Correlation between aerosol therapy in early childhood and Molar Incisor Hypomineralisation.

AIM: To evaluate the correlation between the use of aerosol therapy in early childhood and the presence of Molar Incisor Hypomineralisation (MIH). STUDY DESIGN: a retrospective case-control study in which a group (cases) consisted of children from 6 to 13 years with MIH visited at the unit of Pediatric Dentistry of the Policlinico Tor Vergata (Rome, Italy), and a group (controls) consisted of an equal number of children of the same age without MIH. Data about the aerosol therapy and the presence of MIH were obtained respectively by medical history and intraoral clinical examination. Collected data underwent statistical analysis using mainly non-parametric tests (p < 0.05). RESULTS: In the study were included 182 patients, of which 91 (46 males, 51%) were children with MIH (cases), and 91 (46 males, 51%) were children without MIH (controls). In the group of patients with MIH, in the early childhood, 12 (13.1%) never had aerosol therapy, 6 (6.6%) underwent aerosol therapy less than 7 days per year, 22 (24.2%) from 8 to 15 days per year, 22 (24.2%) from 16 to 45 days a year, and 29 (31.9%) more than 45 days per year. In the control group, in the early childhood, 9 (9.9%) never had aerosol therapy, 29 (31.9%) underwent aerosol therapy less than 7 days per year, 26 (28.6%) from 8 to 15 days per year, 20 (22.0%) from 16 to 45 days a year and 7 (7.6%) more than 45 days per year. STATISTICS: the risk of developing MIH in children undergoing intensive use of aerosol therapy with respect to those receiving a less intensive use resulted in an odds ratio of 3.19 (p <0.001) in the general population, 4.83 (p < 0.001) in males and was not statistically significant in females (p = 0.132). The Spearman correlation between aerosol therapy and MIH was 0.278 (p < 0.001) in the general population, 0.372 (p < 0.001) in male, and it was not statistically significant (p = 0.08) in female subjects. CONCLUSION: Aerosol therapy carried out in early childhood appears to be a risk factor for the development of MIH, particularly in male subjects.

Riga-Fede disease and neonatal teeth.

AIM: The aim of this study is to present a case of Riga-Fede disease (RFD). RFD is a benign and uncommon mucosal disorder, characterized by an ulceration of the tongue, often caused by repetitive traumatic injuries due to backward and forward movements of the tongue over the mandibular anterior incisors. RFD is most commonly associated with the eruption of primary lower incisor in older infants or natal-neonatal teeth in newborns. METHODS: A 2-month-old female infant was referred to our Paediatric Dentistry Unit for ulceration (13 mm diameter) on the ventral surface of the tongue and neonatal teeth. The extraction of neonatal teeth was selected as treatment of choice, over more conservative treatments, for the rapid resolution of the lesion and for the limited risk of inadequate nutrients intake. The extracted teeth underwent a macroscopic/microscopic examination. The complete healing of the lesion took 4 weeks; subsequently, the infant, revised at the 1-year follow-up visit. CONCLUSION: Early detection of RFD is recommended because such lesions properly may induce deformity or mutilation of tongue, dehydration, inadequate nutrients intake by the infant and growth retardation.

MIH: epidemiologic clinic study in paediatric patient.

The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. AIM.: Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. RESULTS AND DISCUSSION.: From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. CONCLUSIONS.: MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and prosthetic, has the aim to certify the functionality and the aesthetic of the dental elements affected by MIH.

The dental age in the child with coeliac disease.

AIM: The coeliac disease deprives affected individual of the main nutritive factors, which are essential to promote body development: coeliac children are often subject to weight loss and have a lower somatic growth rate compared to healthy children. In addition, it is proven that prolonged malnutrition can have irreversible effects on dental eruption: teeth development also suffers a delay or it is slowed down in coeliac children. The purpose of this study was to evaluate and quantify the persistence of a delay in the dental age in children with coeliac disease and the presence of a possible constant relationship between the estimated delay in skeletal development and that referred to the dental age. MATERIALS AND METHODS: Seventy children (24 males and 46 females) were selected, all affected by coeliac disease, aged between 5.3 and 13.8 years, with a mean age of 9 years +/- 22 months SD. Through teleradiography of the skull in latero-lateral projection and orthopantomography of the dental arches, the estimate of the skeletal development and dental age was carried out for each patient, applying two specific methods extensively described in the literature. RESULTS AND CONCLUSION: The results obtained, in agreement with the literature, show how the dental age, which is delayed in children affected by coeliac disease, may be considered as a reliable indicator of somatic growth and also of biological age. Furthermore, a gluten-free diet has considerable beneficial effects on skeletal development in relation to the dental age, in agreement with the hypothesis that dental development is controlled by different regulatory mechanisms, totally independent from those that influence skeletal development and the somatic and sexual development of the individual, even if the delay of dental development decreases progressively from the time of diagnosis of coeliac disease to introduction of a gluten-free diet.

Oral lesions in paediatric patients with graft-versus-host disease.

AIM: This work aims at assessing and describing the most frequent clinical manifestations of the Graft-versus- Host Disease (GvHD) in the oral and maxillofacial region in paediatric patients affected by neoplastic or non neoplastic haematologic disorders who undergo specific haematopoietic stem cell transplantation (HSCT) protocols, with a view to detecting the potential pathological modifications that are recognised as the cause of a possible altered harmonious development of the child. MATERIALS AND METHODS: Thirty-eight paediatric patients aged between 3 and 13 years, coming from the haematological department of Tor Vergata University (Roma, Italy) and affected by GvHD, assessed on the basis of their medical history and accurate clinical and instrumental exams, after having received haematopoietic stem cell transplantation for neoplastic or non neoplastic haematologic disorders, were enrolled in this study. The aim of this work was to assess oral conditions, detect possible oral pathological manifestations and evaluate their incidence both locally and in terms of clinical severity, as well as to mitigate associated symptoms. This was done to prevent and eliminate any oral interference in the systemic treatment protocol. DISCUSSION AND CONCLUSION: In line with the data presented in the literature, clinical GvHD manifestations seem to mainly involve the oral and maxillofacial region from an early phase also in paediatric patients. As a consequence, a timely diagnosis and a multidisciplinary treatment programme are essential for the early detection of the oral signs of potential systemic complications, to improve the quality of life of these young patients, as well as to prevent any potential alterations of dentoskeletal development and growth in the child.

Fluoride supplements in pregnancy, effectiveness in the prevention of dental caries in a group of children.

UNLABELLED: This clinical, retrospective study intends to evaluate whether the systemic administration of fluoride during pregnancy can reduce caries incidence in a group of paediatric patients, compared to a control group.84 patients were selected out of a sample of 2000 children (3-15 years of age) and then divided in two groups: TEST Group: 34 patients (16M - 18F, mean age 9.23), whose mothers had taken fluoride during pregnancy; CONTROL GROUP: 50 patients (23M - 27F, mean age 9) whose mothers had not taken fluoride.Patients underwent a clinical and radiographic inspection to assess the dfs/DFS value as caries index (decayed or filled surfaces for deciduous or permanent teeth). RESULTS: DFS/DFS VALUE: TEST Group: 3.41, CONTROL group 2.49. The TEST group was further divided in individuals who were administered fluoride only during pregnancy (33%) with a dfs/DFS of 3.14 and individuals who were administered fluoride also after birth (67%) with a dfs/DFS of 3. Caries index (dfs/DFS) did not show any significant differences between the test and control groups. Fluoride administration during pregnancy and postpartum does not seem to have a significant impact on the reduction of caries incidence. More preventive strategies should be investigated to contrast the multifactorial etiology of children caries.

Oral manifestations of coeliac disease.: A clinical-statistic study.

AIM.: The aim of the clinical-statistic study was to evaluate the prevalence of the different oral manifestations in a sample of coeliac patients, in comparison with a control group of healthy subjects. Moreover, a second objective was to determine if the clinical oral examination is useful as a diagnostic tool of screening for atypical forms of coeliac disease (CD). METHODS.: The enrolment of 300 coeliac patients, aged between 4 and 13 years (mean age 8.16), was carried out at the Pediatric Dentistry Unit in patients sent from the Pediatric Gastroenterology Unit of the PTV Hospital, University of Rome Tor Vergata. The control group was composed of 300 healthy subjects, age-matched (mean age 8.29), enrolled from the Pediatric Dentistry Unit. The patients were examined for hard tissues (enamel hypoplasia, dental caries), soft tissues (recurrent aphthous stomatitis RAS, atrophic glossitis, geographic tongue) and delay dental eruption. Enamel defects were classified according to Aine's criteria, while dental caries was recorded as dmft/DMFT indices. Statistical analysis was carried out by using SPSS/PC+ Software. Differences between case and control groups were tested using Paired samples T-test, and Chi-Square Test, depending on the variable considered. The minimal level of significance of the differences was fixed at p≤0.05 for all the procedures. RESULTS.: Statistical differences between groups were observed for the prevalence of enamel defects (p=0.0001), RAS (p=0.005), delay in dental eruption (p=0.0001), but not for the prevalence of atrophic glossitis (p=0.664). Differences in symmetrical distribution and a chronologic coherence of enamel defects were statistically significant between CD and control groups (p=0.0001). Regarding dental caries, the coeliac patients had higher indexes of caries than healthy subjects, both in deciduous teeth (dmft 2.31±1.84 vs 1.42±1.13; p= 0.021) and permanent teeth (DMFT 2.97±1.74 vs 1.74±1.64; p=0.0001). CONCLUSIONS.: The clinical oral examination should be considered a diagnostic tool for the characterization of subjects affected by silent-atypical forms of CD.

Comparing the efficacy in reducing dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark commercial desensitizing toothpaste containing 2% potassium ion: an eight-week clinical study in Rome, Italy.

OBJECTIVE: The objective of this double-blind dentin hypersensitivity clinical study was to investigate the effectiveness of a new desensitizing toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate (MFP), compared to that of a benchmark commercially available desensitizing toothpaste containing 2% potassium ion, dosed as 5.0% potassium nitrate, and 1450 ppm fluoride as sodium fluoride (NaF). METHODS: A total of 80 subjects were entered into the study, and stratified into two balanced groups according to their baseline mean tactile and mean air blast sensitivity scores. The two groups were randomly assigned to use either the new arginine toothpaste or the benchmark commercially available desensitizing toothpaste containing 2% potassium ion. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned toothpaste and a commercially available soft-bristled toothbrush. Dentin hypersensitivity examinations, which included tactile and air blast sensitivity measures, were conducted at baseline, one week, two weeks, four weeks, and eight weeks. Subject examinations were conducted by the same dental examiner at each examination period. RESULTS: This clinical study demonstrated that the new toothpaste, containing 8.0% arginine and 1450 ppm fluoride as MFP in a calcium carbonate base, provided a significant reduction in dentin hypersensitivity when used over a period of eight weeks. The study also showed that the new arginine toothpaste provided significantly greater reductions (p < 0.05) in dentin hypersensitivity in response to tactile (38.9%, 28.8%, and 11.6%) and air blast (16.8%, 26.4%, and 33.8%) stimuli than the benchmark commercial desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride as NaF in a silica base, after two weeks, four weeks, and eight weeks of product use, respectively. CONCLUSION: A new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as MFP provides significantly increased hypersensitivity relief (p < 0.05) as compared to a benchmark commercial desensitizing toothpaste containing 2% potassium ion, dosed as potassium nitrate, after two weeks, four weeks, and eight weeks of product use.

Oral manifestations in the Graft versus Host Disease in paediatric patients: case report.

Graft-versus-Host Disease (GvHD) syndrome is characterized by specific pathologic and immunologic clinical manifestations, induced by the transplantation, in a body with compromised immune system, of immunologically active T lymphocytes belonging to a donor whose genome is different from the recipient. GvHD can be clinically classified into two forms: acute (aGvHD), if it is induced only by the cytotoxic effect of the donor T lymphocytes in host tissues and chronic (cGvHD), when it is caused by a cytotoxic effect associated with severe immunodeficiency.Patients affected by GvHD frequently develop a massive and progressive involvement of the oral mucosa, being so severe to impair normal feeding as well.The Authors hereby introduce a GvHD clinical case in a 12-year-old patient who underwent Hematopoietic Stem Cell Transplantation (HSCT) from a compatible donor, with odonto-stomatological diseases induced by the syndrome. Early diagnosis and a multidisciplinary treatment plan in the initial phases of this complex and dynamic syndrome are key factors to improve the quality of life in these patients.

MTA applications in pediatric dentistry.

The aim of this paper is to show and asses the clinical applications of the Mineral Trioxide Aggregate (MTA) in pediatric dentistry, either on primary teeth or on immature apex permanent teeth. We have described the primary tooth pulpotomy technique using MTA, that is characterized by a superior biocompatibility and a sealing ability that make it a more suitable compound compared to other materials in terms of result prediction on a long-term basis. We have also reported the direct capping technique using MTA on immature apex teeth; in these particular cases, MTA is undoubtedly preferable to conventional materials, especially in what its sealing characteristics concern. Furthermore, we have explained the apexogenesis clinical procedure, in which after a chamber pulpotomy on incomplete root development teeth, MTA is used in direct contact with the pulpar stump in order to save the root pulp vitality, allowing the apex and relative canal walls physiological maturation to take place. In case of necrotic teeth with immature apex, we describe the possibility of using MTA as an apical barrier making the apexification treatment faster and predictable, taking profit from its biocompatibility quality, its sealing ability and setting characteristic in humid environments. In all described applications, MTA has demonstrated to be a very versatile and extremely trustworthy material. Either literature and results obtained from the present experience, show how the use of MTA in Pediatric Dentistry, compared to commonly used materials, translates into pulp or periapical tissues being less swollen and, thus, guaranteeing a higher prediction of the therapeutic result on a short-term basis and on a long-term one.

Removal of fibrous epulis with Er,Cr:YSGG laser: case report.

BACKGROUND: Epulis is a benign tumour located in the area of the alveolar bone, periodontal ligament and marginal gingiva. A clinical case of Epulis, treated using an Er,Cr:YSGG laser in our Paediatric Dentistry division of the PTV Hospital, University of Rome Tor Vergata, is described. CASE REPORT: A pink, sessile, broad-based lesion, elastic in consistency, was detected on the maxillary vestibular gum above the lateral right incisor. The lesion was removed with Er,Cr:YSGG laser (2780 nm) without anaesthetic infiltration, power ranged from 1,5 to 2,0 Watts at 20 Hz repetition rate under 20%-15% air-water spray. The histopathological examination confirmed the diagnosis of fibrous epulis. The immediate postoperative course was excellent, with no pain or need for anti-inflammatory or analgesic drugs. Wound healing was good after 1 week, and was completed after 1 month. The patient was followed up for 3-6 months, and checked again after 1 and 2 years to assess possible relapse. The Er,Cr:YSGG laser has several treatment advantages, fundamental in Paediatric Dentistry: it requires only topical anaesthesia, it has a high clinical safety, there is a short treatment time, no surgical sutures are required; no complications were encountered during or immediately following laser surgery, all resulting in excellent patient cooperation.

Pulp capping: advantages of using laser technology.

AIM: Pulp capping represents the boundary between conservative and endodontic therapy. The importance of this technique, which considerably improves the prognosis of the tooth, justifies the quest for new techniques and technologies: the most recent literature reports more predictable results (approximately 90%) with cappings performed using laser of different wavelengths, compared to traditional procedures, which report a success rate of approximately 60%. The purpose of this work is to assess the efficiency of laser technology combined with the use of a self-hardening calcium hydroxide base in pulp capping procedures performed on decayed permanent teeth. MATERIALS AND METHODS: This study was carried out on 34 patients, aged between 11 and 18 years (average 14,5) who needed pulp cappings for deep caries affecting permanent teeth (8 front and 26 back). They were divided into three groups based on the operative protocol employed: traditional technique, laser-assisted technique using Er,Cr:YSGG lasers (2780 nm) and laser assisted technique using Erbium:YAG lasers (2940 nm); all patients were asked to return for follow-up visits (anamnesis, vitality testing and intraoral x-ray) scheduled at 1, 3, 6, 12 months, 2 and 4 years; other 30 cases on adult patients (19 to 40 years, average 27,1), treated with the same methods, were used as control group. RESULTS: Traditional technique group showed a success of 63% (adult control group 50%); Er,Cr:YSGG laser-assisted technique showed a success rate of 80% (adult control group 80%); Erbium:YAG lasers laser-assisted technique showed a success rate of 75% (adult control group 70%). All age groups had good success rates with the pulp capping technique, regardless of the technique used. CONCLUSION: Laser technology proved effective in improving the prognosis of pulp capping procedures on teeth affected by deep caries pathology.

Isolated ovarian metastasis from a spindle cell malignant melanoma of the choroid 14 years after enucleation: prognostic implication of the keratin immunophenotype.

A 47-year-old woman developed metastatic melanoma to the right ovary 14 years after the enucleation of the right eye for a choroidal spindle cell melanoma. An immunohistochemical study was performed on paraffin sections of both primary and metastatic melanoma specimens to identify markers of both aggressive phenotype and metastatic potential with particular attention to the anomalous expression of cytokeratin intermediate filament proteins. Neoplastic cells of both primary and metastatic tumors immunostained positively for S-100, HMB45, MART-1, and vimentin antibodies, but they were negative for cytokeratins 1-19, 8, 18, and 8,18; <10% of neoplastic cells in both the primary and the metastatic melanomas immunostained for Ki-67 proliferating antigen using MIB-1 antibody. We speculate that the indolent behavior of this ovarian metastasis is reflected by the absence of coexpression of cytokeratins 8 and 18 with vimentin. This case supports the practical value of using this panel of antibodies to evaluate the aggressive potential of uveal melanomas.