Dental care protocol based on visual supports for children with autism spectrum disorders.

BACKGROUND: Subjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments. MATERIAL AND METHODS: 83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in order to undergo: an oral examination (stage 1), a professional oral hygiene session (stage 2), sealants (stage 3), and, if necessary, a restorative treatment (stage 4). Each stage came after a visual training, performed by a psychologist (stage 1) and by parents at home (stages 2, 3 and 4). Association between acceptance rates at each stage and gender, intellectual level, verbal fluency and cooperation grade was tested with chi-square test if appropriate. RESULTS: Seventy-seven (92.8%) subjects overcame both stage 1 and 2. Six (7.2%) refused stage 3 and among the 44 subjects who need restorative treatments, only three refused it. The acceptance rate at each stage was statistically significant associated to the verbal fluency (p=0.02; p=0.04; p=0.01, respectively for stage 1, 3 and 4). In stage 2 all subjects accepted to move to the next stage. The verbal/intellectual/cooperation dummy variable was statistically associated to the acceptance rate (p<0.01). CONCLUSIONS: The use of visual supports has shown to be able to facilitate children with ASDs to undergo dental treatments even in non-verbal children with a low intellectual level, underlining that behavioural approach should be used as the first strategy to treat patients with ASDs in dental setting.

Effect of a toothpaste containing triclosan, cetylpyridinium chloride, and essential oils on gingival status in schoolchildren: a randomized clinical pilot study.

OBJECTIVE: This randomized double-blind in vivo pilot study has evaluated the effects of a toothpaste containing fluoride (control) versus toothpaste containing fluoride, triclosan, cetylpyridinium chloride and essential oils (experimental) in controlling supragingival dental plaque and bleeding on probing in a sample of healthy schoolchildren. METHOD AND MATERIALS: In total, 48 children (8 to 10 years) were selected and randomly divided into two groups (experimental and control), using the two different toothpastes twice a day for 2 minutes each for a 4-week period. The investigation included an evaluation of plaque quantity, using the Turesky modified Quigley-Hein method, and bleeding on probing that was recorded dichotomously. The unit of analysis was set at the gingival site level. Plaque Index and bleeding on probing were analyzed using distribution tables and chi-square test. A generalized estimating equation was used to estimate the parameters of a generalized linear model with a possible unknown correlation between outcomes. RESULTS: In total, 40 schoolchildren completed the trial. Considering each group separately, a statistically significant difference in plaque scores was recorded for both treatments (z-test = 9.23, P < .01 for the experimental toothpaste; and z-test = 7.47, P < .01 for the control toothpaste). Nevertheless, the effect over time was higher for the experimental toothpaste than for the control one (3.38 vs 1.96). No statistically significant results were observed regarding bleeding on probing. CONCLUSION: The 4-week use of the experimental toothpaste seems to produce higher plaque reduction compared to fluoridated toothpaste without other antibacterial ingredients. This finding has to be confirmed in a larger study.

Vertical brushing versus horizontal brushing: a randomized split-mouth clinical trial.

OBJECTIVE: The aim of this randomized, single-blind, splitmouth design, clinical trial was to evaluate the effectiveness in plaque removal of two brushing methods, the vertical and the horizontal, in a sample of healthy young adults. METHOD AND MATERIALS: Forty-nine subjects were enrolled and 43 completed the study. All subjects abstained from oral hygiene practices for 48 hours. Plaque and gingival abrasions were recorded according to the Rustogi Modified Navy Plaque Index (RMNPI) and the van der Weijden method by one calibrated examiner before and immediately after the brushing session. A dental hygienist performed the two brushing methods using a randomized split-mouth design. The average plaque scores from the whole mouth, interproximal surfaces, and gingival margin were obtained before and after brushing, and the differences were evaluated using one-way analysis of variance. RESULTS: The differences in mean plaque scores between pre- and postbrushing were statistically significant for both methods. Considering the interbrushing differences, the vertical method produced lower plaque scores compared to the horizontal for the whole mouth (P=.02). In the interproximal surfaces, the vertical method removed more plaque compared to the horizontal one (P<.01). In the gingival margin no statistically significant differences in plaque scores were recorded. Only 10 gingival abrasions were registered, mainly produced by the horizontal method. CONCLUSION: RESULTS suggest that both toothbrushing methods are effective in plaque removal; nevertheless, the vertical brushing method has demonstrated to remove more plaque from the interproximal surfaces than the horizontal method.

The use of probiotic strains in caries prevention: a systematic review.

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the "Consolidated Standards of Reporting Trials" (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

An Innovative Approach to Treat Incisors Hypomineralization (MIH): A Combined Use of Casein Phosphopeptide-Amorphous Calcium Phosphate and Hydrogen Peroxide-A Case Report.

Molar Incisor Hypomineralization (MIH) is characterized by a developmentally derived deficiency in mineral enamel. Affected teeth present demarcated enamel opacities, ranging from white to brown; also hypoplasia can be associated. Patient frequently claims aesthetic discomfort if anterior teeth are involved. This problem leads patients to request a bleaching treatment to improve aestheticconditions.Nevertheless, hydrogen peroxide can produce serious side-effects, resulting from further mineral loss. Microabrasion and/or a composite restoration are the treatments of choice in teeth with mild/moderate MIH, but they also need enamel loss. Recently, a new remineralizing agent based on Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) has been proposed to be effective in hypomineralized enamel, improving also aesthetic conditions. The present paper presents a case report of a young man with white opacities on incisors treated with a combined use of CPP-ACP mousse and hydrogen peroxide gel to correct the aesthetic defect. The patient was instructed to use CPP-ACP for two hours per day for three months in order to obtain enamel remineralization followed by a combined use of CPP-ACP and bleaching agent for further two months. At the end of this five-month treatment, a noticeable aesthetic improvement of the opacities was observed.