Hypnotic approach during dental treatment: analysis of descriptive data of a case series.

Anxiety and worry are important components that affect the patient’s behaviour during dental sessions and influence the effectiveness of dental treatment. Psychological approach and hypnotic approach (HA) have in recent years assumed increasing prominence as effective treatment regimes. Dentists have used a number of methods in the management of dental phobic disorders through HA. However the efficacy of HA in controlling anxiety and worry is controversial. The aim of the present study is to describe the response of patient to HA during dental treatment. The study of the population consisted of 42 patients, these being 50% random sample of consecutive patients presenting to a private practise over an 8-year period. In 38 patients HA was induced. 4 patients were not susceptible to HA. There were 20 women (52.6%) and 18 men (47.3%) with a mean age of 47.2 years (range 30-69 years). At the end of dental sessions with HA all the patients were asked to answer the following questions: 1) Have you been hypnotized in the past? 2) Were you aware of dental applications of HA? 3) How do you evaluate the use of this technique in the field of dental care? 4) Do you think that you can use this procedure in the future too? The answers were as follows: question 1: 34 patients answered yes, 4 no; question 2: 34 answered yes, 4 no; question 3: the choice was between “very useful”, “useful”, “Indifferent”, “to avoid”. Twenty-nine patients indicated “very useful”, and 9 “useful”; question 4: the choice was between yes and no. All patients answered yes. This study adds further support to a growing body of evidence relating HA to a better compliance to dental treatment. The dental situation in particular lends itself to carefully controlled investigation providing further evidence to support a robust theory.

FDPS finish line design and tooth preparation technique.

The purpose of this research is to perform and verify the “modified 50° preparation” suggested by the authors. This procedure was performed with a scrupulous standardization of the tooth’s preparation and then of the laboratory techniques to produce a metal-ceramic crown, and the same for the crown cementation technique of on the preparation of the original sample. After the esthetic evaluations, the obtained sample was included in EPON resin and sectioned in the lingual-vestibular sense. The sections were then observed with an optical microscope in different magnifications for the final evaluations. The geometric design proposed presents the advantages of two great preparation techniques: 50° preparation and circumferential shoulder. The 50° bevel designed in first phase of preparation and the second phase of the circumferential 27° shoulder, together allowed to satisfy the following requirements: aesthetic, marginal accuracy, periodontal compliance, conservation and stability. However, this type of prosthetic preparation is not the only one, but it is one of the marginal designs in prosthetic dentistry.

Different signals induce mast cell inflammatory activity: inhibitory effect of Vitamin E.

Vitamin supplementation in disease reduces morbidity and mortality in humans by promoting the activation of different genes which influence several pathways. The purpose of this article is to clarify the role of vitamin E in mast cell inflammation. Vitamin E is a fat soluble antioxidant which protects from low-density lipoprotein (LDL) oxidation. Vitamin E promotes a barrier function and anti-inflammatory responses by binding the regulatory domain of protein kinase Cα (pkcα) (a regulator and antagonist of heart failure) and decreases the activation of NF-қb, a proinflammatory transcription factor, causing the generation of cytokines/chemokines and mast cell activation. Mast cells participate in innate and acquired immunity and inflammation. Several factors, including cytokines and chemokines, regulate the development and migration of activated mast cells. Mast cells generate and release inflammatory compounds in asthma and allergic diseases and have a detrimental effect on the vessel wall, which can be inhibited by vitamin E. Vitamin E inhibits histamine release generated in activated mast cells, increases calcium Ca2+ uptake and prevents the oxidation of unsaturated fatty acids. Vitamin E is relatively non-toxic, however, administered at very high doses may suppress normal hematological response as well as causing other adverse effects. Therefore, vitamin E may be beneficial in the prevention of diseases mediated by mast cells and can have special value in the treatment of asthma and allergic diseases; however, the exact mechanism by which vitamin E acts is still unclear, thus warranting future research.

Prevalence of HIV-related oral manifestations and their association with HAART and CD4+ T cell count: a review.

HIV infection is one of the major health problem of the last decades. This disease causes a chronic infection that can lead to acquired immunodeficiency syndrome (AIDS). According to the Global AIDS update, released in 2016 by HIV department of World Health Organization (WHO) and by the Joint United Nations Program on HIV/AIDS (UNAIDS), at the end of 2015, 36.7 million people were infected by HIV: 34.9 million of these were adults and 1.8 million were children under 15 years of age. The same report shows that during 2015, 2.1 million of new infection cases have occurred all over the world and about 1.1 million people have died for HIV. The aim of this short review is to up-date of the main HIV-related oral manifestations and their correlation with HAART (Highly Active Antiretroviral Therapy) and CD4+ T-cell count. Despite that more than 20 years have elapsed, this classification still remains valid: even today, group 1 lesions are found in the majority of HIV-positive patients with oral manifestations. Group 1 includes the following conditions: oral candidiasis (pseudomembranous candidiasis, erythematous candidiasis, angle cheilitis), oral hairy leukoplakia, periodontal diseases (necrotizing gingivitis, necrotizing periodontitis, linear gingival erythema), Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. Melanotic hyperpigmentation, HSV infection and HPV infection, which are included in group 2, are also common. Oral candidiasis, oral hairy leukoplakia, Kaposi’s sarcoma and HSV infection are the lesions that have seen the major drop in their incidence after the HAART introduction. The increase in CD4+ T-cell count is not significantly correlated to the decrease of every type of oral lesions, but it is statistically significant only in relation to oral candidiasis (p-value less than 0.001). Oral lesions are an important sign of immunodepression and with the introduction of HAART their incidence has strongly decreased, particularly in urban areas. Nevertheless, developing countries still have a high prevalence of these manifestations because of the persistence of many risk factors, like the difficulty to access treatment, poor oral hygiene, low socioeconomic status and late diagnosis.

Hyperbaric oxygen therapy (HBOT) and peridontal health.

This study has tested the effects of hyperbaric oxygen in periodontal structures in agreement with the theories supported by literature research. Eight patients, from 30 to 50 years-of-age, were tested with pure oxygen inhalation, at the 2.5 ATA absolute pressure. Main approved tests of periodontal health were evaluated before and after HBOT’s cycles. The results in all patients treated with HBOT, have founded clear improvement of clinical and instrumental parameters.

Clinical applications of Natural Bone Morphoproteins in dentistry: a narrative review.

The need to restore bone loss in maxilla and mandible has led to find natural bone substitutes, such as fresh autogenous bone grafts. Fresh autogenous bone grafts (FABGs) have a remarkable capacity to induce new bone formation, a phenomenon called ‘osteoinduction.’ FABGs are useful in craniomaxillofacial and oral applications to restore bone deficiencies. The isolation of those proteins believed to be responsible for the osteoinductive activity of FABGs, namely Natural Bone Morphogenetic Proteins (NBMPs), led to a new era in bone regeneration. NBMPs have been approved for use in specific oral and maxillofacial applications. Clinical trials and studies of oral and craniofacial surgery have indicated that NBMPs can promote bone repair. Information about the biology, chemistry, and actions of NBMPs has called into question whether NBMPs would result in clinically useful bone induction and morphogenesis. Preclinical and specific clinical trials have indicated the efficacy of NBMPs either combined with autograft or compared with an autograft alone. In light of questions about potency and safety of NBMPs, however, additional high-level evidence is needed for specific clinical indications and appropriate patient populations that would benefit from their use.

Peri-implant test is a proposal of a new procedure to prevent peri-implantitis and forensic claims.

Implant dentistry has become one of the most successful techniques for oral rehabilitation over the last 20 years. The success rate of implant oral rehabilitation is above 80% while peri-implant disease (PID) is the most important complication of implant dentistry. The main cause of PID is considered bacterial leakage at the implant-abutment connection of a two-piece implant system. Prevention and control of bacterial leakage at the implant-abutment connection is mandatory for reducing inflammation process around implants neck and achieving bone stability. Since bacteria leakage at implant-abutment connection level is the main cause of PID, a microbiological test should be important to identify bacteria that cause PID. According with the conclusion of workshop of the European Federation on Periodontology, a test that detects the most frequent bacterial species involved in the onset of PID (Actinobacillus actinomycetecomitans, Porphyromonas gengivalis, Tannnerella forsythia, Treponema denticola) should be used in clinical practice. In fact, PID progression depends on the typology, quantity and composition of bacterial flora in peri-implant pockets, so controlling PID onset and progression, is a keystone for preventing implant failures and consequently forensic conflicts. The effort to prevent PID and consequently assurance or forensic conflicts have become one of the main focal points of all dental professionals. Behind these efforts lie, above all, ethical but also economic reasons, as well as a desire to prevent PID, improving implant care quality and increasing the legal security of health care professionals themselves. Since the legal decisions in our society influence how we practice dentistry, especially in the fast-evolving field of implant dentistry, using diagnostic tools that will allow dentists to demonstrate that they have acted correctly in accordance with the knowledge of modern medicine, it is of great importance to defend themselves in the case of legal-legal disputes.

Mechanical, chemical and biological aspects of titanium and titanium alloys in implant dentistry.

Implant dentistry has become a popular restorative option in clinical practice. Titanium and titanium alloys are the gold standard for endo-osseus dental implants production, thanks to their biocompatibility, resistance to corrosion and mechanical properties. The characteristics of the titanium implant surface seem to be particularly relevant in the early phase of osseointegration. Furthermore, the microstructure of implant surface can largely influence the bone remodelling at the level of the bone-implant surface. Recently, research has stated on the long-term of both survival and success rates of osseointegrated implants and mainly on biomechanical aspects, such as load distribution and biochemical and histological processes at the bone-implant interface. This short review reports recent knowledge on chemical and mechanical properties, biological aspects, innovations in preventing peri-implantitis, describing clinical applications and recent improvements of titanium dental implants. In addition, it highlights current knowledge about a new implant coating that has been demonstrated to reduce the number of initially adhering bacteria and peri-implantitis.

Radiosurgery-assisted gingival displacement: a proof of concept technique to enhance the efficiency of intraoral digital impression.

Nowadays, an increasing number of dentists are using intraoral scanners (IOS) in their daily practice as an alternative to conventional impression taking. One of the main concerns is related to the capability of scanning the subgingival anatomy of the die, usually very challenging due to the limited operative field and the presence of oral fluids. The radiosurgery assisted gingival displacement technique (RAGD) may enhance the intraoral optical scanning of the finish line and neighbor tooth anatomy. The contour of the interim prosthesis is used to drive the tip of radiosurgery electrode along the tooth surface and open selectively the gingival crevice with a prosthetically-driven and minimally invasive approach. The clinical implication of this technique is related to increasing the efficiency and accuracy of the digital impression technique in the critical zone of the prosthetic shoulder.

The role of zinc plus octenidine in the regulation of gene expression: an in vitro study.

Zinc was known in ancient times, and is diffused in the environment. The potential benefits offered by zinc supplementary therapy have been demonstrated in numerous clinical trials using oral or topical zinc products. The benefit of zinc can be in principle increased through association with other actives. The aim of this study is to evaluate the effect on primary human gingival fibroblast cell of a new formulation containing zinc and octenidine cations. Human gingival fibroblast cells were obtained from three healthy patients (14-year-old man, 15-year-old woman and 20-year-old man) during extraction of teeth. The gene expression of 14 genes (ELANE, FN1, FBN, ITGA1, HAS1, ELN, DSP, ITGB1, HYAL1,TGFB1, TGFB2, TGFB3, TGFBR1 and TGFBR2) was investigated in HGF cell culture treated with 80µm of Octenidine, 1000µm of Zinc, 80µm Octenidine + Zinc solution and the medium alone at 30 min. Prestoblue™ data showed that as the active concentration increases (Octenidine, Zinc and Octenidine + Zinc) the percentage of cell vitality compared to that of untreated cells decrease. In this study, no statistically significant gene expression was observed between cells, treated with difference substances, and control cells. Our results points out that zinc plus octenidine shows a positive potential in periodontal disease treatment.

Zinc plus octenidine: a new formulation for treating periodontal pathogens. A single blind study.

Periodontal treatment has the aim to reduce oral infection, and prevent the progression of the disease. The potential benefits of new chemical devices for periodontal therapy, include improved patient compliance, an easier access to periodontal pocket and a lower dosage of antimicrobial agent. The objective of this study was to explore the efficacy of a chemical device containing zinc and octenidine in the treatment of chronic periodontitis in adult patients. Ten patients with a diagnosis of chronic periodontitis (20 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The chemical device zinc plus octenedine was used by each patient after daily oral hygiene. Microbial analysis were analyzed at baseline and on the 15th day. After the treatment, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the study group. Specifically T. Forsythia and T. Denticola were eradicated whereas Total Bacteria Loading and Fusobacterium Nucleatum showed a reduction of 38% and 55%, respectively. Our study demonstrated the efficacy of the new chemical device containing zinc and octenidine in a sustained release drug delivery system in the management of moderate to severe chronic periodontitis.

Stimulated mast cells release inflammatory cytokines: potential suppression and therapeutical aspects.

Mast cells (MCs) are derived from bone marrow precursors and are immune cells involved in acute and chronic inflammation. MCs are ubiquitous and play a crucial role in innate and acquired immunity. They are activated through cross-linking of their surface high affinity receptors (FcεRI), leading to immediate secretion of stored inflammatory mediators, and late production and release of pro-inflammatory cytokines/chemokines without degranulation. Therefore, MCs are important in inflammatory responses. Members of the interleukin (IL)-1 cytokine family, such as IL-1 and IL-33, and various antigens markedly increase IL-1 and tumor necrosis factor (TNF) expression and secretion from MCs. One of the latest cytokines is IL-33, an IL-1 family member acting via its ST2/IL-1R4, which has been shown to regulate MCs. IL-1 and IL-33 are cytokines found to be implicated in many inflammatory disorders including rheumatoid arthritis, atherosclerosis and psoriasis. In general, IL-1 family member cytokines play a pro-inflammatory role and increase the pathological state. IL-37 is a member of the IL-1 family with anti-inflammatory activity through inhibition of pro-inflammatory cytokines. IL-37 particularly suppresses IL-1-mediated innate inflammatory response, but also acts on the acquired immune response. IL-37 is activated by pro-inflammatory agents and cytokines, playing a protective role against inflammation. This cytokine is a natural regulator of immunity and is a therapeutic promise against inflammatory diseases. Since IL-1 is produced by and activates MCs to release IL-33 and TNF, here we hypothesize that MCs can be inhibited by IL-37 and therefore reduce their pro-inflammatory activity. However, the maturation, transport and secretion of IL-37 remain to be clarified.

Low-grade chronic inflammation mediated by mast cells in fibromyalgia: role of IL-37.

It has been observed that acute stress causes the activation of TH1 cells, while TH2 cells regulate and act on chronic inflammation. Fibromyalgia (FM) is a chronic, idiopathic disorder which affects about twelve million people in the United States. FM is characterized by chronic widespread pain, fatigue, aching, joint stiffness, depression, cognitive dysfunction and non-restorative sleep. The mechanism of induction of muscle pain and inflammation is not yet clear. In FM there is an increase in reactivity of central neurons with increased sensitivity localized mainly in the CNS. Mast cells are involved in FM by releasing proinflammatory cytokines, chemokines, chemical mediators, and PGD2. TNF is a cytokine generated by MCs and its level is higher in FM. The inhibition of pro-inflammatory IL-1 family members and TNF by IL-37 in FM could have a therapeutic effect. Here, we report for the first time the relationship between MCs, inflammatory cytokines and the new anti-inflammatory cytokine IL-37 in FM.

New concepts in neuroinflammation: mast cells pro-inflammatory and anti-inflammatory cytokine mediators.

The activation of brain nociceptors and neurons may lead to neurogenic inflammation, an event that involves immune cells including mast cells (MCs). Microglia are similar to macrophages and secrete pro-inflammatory IL-1 family members and TNF. TNF is rapidly released (first 10 minutes from MC granules) and is subsequently secreted along with other pro-inflammatory cytokines with a new synthesis after several hours. MC-derived TNF is a very powerful pro-inflammatory cytokine which mediates sensitization of the meningeal nociceptors. Here, we report the involvement of MCs in neuroinflammation, the role of inflammatory cytokine IL-1 family members, and of TNF, as well as the potential inhibition of IL-37.

IL-33 mediates allergy through mast cell activation: Potential inhibitory effect of certain cytokines.

Mast cells (MCs) are hematopoietic immune cells commonly found in adjacent to blood vessels in the lamina propria of airway mucosa. They are important in allergic reactions since the cross-linking of their surface high affinity receptor FceRI induces activation of these cells, and provokes the synthesis, degranulation and release of inflammatory mediators including arachidonic acid-derived eicosanoids (de novo synthesized), stored enzyme mediators, and inflammatory TH1 and TH2 cytokines, and chemokines. Interleukin (IL)-33 participates in innate and adaptive immunity and inflammation and, acting on CD34+ cells, causes MC differentiation and maturation. IL-33 is generated by activated immune cells, and activates MCs which degranulate and release pro-inflammatory mediators. IL-33 is very important in mediating allergic inflammation and can be induced by IL-1 beta. It is also called "alarmin" and is an inflammatory cytokine IL-1 family member, expressed from mocytes and MCs, which binds its receptor ST2, provoking its release after cell damage. MC-derived allergic compounds in response to IL-33 is critical to innate type 2 immunity. IL-37 is expressed by immune and non-immune cells after pro-inflammatory stimulus. IL-37, an anti-inflammatory cytokine, binds IL-18Ra and suppresses pro-inflammatory IL-1 beta released by activated immune cells such as macrophages. Here, we hypothesize that pro-inflammatory IL-1 family member cytokines released by activated MCs, mediating inflammatory allergic phenomenon, can be suppressed by IL-37.

Colonization of Legionella spp. In dental unit waterlines.

Legionella spp. are ubiquitous in aquatic habitats and water distribution systems, including dental unit waterlines. Surveys have shown that the percentage of samples taken at different dental sites that were positive for Legionella spp. were highly variable and ranged from 0% to 100%. Cultivation is the principal approach to evaluating bacterial contamination employed in the past, but applying this approach to testing for Legionella spp. may result in false-negative data or underestimated bacterial counts. PCR and direct fluorescent counts can detect viable non-cultivable bacteria, which are not counted by plating procedures. Legionella spp., commonly form such viable non-culturable cells and it is likely that they contribute to the difference between plate count results and those of PCR and fluorescent-antibody detection. However, studies have shown that Legionella is present in the municipal water source in spite of the current filtration and chlorination procedures. Once Legionella reaches the building water system, it settles down into a biofilm layer of stagnant water. By means of this layer, Legionella can protect itself from antimicrobial agents and then multiply. Dental unit waterlines may be contaminated with opportunistic bacteria. The water quality in the dental units should be controlled to eliminate opportunistic pathogens and to provide water for dental treatment that meets public health standards for potable water.

Focus on periodontal disease and development of endocarditis.

Infective endocarditis is a devastating disease with high morbidity and mortality. The link to oral bacteria has been known for many decades and has caused ongoing concern for dentists, patients and cardiologists. The microbiota of the mouth is extremely diverse and more than 700 bacterial species have been detected. Half of them are uncultivable so far. Oral microbiota is not uniform, specific sites exist in the mouth such as tongue, palate, cheek, teeth and periodontal pockets that have their own microbiota. Factors involved in the development of a bacterial endocarditis are difficult to define but a vulnerable surface (i.e. a damaged endocardium) and a high bacterial load in the blood seems to be decisive. The cause of microorganisms, in 90% of cases, are staphylococcus, streptococcus and enterococcus. Oral streptococci belong to viridans group (streptococcus mutans and streptococcus sanguis). As they are part of dental plaque, they could enter the bloodstream causing bacteraemia through daily habits like chewing or tooth brushing. Effective treatment of periodontal infections is important to reduce local inflammation and bacteraemia. In addition, poor periodontal health appears to increase the risk of cardiovascular disease, pulmonary disease, and preterm and low birth weight. CONCLUSIONS: Long-standing oral disease prevention protocols reduce the risk of developing periodontal disease. Data suggests that methods used to prevent cases of IE that originate from oral bacteria should focus on improving oral hygiene and reducing or eliminating gingivitis, which should reduce the incidence of bacteraemia after tooth-brushing and the need to extract teeth owing to periodontal disease and caries.

ADULT syndrome: dental features of a very rare condition.

The Acro-Dermato-Ungual-Lacrimal-Tooth syndrome (ADULT syndrome) is one of the rarest ectodermal dysplasias and it is associated with several malformations involving especially the limbs. The most clinical features are the presence of ectrodactyly, syndactyly, hypermelanosis or multiple lentigines, onhycodysplasia, abnormalities in the lacrimal duct, recurrent conjuntivitis, photophobia, mammarian hypoplasia, hypotrichosis and frontal alopecia, hypohydrosis, cutaneous photosensitivity, nasal bridge prominence, exfoliative dermatitis and xerosis. The ectodermal dysfunction expresses itself with conoid teeth, enamel hypoplasia, dentinal dysplasia and especially hypodontia, with following functional and aesthetic defects. We report the case of an 11-year-old Caucasian girl affected by ADULT syndrome.

Human ß2-defensin in oral lichen planus expresses the degree of inflammation.

Syndrome (BMS). Seventeen OLP patients, with a positive histopathologic diagnosis of the disease, were recruited into this study in order to measure the relative quantity of HBD-2 in their saliva and crevicular fluid. The values were compared with those collected from a group of 9 patients affected by the Burning Mouth Syndrome (BMS) and with a control group (CTRL) of 9 patients. There was no statistically significant difference between the groups (p=0.523; p=0.897). However, patients affected by OLP showed a dycotomic distribution of values: while 10 of them showed similar values to those found out in the other two groups, 7 patients expressed high levels of HBD-2 and 3500 pg/ml was the threshold to distinguish the subgroups. During the dental visit the clinician classified OLP patients into two groups according to the clinical presentation of the disease: reticular and hyperplastic (white OLP), atrophic and erosive forms (red OLP). There was a statistical significant correlation between the clinical and numeric classification of the patients (p=0.004; p=0.001), and the expression of HBD-2 was higher in the red OLP group than in the white OLP group (p=0.000; p=0.000). In conclusion, this study shows that HBD-2 represents an index to assess active inflammation and it is probably linked to the presence of the typical band-like CD8+ infiltrate in Oral Lichen Planus.

The “elfin face”: craniofacial and dental aspects of the Williams-Beuren syndrome.

Williams Syndrome is a rare congenital disorder characterized by supravalvular aortic stenosis, peripheral pulmonary artery stenosis, mental retard and dysmorfic facial features. As regards the dental aspects of the syndrome, the deletion of the elastin gene induced clinicians to suspect periodontal alterations with a greater frequency of gingivo-periodontitis, but on the contrary no association between the syndrome and periodontal diseases have been found. Furthermore, patients show a higher frequency of teeth hypoplasia, an abnormal tooth morphology during primary dentition (12.5%) and during permanent dentition. We present a case report of a 12-year-old Caucasian boy affected by Williams-Beuren Syndrome who visited our hospital for a dental and orthodontic evaluation.