Paediatric Oral Health during and after the COVID-19 Pandemic.

BACKGROUND: During the period of health emergency linked to the current COVID-19 pandemic, the paediatric dentists' management of oral health problems in children must have as primary objective the control of the spread of the disease according to specific protocols aimed at minimizing the risk of viral transmission. AIM: This paper examines the possible clinical conditions that may require intervention by the paediatric dentist, distinguishing clinical situations that fall into the category of paediatric dental emergencies from conditions of oral pathologies that normally do not represent an emergency. The definition of rigorous and highly effective infection control protocols in the dental settings must therefore be complemented by the development and strengthening of remote communication techniques with the parents, who must be adequately educated on preventive and palliative measures for the management of their children's oral health, with the aim of postponing clinical attendance to when the circumstances become favourable. CONCLUSIONS: The experience gained with these approaches and models of treatment, where remote interaction techniques play a central role, will hone the communication skills of the paediatric dentist and will retain its usefulness even at the end of the current emergency period.

Graphene-based dental adhesive with anti-biofilm activity.

BACKGROUND: Secondary caries are considered the main cause of dental restoration failure. In this context, anti-biofilm and bactericidal properties are desired in dental materials against pathogens such as Streptococcus mutans. To this purpose, graphene based materials can be used as fillers of polymer dental adhesives. In this work, we investigated the possibility to use as filler of dental adhesives, graphene nanoplatelets (GNP), a non toxic hydrophobic nanomaterial with antimicrobial and anti-biofilm properties. RESULTS: Graphene nanoplatelets have been produced starting from graphite intercalated compounds through a process consisting of thermal expansion and liquid exfoliation. Then, a dental adhesive filled with GNPs at different volume fractions has been produced through a solvent evaporation method. The rheological properties of the new experimental adhesives have been assessed experimentally. The adhesive properties have been tested using microtensile bond strength measurements (µ-TBS). Biocidal activity has been studied using the colony forming units count (CFU) method. The anti-biofilm properties have been demonstrated through FE-SEM imaging of the biofilm development after 3 and 24 h of growth. CONCLUSIONS: A significantly lower vitality of S. mutans cells has been demonstrated when in contact with the GNP filled dental adhesives. Biofilm growth on adhesive-covered dentine tissues demonstrated anti-adhesion properties of the produced materials. µ-TBS results demonstrated no significant difference in µ-TBS between the experimental and the control adhesive. The rheology tests highlighted the necessity to avoid low shear rate regimes during adhesive processing and application in clinical protocol, and confirmed that the adhesive containing the 0.2%wt of GNPs possess mechanical properties comparable with the ones of the control adhesive.

FEM and Von Mises Analysis on Prosthetic Crowns Structural Elements: Evaluation of Different Applied Materials.

The aim of this paper is to underline the mechanical properties of dental single crown prosthodontics materials in order to differentiate the possibility of using each material for typical clinical condition and masticatory load. Objective of the investigation is to highlight the stress distribution over different common dental crowns by using computer-aided design software and a three-dimensional virtual model. By using engineering systems of analyses like FEM and Von Mises investigations it has been highlighted the strength over simulated lower first premolar crowns made by chrome cobalt alloy, golden alloy, dental resin, and zirconia. The prosthodontics crown models have been created and put on simulated chewing stresses. The three-dimensional models were subjected to axial and oblique forces and both guaranteed expected results over simulated masticatory cycle. Dental resin presented the low value of fracture while high values have been recorded for the metal alloy and zirconia. Clinicians should choose the better prosthetic solution for the teeth they want to restore and replace. Both prosthetic dental crowns offer long-term success if applied following the manufacture guide limitations and suggestions.

Obstructive Sleep Apnea Syndrome (OSAS): evaluation and treatment of odontostomatological problems. / Sindrome delle Apnee Ostruttive del Sonno (OSAS):valutazione e terapia dei problem a livello odontostomatologico.

The Obstructive Sleep Apnea Syndrome (OSAS) is a breathing disorder characterized by repeated episodes of apnea/hypopnea occurring during sleep and caused by the obstruction of the upper airway. As OSAS can have a significant impact on quality of life, an early diagnosis and a multi-specialized recognition become important. Therapeutic proposals include the Mandibular Advancement Devices (MADs), intraoral devices that induce a mandibular advancement during the night to eliminate snoring and apnea. Italian guidelines on dental aspects of OSAS in adults and children focus primarily on anamnestic and clinical methods by which the dentist, in a role of epidemiological sentinel, can first identify a patient with OSAS and then participate in the therapeutic process using specific orthodontic intraoral devices.

Assessing risk factors for dental caries: a statistical modeling approach.

The problem of identifying potential determinants and predictors of dental caries is of key importance in caries research and it has received considerable attention in the scientific literature. From the methodological side, a broad range of statistical models is currently available to analyze dental caries indices (DMFT, dmfs, etc.). These models have been applied in several studies to investigate the impact of different risk factors on the cumulative severity of dental caries experience. However, in most of the cases (i) these studies focus on a very specific subset of risk factors; and (ii) in the statistical modeling only few candidate models are considered and model selection is at best only marginally addressed. As a result, our understanding of the robustness of the statistical inferences with respect to the choice of the model is very limited; the richness of the set of statistical models available for analysis in only marginally exploited; and inferences could be biased due the omission of potentially important confounding variables in the model's specification. In this paper we argue that these limitations can be overcome considering a general class of candidate models and carefully exploring the model space using standard model selection criteria and measures of global fit and predictive performance of the candidate models. Strengths and limitations of the proposed approach are illustrated with a real data set. In our illustration the model space contains more than 2.6 million models, which require inferences to be adjusted for 'optimism'.

Osteogenesis imperfecta and rapid maxillary expansion: Report of 3 patients.

INTRODUCTION: The aim of this study was to analyze the effects of orthopedic therapy with rapid maxillary expansion (RME) in growing patients affected by osteogenesis imperfecta and treated with bisphosphonates. METHODS: Three boys with osteogenesis imperfecta (mean age, 10.6 years) were treated with RME. They all had treatment with quarterly intravenous infusions of bisphosphonates. They were in either the early or the late mixed dentition and had indications for RME. The expansion screw was activated twice daily until correction of the transverse relationships was achieved. The retention period with the expander in place was 6 months. In 2 Class III patients, RME was associated with the use of a facemask. In all patients, occlusal radiographs were taken at the end of active RME therapy to assess the opening of the midpalatal suture and 1 year after the end of active expansion therapy to evaluate the reossification and reorganization of the midpalatal suture. RESULTS: In all patients, the opening of the midpalatal suture and the healing with reorganization of the midpalatal suture were documented with the occlusal radiographs. No complications were found after a 1-year follow-up. CONCLUSIONS: In growing patients affected by osteogenesis imperfecta and treated with bisphosphonates, it is possible to perform RME with a standard protocol with no complications after a 1-year follow-up.

Today prospects for tissue engineering therapeutic approach in dentistry.

In dental practice there is an increasing need for predictable therapeutic protocols able to regenerate tissues that, due to inflammatory or traumatic events, may suffer from loss of their function. One of the topics arising major interest in the research applied to regenerative medicine is represented by tissue engineering and, in particular, by stem cells. The study of stem cells in dentistry over the years has shown an exponential increase in literature. Adult mesenchymal stem cells have recently been isolated and characterized from tooth-related tissues and they might represent, in the near future, a new gold standard in the regeneration of all oral tissues. The aim of our review is to provide an overview on the topic reporting the current knowledge for each class of dental stem cells and to identify their potential clinical applications as therapeutic tool in various branches of dentistry.

Allergic rhinitis as a possible risk factor for malocclusion: a case-control study in children.

BACKGROUND: Prolonged oral respiration is known to cause postural alterations, which can lead to dental malocclusions. Allergic rhinitis, a common cause of upper airway obstruction in children, must therefore be seen as a possible risk factor in the development of malocclusions. AIM: Aim of this study was to investigate the association between allergic rhinitis and malocclusions in primary and early-mixed dentition. DESIGN: A case-control study was carried out involving 275 Italian children aged 5-9. The case group and the control group were composed of 125 individuals affected by malocclusions and by 150 healthy patients, respectively. Through a questionnaire, we assessed the presence of professionally diagnosed allergic rhinitis. Data were analysed to identify associations between these variables and the presence of malocclusions. RESULTS: Children with a history of allergic rhinitis had a threefold increased risk to develop one or more dento-skeletal alterations [OR = 3.16; 95% CI (1.79-5.58), P < 0.001]. Statistically significant associations were found between allergic rhinitis and the development of posterior crossbite and increased overjet. No significant association was found for anterior openbite. CONCLUSIONS: Allergic rhinitis is a significant risk factor for the development of malocclusions in general and is associated with the development of posterior crossbite and increased overjet.

Friedman Tongue Position and the Anthropometric Parameters in Adult Patients with Obstructive Sleep Apnea: An Observational Study.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) is a relevant public health problem; dentists can play an important role in screening patients with sleep disorders by using validated tools and referring patients to a specialist, thereby promoting an interdisciplinary approach. The aim of the study is to identify if the OSAS severity, measured by the apnea-hypopnea index (AHI), and some anthropometric measurements are associated with the Friedman Tongue Position (FTP) within a population with dysmetabolic comorbidities. MATERIALS AND METHODS: A questionnaire containing information about clinical data including height, weight, Body Mass Index (BMI), neck circumference, waist circumference, hip circumference and FTP was administered. The AHI value was measured by means of an unattended home polysomnography device. Pearson correlation coefficients were calculated, and Kruskal-Wallis, Kolmogorov-Smirnov (both nonparametric) and independence tests were performed to probe the possible relationships. The significance was set at p ≤ 0.05. RESULTS: A total of 357 subjects were analyzed. The association between the FTP and AHI was not statistically significant. On the contrary, the AHI showed a positive correlation with BMI and neck circumference. A statistically significant association between the number of subjects with a larger neck and an increasing FTP class was found. BMI, neck, hip and waist circumference was associated with the FTP scale. CONCLUSIONS: although the FTP was not directly associated with OSAS severity, there was also evidence that an FTP increase is associated with an increase in the considered anthropometric parameters, and FTP can be a clinical tool used in the assessment of risk for OSAS risk factors.

Early Class III Treatment Using a Hybrid Rapid Palatal Expander and Facemask in a Patient with Partially Edentulous Maxilla Post MNTI Removal: A Case Report.

This case report describes the orthodontic treatment of a 9-year-old girl who presented with multiple agenesis, maxillary contraction, and skeletal Class III malocclusion after the surgical removal of a melanocytic neuroectodermal tumour of infancy (MNTI) or the so-called melanocytic progonoma at 40 days of age. The lack of dental anchorage in the posterior segment of the second quadrant and the search for maximum control during suture expansion to reduce dental effects led to the use of a hybrid rapid palatal expander (RPE) with dental anchorage in the first quadrant and skeletal anchorage on the two miniscrews placed in the second quadrant, to allow a more even distribution of expansion forces. The expansion procedures performed with the hybrid anchorage device and extraoral traction demonstrate the possibility of solving the contraction in the posterior segments and anterior crossbite in a few months with maximum control of the applied forces, despite the objective difficulties related to the specificity of the case.

Baby Food and Oral Health: Knowledge of the Existing Interaction.

BACKGROUND: The purpose of this study is to verify parents' knowledge of child nutrition and their awareness of the interaction between unhealthy sugars in their child's diet and caries formation. METHODS: a questionnaire was proposed using Instagram to analyze type of breastfeeding; type of weaning and diet; home oral hygiene maneuvers; bad habits (use of pacifiers, bottles, and sugary substances); knowledge on the usefulness of fluoride; and first dental visit. A total of 200 parents from different regions of Italy with children aged 2 months to 6 years were contacted. Results showed that 66% parents preferred breastfeeding, while the remaining 34% chose artificial breastfeeding. Fifty percent (100 babies) started weaning at six months, 20% (40 babies) at the fifth month, 13.5% (27 babies) at the fourth month, and only 11.5% (23 babies) in a range from the seventh to ninth month of life. Oral hygiene practices were performed only by 25% of parents before eruption of the first tooth. After eruption of the first tooth, there is greater attention to home oral hygiene practices: 59% of parents carry out and teach their children daily home oral hygiene maneuvers. CONCLUSIONS: it is possible to raise awareness among parents and caregivers on the importance of food education.

Root Fracture and Extrusive Luxation in Primary Teeth and Their Management: A Case Report.

BACKGROUND: Extrusion, lateral luxation, and intrusion are among the most serious types of dental trauma. Only a few studies have specifically focused on extrusion; the present one was aimed at reporting a case of domestic traumatic dental injury to primary tooth and describing the measures taken in managing the trauma in order to avoid future consequences to the underlying permanent tooth germ. CASE REPORT: A 3.5-year-old boy reported a dental injury with extrusion and root fracture of deciduous tooth 5.1. After intraoral and radiographic evaluation, the element was repositioned and stabilized by an orthodontic flexible splint attached to the adjacent teeth. Several follow-up checkups were made and showed good healing of the tissues and physiological exfoliation of the tooth, with a healthy and unaffected corresponding central permanent incisor. CONCLUSION: This case report strengthens the importance of well-timed diagnosis and treatment and of regular follow-up of traumatized teeth as they may affect both dentitions with a negative impact on Oral Health-Related Quality of Life. Conservative treatment should be taken into consideration when possible, being in some cases more appropriate.

Comparative Evaluation of Esthetic and Structural Aspects in Class II Functional Therapy. A Case-Control Retrospective Study.

Background: To compare the skeletal, dental, and esthetic changes produced by three functional devices, Fränkel-2 appliance (FR-2), Twin Block (TB), and Occlus-o-Guide® (O-o-G®), for the treatment of Class II malocclusion. Methods: Sixty-five patients with Class II Division 1 malocclusion were divided into three groups and were analyzed through cephalometric analysis of skeletal, dental, and esthetic variables before and after treatment. The first group of 23 patients (F: 9; M: 14; mean age: 10.3 ± 1.08 years) was treated with FR-2, the second group of 18 patients (F: 8; M: 10; mean age 10.7 ± 1.05 years) was treated with TB, the third group (F: 11; M: 13; mean age: 9.05 ± 0.39 years) of 24 patients was treated with O-o-G®. The structural effects of the three devices were compared with a control group generated by the growth variations reported in the cephalometric atlas of Bhatia and Leighton. Esthetic analysis was performed comparing the results of the patients treated with a control group of 20 subjects with mandibular retrognathia and Class II Division 1 malocclusion, not subjected to therapy. Results: The three devices resulted in a significant increase in mandibular length, with higher results obtained for FR-2 and TB. A statistically significant increase in the IMPA angle was found for the O-o-G® group, and a notable reduction of both overjet and overbite was detected in all three groups of treated patients. The esthetic evaluation showed overall more significant results in the TB group, especially with regard to the reduction of facial convexity. The retrusion of the upper lip was on average more significant in the O-o-G® group, followed by that in the TB. Conclusions: All three devices have proven to be effective overall in resolving skeletal changes and improving facial esthetics.

Bond Strength of Self-Adhesive Flowable Composites and Glass Ionomer Cements to Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies.

Background: Conventional composites are largely used in pediatric restorative dentistry and demonstrate successful clinical outcomes. However, the need for simplification of operative steps in young or uncooperative children demands reliable alternatives. Therefore, the aim of the present systematic review and meta-analysis was to evaluate the in vitro bond strength of glass ionomer cements (GICs) and self-adhesive flowable composites (SFCs) on deciduous teeth. Methods: A comprehensive literature search according to the PRISMA checklist was manually and electronically performed by two independent reviewers through the following databases: MEDLINE/PubMed, Google Scholar, Scopus, and Embase, to include in vitro studies comparing GICs and SFCs bond strength values of restorations on primary teeth. In addition, three groups of meta-analyses were conducted using random-effects models. Results: Three articles meeting the inclusion criteria were selected and subjected to both qualitative and quantitative assessment. No statistically significant difference was found between SFC versus GIC; however, both groups significantly differed with conventional flowable composites (CFs). Conclusions: Despite the absence of significant difference in bond strength values, SFCs may be considered a valid alternative to GICs in the restoration of deciduous teeth, although CFs proved better in vitro performances.

Treatments of sleep bruxism in children: A systematic review and meta-analysis.

Objective: Treatment of sleep bruxism (SB) in children is not well established. The aim of this study was to develop evidence-based recommendations on SB therapy in children between the ages of 2 and 17. Methods: A systematic review and meta-analysis was conducted. Literature searches were performed using MedLine (PubMed), Web of Science, Scopus, and the Cochrane Library (November 30 2017). Results: The search strategy identified 268 potential articles; 10 papers were included in the qualitative synthesis and 3 in the meta-analysis, for a total of 94 patients. Hydroxyzine therapy showed the strongest efficacy on SB (OR 10.63; CI 95%, 1.48 to 76.08). Flurazepam and Melissa officinalis therapies presented lower grades of association with decreased SB symptoms. Conclusions: Data on treatments of SB in children are limited. Future studies with a proper design, conducted on a meaningful number of patients, and based on standardized and developed diagnostic criteria are desperately needed.

The Role of the Pediatric Dentist in the Multidisciplinary Management of the Cleft Lip Palate Patient.

The focus of this paper is the pediatric dental care of Cleft Lip and Palate (CLP) children and the role of the pediatric dentist in the CLP team. The management of children with cleft lip and palate presents many challenges and a multidisciplinary and prepared team is always required. Affected individuals present a multiplicity of problems: effective management involves a wide range of specialities. The value of a multidisciplinary team is widely known and mentioned in the literature, but very few papers focus on the role and the importance of the pediatric dentist. Therefore, the purpose of this article is to underline the role of the pediatric dentist as a member of the cleft lip and palate team which ranges from prenatal counseling, presurgical prevention and orthopedics, to post-treatment rehabilitation and restoration.

Diode versus CO2 Laser Therapy in the Treatment of High Labial Frenulum Attachment: A Pilot Randomized, Double-Blinded Clinical Trial.

Background: The labial frenula are triangular plicas departing from the alveolar mucosa and attaching themselves at different heights of the gingiva. Sometimes a high attachment can determine a gingival recession. The most suitable surgical resolution is the use of laser devices. The aim of this study was to compare the labial frenulectomy through the use of Diode and CO2 laser techniques in pediatric patients with a high labial frenulum attachment, clarifying at the same time the preventive role of the surgical treatment to avoid further recession. Methods: A pilot randomized, double-blinded clinical trial was conducted to compare both the surgical advantages and the preventive treatment of laser technology using two different wavelengths within a population of pediatric patients with a high labial frenulum attachment. Different parameters intra and post-surgery were taken into account (Bleeding, Wound Healing, Gingival Recession, Periodontal pocket and Numerical Scale Value for pain) to compare Diode versus CO2 laser therapy. Results: Although both the laser devices provide a good performance in the post-operative period, the Diode laser shows better results (p < 0.001) in three of the five parameters evaluated. Conclusions: From the results it was found that the Diode Laser device is more suitable compared to the CO2 device.

New 3D Cone Beam CT Imaging Parameters to Assist the Dentist in Treating Patients with Osteogenesis Imperfecta.

(1) Background: The aim of the work is to identify some imaging parameters in osteogenesis imperfecta to assist the dentist in the diagnosis, planning, and orthodontic treatment of Osteogenesis Imperfecta (OI) using 3D cone beam Computed Tomography (CBCT) and the Double Energy X-ray Absorptiometry (DEXA) technique. (2) Methods: 14 patients (9 males and 5 females; aged mean ± SD 15 ± 1.5) with a clinical-radiological diagnosis of OI were analyzed and divided into mild and moderate to severe forms. The patients' samples were compared with a control group of 14 patients (8 males and 6 females; aged mean ± SD 15 ± 1.7), free from osteoporotic pathologies. (3) Results: The statistical analysis allowed us to collect four datasets: in the first dataset (C1 sick population vs. C1 healthy population), the t-test showed a p-value < 0.0001; in the second dataset (C2 sick population vs. C2 healthy population), the t-test showed a p-value < 0.0001; in the third dataset (parameter X of the sick population vs. parameter X of the healthy population), the t-test showed a p-value < 0.0001; in the fourth dataset the bone mineralometry (BMD) value detected by the DEXA technique compared to the C2 value of the OI affected population only) the Welch-Satterthwaite test showed a p-value < 0.0001. (4) Conclusions: The research has produced specific imaging parameters that assist the dentist in making diagnostic decisions in OI patients. This study shows that patients with OI have a characteristic chin-bearing symphysis, thinned, and narrowed towards the center, configuring it with a constant "hourglass" appearance, not reported so far in the literature by any author.

Difficult-to-treat OSAS: Combined continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) therapy. A case report.

Background: Obstructive sleep apnea syndrome and is characterized by recurrent episodes of partial or complete upper airway collapse during sleep with consequent oxygen desaturations and cardiovascular, neurological, and metabolic impairment. Clinical presentation: The authors report the case of a 66-year-old male presenting "metabolic syndrome" (obesity, impaired glucose tolerance, dyslipidemia, multi-drug treated arterial hypertension), atopy, mouth breathing due to turbinate hypertrophy, and pathological daytime sleepiness. As patient's compliance to standard continuous positive airway pressure (CPAP) therapy was poor, he was treated using low-pressure CPAP combined with a mandibular advancement device (MAD). Conclusion: In selected patients, a treatment combining CPAP and MAD might be a more tolerable alternative to CPAP alone. The improved pharyngeal patency, promoted by mandibular advancement and stretching of the pharyngeal muscles, allows operating the CPAP at lower pressures when the MAD alone is not sufficient to induce a safe sleep profile.

Prevalence of maxillary canine impaction in skeletal Class III malocclusions compared to Class I malocclusions.

BACKGROUND: The aim of the present investigation was to evaluate if an orthodontic population of Class III malocclusion patients shows a different prevalence of maxillary canine impaction than Class I subjects. MATERIAL AND METHODS: Fifty-eight subjects were retrospectively selected and assigned to the Class I group (n= 32) or the Class III group (n= 26), depending on the ANB and WITS values. Lateral cephalograms were used to collect angular and linear measurements that described the skeletal and dental maxillary features of the subjects, while orthopantomography was used to assess the impaction or the correct eruption of the maxillary canines. An independent samples T-test or a Mann-Whitney U-test was used to compare the cephalometric values between the two groups, while a chi-squared test was used to evaluate the distribution of maxillary canine impaction between the two groups. RESULTS: No statistically significant difference was found for the cephalometric variables, and the frequency of canine impaction showed no difference between the Class III and Class I subjects. CONCLUSIONS: Patients with skeletal Class III malocclusions did not show a different prevalence of canine impaction; therefore, such skeletal features cannot be used as a diagnostic aid for assessment of the risk of maxillary canine impaction. Key words:Skeletal Class III, Angle Class III, maxillary canine impaction, tooth impaction.