Bacteria prevalence in a large Italian population sample: a clinical and microbiological study.

The present study detects those bacterial species which are more strongly related to bleeding on probing, suppuration and smoking in periodontal-affected patients. Nine hundred and fifty-one patients with periodontal diseases were admitted to the Department of Periodontology and Implantology, Dental School of Bologna University where they underwent microbiological tests for six periodontal pathogens (Actinomyces actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, Fusobacterium nucleatum and Tannerella forsythia). Cluster analysis explored the variables that mostly influence both the presence and absolute\relative bacterial load. Logistic regression and multivariate linear regression quantifies these relations. The probability of recovering bacteria belonging to the Red Complex is greater by 25-48% in presence of bleeding on probing. When probing depth is less than 3 mm the probability of presence of each bacterial species is inferior in comparison with depth >6 mm both for Red Complex (of 20-37%), the Orange complex (of 41-61%) and Actinomyces actinomycetemcomitans (46%). Total bacterial cell count increases with pocket depth above all for the Red Complex. As Treponema Denticola and Tannerella Forsytia presence is associated with bleeding on probing and Prevotella intermedia presence with suppuration and smoking. The examination of these three as indicators of periodontitis evolution is suggested.

The effect of zinc-carbonate hydroxyapatite versus fluoride on enamel surfaces after interproximal reduction.

The aim of this study was to qualitatively investigate the effects of a zinc-carbonate hydroxyapatite (Zn-CHA) containing toothpaste on stripped enamel morphology in a pH cycling model in vitro and to compare the efficacy of this toothpaste versus fluoride one which still represent the gold standard to remineralize early enamel lesions. Twenty-one extracted lower incisors underwent to interproximal enamel reduction with metal strips (Horico 80 µm) on both mesial and distal surfaces. They were then sliced into mesial and distal halves and the 42 samples obtained were randomly assigned to 3 groups of 14 enamel specimens each. For 8 days, teeth were placed in lactic acid solution for 2 h three times a day with 2 h distilled water preservation in between. After each demineralization bath, samples of Group A were brushed with Zn-CHA containing toothpaste while samples of Group B were brushed with 1,400 ppm fluoride dentifrice for 5 min before immersion into water. Group C of untreated samples served as control. All the samples were then prepared for scanning electron microscopy (SEM) analysis. A score rating system was used to perform a non-parametric statistical analysis. No statistically significant differences were found between the samples brushed with fluoride toothpaste and those untreated (Groups B and C) where the highest grade of damage was found, while the lowest grade was recorded in the samples brushed with Zn-CHA (Group A) and there was a statistically significant difference between this group and the other two groups.

Periodontal healing after 'orthodontic extraction' of mandibular third molars: a retrospective cohort study.

In this study we investigated periodontal healing of mandibular second molars following 'orthodontic extraction' of adjacent impacted third molars, under the null hypothesis that there would be no difference in probing pocket depths (PPD) and clinical attachment levels (CAL) at the distal aspect of second molars before and after treatment. A retrospective survey was conducted of 64 patients who consecutively underwent 'orthodontic extraction' of mandibular third molars in close anatomical relationship with the mandibular canal from January 1997 to January 2011. Age, smoking habit, and PPD and CAL at the distal aspect of second molars before and after treatment were recorded. A statistically significant difference was found in PPD and CAL before and after treatment for the overall sample and for the sample classified by age (>25 or ≤25 years), smoking habit (smoker or non-smoker), and type of third molar impaction (horizontal, mesioangular, or vertical). Median PPD and CAL reductions amounted to 6mm and 5mm, respectively. The null hypothesis was rejected and orthodontic extraction proved to be indicated for those impacted mandibular third molars at high risk of a postoperative periodontal defect at the distal aspect of the adjacent second molar.

Occupational exposure to blood and body fluids in a department of oral sciences: results of a thirteen-year surveillance study.

OBJECTIVES: Aim of this analysis was to identify trends that will aid in the prevention of injury. METHODS: Our data were collected from 1999 to 2011 during a surveillance program of occupational exposures to blood or other potentially infectious materials in a Dental School by using a standard coded protocol. RESULTS: 63 exposures were reported. 56/63 (89%) percutaneous and 7/63 (11%) mucosal, involving a splash to the eye of the dental care workers (DCW). 25/63 (40%) involved students, 23/63 (36%) DCW attending masters and doctorate, 13/63 (21%) DCW attending as tutors and 2/63 (3%) staff. 45/63 (71%) and 18/63 (29%) occurred respectively during and after the use of the device; of last ones, 1/18 (0.05%) were related to instrument clean-up and 1/18 (0.05%) to laboratory activity, 12/18 (67%) occurred when a DCW collided with a sharp object during the setting, and 4/18 (22%) during other activities. The instrument and the body part most likely involved were needle and finger respectively. The overall exposure rate was 4.78 per 10,000 patient visits. CONCLUSIONS: Our results may serve as benchmark that Dental Schools can employ to assess their frequency of injury.

Clinical-radiographic and histological evaluation of two hydroxyapatites in human extraction sockets: a pilot study.

After tooth extraction the healing process involves bone resorption and soft tissue contraction, events that can compromise the ideal implant placement with functional and aesthetic limitations. Following tooth extraction, a socket preservation technique can limit bone resorption. This study evaluated two different types of hydroxyapatite (HA) grafting materials placed into fresh extraction sockets, 6 months after tooth extraction, histologically, clinically and radiographically. Ten extraction sockets from 10 patients were divided in two groups: 5 sockets received a biomimetic HA and 5 received nanocrystalline HA. After 6 months, before implant placement, samples from the grafted area were harvested and evaluated clinically, radiographically and histologically. The percentages of bone, osteoid areas and residual material in the two groups were not statistically different. All samples showed great variability with extensive bone formation and total material resorption or amounts of osteoid tissue that filled the spaces between the residual material particles. The authors did not find any differences between biomimetic and nanocrystalline HA and assume that, within the limits of this study, both these materials could be applied into fresh extraction sockets to limit bone resorption. A control material and a much larger sample size are needed to confirm these findings.

Dental phobia in dentistry patients.

AIM: This study evaluated the presence of current and general phobia and anxiety symptoms in periodontology patients just before treatment in relation to specific dental fears and to general health status and quality of life. METHODS: The study population was all consecutive outpatients attending the Periodontics and Implantology Services, School of Dentistry, University of Bologna, over a 12-month period in 2007. Data collection instruments were psychological questionnaires (State-Trait Anxiety Inventory [STAI]-Y1, Marks-Sheehan Phobia Scale [MSPS], World Health Organization Quality of Life [WHOQOL] short form) plus supplementary items investigating specific dental fears, patient's dental history, and the dentist's clinical assessment of the patient. RESULTS: In all, 250 consecutive patients were recruited. Most (86%) presented with very mild anxiety and phobia symptoms; 13.2% and 13% presented with psychological symptoms of anxiety and phobia, respectively, independently of those subjects with specific dental fears who were significantly younger. The most common dental fears were fear of pain (48.8%) and of receiving an injection (29.9%). The patients' quality of life did not appear to be affected by these fears. CONCLUSIONS: In the dental outpatients seeking treatment for moderate-to-severe dental pathology at a university periodontics and implantology clinic and referring good general health and psychosocial functioning, levels of anxiety and phobia were usually low or absent; but when present, they were independent of ascertained specific dental fears.

Periodontal disease as a risk factor in pregnancy.

There is growing evidence that periodontal disease represents a risk factor for preterm delivery and premature membrane rupture. To prevent an oral inflammatory process evolving into a full-blown form of periodontitis, with possible severe repercussions on pregnancy outcome following systemic spread, future mothers should receive regular professional oral hygiene care throughout pregnancy.

The electric toothbrush: analysis of filaments under stereomicroscope.

BACKGROUND: The use of manual and electric toothbrushes has a fundamental role in primary prevention in oral hygiene. However, aggressive use of the toothbrush, especially those with non-rounded filaments, can result in lesions in both soft and hard oral tissue. Without doubt, the electric toothbrush is a useful aid for the patient, and it is therefore interesting to evaluate not only its effectiveness in plaque removal, but also the relationship between morphology of filaments and incidence of muco-gingival pathologies. OBJECTIVE: The aim of this research was to evaluate various forms of bristles of electric toothbrushes under a stereomicroscope vision. DATA SOURCES: Brushes tested included two samples of toothbrushes from six different types. Tufts from the same position on the toothbrush head were removed and examined under stereomicroscope. In this study the percentage of rounded filaments that is considered acceptable and non-traumatic was evaluated according to the Silverstone and Featherstone classification. CONCLUSIONS: Morphological analysis of electric toothbrush filaments revealed a low percentage of rounded filaments. In only four of 12 electric toothbrushes tested there were more than 50% of the filaments rounded in appearance.

[Genetic and microbiologic tests in periodontal disease]. / Test genetico e microbiologico nella malattia parodontale.

AIM: The presence of genetic polymorphisms IL-1A and IL-1B was demonstrated to be associated to an increased clinical severity of Periodontitis. The aim of our study was to verify the existence of a relationship between such genetic polymorphisms and pathogenic variations of Actinobacillus actinomycetemcomitans (Aa), Prevotella intermedia (Pi) and Porphyromonans gingivalis (Pg), in patients with periodontitis before and after active therapy. METHODS: Twenty-five patients were randomly selected among those attending the Department of Periodontology, University of Bologna, on the basis of radiographic and clinical data. At the end of active therapy, subjects had to undergo "PST" test. RESULTS: The "PST" was positive in 32% (8 out of 25) of patients; the majority of them (4 out of 8) were classified ADA IV, 3 were ADA III and 1 was ADA I (p > 0.05). All subjects with good hygiene therapy (13 out of 24 patients) have shown a reduced bacterial count after active clinical therapy (Fisher test p = 0.03). CONCLUSION: No statistically significant association was observed between positivity to "PST" and severity of periodontal disease.

Update on burning mouth syndrome: overview and patient management.

Burning Mouth Syndrome (BMS) is a chronic pain syndrome that mainly affects middle-aged/old women with hormonal changes or psychological disorders. This condition is probably of multifactorial origin, often idiopathic, and its etiopathogenesis remains largely enigmatic. The present paper discusses several aspects of BMS, updates current knowledge, and provides guidelines for patient management. There is no consensus on the diagnosis and classification of BMS. The etiopathogenesis seems to be complex and in a large number of patients probably involves interactions among local, systemic, and/or psychogenic factors. In the remaining cases, new interesting associations have recently emerged between BMS and either peripheral nerve damage or dopaminergic system disorders, emphasizing the neuropathic background in BMS. Based on these recent data, we have introduced the concepts of "primary" (idiopathic) and "secondary" (resulting from identified precipitating factors) BMS, since this allows for a more systematic approach to patient management. The latter starts with a differential diagnosis based on the exclusion of both other orofacial chronic pain conditions and painful oral diseases exhibiting muco-sal lesions. However, the occurrence of overlapping/overwhelming oral mucosal pathologies, such as infections, may cause difficulties in the diagnosis ("complicated BMS"). BMS treatment is still unsatisfactory, and there is no definitive cure. As a result, a multidisciplinary approach is required to bring the condition under better control. Importantly, BMS patients should be offered regular follow-up during the symptomatic periods and psychological support for alleviating the psychogenic component of the pain. More research is necessary to confirm the association between BMS and systemic disorders, as well as to investigate possible pathogenic mechanisms involving potential nerve damage. If this goal is to be achieved, a uniform definition of BMS and strict criteria for its classification are mandatory.

Toothbrush filaments end-rounding: stereomicroscope analysis.

BACKGROUND, AIMS: Toothbrush filaments with rounded ends allow for efficient removal of bacterial plaque and are less harmful to periodontal tissues than non-rounded bristles. The aim of this research was to evaluate the % of rounded filaments considered to be of acceptable quality in different toothbrush brands and to determine whether there is a standardization of quality, as manufacturers claim. METHOD: Brushes tested included 2 samples of medium-hard nylon or tynex toothbrushes from 31 various types found on the retail market in Italy. Tufts from the same position on the toothbrush head were removed and examined under a stereomicroscope, utilizing methods which did not alter the physical properties of the filaments. In 4 of the 31 toothbrush brands tested, more than 50% of the filaments appeared rounded, in 19 of them, between 11.9% and 40.5% and in 8 brands between 0% and 7%. RESULTS: Differences were found in the number and disposition of filaments among different brands and even within the same toothbrush brand. CONCLUSION: The results appear to indicate that a large % of toothbrushes on the retail market do not meet acceptable quality criteria.

Intraoral fluoride releasing device: a new clinical therapy for dentine sensitivity.

BACKGROUND: Dentinal sensitivity (DS) occurs frequently in adult populations in western countries. The purpose of this work was to assess the effectiveness of a new intraoral fluoride releasing device (IFRD) in reducing the level of pain in patients with primary or postsurgical dentine sensitivity. METHODS: A total of 49 individuals were selected for this study, 15 of whom had post-periodontal surgery dentine sensitivity and 34 with primary sensitivity. An IFRD was applied to 39, while 10 received a placebo device. All individuals in the control group suffered from primary sensitivity. The IFRD used in this study consists of sodium fluoride encased in an acrylic polymer which releases fluoride at a rate of approximately 0.04 mg/day. All patients were asked to rinse with cold water (10 degrees C) and to indicate the level of pain on a 0 to 10 visual analog scale, 0 equalling "no pain" and 10 "maximum bearable pain." All subjects were evaluated once a week during 4 months. Statistical analysis of dentine sensitivity was performed as a univariate study, in relation to the main factors: age, gender, and primary sensitivity or postsurgical etiology. RESULTS: Symptoms decreased dramatically in all treated patients. The level of sensitivity did not change during the first week after IFRD application, but decreased significantly within the fourth week and remained absent through the duration of the treatment (P <0.01). Difference in sensitivity with respect to different etiology was significant only after 4 weeks (P= 0.01), while there was no statistical difference with respect to age or gender. CONCLUSIONS: This paper is an initial study to evaluate the effectiveness of the IFRD. The method is fast, painless, inexpensive, and it appears to be suitable as a routine treatment. The presented data support the conclusions at this stage and warrant more comprehensive evaluation.

Water characteristics associated with the occurrence of Legionella pneumophila in dental units.

This study evaluated the incidence of Legionella pneumophila in dental unit water samples and investigated how the occurrence of these bacteria may be related to some physical, chemical and bacteriological characteristics of the water. The samples were taken from the incoming tap water, oral rinsing cup, air-water syringe, ultrasonic scaler, and the turbine of 23 dental units of private and public institutions. Apart from L. pneumophila (serogroup 1 and 3) isolated in 22 out of the 101 (21.8%) water samples tested, two other species were found: L. bozemanii and L. dumoffii. The highest densities and frequency of L. pneumophila were observed in the water coming into the units and in the dental units of public institutions. A negative association between L. pneumophila and 36 degrees C and 22 degrees C heterotrophic total plate counts and other gram-negative bacteria was found. An inverse association between the concentration of L. pneumophila and water temperature was also observed. The values of pH and total hardness did not show any significant difference in the L. pneumophila-positive and -negative dental unit waters. Finally, the chemical oxygen demand (COD) and residual chlorine were found to correlate positively with L. pneumophila.

The effects of nicotine and age on replication and viability of human gingival fibroblasts in vitro.

The aim of the present study was to examine: (1) the effects of nicotine on human gingival fibroblasts (HGF); (2) differences between smokers (> or = 10 cigarettes/day at least for 5 years) and non-smokers; (3) differences between patients of different age. HGF were obtained, through biopsies during periodontal surgical procedures, from 15 patients which were divided in 4 groups: 4 patients, smokers aged < or = 25 years; 4 patients, non-smokers aged < or = 25 years; 3 patients, smokers aged > or = 40 years; 4 patients, non-smokers aged > or = 40 years. Nicotine has been tested in 3 different concentrations: 6 microg/ml; 60 microg/ml; 600 microg/ml. To assess cells viability, the neutral red (NR) test was used; to evaluate cell proliferation, the Hoechst test was employed. After 48 h of nicotine exposure, it was found that 600 microg/ml nicotine was strongly cytotoxic to HGF of all groups, with a significant reduction of both proliferation and viability of cells versus control. Comparison between groups of the same age: when comparing untreated HGF (i.e., control values) of smokers < or = 25 years versus non-smokers < or = 25 years, cell proliferation, but not viability, was found to be increased in smokers. Both viability and proliferation of control cells of smokers > or = 40 years were increased versus non-smokers > or = 40 years. HGF of non-smokers < or = 25 years, when exposed to nicotine 600 microg/ml, have less viability and proliferation than HGF of smokers of the same age. Comparison between groups of different age: In the smoker group, untreated HGF (i.e., control values) had similar viability and proliferation, irrespective of age, but nicotine 600 microg/ml kills more HGF in smokers < or = 25 years than in smokers > or = 40 years. In non-smokers, untreated HGF < or = 25 years replicate less, but are not less viable than HGF > or = 40 years. When challenged with nicotine 600 microg/ml, HGF < or = 25 years were less viable than HGF > or = 40 years. From this study, it appears that the smoking history and the patient age could be relevant for final evaluation of the results, since HGF from smokers are less sensitive to nicotine than HGF from non-smokers, and cells from older donors are more resistant to nicotine than cells from younger donors.

Management of bilaterally impacted mandibular second and third molars.

BACKGROUND: The authors present an interdisciplinary approach to treating bilateral impaction of mandibular second molars. CASE DESCRIPTION: A 22-year-old man had a bilateral deep horizontal impaction of his mandibular second molars. The mandibular third molars lay above and parallel to the second molars. After an orthodontic assessment, the authors decided to distally upright the third molars, remove them and then orthodontically reposition the second molars if they were not ankylosed. This combined orthodontic-surgical approach was successful. CLINICAL IMPLICATIONS: This case illustrates the importance of strong cooperation among various specialists to establish the optimal comprehensive treatment plan.

Gingival recession and toothbrushing in an Italian School of Dentistry: a pilot study.

The aim of this pilot study was to evaluate the prevalence of gingival recession at buccal tooth surfaces in a student population of Bologna University Dental School. A total of 55 subjects, attending the 1st and 5th year of the course were examined. The clinical examination involved assessment of plaque, calculus, width of keratinized gingiva, buccal probing depth and buccal gingival recession. Information about toothbrushing behavior was collected in an interview. The multiple regression analysis showed that level of education (p=0.002), toothbrushing technique (p=0.013) and toothbrushing frequency (p=0.016) are significant contributors to gingival recession. Notwithstanding the limits of a preliminary study, a higher prevalence of buccal recession is observed in the final year students, which have also a significantly lower % of buccal surfaces with calculus (p=0.014). In addition, it clearly appears that there is the necessity to investigate other factors connected with toothbrushing (pressure, time, toothpaste quantity) in order to provide an oral hygiene education without undesired effects.

Antibiotic therapy in impacted third molar surgery.

The use of routine antibiotic therapy in patients undergoing surgical third molar extraction is controversial. The efficacy of antibiotic therapy in preventing postoperative complications following surgical third molar extractions was evaluated in 141 patients. In the test group (66 patients), the protocol utilized a regimen of 2 g of amoxicillin orally daily for 5 d postoperatively, starting at the completion of surgery. In the control group (75 patients), no antibiotic therapy was given. No significant difference was found between the test group and the control group in the incidence of postoperative sequelae, i.e. fever, pain, swelling and alveolar osteitis. A statistically significant association between smoking, habitual drinking and increased postoperative pain and fever was found. Patient age > or = 18 yr was positively correlated with an increased incidence of alveolar osteitis. Swelling was found to be gender-related, in that female patients experienced more swelling than male patients. No correlation was found between the time required for surgery or difficulty of extraction and post-operative pain. In conclusion, no difference was found between patients receiving postoperative amoxicillin and the control group in the incidence of postoperative sequelae.

A retentive system for intra-oral fluoride release during orthodontic treatment.

The aim of this study was to test a particular type of intra-oral fluoride releasing device (IFRD), designed to release 0.04 mg/day of fluoride over a period of 6 months, using customized holders, in patients receiving orthodontic treatment. Discomfort, holder detachment, plaque accumulation near the device, and the presence of gingivitis, bleeding, white spot lesions, and/or decay was recorded in 76 orthodontic patients (53 experimental and 23 controls) before and after wearing the device for 12 months. The system proved to be easy and quick to use, and did not cause discomfort. There were no significant differences between the treated and the control groups for plaque index, bleeding, or the presence of gingivitis. In addition, no carious and/or white spot lesions occurred during the duration of this study in the test group.