Early orthodontic treatment need in paediatric age: a prospective observational study in Italian school-children.

AIM: This study evaluates the prevalence of Interceptive Orthodontic Treatment Need (IOTN) in Italian school-children. METHODS: A prospective observational study was conducted to assess the prevalence of IOTN in patients undergoing a first visit at the Santa Chiara Hospital Paediatric Dentistry Unit in Pisa, Italy. Two thousand, one hundred ninetynine subjects met the inclusion criteria and were enrolled in the study; data on age, gender and concomitant systemic pathologies were collected from medical records. All participants were examined for individual IOTN: the presence of anterior and/or unilateral/bilateral crossbite with or without midline deviation, bad habits (finger, sucking habits, mouth breathing, and tongue thrust), overjet > 3 mm, lack of space for 1.2 and 2.2 eruption were investigated. The presence of one of the above mentioned parameters was considered positive for IOTN. Chi-square test was used to evaluate any statistically significant difference (p < 0.05). CONCLUSION: The study confirms the presence of a significant percentage of paediatric patients who need IOTN; early treatment is highly recommended to reduce malocclusion outcomes in the adult population.

Age, gender and degree of inclusion are predictors of timing for spontaneous repositioning of intruded primary teeth in pre-school children.

AIM: To investigate the timing for spontaneous repositioning of primary teeth with intrusive luxation in relation to degree of inclusion, gender and age of injured children. METHODS: This retrospective study analysed records of 1- to 6-year-old children referred to the Section of Paediatric Dentistry, C.I.R. Dental School, University of Turin (Italy) between January 2009 and December 2020 for traumatic intrusion of primary teeth. Time to the total re-eruption was calculated, and related factors were explored using Cox and Kaplan-Meier analyses. CONCLUSION: Timing for spontaneous re-eruption seems to be associated to age, particularly as far as total intrusion of primary teeth is concerned. This observation could be related to the degree of bone mineralisation, which is modified during growth.

Mechanics of facial growth in young patients.

AIM: The aim of this work is to focus on the impact of occlusion on facial development. METHODS: Literature was searched using Medline, Embase and Cochrane Library. The key words and mesh used were bone remodelling, facial growth, masticatory muscles, children. Only articles written in English were included in the study. CONCLUSION: Disturbances in the harmonious interplay of the masticatory muscles may result in facial alteration and asymmetries. If not treated, the dysplastic pattern of growth continues and worsens with time.

Impairment of salivary function in juvenile idiopathic oligoarticular arthritis is a sign of early onset disease.

AIM: Recent evidences of the presence of reduced stimulated salivary flow rate and altered saliva composition in oligoarticular juvenile idiopathic arthritis (o-JIA) suggest a specific damage to the salivary glands. The aim of this cross-sectional study was to investigate whether reduced salivary flow rate could be related to age and gender at disease onset in o-JIA. METHODS: A total of 57 Caucasian patients (41 females and 16 males) aged 5 to 16 years affected by o-JIA were consecutively enrolled in the study. Information on medication intake, dietary and oral hygiene habits were gathered through a standardised questionnaire. All patients underwent oral and sialometry examination. CONCLUSION: Early onset disease would seem to be associated with salivary glands impairment. Regular dental and salivary gland function assessments may be highly recommended in o-JIA patients considering that saliva collection is a non-invasive and inexpensive procedure.

Long-term effect of anticancer therapy on dentition of Italian children in remission from malignant disease: A cross-sectional study.

AIM: To investigate the effects of anticancer therapy on dental development and caries formation in Italian childhood cancer survivors compared to healthy controls. METHODS: A total of 52 children treated with chemotherapy and/or radiotherapy when younger than 10 years and in remission from at least 2 years, and 52 healthy age- and gender-matched children were consecutively enrolled in this cross-sectional study. All participants were examined for dental caries and enamel defects according to the decayed-missing-filled teeth (dmft/DMFT) index and the Aine rating scale. Panoramic radiographs were taken to estimate dental age and to assess dental abnormalities using the Höltta Defect Index. CONCLUSION: These children are at high risk for tooth developmental abnormalities and poor dental health and should be closely monitored by a specialist dentist.

The effect of an oral spray containing an aqueous extract of Triticum vulgare on dental plaque and gingival inflammation in schoolchildren: A randomized controlled trial.

AIM: To investigate whether the daily use of a spray containing an aqueous extract of Triticum vulgare (TV), belonging to the family of Graminaceae, associated with supervised toothbrushing may improve gingival health in schoolchildren with mixed dentition. MATERIALS AND METHODS: Study design: Randomised, controlled, single-centre, examiner blind, parallel-group study. The study population included 57 schoolchildren with plaque-induced gingivitis randomly allocated to test (n = 29) and control (n = 28) group. Both groups were enrolled in a mechanical plaque control programme for a period of 2 weeks. The test group was also instructed to use a gluten free spray formulation of TV spray twice daily after toothbrushing. Evaluations of plaque index, modified gingivitis index (GI), salivary pH and whole stimulated saliva quantity took place at baseline and after 1 and 2 weeks of study product use. RESULTS: No side effects were observed. Plaque accumulation and GI statistically significantly improved compared with baseline in both groups (all P-values < 0.005), while salivary pH remained nearly unchanged. Between-group differences in index reduction were statistically significant only for GI favouring the test group (P = 0.013). STATISTICS: Repeated-measures ANOVA and the Friedman test were applied to evaluate the influence of time on quantitative variables within each treatment group. Differences between test and control groups were tested using the unpaired t test or the Mann-Whitney U-test with Bonferroni correction. CONCLUSIONS: This study found that TV in spray formulation is safe and effective in controlling gingival inflammation. Thus, it may be a potential adjuvant in the treatment of gingivitis in combination with mechanical plaque control in schoolchildren.

180-day screening study for predicting the risk factors for developing acute oral Graft-versus-Host disease in paediatric patients subjected to allogenic haematopoietic stem cells transplantation.

AIM: In this study, 58 paediatric patients were prospectively evaluated with a number of screening studies performed between 0 and 180 days after allogenic hematopoietic stem cells transplantation (HSTC) to detect any risk factors for developing oral manifestations of acute Graft-versus-Host Disease (a-GvHD). MATERIALS AND METHODS: A total of 58 paediatric allogenic HSTC patients (37 males aged 1 to 15, and 21 females aged 4 to 18), entered the study and were observed by a trained dental team for a period of 6 months following transplantation while assuming cyclosporine, an immunosuppressive agent with a-GvHD prophylactic activity. Mean age at transplantation was 7.2 years old. Screening studies included physical examination, complete blood counts and liver function tests. Complete extraoral and intraoral clinical examinations were performed for all patients to detect oral lesions. Furthermore, some variables (sex, number of HSTC performed in the same patient, degree of HLA disparity and the positive/negative result of cytomegalovirus antigenemia test during the three months after engraftment) were investigated in the attempt to evaluate their predictive and/or diagnostic value in paediatric HSTC recipients. The resulting data were analysed with the Fisher's exact test. RESULTS: Twenty-two percent of the patients developed oral manifestations of a-GvHD. Oral symptoms frequently are the major complaints of the patients during the follow-up period. The oral changes included mucositis, erosions and/or ulcerations; xerostomia, pain and bleeding were also referred. The variables investigated for predictive and/or diagnostic value in paediatric HSTC recipients included: sex (relative risk 0.494, 95% confidence interval 0.119-2.052, P=0.1242); number of HSTC performed in the same patient (relative risk 5.4, 95% confidence interval 0759-3.843; P=0.0714); degree of HLA disparity (relative risk 0.24, 95% confidence interval 0.058-0987, P=0.0428); and the result to cytomegalovirus (CMV) antigenemia test during the three months after engraftment (relative risk 0.86, 95% confidence interval 0.273-2.712, P=1). CONCLUSION: Patients presenting two or more risk factors should be closely monitored for development of clinical oral a-GVHD, as oral complications are a significant cause of morbidity and potential mortality for children undergoing HSTC and can interfere significantly with transplant recovery.

Clinical evaluation of temporomandibular disorders in children and adolescents: a review of the literature.

AIM: The abbreviation TMD (temporomandibular disorders) has been used to signify the variety of symptoms, signs and combinations that have often been assigned to the TMJ (temporomandibular joint) and its related structures (muscles, bone and facial structures). The prevalence of temporomandibular disorders in children and adolescents varies widely in literature. The most common signs and symptoms of TMD are: temporomandibular joint sounds, impaired movement of the mandible, limitation in mouth opening, preauricolar pain, facial pain, headaches and jaw tenderness on function. Many studies have shortcomings in their method of assessing or measuring TMD: the problem is probably due to the fact that temporomandibular disorders have multiple aetiological factors. The aim of this article is a review of the literature about the diagnostic procedures used to assess signs and symptoms of temporomandibular disorders in children and adolescents. MATERIALS AND METHODS: Literature was searched using Medline, Embase, and Cochrane Library from 1992 to February 2008. Only articles written in English were included in the study. The key words and mesh used were: temporomandibular disorders, mandibular dysfunction, children, adolescents. The inclusion criteria were: symptoms and signs of TMD, questionnaire, clinical protocol examination. Clinical studies as well as cross-sectional studies, longitudinal and epidemiological researches were considered. The articles reviewed were grouped according to the diagnostic procedure used. RESULTS: Out of the 37 articles selected, the Helkimo Clinical Dysfunction Index was used in 6 studies (16.22%), the CMI Index in 1 (2.70%), the RCD/TMD in 9 (24.33%) and a clinical protocol examination in 21 (56.75%) articles. CONCLUSION: The review of the literature shows that clinical examination protocols without reproducible items and a measurable and reproducible classification into diagnostic subgroups was the type of investigation used in most of the cases. This ended in a multitude of different results depending on the criteria used and the method of data collection. Such methodological problems should be acknowledged in studies relating to TMD in order to obtain a reliable diagnostic procedure.

[The role of saliva in maintaining oral health]. / Il ruolo dei fluidi salivari nel mantenimento dello stato di salute orale.

It is now established that saliva is important for the health of both soft and hard oral tissues. This article focuses on the role played by saliva in influencing oral structures: the most important factors related to it will be illustrated. The action of saliva and the multifunctional aspects of its components in both detrimental and beneficial effects on oral health are underlined.

Penetration of the mandibular condyle into the middle cranial fossa: report of a case in a 6-year-old girl.

Reported cases of dislocation of the mandibular condyle into the middle cranial fossa are rare. Treatment of this injury should be individualized and should take in account the age of the patient, growth potential, the degree of glenoid fossa destruction, the risk of ankylosis and the risk of further cranial injury. In children, functional therapy is aimed at helping the restoration of posterior facial height, good occlusal relations and function. Long-term follow-up is mandatory. Surgery may be required later to correct asymmetrical growth or developing ankylosis. This article describes a case of condylar penetration into the middle cranial fossa in a six-year-old child and the treatment performed to minimize consequences on occlusion and facial development.

Condylar fractures treatment in children and youths: influence on function and face development (a five year retrospective analysis).

To evaluate relationship between consequences of TMJ fractures in children and disturbed facial skeleton growth, 46 children (18 girls, 28 boys), who were 14 years of age or younger and had undergone combined clinical and radiolographic examination for five years were retrospectively analyzed. Imaging studies were performed to investigate symptoms that included, either individually or in various combinations, pain, mechanical TMJ disfunction and facial skeleton abnormalities. The children were divided into two groups: those belonging to the former had been treated by functional orthopedic method alone, while the others had just been treated by physiotherapy. Both TMJs were normal in the patients treated functionally and they all showed normal facial structure, while different types of alterations (ranging from inflammatory to mechanical and structural ones) were observed in the others. We concluded that therapeutic procedures adopted after TMJ fractures in children are essential in minimizing consequences on occlusion and facial development.

TMJ fractures in children: clinical management and follow-up.

The mandible is the facial structure that is the most affected by trauma and the most common fracture site is the condyle. New perspectives for this problem are due to the fact that often TMJ fractures in children are undiagnosed and consequently untreated. This becomes evident when growth disturbances show up a year or two later. These types of trauma must be focused not only as a cause of direct damage to osseous structures, but also of future disturbances of the dentofacial development. Three cases of particular significance for the requested therapeutic approach are reported.

Rational and philosophic basis for a functional approach to TMJ fractures in children.

Craniofacial injuries can cause future disturbances of dentofacial development in children and youths: their treatment is very important to prevent and minimize the consequences on face development. A case of a bilateral condylar fracture is reported. Problems connected with clinical management are discussed.

Ankyloglossia and its influence on maxillary and mandibular development. (A seven year follow-up case report).

The consequences of not treating improper tongue function may be very important as this organ can influence face development and dental therapy. The role of the tongue in the development of the skeletal structures of the face has been considered in different perspectives over the years. For some, the tongue adapts to the "tongue box," for others the "tongue box" has been created and stabilized by the morphogenetic action of the tongue during development and growth. A case of ankyloglossia treated with lingual frenectomy and followed clinically and radiologically for seven years is reported. Spontaneous upper arch expansion occurred and therefore orthodontic treatment following surgical intervention was unnecessary.

The marginal seal of various restorative materials in primary molars.

The use of resin composite restorations in posterior teeth has become an accepted clinical procedure. Microleakage at the posterior composite/tooth interface is a major problem. The in vitro quality of the marginal seal was tested in eighty teeth extracted for orthodontic reasons using a glass-ionomer cement reinforced with amalgam, two light self-curing glass-ionomer cements and a compomer. All the teeth were subjected to thermocycling to simulate clinical situation. Compomers showed the best mechanical and esthetic properties combined with a good marginal seal.

Apexification in the endodontic treatment of pulpless immature teeth: indications and requirements.

The problems of performing the apexification technique, the indications and requirements for apexification are discussed. A case report is shown as an example.

[Dilacerations: the clinical, diagnostic and therapeutic problems]. / Dilacerazioni: problematiche cliniche, diagnostiche e terapeutiche.

The authors consider the problems connected with diagnosis and prognosis of dilaceration. Case reports of varying prognosis importance are given as examples.

A SEM investigation on pulpal-periodontal connections in primary teeth.

The ideal goal of pulpotomy procedure in a primary tooth is to maintain space length, preserve masticatory function, and remove infection and chronic inflammation from the oral cavity. From a population of 150 patients between the ages of four and seven years, we collected a sample of 30 primary (nine maxillary and twenty-one mandibular) molars used in this investigation. The aim was to observe the presence of accessory channels on the pulpal floor; they were found in twenty-one of the thirty teeth examined. The scanning electron microscope proved to be an excellent means of evaluating the pulpal floor, where failure of pulp treatment often has its cause.

[The illustration of a health education program directed at children in the 1st and 2d elementary grades. Preliminary notes]. / Illustrazione di un programma di educazione sanitaria diretto ai bambini del primo e secondo ciclo elementare. Note preliminari.

The paper describes an experimental health education plan for children in the first and second years of primary school. The plan focuses on nutritional and dietary aspects and the correlations between diet, oral hygiene and dental health.