Upper Jaw Development After Lingual Laser Frenectomy and Myofuntional Therapy.

AIM: Over the years, the role of the lingual frenulum in the development of skeletal structures has been evaluated. However, the effect of short lingual frenulum treatment on bone structures is unclear. We need to investigate the effect of surgery and myofunctional therapy on maxillary development. This could be the rationale to establish an orthodontic interception protocol. METHODS: The case-control study was carried out in the Operative Unit of Pedodontics of the University Dental Clinic, at the Department of Medical, Oral and Biotechnological Sciences of the University of "G. D'Annunzio" Chieti-Pescara. The study population consisted in thirty children. The data were collected through anamnesis carried out by qualified health personnel before dental examination. Photos, frenulum length and cast measurements were taken. Student's t-test statistical analysis was used. Significance was ascertained based on the obtained P value of less than 0.01. CONCLUSION: The results confirmed the benefit of laser surgical treatment. The change in parameters related to the anterior palate region showed the power of frenectomy and myofunctional therapy in restoring the tongue's ability to stimulate bone development. The protocol adopted in the following study could be used in interceptive orthodontics. However, further studies are needed to evaluate the effects on the upper jaw over the long term that have higher sample numbers.

Duodenal Follicular Lymphoma: Track or Treat?

Duodenal follicular lymphoma (DFL) is a rare variety of non-Hodgkin's lymphoma of the gastrointestinal tract that usually carries a favorable course, recognized as a new entity in 2016. It is usually diagnosed at an early stage located predominantly in the second portion of the duodenum. We report the case of a 74-year-old male patient with epigastric pain in whom gastroscopy revealed white mucosal nodules that were pathologically diagnosed as grade 1-2 DFL. Staging investigations revealed secondary lesions in the spleen and at the base of the tongue together with latero-cervical adenopathy. The tumor was stage IV according to the Lugano staging system. We reviewed the recent (last five years) literature defining the importance of combination therapy in the advanced stage. The patient achieved complete remission of the disease through chemoimmunotherapy following the Rituximab-Bendamustine scheme.

Short lingual frenulum: From diagnosis to laser and speech-language therapy.

AIM: To evaluate the effects of tongue frenulectomy performed with two therapeutic approaches: Laser frenulectomy and combined laser and speech-language therapy. MATERIALS AND METHODS: The study involved 180 patients (90 males and 90 females) aged between 6 and 12 years. After examination and data collection, the patients were stratified according to three degrees of severity: mild, moderate and severe. After treatment, the test group (laser frenulectomy and combined laser and speech-language therapy) was compared with the control group (laser frenulectomy) in the pre-surgical phase, at one week, 1 month, 3 months, 6 months and 12 months after surgery. RESULTS: Statistical analysis showed statistically significant differences between the pre-surgical and post-surgical values at 3 months, 6 months and 12 months after surgery (p<0,05). CONCLUSIONS: It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech-language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.

Comparison of salivary antioxidant enzyme activity between ex-smokers and subjects who had never smoked.

Smoke contains oxidants such as oxygen-free radicals which are probably the major cause of damage to biomolecules. A decrease of salivary antioxidant enzymes was detected in habitual smokers. However, the effects of cigarette smoke on salivary antioxidant enzymes may persist after withdrawal from smoking. The objective of this study was to assess salivary superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity in ex-smokers in comparison with that of subjects who had never smoked. The test group included 25 ex-smokers (13 males and 12 females; mean age: 48 ± 8 years) who had given up smoking for at least one year but for no more than 2 years, and a control group consisting of 25 subjects (14 males and 11 females; mean age: 50 ± 12 years) who had never smoked. Salivary samples were collected and SOD and GSH-Px activity was measured. Student’s t-test was used to evaluate differences between groups and significant differences were observed for p < 0.05. A significant decrease (p < 0.05) of GSH-Px (14.5 ± 2) was observed in the test group compared to the control group (30 ± 4). However, SOD was very similar in the two groups: 0.9 ± 0.3 in the test group and 0.8 ± 0.3 in the controls and no significant difference was detected (p> 0.05). Detoxification of hydrogen peroxide by the GSHPx was altered even after withdrawal from smoking, while the production of hydrogen peroxide, that is mediated by SOD, was not modified.

Hyaluronic acid-based medical device and oral disorders: can it be used in paediatric dentistry?

Due to its physical and biological characteristics and safety profile, hyaluronic acid is very widely used in numerous clinical conditions, ranging from its best-known use in cosmetic surgery (as a filler and for its ability to promote tissue regeneration and therefore minimise scarring) to lesser-known fields such as ophthalmic surgery, major abdominal surgery (where it is used to prevent the complication of adhesion bands) and intra-articular use. Studies were recently published in which this type of device was also used in paediatric patients for the management of inflammatory disorders of the oral cavity and teething symptoms. As this is a highly topical field for dentists, we felt it would be useful to review the efficacy and safety of the device in the paediatric population treated, and analyse any discrepancies with the results obtained in the adult population. The preparations of hyaluronic acid used in pediatric dentistry, thanks to their anti-inflammatory and angiogenic properties, proved to be very effective in therapy of oral diseases in children. Further clinical research is needed to confirm the effectiveness of these products to dispel doubts about any side effects.

Vascular endothelial growth factor (VEGF), mast cells and inflammation.

Vascular endothelial growth factor (VEGF) is one of the most important inducers of angiogenesis, therefore blocking angiogenesis has led to great promise in the treatment of various cancers and inflammatory diseases. VEGF, expressed in response to soluble mediators such as cytokines and growth factors, is important in the physiological development of blood vessels as well as development of vessels in tumors. In cancer patients VEGF levels are increased, and the expression of VEGF is associated with poor prognosis in diseases. VEGF is a mediator of angiogenesis and inflammation which are closely integrated processes in a number of physiological and pathological conditions including obesity, psoriasis, autoimmune diseases and tumor. Mast cells can be activated by anti-IgE to release potent mediators of inflammation and can also respond to bacterial or viral antigens, cytokines, growth factors and hormones, leading to differential release of distinct mediators without degranulation. Substance P strongly induces VEGF in mast cells, and IL-33 contributes to the stimulation and release of VEGF in human mast cells in a dose-dependent manner and acts synergistically in combination with Substance P. Here we report a strong link between VEGF and mast cells and we depict their role in inflammation and immunity.

Nutrition and cancer prevention.

Cancer cells invade surrounding tissues and metastasize to distant sites. Diet high in fat is a strong link to, and perhaps causes, a high incidence of tumours. Trans-fatty acid might impair the function and it could be involved in the development of cancer. Cholesterol is also strongly suspected to be involved in the development of tumours, therefore it is important for everyone to eat well, especially for people with cancer to prevent the body tissues from breaking down and helping to rebuild the normal tissue that may have been affected by the treatments. Factors secreted by adipocytes and macrophages such as TNF-alpha and other inflammatory proteins are involved in inflammation in cancer. In addition, MCSF which up-regulates adipocyte tissue is also important for the stimulation of fat cell proliferation and is expressed by human adipocytes. Many cytokines, such as IL-1, IL-6, IL-8, IL-32, IL-33 and MCP-1, are biomarkers for cancer and chronic diseases along with transcription factors NFκB and AP-1; these last two factors are important bioactive substances on the molecular mechanism of the control of genes which in turn affect cellular metabolism. In this paper we revisit the interrelationship between cancer and metabolism.

Management of compound odontoma in a 10-year-old girl preserving the associated impacted permanent tooth.

AIM: Compound odontoma has been reported to be the most common of all odontogenic neoplasms and tumor- like lesions. Only rarely the treatment of this lesion in association with an impacted tooth has been reported. CASE REPORT: A compound odontoma in a 10-year-old girl, associated with an impacted permanent incisor is described, focusing on the diagnosis and the importance of early treatment of this lesion. The patient underwent surgical excision of the lesion and it was decided to wait for the spontaneous eruption of the impacted tooth. After 6 months no eruption was observed and thus the orthodontic treatment was deemed necessary. At the one-year follow-up, the tooth was brought into the maxillary arch.

Interleukin-9 and mast cells.

Mast cells are granulated hematopoietic cells derived from stem cells that reside in nearly all tissues and are involved in protection of a host from bacterial infection with a protective and pathogenic activity. Mast cells are important for both innate and adaptive immunity in tissues which are in close contact with the environment. These cells express proinflammatory cytokines such as IL-1, IL-6, IL-8 and tumor necrosis factor which are necessary for innate immunity. Mast cells also produce interleukin-9 and enhance mast cell expression of several cytokines including IL-1beta, IL-5, IL-6, IL-9 and IL-13. In addition, IL-9 can induce mast cell production of TGF-beta which can have proinflammatory downstream effects. IL-9 can function as either a positive or a negative regulator of immune responses and can have a detrimental role in allergy and autoimmunity. Furthermore, IL-9 contributes to disease by promoting mast cell expansion and production of IL-13 which in turn contributes to airway hyperresponsiveness. Here, in this editorial we review the interrelationship between IL-9 and mast cells.

Endothelial cells, cholesterol, cytokines, and aging.

It has been reported that high levels of cholesterol and triglycerides are associated with increased risk of developing atherosclerosis and shorter life. In fact, vascular endothelial dysfunction occurs during the human aging process. Accumulation of lipids in vascular endothelium activates leukocytes to produce cytokines and chemokines which recruit macrophages. On the other hand, macrophages augment inflammatory response and secrete vascular endothelial growth factor, a key cytokine that mediates angiogenesis and inflammatory response. In addition, hyperlipidaemia is one of the main risk factors for aging, hypertension and diabetes. Here, we review the interrelationship between endothelial cells, high level of cholesterol, and aging.

Psychological stress and vitamins.

Conditions of stress and anxiety have complex interactions with insufficient vitamin intake and malnutrition. This study, based on literature research in Medline, analyzes the inter-relationship between vitamins and stress. This report concerns a number of vitamins that have been receiving much attention in earlier reviews of the literature, for their potential to protect against stress-related events, and focus is placed upon recent findings.

Atherosclerosis: a classic inflammatory disease.

Atherosclerosis is an inflammatory disease due to a diet high in saturated fat, hypercholesterolemia, obesity, hypoglycemia, etc. mainly mediated by the infiltration of macrophage and T cells into the vascular wall. Once the endothelial is damaged monocytes penetrate the tissue and are transformed in scavenger cells. Upon stimulation of Th1 cells, a group of cytokines is released and contributes to the inflammatory response of atherosclerotic tissue. When macrophages proliferate they amplify inflammatory response through the secretion of growth factors and cytokines such as TNF and IL-1. In addition, chemokines such as RANTES and other C-C chemokines are generated, and matrix metalloprotinease 9 (MMP-9) are produced by activated monocytes. However, the immune system in atherosclerosis still remains unclear. Here, in this study we revisited the inter-relationship between atherosclerosis and inflammation.

VEGF, substance P and stress, new aspects: a revisited study.

Mast cells play an essential role in diverse physiological and pathological processes, such as atherosclerosis, malignancy, asthma, pulmonary fibrosis and arthritis, directly interact with bacteria, and appear to play a vital role in host defense against pathogens. Mast cells could be recruited in the inflammatory site, by MCP-1, RANTES and SCF, to selectively secrete proinflammatory molecules; these could include growth factors, histamine, which is mitogenic (H1) and an immunosuppressant (H2), neovascularization agents, such as heparin, IL-8, and VEGF, as well as proteases that could permit new blood vessel formation. Neurogenic inflammation involves vasodilation and plasma protein extravasation in response to neural stimulation. Upon stimulation, sensory neurons release Substance P and other neuropeptides and activate neurokinin-1 receptors leading to plasma protein extravasation from post-capillary venules. Substance P is a neuropeptide that is released from nerve endings in many tissues and plays an important role in immunological and inflammatory states, and it is also a mediator of tissue injury, asthma, arthritis, allergy and autoimmune diseases. SP-positive nerve fibers and mast cell contacts are increased by acute stress in mice leading to dermal mast cell degranulation. VEGF is produced by flammatory cells. IL-33 is the newest inflammatory member of the IL-1 cytokine family and we show here that SP can induce VEGF secretion from mast cells and IL-33 augments the effect of SP in VEGF transcription and translation protein.

Effects of cigarette smoke on salivary superoxide dismutase and glutathione peroxidase activity.

Cigarette smoke contains oxidants such as oxygen-free radicals and volatile aldehydes, which are probably the major causes of damage to biomolecules exposed to cigarette smoke. However, saliva has an antioxidant defense system able to counter toxic activities of radical species that is formed by antioxidant enzymes, including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). The purpose of this study is to verify the possible effects of cigarette smoke on SOD and GSH-Px. Forty-four patients (25 males and 19 females) were enrolled in this study. The participants were 20 smokers (12 males and 8 females) and 24 non-smokers (13 males and 11 females). Furthermore, 10 subjects of the control group were ex-smokers (9 males and 1 female). Their mean age plus or minus standard deviation (SD) was 58.8 plus or minus 15.9 years for the case group and 73.8 plus or minus 10.6 years for the control group. All patients were underwent a careful anamnestic investigation and examination of the oral cavity. After rinsing the mouth with water, each subject put 3 cc of non-stimulated saliva inside a test tube. The saliva was centrifuged and oral peroxidase and superoxide dismutase activity was measured according to a specific assay. Statistical analysis was performed to evaluate differences between the groups and significant differences were observed for p less than 0.05. A significant decrease of GSH-Px activity was detected in the smoking group (p less than 0.05), while the SOD activity was similar in the control and case groups. According to the sex, a significant decrease of GSH-Px activity was noted in males of the smoker group (p less than 0.05), while in the sample of females no significant difference of the enzymatic activity was found. Moreover, among ex-smokers, there was a significant difference in the values of GSH-Px between those who had not smoked for less than ten years and those who had not smoked for more than ten years. Cigarette smoke may alter the detoxification of hydrogen peroxide through a decrease of GSH-Px activity. The overproduction of H2O2 may lead to an oxidative stress that is involved in a large number of diseases, including precancerous and neoplastic lesions of the oral cavity. The effects of cigarette smoke on salivary antioxidant enzymes decrease after withdrawal from smoking and the benefits become more evident with the passage of time.

[Assessing knowledge, attitude, and practice on occupational blood exposure in caregiving facilities, in Morocco]. / Evaluation des connaissances, attitudes et pratiques sur les accidents d'exposition au sang en milieu de soins au Maroc.

OBJECTIVE: This study had for aim to evaluate practices and knowledge of infectious hazards, to determine the prevalence of viral infections related to occupational blood exposure among health care workers, and to propose a preventive policy. DESIGN: This descriptive multicentric and transversal epidemiological survey was carried out from 2003 to 2004 in 10 Moroccan cities. Two thousand eight hundred and forty four persons were contacted and 2086 accepted to answer the questionnaire (73.3 %). RESULTS: The mean age was 40.8+/-7.8 years and seniority 15.6+/-7.4 years. Blood was the most incriminated product (96.1%), followed by dirty linen and hospital waste. Instruments most often mentioned as dangerous were hollow needles (80.3%). The most feared infections were viral hepatitis (77.5%) and HIV (89.3%). Only 40.6% of the personnel were adequately vaccinated against hepatitis B. Post-vaccine serology was performed on only 1.8% of the vaccinated staff. During the last 12 months, 58.9% of the personnel underwent at least one occupational blood exposure 5.8% of which was reported. Universal precautions appeared poorly used as only 65.6% wore gloves for invasive acts and 61.5% correctly disinfected their hands. Re-sheathing used needles was frequent (51.2%). CONCLUSIONS: Infectious hazards in healthcare facilities are not sufficiently taken into account: the recent creation of occupational health services in hospital facilities should contribute to improve working conditions, make hepatitis B vaccination available and mandatory, and lead to more information and education on hazards related to occupational blood exposure for healthcare personnel.

Microbiological study and scanning electron microscopic analysis of root canal wall dentin following pumped Diodium Nd:YAG laser irradiation.

The capability of Nd:YAG laser in sterilizing root canals and the alterations of dentinal walls induced by laser treatment were investigated. Thirty root canals were infected by P. aeruginosa ATCC 27853 and thirty canals by A. naeslundii CH-12. Within each infection, 4 groups were selected on the basis of the treatment. Among them, 2 test groups (TGs) were treated by Nd:YAG laser at 15 Hz for 15 s, using 2 different settings: 1 Watt/70 Joule and 1.5 Watt/100 Joule, respectively (n = 10 each). The other 2 groups, used as controls (CGs), were: untreated (positive control, n = 5) and sterilized by 5.25% NaClO group (negative control, n = 5). Observations under scanning electron microscope (SEM) and quantitative bacterial counts were performed. These analyses were performed once per group after infections and treatments. Laser treatments significantly reduced the number of both bacteria. SEM investigation showed melting and crystallization of canal dentin over 1.5 W/100 J. Laser irradiation has a bactericidal effect but it does not completely sterilize the root canal as NaClO 5.25% solution does if the goal of treatment is also to avoid alterations of dentinal walls.

Human dental pulp vasculogenesis evaluated by CD34 antigen expression and morphological arrangement.

Vasculogenesis describes the process by which endothelial precursor cells form new blood vessels. To characterize the topography and the cellular processes underlying vascularization of human dental pulp, we examiend the expression of the human hematopoietic progenitor cell antigen CD34. Dental pulps, obtained from deciduous and permanent teeth, were morphologically examined at light- and electron-microscope levels and by expression of CD34. The findings indicate that vasculogenesis of dental pulp is a complicated process starting from single CD34(+) cells. These subsequently coalesce to form solid vascular cords inside the developing connective tissue, which later hollows. Pericytes were embedded within the fully formed microvessels' basement membrane. The presence of CD34(+) endothelial cells in permanent teeth reveals that the process of vasculogenesis persists into adult life, where it contributes to continuous adjustment of vessel and network structures in response to functional needs and dental tissue homeostasis.

[Respiratory symptoms and ventilatory disorders among a group of cement workers in Morocco]. / Symptômes respiratoires et troubles ventilatoires chez les travailleurs dans une cimenterie au Maroc.

There are 8 cement works in Morocco employing 3 600 people and producing 8 million tons annually. The aim of our study is to determine the prevalence of respiratory symptoms and to propose some preventive measures. The study involved a group of workers of whom 280 were exposed to cement dust (who were further subdivided into three categories according to the intensity of exposure) and 73 who were not. It included a medical history with a standardised questionnaire, a clinical examination and spirometry. 65% of those exposed had clinical symptoms as opposed to 34.2% of the non-exposed. Cough, expectoration rhinitis, chronic bronchitis and asthma were significantly more common with incidences of 56.1%, 52.5%, 49.3%, 29.3% and 14.3% respectively in the exposed against 19.2%, 24.6%, 26%, 9.6% and 6.8% in the non-exposed. Among the exposed the prevalence of chronic bronchitis increased significantly with the degree of exposure, from 11.4% in category 1 to 41.6% in category 3. Age did not seem to influence the development of chronic bronchitis but on the other hand a smoking history of more than 10 years did. Exposure is responsible for the development of respiratory problems because among non smokers the exposed (55.6% are more symptomatic than the non-exposed (13.3%). Tobacco smoking potentiates the effects of occupational airborne contamination because exposed smokers (73.6%) and ex-smokers (67.8%) have more respiratory problems than exposed non-smokers (55.6%). The incidence of abnormalities of respiratory function is significantly higher in the exposed than in the non-exposed (32.5% against 13.7%). Among the exposed workers presenting disorders of ventilatory function 72.5% have no more than a disorder of the small airways or a slight deficit. Among the exposed the prevalence of impaired respiratory function is greater in smokers and ex-smokers (47.9% than in non-smokers (10.4%). Tobacco smoking augments the impairment of respiratory function. Prevention depends therefore on a programme of technical (collective and individual) and medical protection of the workforce.

[Prevalence of respiratory problems in workers at two manufacturing centers of ready-made concrete in Morocco]. / Prévalences des troubles respiratoires chez les travailleurs de deux centrales de fabrication de béton prêt à l'emploi au Maroc.

SETTING: Employees at factories for ready-made concrete are exposed to the dust emanating from the products (such as sand, gravel and cement); however, there have been few studies on the subject. METHODS: A retrospective cohort analysis was conducted in a male population: 120 employees working in cement production and 120 non-exposed civil servants working at the Casa-Anfa prefecture. Each employee underwent interview by standardised questionnaire, spirometry test and standard chest radiography. RESULTS: Statistical analysis of the results revealed an increase in the prevalence of exposed symptomatic subjects compared to non-exposed subjects (57.5% vs. 24.2%) and increased prevalence of all of the symptoms: cough (15.8% vs. 15%), dyspnea (21.6% vs. 5%), chronic bronchitis (11.7% vs. 6.7%), asthma (14.2% vs. 7.5%), rhinitis (40% vs. 19.2%), conjunctivitis (48.3% vs. 10%) and dermatitis (22.5% vs. 6.7%). This increase is only statistically significant for dyspnea, rhinitis, conjunctivitis and dermatitis. Changes in lung function parametres were much more frequent among the workers at the two factories than among the non-exposed workers (40.8% vs. 11.7%). Tobacco also seemed to have an effect on respiratory deficit. Analysis of the chest radiographs of the exposed subjects, using the ILO international classification, revealed 19 (15.8%) abnormal films. CONCLUSIONS: Working conditions in cement factories must be improved rapidly (particularly collective technical prevention) and a medical service should be set up for regular management and follow-up of the workers.

Alkaline phosphatase activity in normal and inflamed dental pulps.

Alkaline phosphatase (ALP) seems to be important in the formation of mineralized tissues. High levels of ALP have been demonstrated in dental pulp cells. In the present study ALP activity was analyzed in normal healthy human dental pulps, in reversible pulpitis, and in irreversible pulpitis. Enzymatic ALP control values for the normal healthy pulps were 110.96+/-20.93. In the reversible pulpitis specimens the ALP activity increased almost eight times to 853.6+/-148.27. In the irreversible pulpitis specimens the values decreased sharply to 137.15+/-21.28 and were roughly equivalent to those seen in normal healthy pulps. The differences between the groups (control vs. reversible pulpitis and reversible pulpitis vs. irreversible pulpitis) were statistically significant. These results could point to a role of ALP in the initial pulp response after injury.