation of the questionnaire. Kaiser-Meyer-Olkin measure of sampling adequacy was equal to 0.91, and Bartlett's test of sphericity was statistically significant (P = .001), so the items were treated with the exploratory principal component analysis (PCA). RESULTS: Cronbach's alpha ranged from 0.69 to 0.95. PCA demonstrates that all the items load on the first component (87% of explained variance). All the Spearman correlation coefficients between each subscale (positive scenario: 0.563; negative scenario: 0.665) and the general acceptability showed significant correlation (P = .0001). Different age, educational level, and family income of the parents did not produce statistically significant different scores on any of the subscales (P > .05; Mann-Whitney test). CONCLUSION: The Italian version of the questionnaire showed high internal consistency and construct validity and was appropriate to be used in an Italian population.

Craniofacial and occlusal features of children with Noonan syndrome.

Craniofacial features of 12 children with Noonan syndrome (NS) were compared with age and gender matched healthy children. Dental history, panoramic radiograph, dental casts, and cephalometric measurements were assessed. The palatal height was significantly increased in the study group compared with the control group (p = .009; paired t-test). The palatal width was significantly reduced in the study group compared with the control group (p = .006; paired t-test). The mean SNB was reduced in the study group compared with the control group (p = .02; paired t-test) and the ANB increased (p = .009; paired t-test). The mean Sum (NSAr + SArGo + ArgoMe) angle and SN-GoMe were increased in the study group compared with the control group (respectively, p = .015 and p = .002; paired t-test). The cephalometric analysis assessed a retruded position of the mandible, skeletal class II characteristics, and a vertical growth pattern. The mandibular hyperdivergency was associated to a positive overbite.

Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT.

OBJECTIVES: To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects. METHODS: One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment. RESULTS: Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded. CONCLUSIONS: PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain.

Effects of audiovisual distraction in children with special healthcare needs during dental restorations: a randomized crossover clinical trial.

BACKGROUND: Audiovisual distraction using video eyeglasses is useful in managing distress and reducing fear and anxiety in healthy children during dental treatments. AIM: To evaluate the effect of audiovisual distraction on behavior and self-reported pain of children with special healthcare needs (SHCN) without intellectual disability during dental restorations and its influence on the operator stress and the time of the appointment. MATERIAL AND METHODS: This randomized controlled crossover trial comprised 48 children with SHCN requiring at least two dental restorations. One restoration was done wearing the video eyeglasses and one wearing conventional behavior management techniques. Subjective and objective pain was evaluated using the Faces Pain Scale - Revised (FPS-R) and the revised Face, Leg, Activity, Cry, and Consolability scale (r-FLACC). The operator stress using a VAS, the time of the appointment, and the child satisfaction were recorded. RESULTS: The use of video eyeglasses significantly reduced the operator stress. The bivariate analysis showed that the mean FPS-R score and the mean r-FLACC score were significantly lower using the video eyeglasses only during the second clinical session. CONCLUSION: Audiovisual distraction could be useful in managing distress in SHCN children without intellectual disability but cannot replace the conventional behavior management techniques.

Oral Health Status in Alzheimer's Disease Patients: A Descriptive Study in an Italian Population.

AIM: To evaluate the oral health status in Alzheimer's disease (AD) patients. MATERIALS AND METHODS: A descriptive study was performed on 120 AD patients (60 institutionalized in a public institute and 60 attended a daytime center), from September 2013 to January 2014. About 103 subjects formed the control group. The following medical and dental data were collected: dementia severity, pharmacological therapy, physical status (American Society of Anesthesiologists [ASA]), decayed (D), filled (F), and remaining natural teeth (T), DF/T ratio, community periodontal index (CPI), and gingival index (GI). A t-test for independent samples and the Spearman's correlation test were used to evaluate all variables. The significance level was set at 0.05. RESULTS: Statistically more AD patients (91.7%) were under pharmacological therapy and their physical status was more severe (ASA 2, ASA 3) compared with control subjects (p < 0.001). Moreover, they presented numbers of D, CPI, and GI significantly higher (p ≤ 0.005). In the institutionalized subgroup, statistically more moderate and severe AD cases were detected and more patients were edentulous (p < 0.001). Noninstitutionalized patients presented DF/T ratio, CPI, and GI significantly lower (p ≤ 0.024). A significant weak negative correlation (r = -0.121 to -0.372) between epidemiologic indices and AD severity was observed. CONCLUSION: Alzheimer's disease patients show a low oral health status that decreases progressively as the disease severity aggravates. Therefore, further studies are necessary to investigate oral health care interventions for AD patients. CLINICAL SIGNIFICANCE: It would be beneficial to introduce trained professional figures in specialized elderly institutions for regular follow-up visits and professional oral hygiene procedures. This task has to be coordinated with the treating physician, family members, and/or caregivers. Knowing that the severity of AD has a negative effect on the oral health status and the type of institutionalization exacerbates it.

Oro-dental features of Pallister-Killian syndrome: Evaluation of 21 European probands.

Pallister-Killian syndrome (PKS) is a rare sporadic multi-systemic developmental disorder caused by a mosaic tetrasomy of the short arm of chromosome 12. A wide range of clinical characteristics including intellectual disability, seizures, and congenital malformations has previously been described. Individuals with PKS show a characteristic facial phenotype with frontal bossing, alopecia, sparse eyebrows, depressed nasal bridge, long philtrum, telecanthus, and posteriorly rotated ears. Oro-dental features, such as "Pallister lip," macroglossia, delayed eruption of primary teeth, high arched-palate, prognathism, and cleft palate have been occasionally reported in the medical literature. The aim of the study was to assess the oro-dental phenotype of PKS and to describe the oral health status in a cohort participating in the First European Workshop on PKS. A clinical dental examination was performed in 21 Caucasian probands and data regarding medical and dental history collected. Twelve probands (57%) showed an atypical dental pattern, with multiple missing teeth (primarily the first permanent molars) and 2 (10%) a double teeth. The severity of gingivitis and dental caries increased with age and gingival overgrowth was a common finding. A characteristic occlusive phenotype was found: a high-arched palate with mandibular prognathism associated with an anterior openbite and crossbite and with posterior crossbite (unilateral or bilateral). The prevalence of oral habits (non-nutritive sucking, mouth breathing, bruxism) was high, even in older probands. This study suggests that individuals affected by PKS should be observed closely for oro-dental diseases and a multidisciplinary approach is needed to implement the right preventive measures. © 2016 Wiley Periodicals, Inc.

Role of dental training and distance of the observer on the perception of apically shifted gingival margin with increased vertical tooth size in the esthetic zone.

OBJECTIVES: To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated. MATERIALS AND METHODS: Two groups were identified: 33 first-year dental students (inexperienced) and 40 last-year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an "ideal" female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected. RESULTS: Considering a score >6 for a "pleasant smile," only one 4 mm single alteration at the canine gingival contour obtained an insufficient score. "Observational distance" and "clinical training" did not influence the final score, while size and symmetry of alterations displayed a significant role. CONCLUSIONS: The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations.

Preparing Children for Their First Dental Visit: A Guide for Parents.

The aim of the study was to test an information booklet containing suggestions to parents on how to prepare their child for the first dental visit. Forty-five children and one parent per included child took part in the trial. Children were randomized in two groups; the information booklet was e-mailed to the parents of the study group. At the end of the visit, the dentist and the parent evaluated the child's behavior through the Frankl Behavior Rating Scale (FBRS) and the utility of the booklet through a Likert scale. The children evaluated the pleasantness of the visit and the perceived pain through the Wong-Baker FACES® Pain Rating Scale (WBFPRS). Parents evaluated the information booklet as highly understandable and useful. According to the dentist, informed children were more cooperative (FBRS median score: 4; IQR: 3.5-4) than the control group (median score 3; IQR: 2-4) (p = 0.013; Mann-Whitney U test). Children prepared with the booklet reported less pain (WBFPRS: 0.40 ± 0.82 vs. 1.42 ± 1.99; p = 0.034; t-test;) and tended to evaluate the visit as more enjoyable (WBFPRS: 1.1 ± 2.14 vs. 2.75 ± 3.43; p = 0.064; t-test) than unprepared children. The information booklet increases the child's ability to cooperate during the visit and could represent a useful instrument for the clinical practice.

Rapid maxillary expansion on oral breathing children: effects on tongue location, hyoid position and breathing. A pilot study.

BACKGROUND: Oral breathing and downward tongue position are generally associated with transverse hypo-development of the upper maxilla. Rapid maxillary expansion aims to expand the upper maxilla transversely. This pilot retrospective clinical study evaluates the effects of rapid maxillary expansion therapy on the resting position of the tongue, on the position of the hyoid bone and on clinical respiratory pattern in a group of mouth breathing patients with mono- or bilateral cross-bites due to transversal deficits of the maxilla. METHODS: A total of 39 prepubertal oral breathing subjects with posterior cross-bite (mean age 8.5 year) have been studied. Before (T0) and after treatment (T1), changes in the position of the hyoid bone and tongue were evaluated by comparing latero-lateral radiographs (TLL), while the modification of respiratory patterns by a clinical and anamnestic assessment. RESULTS: After the treatment, the dorsum of tongue moved closer to the palatine vault, the position of the hyoid bone did not undergo significant variations and the respiratory pattern clinically improved in 64% of subjects. CONCLUSIONS: In patients in early stages of oral respiratory development, rapid maxillary expansion promoted correct tongue position but did not produce significant changes in the position of the hyoid bone. It has been observed a general improvement of the breathing pattern.

Case report of a novel interim approach to prevent early posteruptive enamel breakdown of molar-incisor hypomineralization-affected molars.

BACKGROUND AND OVERVIEW: Severely molar-incisor hypomineralization (MIH)-affected teeth are prone to develop early posteruptive enamel breakdown (PEB) and caries. A novel conservative interim approach for the prevention of this complication is presented. CASE DESCRIPTION: A 6-year-old boy with strong hypersensitivity and extensive brown opacities in the partially erupted mandibular permanent first molars (PFMs) was diagnosed with MIH. Constant hygiene and dietary counseling were followed by the application of luted orthodontic bands and glass ionomer sealants to protect PFMs from caries and PEB until the complete eruption of the teeth. After 36 months, the PFMs were completely erupted, with no caries and PEB, and the cooperation of the child increased. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Temporary strategies are useful to preserve MIH-affected PFMs. With the methodology described, the hypersensitivity decreased and the patient reached a good degree of cooperation, making possible definitive rehabilitative considerations.

Applicability of Demirjian's method for age estimation in a sample of Italian children with Down syndrome: A case-control retrospective study.

Age estimation is widely applied in several clinical and forensic fields. The radiographic evaluation of dental development is one of the most accepted tools for this purpose. Among the different methods proposed, Demirjian's method was the most extensively used and tested in the medical literature revealing that the original standards for the French-Canadian population tends to over-estimate the age of different population groups. The aims of this study were to evaluate the applicability of the Demirjian method in a sample of Italian children with Down syndrome (DS) and to compare the data with age and gender matched healthy subjects (non-DS). A retrospective study was performed on 146 orthopantomograms of DS individuals aged 6.3-16 years. The mean chronological age (CA) and the mean dental age (DA) were calculated. Using Cohen's kappa statistics, the inter- and intra-examiner agreement was reported as good (k = 0.75) and very good (k = 0.86). The differences between CAs and DAs were statistically significant for males and females (Wilcoxon Signed Rank test; p < 0.05). The median overestimation was 0.6 years in males and 0.9 years in females. Demirjian's method is unsuitable for dental age estimation in DS individuals. The same trend in overestimation was found in the control group. Comparing DS and non-DS subjects, the differences between DAs were not statistically significant for both males and females revealing that the dental development process is similar.