WHO: healthy diet to prevent chronic diseases and caries.

For some years now, the WHO has recommended less than 10% of energy intake from free sugars. The same document also stresses the need to bring this limit below 5% as soon as possible. These guidelines have been promoted with the aim of reducing the prevalence of chronic non-communicable diseases such as diabetes, cardiovascular disease, obesity and metabolic syndrome. At the same time, the reduction of free sugars in the diet can be part of a strategy to reduce the prevalence of caries, which is known to be an infectious and transmissible multifactorial disease known to be "triggered" by wrong dietary habits. For this reason, paediatricians and paediatric dentists should combine their efforts to promote good eating habits from an early age and perhaps even earlier! In fact, we should teach future mothers and their children to prefer slowly absorbed sugars and drastically reduce the intake of free sugars with the diet. As soon as the child is able to chew, the diet should include fibre-rich foods, and water should be preferred over any sweetened drink. Raising children with a healthy and balanced diet means investing in his or her long-term general health and offer a dental future free of caries!

Molar Incisor Hypomineralization: paediatricians should be involved as well!

Tooth structure anomalies affect the deciduous or permanent dentition with varying degrees of severity, depending on the odontogenesis phase in which the disturbance factor occurs. Some forms are clearly increasing and becoming of common clinical observation, as is the case of MIH (Molar Incisor Hypomineralization) whose prevalence ranges from 3 to 25%. However, often stucture anomalies are still under-diagnosed. Early diagnosis should be within the reach of all clinicians (both dentist and non-dentist), and is essential for improving the treatment outcome and quality of life of affected patients. The objectives of treatment consist in the resolution of the symptoms and in the aesthetic, morphological and functional restoration of the affected teeth, which can be achieved with a multidisciplinary approach. Therefore, in order to prevent damage to the teeth with structure anomalies, early visits and close follow-ups are necessary. In children the first dental visit is recommended at the age of 3-4 years, however in the presence of important dental abnormalities of the deciduos dentition, the paediatrician or the parents should request a visit even at a younger age. Because of the sensitivity that is often associated with these disorders, in fact, daily tooth brushing is often inadequate. It is therefore important to inform the parents and instruct them to intervene in order to maintain proper oral hygiene. Finally, special attention should also be paid to the diet, which should not be cariogenic and exclude foods and drinks with acidic pH. Perhaps it would be appropriate to share this information with the paediatricians and general practitioners we collaborate with: I am sure that a better knowledge of this dental condition will translate into an even earlier diagnosis and improved treatment outcomes for our (and their) patients! What are your thoughts about it?

Child abuse: Awareness is the first step to action.

Most of the physical injuries that children are subjected to affect the head and neck region; approximately 50% of injuries due to child abuse occur in the orofacial region and almost 15% of these injuries are confined to the head region (Cairns A.M.). For this reason, the dental team has a key role in identifying and detecting child abuse. In addition, having paediatric dentists an ongoing relationship with their young patients and families give them the opportunity to observe and assess not only the physical and psychological condition of the children, but also the family environment (the majority of abuse cases toward children are from the caregiver or the parents). These types of lesions could be confused with occasional children traumatic injuries, and this is why dentist should be trained to detect the signs of child abuse, as well be informed on how these cases should be reported to authorities. In a recent research about child abuse in the United Arab Emirates-UAE (H. Al Hajeri et al. Assessment of the knowledge of United Arab Emirates dentists of child maltreatment, protection and safeguarding) more than half of the respondents (54.6%) were not aware of such guidelines/procedures. According to the authors, the main factors affecting the decision of reporting were the lack of knowledge on the appropriate reporting procedure (60%), and the fear of family retaliation toward the child (59%). The Arab colleagues rightly concluded: "diagnosis is a shared responsibility of the child protection team and no matter what obstacles and fears the dentist may have; the main priority is the child". More efforts should be made to improve knowledge, attitude and practice of dentists in this social problem in order to decrease child abuse worldwide.

Dental Sealants. Part 1: Prevention First.

BACKGROUND: Tooth decay is still one of the most common chronic childhood diseases in the world, even if during the last five decades measures to combat dental caries have been developed, tested and applied in many populations. Preventive care and education programmes are essential to keeping children's mouths healthy. Within the prevention methods, dental sealants play an important role in preventing the onset and the development of dental cavities.

Dental Sealants Part 4: Bisphenol A: What dentists should know.

BACKGROUND: Bisphenol A (BPA) is a synthetic chemical resin used worldwide to produce plastic products. It is also a component of the bisphenol A diglycidylether methacrylate (Bis-GMA), which is a monomer found in dental resin-based materials (including resin-based dental sealants, RBSs). The controversy about its possible toxicity begins around the early '30s. Even if the amount of BPA released by dental sealants is well below the limit proposed by the U.S. Environmental Protection Agency and the European Food Safety Authority, we can reduce the risk of exposure, particularly for children, following precautionary measures.

Pain and anxiety associated with Computer-Controlled Local Anaesthesia: systematic review and meta-analysis of cross-over studies.

AIM: This review focuses on Computer-Controlled Local Anaesthesia Delivery systems (CCLAD), in comparison with conventional carpule anaesthesia in means of pain and anxiety. METHODS: Medline, Embase, Web of Science and Cochrane Database for Systematic Reviews were searched up to August 2018. Only cross-over split-mouth design studies aimed to clinically compare CCLAD with a conventional carpule anaesthesia are included. Data about pain and anxiety associated with anaesthesia were sought. The authors performed meta-analysis where appropriate. RESULTS: A total of 20 studies are included in the systematic review (n = 973 subjects). Quantitative synthesis (conducted on VAS scores from 8 studies) shows that pain intensity is over 9 points lower in CCLAD than in conventional anaesthesia on a scale from 0 to 100 (95% confidence interval, ?12.90 to ?5,53; P<.001). The systematic review showed no differences between the two techniques according to the physiological parameters of pain (heart rate or blood pressure), and the data about anxiety are inconsistent. CONCLUSION: CCLAD results in significantly slightly less pain perception with respect to conventional injection and is a promising device to help patients. The literature needs to be expanded, mostly regarding anxiety.

Caring for baby's teeth starts before birth.

Care for a child's teeth and gums can start even before the baby is born. Pregnancy causes many hormonal changes, among these the rise of estrogen and progesterone increases the risk of developing oral health problems, like gingivitis and periodontitis.The presence of maternal periodontal diseases and active infections has been associated with adverse pregnancy outcomes, such as preterm birth, preeclampsia, gestational diabetes and foetal loss. Therefore, it is important to educate pregnant women about their oral hygiene and the importance of taking care of their newborn's oral health. J. Courtad and A. Horowitz devised six steps to help us in promoting oral health (ADA Convention- 2016 Denver): 1. Asking right questions such as "Has there been any change in your health history since your last visit?" and "When did you brush your teeth last?" is recommended in order to find out wether your patient is pregnant and to get to know her dental care better. 2. Know your audience: Mothers are increasingly informed about childbearing, however not every piece of information is correct! Let them know what they are doing well and do not sound like you are preaching to them. 3. Use informal language. 4. Emphasize the need to get dental treatments and to prevent decay: Parents can pass bacteria to their newborns, therefore we want mothers to have a healthy mouth before they give birth! 5. Mom and dad as first dentists: Teach parents about nutrition and when and how to clean their children's mouth. 6. Listen to patients and confirm what they heard: Ask the patient to tell you what she is going to do at home and confirm. As pregnant women are more receptive to oral health information than in any other moment in their life, our aim is to take this opportunity by providing good prevention information and instilling healthy habits as early as possible.

Staying true to our values.

With the JCR published last summer, the IF of the EJPD reached 0.683! This is the highest value that the journal has ever reached and it shows a clear progression compared to the 2015 value of 0.421. This event, occurred shortly after the death of professor Giuliano Falcolini, led me to reflect and read again his editorial published in the issue N.3, 2011 of the EJPD. In that editorial professor Falcolini communicated with joy and enthusiasm ( ... we were honoured and thrilled to see our European Journal of Paediatric Dentistry included in the list ...) to the whole dental scientific world that the journal had been awarded the IF (the editorial can be read in full at http://www.ejpd.eu/bibliografia_detail. asp? id=399). I believe that reading again what he wrote at the time is the best way to remember him and to be aware of the solid foundations that professor Falcolini has laid in order to succeed both as journal and scientific society. The enthusiasm, joy, and desire to do well, together with the rigorous scientific competence with which professor Falcolini led the EJPD in those years are the same values that the whole SIOI group will continue to follow in order to reach new and higher goals.

Dental caries, parents educational level, family income and dental service attendance among children in Italy.

AIM: The aim of this study was to verify whether socioeconomic determinants, such as parents' educational level, family income and dental service attendance by children, are associated with the presence of caries among an Italian population of children. MATERIALS AND METHODS: An observational retrospective study was carried out in a population of children aged 4-14 years who visited the Paediatric Dentistry Department of the University of Perugia, Italy. Children were stratified according to familial socioeconomic level (father's and mother's educational level, family income) and dental service attendance of children. Age- and sex- adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated by means of multivariate logistic regression models. RESULTS: A sample of 231 children (mean age 8.1 yrs, SD 2.6; 127 males, 104 females) was recruited. One hundred and sixty three (70.46%) children in the study had caries. Caries presence in children was higher in children where the mothers' educational level was lower (OR =6.1; 95% CI = 3.1 to 12.7), in children where the fathers' educational level was lower (OR =2.9; 95% CI =1.6 to 5.5) and in children with lower family income (OR = 9.9; 95% 95% CI = 5.1 to 20.1). No statistically significant difference were observed in terms of caries presence between the children who were visited at least once by a dentist and children who were not previously seen by a dental practitioner (OR = 0.8; 95% CI = 0.4 to 1.6). CONCLUSION: Socioeconomic level was an important predictor of caries presence among children. Both low income and low parental educational level were related to an increased presence of caries, whereas previous dental visits experience did not affect caries presence in children.

Reliability and validity of the Italian versions of the Children's Fear Survey Schedule - Dental Subscale and the Modified Child Dental Anxiety Scale.

AIM: Children's dental fear and anxiety (DFA) causes significant problems in clinical practice. The 15-item Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the 8-item Modified Child Dental Anxiety Scale (MCDAS) are the most widely used measures of dental fear in children. The aim of this study is to examine the reliability and validity of the Italian versions of the CFSS-DS and MCDAS, also in comparison with a simple visual analogue scale (VAS). MATERIALS AND METHODS: The CFSS-DS and MCDAS were translated into Italian by a consensus panel of experts and administered to 210 dental patients aged 4-11 years from three Italian Institutions. Internal reliability was assessed using the Cronbach's alpha correlation. A sub-sample of 60 children was selected for test-retest analysis. CFSS-DS and MCDAS, plus a VAS scale, rated both by children and parents, were validated using as gold standard the 4-item Frankl scale for behaviours assessed by dentists. RESULTS: Mean CFSS-DS score was 30.8 (SD: 11.1) and mean MCDAS score was 17.9 (SD: 7.2), significantly higher among children aged 4-7 years and among children at their first dental visit. The alpha value for internal reliability was 0.90 (95%, CI= 0.88-0.92) for CFSS-DS and 0.87 (95% CI=0.85-0.90) for MCDAS. Both CFSS-DS and MCDAS showed good test-retest reliability (rsp= 0.80; p<0.001 for both scales). CFSS-DS and MCDAS predicted a Frankl score ≤2 (i.e., indicating children with an uncooperative behaviour) with a fair accuracy (AUC=0.69 and AUC=0.68, respectively). The VAS scale was more effective in predicting a negative behaviour (AUC=0.78). The scales self-reported by children were only slightly more accurate than those reported by parents. CONCLUSION: The Italian versions of the CFSS-DS and MCDAS are valid and reliable tools for the assessment of dental fear in Italian children aged 4-11 years. A simple, one-item VAS, and dental fear and anxiety evaluation by parents may be valid and quick alternatives to multi-item indices to predict an uncooperative children behaviour.

Pit and fissure sealants or fluoride varnishes?

Despite the general advances in dental care, dental caries is still a global health problem affecting many children. Occlusal surfaces of first permanent molars are the most susceptible sites in the developing permanent dentition. Dentists should use sealants or fluoride varnish - as well as other means - to limit the onset of tooth decay. Application of sealants is a recommended procedure to prevent or control caries. Sealing occlusal surfaces of newly erupted permanent molars in children and teenagers delays caries onset up to 48 months compared with unsealed teeth. However longer follow-ups shows a reduction of the preventive effect [Tikhonova et al., 2015]. A review of 2013 pointed out how sealants are effective in high risk children, however information about the benefits of sealing in other conditions is still scant [Ahovuo-Saloranta et al., 2013]. Fluoride varnishes are frequently used to prevent early childhood caries and reduce caries increment in very young children [Weintraub et al., 2006] and in the most vulnerable populations, where the prevalence of caries is higher and specialist visits are occasional [Chu et al., 2010]. Many studies have reported the effectiveness of different types and forms of fluoride agents in preventing dental caries among children and adolescents [Divaris et al., 2013]. A review clarifies that professional application of a 5% sodium fluoride varnish leads to remineralisation of early enamel caries in children. Solutions of 38% silver diamine fluoride are effective in arresting active dentine caries [Gao et al., 2016]. The last systematic review [Ahovuo-Saloranta et al., 2016], comparing pit and fissure sealants with fluoride varnishes explains that the pooled estimate slightly favours resin sealants over fluoride varnishes at two years. At four and nine years, the only comparative study (with high drop-out rates) found more caries on fluoride-varnished occlusal surfaces than on resin-sealed surfaces. There is evidence suggesting the superiority of resin-based fissure sealants over fluoride varnishes for prevention of occlusal caries in permanent molars, however it is not relevant. Eventually, Ahovuo-Saloranta et al. state that current data do not allow to draw definitive conclusions on whether to apply sealants or fluoride varnishes on occlusal surfaces of permanent molars [2016]. We will publish your opinion and experiences related to this topic in the next EJPD issue: join the discussion and write a letter to the editor!

Dental fear in Italy: what is going on.

If your young patient doesn't feel comfortable and thinks something dreadful is going to happen when he comes to your office, maybe he will develop dental fear. Nowadays, children and teenagers' strong negative emotions related to dental treatment are defined as "Dental Fear and Anxiety" (DFA). Since DFA can result in children's avoidance or delay in undergoing dental visits, this problem represents a relevant social barrier as important as other well-known factors like low family income or parental education. Luckily the Italian Ministry of Health is implementing a programme to quantify the importance of the phenomenon. The project "No more dental fear" was created by the Umbria region and Prof. S. Cianetti (University of Perugia, Italy), with the important collaboration of Abruzzo and Lombardy region. Approval of the project by the National centre for prevention and disease control (CCM) in 2015 underscores the importance of this topic. The project consists in the systematic assessment - at national level - of different psychometric scales on children's dental fear, psychological or pharmacological techniques for the management of fear, and mini-invasive methods of prevention/treatment of dental caries. The aim is to first develop an integrated protocol, and secondly to propose a standardised model in order to quantify dental fear and anxiety on the whole Italian territory. Lately, the attention toward young patients is highly improved and this can be seen in the increasing rate of children's first visits. However, the steady percentage of children and teenagers that do not see the dentist because of DFA should not be overlooked, since future treatments may be more challenging. British researchers have already highlighted this problem and it would be productive to cooperate with other European countries.

Familial and dietary risk factors in Early Childhood Caries.

AIM: To evaluate the causes of Early Childhood Caries. STUDY DESIGN: A statistical comparison of two groups of patients, aged between 3 and 6, and their parents, in the 3-year period 2013-2015 was performed. Two groups of patients were selected: 40 children with early childhood caries (ECC group) and 40 children with no decay (controls). Parents were asked to fill out a questionnaire on food habits, oral hygiene habits, fluoride prophylaxis and family history of caries. A dental visit of children and parents was performed (collection of dmft and DMFT index). The saliva features of the two groups of children (concentration of Streptococcus mutans, pH of the oral cavity and buffer capability of stimulated saliva) were examined by means of salivary tests. The distribution of the population was analysed and parametric and non-parametric tests for continuous and non-continuous variables, were used when appropriate. The statistical significance was set at p > 0.005. RESULTS AND STATISTICS: The average age, gender and BMI index of children of the two groups was similar. The difference between the two groups is statistically significant for pH (p=0.000) and buffer capability (p=0.001). The DMFT index in the group of mothers of ECC children is higher compared to the mothers of controls (p=0.004). The comparison among the means, for the parameters connected to the consumption of fruit juice, tea, soft drinks, candies, use of pacifier dipped in sugar or honey and the length (in months) of consumption of candies show statistically significant differences (p>0.05). The pH is higher in those children (24) who never consumed fruit juice, tea, soft drinks before the information received (p<0.05). CONCLUSIONS: Children developing Early Childhood Caries have a diet characterised by high free sugars intake. Diet and, in particular, the consumption of drinks containing free sugars is the most important factor in determining the onset of ECC, being able to affect the oral environment and, in particular, saliva. There is a relationship between maternal and child's oral health, with a DMFT higher in mothers of ECC subjects than in controls' mothers.

Does breastfeeding increase risk of early childhood caries?

According to the WHO, "breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond". However, several studies have reported prolonged and unrestricted breastfeeding as a potential risk factor for primary tooth caries (ECC). On-demand breastfeeding, particularly while lying down at night, would seem to cause ECC because milk remains in the baby's mouth for long periods of time. There is lack of evidence that human milk is cariogenic; other factors, such as oral hygiene, may be more influential in caries development than on-demand breastfeeding. Moreover the biomechanics of breastfeeding differs from those of bottle feeding and milk is expressed into the soft palate and swallowed without remaining on teeth. Indeed we cannot forget that the main factor influencing caries development in infants is the presence of bacteria streptococcus mutans that thrives in a combination of sugars, small amounts of saliva and a low pH. Today the question is open and recently Chaffee, Felines, Vitolo et al. [2014] have found that breastfeeding for 24 months or longer increases the prevalence of severe early childhood caries in low-income families in Porto Alegre, Brazil. These results do not claim that prolonged breastfeeding is the cause of tooth decay; we can expect an association with food for infants often rich in refined sugars, which cause the reduction of the protective effect of saliva on the deciduous teeth enamel. In Japan, Kato, Yorifuji, Yamakawa et al. [2015] have found that infants who had been breastfed for at least 6 or 7 months, both exclusively and partially, were at elevated risk of dental caries at the age of 30 months compared with those who had been exclusively fed with formula. The authors themselves say, however, that further studies with more elaborate methods of assessment of breastfeeding may be necessary to determine the cariogenic nature of breastfeeding. In the meantime, given the many benefits of breastfeeding, the practice should continue to be strongly encouraged. Dental professionals should encourage parents to start proper oral hygiene with their children as soon as the first tooth erupts, and they should keep the intake of sugary beverages to a minimum.

Children's rights and dental care treatment.

Dentists, especially paediatric dentists, should inform their young patients of the treatment to be undertaken in an appropriate and comprehensive manner. In 1989, the UN Convention on the Rights of the Child (United Nations Convention on the Rights of the Child - UNCRC - https://www.unicef. org/child-rights-convention/convention-text) was adopted, comprising of 54 articles concerning every aspect of a child's life, notably health, including oral health. More than 30 years after the Declaration of the Rights of the Child, both health professionals and parents still struggle to grasp this subject, resulting in its scarce application in daily practice. Children's rights have also been mentioned several times in medical and dental literature, reminding health professionals that the approach to young patients must be age-appropriate. The clinician must learn to consider children as the main protagonists in the choices concerning their health, and they must be aware of their rights from an early age. Particularly in the field of dentistry, it is a matter of guaranteeing the best dental care for every child with particular attention to the indigent or disabled (Article 23). In addition to this, the most effective and up-to-date treatment must be proposed, avoiding unnecessary extractions and favouring conservative therapy that can guarantee a better quality of life in the future, while reducing treatment under general anaesthesia. In current practice, consent to treatment is often demanded from the parents, without involving the child. However, every child has the right to freely express their opinion and be actively involved in any matter that concerns them. This opinion is expressed in different ways according to age and stage of maturity. Pictures, drawings, cartoons and videos can help the healthcare provider when explaining procedures to the young patient, thus allowing them to obtain consent and cooperation. In individual countries, it would be advisable to have guidelines that facilitate the child's active consent to health treatments. So, what happens in your country?

Risk factors for Early Childhood Caries in Italian preschoolers: A cross-sectional analysis.

AIM: Early childhood caries (ECC) represent a relevant public health issue in paediatric population globally. The current study aimed to investigate the main risk factors of this condition. METHODS: This is a cross-sectional study carried out at the Child Dentistry Clinics of the Istituto Stomatologico Italiano, Milan, Italy, including patients aged 12-71 months and their parents. Demographical data, anthropometric measurements, oral hygiene and health assessment, and children's eating habits were collected. CONCLUSION: Our findings, according to recommendations, suggest that the prevention of ECC needs to begin in infancy. Oral health providers, physicians, nurses, and other health care personnel play an important role in educating parents about their child's oral and dental care and food choices.

Protecting children from the harmful impact of food marketing.

A healthy and balanced diet should be promoted already in childhood, a crucial period for the psychophysical development of the individual. In particular, the consumption of free sugars and soft drinks in children and adolescents should not exceed the current WHO recommendations. This trend is very difficult to counter as the preference for sweet flavours is innate and often further reinforced by pre- and post-natal exposure and aggressive marketing. Unfortunately, sugar consumption continues to grow alarmingly due in part to the easy availability of foods and drinks rich in added sugars from vending machines, supermarkets and fast-food restaurants. Recently, the WHO (with the recommendations included in the QR Code below and in the following link: WHO recommends stronger policies to protect children from the harmful impact of food marketing) pointed out how exposure to food marketing affects children's health, eating behaviours and beliefs about food, thus becoming a real threat to public health. Among the proposals made, it is interesting to note the need for national governments to "curb the persuasive power of food marketing" by limiting the use of cartoons and other techniques that appeal to children, such as the inclusion of toys in packaging or advertisements with songs and celebrity endorsements. It is already evident in the literature that an excessive intake of sugar predisposes children to a number of pathological conditions that in the long term may favour the onset not only of carious disease but also obesity, type 2 diabetes mellitus, liver disease, cardiovascular and dysmetabolic diseases. As paediatric dentists, sugar-related dietary excesses are already very obvious to us since it is mainly these that drive young patients to our clinics. In our privileged position, we should therefore increasingly promote knowledge on the possible correlations between excessive sugar consumption and the onset of these diseases, drawing the attention of parents of young patients to all foods that are harmful to their growing children. Therefore, let us welcome these new guidelines promoted by the WHO to protect children and adolescents from the harmful impact of food marketing; and may we not miss the opportunity to share and promote this important battle for future generations!

Interceptive orthodontics: awareness and prevention is the first cure.

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.

Aligners, can my child use them too?

This is a frequently asked question. The answer depends on various factors, with cooperation being among the most essential. As a parent, you must ask yourself if you can rely on your child to wear aligners correctly for most of the day. If the answer to this question is yes, then clear aligners may be a better choice than traditional braces. There are three major benefits of clear aligners in children: 1. Greater comfort, aligners are less voluminous than traditional braces and more likely to prevent irritation, mouth ulcers and other discomfort that derives from the movement of the orthodontic wire or braces. 2. Better hygiene, as their removal during meals and tooth cleaning manoeuvres makes home oral hygiene easier. 3. Better aesthetics, thanks to the transparency of the plastic replacing the metal. However, a certain degree of caution is advised to those who are considering this treatment option. Although aligners allow us to start resolving certain tooth malpositions (which can cause periodontal and aesthetic problems or increase the severity of damage in the event of trauma), and to improve alignment and minor crowding at an early age, it must not be forgotten that the intervening period for changing the definitive position of individual teeth is still the period of permanent teeth. It is important to consider whether a child has a dental or skeletal problem. In cases where a child's problem is exclusively dental, the aligner may be one of the tools used. In cases of skeletal problems, the literature advises against the aligner, as it is not the right instrument at this stage of development. The literature in some cases refers to aligners as the universal remedy, valid for every malocclusion, presenting them as a panacea for all orthodontic problems of very young patients. It is necessary to remain open to the innovations that the market offers us and that can improve our daily clinic, and aligners can be a valid support in this regard, but, as dentists, we should always keep a critical and open eye on treatments with an evidence-based rationale. As with all other orthodontic appliances, aligners must be evaluated on a case-by-case basis, keeping in mind that they are one of the tools in the hands of the clinician. When the clinical situation makes it possible and when both the child's requirements and the parent's expectations are fulfilled, it is certainly worth considering clear aligners as a viable route in the family-child's orthodontic treatment, making it as simple and convenient as possible. Lastly, we should remember the concept of efficiency regarding an orthodontic treatment, which depends on its cost/benefit ratio, with the former being understood in a biological sense and in terms of its impact on the life of the patient and their family with respect to duration, cooperation required, discomfort induced by the equipment used and frequency of check-ups. The latter should obviously be considered in terms of results obtained in relation to the pre-established treatment goals. A consideration that we should always keep in mind: let us never forget that is the orthodontist who treats the patient, not the appliance!

Fake academic writing: ethics during chatbot era.

"Professor, have you ever seen anything like this?". Few weeks ago I was asked this question by two young and esteemed specialist in orthodontics of my research group, actually PhD students, who showed me a laptop screen. "No, I have never seen anything so potentially extraordinary. But doubts arise: is this legal? Or rather, is it ethical for us to use it in the field of research?" So I asked the questioners, Dr. Serafin and Dr. Bocchieri, to write a short essay on this new form of artificial intelligence, the chatbots, to give me an idea of what they are, what their potential is, and how they can change the veracity of data when an artificial mind replaces a human one. After "letterally" 5 minutes, they returned to me and let me read the following: The rapid advancement of artificial intelligence (AI) technology has led to a proliferation of AI-powered tools that are having a significant impact in the realm of academic writing to automate various aspects of the editorial process, from research to proofreading and even generating complete high-quality scientific articles. Chatbots are AI-virtual assistants that offer significant benefits but there are also important ethical considerations that must be considered. One concern is related to the accuracy and reliability of AI-generated content, particularly in scientific writing where accuracy is of utmost importance. There are also concerns about the potential for AI to be used to produce plagiarized or fraudulent content, which could undermine the credibility of scientific soundness. To mitigate this risk, it is crucial to establish clear guidelines and regulations for their use. Additionally, academic institutions and publishers should take steps to verify the authenticity of authors and promote transparency and accountability in the publishing process. The use of chatbots in academic writing has the potential to revolutionize the way in which research is conducted and written. However, it is important to ensure that the ethical implications of this technology are carefully considered and addressed. This includes ensuring that AI-generated content is accurate, reliable, and trustworthy and that the use of AI does not result in the displacement of human imagination. To address these ethical considerations, it is recommended that academic institutions and scientific journals work together to establish clear guidelines and regulations for the use of AI in academic writing, ensuring that AI-powered tools are ethical. By taking a responsible approach, we can ensure that the benefits of this technology are realized while minimizing any potential negative consequences. Finally, the most important but missing information is that this editorial is fully written by a chatbot. Therefore, pay attention: the search for health for our patients must go through scientific honesty that produces data and analyzes them "humanly". I share my amazement, but also my concern. As a university professor, as a clinician, as a researcher, but also as a "father" of future orthodontists, I always have doubts about the message we want to leave, and in this editorial I would like to reproduce an excerpt from a conversation with Marco and Salvo, as if we were discussing the legitimacy of cheating in a card game.