Association between blood transfusions and complications in head and neck reconstruction: a systematic review and meta-analysis.

PURPOSE: The aim of this meta-analysis is to assess the correlation between blood transfusions and the medical/surgical complications after head and neck reconstructive surgery. METHODS: The PRISMA protocol was used and the literature search was performed on Pubmed, Scopus, Cochrane Library and Web of Science up to March 13, 2020. The risk of bias in individual studies was assessed through the Newcastle Ottawa Scale. RESULTS: A total of 1219 records were screened after the electronic search, 22 of which were included in the qualitative analysis. Of there 22 scores, 18 articles were included in the meta-analysis. The OR for medical and surgical complications of transfused patients was 1,64 (95% CI 1.23-2.21); while, the OR for hospital readmission was 1.53 (95% CI 1.29-1.81). CONCLUSIONS: The results of this meta-analysis suggested that blood transfusions are associated with both an increased risk of surgical and medical complications of head and neck flaps and with the hospital readmission.

Relationship between preterm birth and developmental defects of enamel: A systematic review and meta-analysis.

BACKGROUND: A putative relationship between preterm birth and developmental defects of enamel (DDE) has been described in the literature. Although systematic reviews have found preterm birth may lead to DDE, the effect size has not been quantified. AIM: The aim of this systematic review and meta-analysis was to determine the association between preterm birth and DDE. DESIGN: An electronic search was performed in PubMed, Cochrane Library, Scopus, and Web of Science to identify relevant studies. Two independent reviewers selected the studies in a two-stage process in accordance with the PRISMA statement. The risk of bias was also analysed using the Newcastle-Ottawa Scale criteria. RESULTS: A total of 1041 publications were considered after an electronic search, 20 of which were included in the systematic review. Of these 20 publications, 18 articles were included in a meta-analysis. The meta-analysis detected an increased risk of developing DDE in preterm children [OR: 3.27 (95% CI 2.02, 5.30; P < .001)], with a greater risk in the primary dentition. In addition to this, a subgroup analysis showed a greater risk in the development of hypoplasia in preterm children. CONCLUSIONS: The results of this meta-analysis showed a three times increased risk of developing DDE in preterm children.

Can psychobiotics intake modulate psychological profile and body composition of women affected by normal weight obese syndrome and obesity? A double blind randomized clinical trial.

BACKGROUND: Evidence of probiotics effects on gut function, brain activity and emotional behaviour were provided. Probiotics can have dramatic effects on behaviour through the microbiome-gut-brain axis, through vagus nerve. We investigated whether chronic probiotic intake could modulate psychological state, eating behaviour and body composition of normal weight obese (NWO) and preobese-obese (PreOB/OB) compared to normal weight lean women (NWL). METHODS: 60 women were enrolled. At baseline and after a 3-week probiotic oral suspension (POS) intake, all subjects underwent evaluation of body composition by anthropometry and dual X-ray absorptiometry, and psychological profile assessment by self-report questionnaires (i.e. EDI-2, SCL90R and BUT). Statistical analysis was carried out using paired t test or a non-parametric Wilcoxon test to evaluate differences between baseline and after POS intake, one-way ANOVA to compare all three groups and, where applicable, Chi square or t test were used to assess symptoms. RESULTS: Of the 48 women that concluded the study, 24% were NWO, 26% were NWL and 50% were PreOB/OB. Significant differences in body composition were highlighted among groups both at baseline and after a POS (p < 0.05). After POS intake, a significant reduction of BMI, resistance, FM (kg and %) (p < 0.05), and a significant increase of FFM (kg and  %) (p < 0.05) were observed in all subjects in NOW and PreOB/OB. After POS intake, reduction of bacterial overgrowth syndrome (p < 0.05) and lower psychopathological scores (p < 0.05) were observed in NWO and PreOB/OB women. At baseline and after POS intake, all subjects tested were negative to SCL90R_GSI scale, but after treatment subjects positive to BUT_GSI scale were significantly reduced (8.33%) (p < 0.05) compared to the baseline (33.30%). In NWO and PreOB/OB groups significant differences (p < 0.05) in response to the subscales of the EDI-2 were observed. Significant improvement of the orocecal transit time was observed (p < 0.05) after POS intake. Furthermore, significant differences were observed for meteorism (p < 0.05) and defecation frequency (p < 0.05). CONCLUSIONS: A 3-week intake of selected psychobiotics modulated body composition, bacterial contamination, psychopathological scores of NWO and PreOB/OB women. Further research is needed on a larger population and for a longer period of treatment before definitive conclusions can be made. Trial registration ClinicalTrials.gov Id: NCT01890070.

Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature.

BACKGROUND: It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments. METHODS: The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations. RESULTS: Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered. CONCLUSIONS: this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.

Management of Enamel Defects with Resin Infiltration Techniques: Two Years Follow Up Retrospective Study.

BACKGROUND: Developmental Defects of Enamel (DDE) represent an aesthetic, functional, and often psychological problem, especially in young patients. Infiltrative treatment with resin (Icon-DMG, Hamburg, Germany) is a minimally invasive technique based on the infiltration of high viscosity resin inside the hypomineralized enamel, modifying its optical properties. The aim of this paper is to evaluate the clinical efficacy of superficial infiltration in the treatment of white enamel defects of the anterior sector with pre-eruptive etiology and its stability over time. METHODS: Thirty-three patients affected by DDE associated with mild and moderate Molar Incisor Hypomineralization (MIH), mild and moderate fluorosis, and post-traumatic hypomineralization treated with resin infiltration were retrospectively retrieved. RESULTS: In all cases an improvement in aesthetic appearance was achieved, and the 24-month follow-up confirmed the stability of the results. However, in the cases of traumatic hypomineralization the results were not completely satisfactory. CONCLUSIONS: The superficial infiltration technique can be considered a valid minimally invasive alternative to traditional treatment of mild or moderate fluorosis and mild MIH.

The Impact of Chronic Kidney Disease on Nutritional Status and Its Possible Relation with Oral Diseases.

Several studies have demonstrated a strong relation between periodontal diseases and chronic kidney disease (CKD). The main mechanisms at the base of this link are malnutrition, vitamin dysregulation, especially of B-group vitamins and of C and D vitamins, oxidative stress, metabolic acidosis and low-grade inflammation. In particular, in hemodialysis (HD) adult patients, an impairment of nutritional status has been observed, induced not only by the HD procedures themselves, but also due to numerous CKD-related comorbidities. The alteration of nutritional assessment induces systemic manifestations that have repercussions on oral health, like oral microbiota dysbiosis, slow healing of wounds related to hypovitaminosis C, and an alteration of the supporting bone structures of the oral cavity related to metabolic acidosis and vitamin D deficiency. Low-grade inflammation has been observed to characterize periodontal diseases locally and, in a systemic manner, CKD contributes to the amplification of the pathological process, bidirectionally. Therefore, CKD and oral disease patients should be managed by a multidisciplinary professional team that can evaluate the possible co-presence of these two pathological conditions, that negatively influence each other, and set up therapeutic strategies to treat them. Once these patients have been identified, they should be included in a follow-up program, characterized by periodic checks in order to manage these pathological conditions.

Comparative evaluation of the efficacy of three commercially available toothpastes on dentin hypersensitivity reduction: an eight-week clinical study.

OBJECTIVE: The objective of this eight-week, single-center, three-cell, double-blind, and randomized clinical study was to evaluate the dentin hypersensitivity reduction efficacy of three commercially available toothpastes: 1) Colgate Sensitive Pro-Relief Toothpaste (also marketed as elmex Sensitive Professional); 2) Sensodyne Rapid Relief Toothpaste; and (3) Crest Cavity Protection Toothpaste. METHODS: 150 subjects, having two teeth with tactile and air blast hypersensitivity, were assigned to one of the three study groups (50/group). Subjects were then asked to brush their teeth for one minute, twice daily, with the given toothpaste. The dentin hypersensitivity and oral tissues were evaluated at baseline, two weeks, four weeks, and eight weeks. Comparison of the treatment groups with respect to gender was conducted using a chi-square analysis, and with respect to age and baseline hypersensitivity scores was performed using the analysis of variance (ANOVA). Within-treatment effects were analyzed using the paired t-test, while the analysis of covariance (ANCOVA) was used to examine between-treatment effects. The post hoc Tukey test was performed for pair-wise comparisons. All statistical tests were two-sided using a significance level of alpha = 0.05. RESULTS: After two, four, and eight weeks of daily use of the products, all three groups showed a statistically significant reduction from baseline in tactile and air blast dentin hypersensitivity (p < 0.05). Colgate Sensitive Pro-Relief toothpaste produced a significant improvement in mean tactile and air blast dentin hypersensitivity scores, and was more effective than Sensodyne Rapid Relief toothpaste and Crest Cavity Protection toothpastes (p < 0.05). CONCLUSION: Colgate Sensitive Pro-ReliefToothpaste, used twice daily, significantly reduces dentin hypersensitivity, and is significantly more effective in reducing dentin hypersensitivity than Sensodyne Rapid Relief Toothpaste and Crest Cavity Protection Toothpaste.

Cariogenic Risk and COVID-19 Lockdown in a Paediatric Population.

The Severe Acute Respiratory Syndrome Coronavirus 2 disease COVID-19 pandemic caused several lifestyle changes, especially among younger people. The study aimed to describe the impact of eating habits, lifestyle, and home oral hygiene during the COVID-19 pandemic, on the cariogenic risk in the Italian paediatric population, by using an online survey. The survey was conducted through a virtual questionnaire divided into four parts: child personal and anthropometric data; oral health; child dietary habits (KIDMED test); and child lifestyle, before and during COVID-19 lockdown. During the lockdown, only 18.6% of the participants had high adherence to a Mediterranean diet, recording an increase in sweets consumption and the number of meals (p < 0.001). In terms of lifestyle, the percentage of moderately and vigorously active children decreased (41.4% and 5.0%, respectively) (p = 0.014). The percentage of children sleeping more than 9 h increased (p < 0.001). They watched more television programs (p < 0.001). Regarding oral hygiene, children did not change their brushing habits (p = 0.225). The percentage of children using non-fluoridated toothpaste was higher (6.4%), and no changes were observed (p > 0.05). In some cases, dental pain and abscesses were declared (10% and 2.7%, respectively). This study confirms the need for campaigns to promote hygiene and dental care in combination with food education for a correct habit and promotion of a healthy and sustainable dietary style.

Oral health in children with cerebral palsy: A systematic review and meta-analysis.

AIMS: Aim of the present systematic review and meta-analysis is to investigate the oral health status of children with cerebral palsy and to compare it to that of healthy children. METHODS AND RESULTS: An electronic search extended to October 2019 was conducted on PubMed, Scopus, Web of Science and Cochrane Library. Two independent reviewers selected publications using a two-stage process; data were extracted according to PRISMA statement. The Newcastle Ottawa Scale was used to evaluate the risk of bias in individual studies. After screening of the 5460 studies selected 20 publications were included in the systematic review, 15 underwent quantitative analysis. In the palsy population statistical analysis showed an OR = 1.45 (95% CI: 1.05-2.00) for dental caries in the primary dentition and OR = 1.87 (95% CI: 1.07-3.24) for the simplified oral hygiene index. The OR of Angle's Class II and anterior open bite were 3.27 (95% CI: 1.22-8.81) and 14.06 (95% CI: 6.26-31.62), respectively. CONCLUSION: Children with cerebral palsy seem to present an increased risk of dental caries in the primary dentition, of Angle's Class II malocclusion, anterior open bite and a lower gingival status.

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

OBJECTIVE: This paper presents the results of one of two eight-week dentin hypersensitivity clinical studies in which the efficacy of a novel toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride as sodium monofluorophosphate (MFP) was compared to that of a benchmark commercial toothpaste containing 2% potassium ion, dosed as 3.75% potassium chloride, and 1450 ppm fluoride as sodium fluoride (NaF). METHODS: An eight-week clinical study, with eighty patients, was conducted in Rome, Italy using a double-blind, stratified, two-treatment design. Tactile sensitivity assessments, as well as air blast sensitivity assessments, were used to compare the efficacy of the two products. RESULTS: This clinical study showed 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 this new arginine toothpaste provided significantly greater reductions (p < 0.05) in dentin hypersensitivity in response to tactile (37.0%, 30.0%, and 12.2%) and air blast (23.9%, 32.0%, and 29.3%) stimuli than the commercial sensitive 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 sodium monofluorophosphate (MFP) provides significantly increased dentin hypersensitivity relief (p < 0.05) compared to a commercial sensitive toothpaste containing 2% potassium ion after two weeks, four weeks, and eight weeks of product use.

Association between oral cleft and transcobalamin 2 polymorphism in a sample study from Nassiriya, Iraq.

Orofacial clefts are common congenital defects whose prevalence differs between geographical regions and ethnic groups. The inheritance is complex, involving the contribution of both genetic and environmental factors. The involvement of genes belonging to the folate pathway is still matter of debate, with strong evidences of association and conflicting results. After demonstrating the contribution, for a sample from the Italian population, of common mutations mapping on three genes of the folate pathway, our group tried to unravel their contribution in independent sample studies with different ethnicity. In the present investigation a set of 34 triads with oral cleft from Nassiriya, Iraq, has been genotyped for rs1801133 of MTHFR, rs1801198 of TCN2, and rs4920037 of CBS polymorphisms. Association analysis evidenced a decreased risk of cleft for children carrying the 667G allele at TCN2 gene (P = 0.02). This evidence further supported the relationship between polymorphisms of folate related genes and oral clefts, and outlined the relevance of studying populations having different ethnicity.

Copy number variation analysis of twin pairs discordant for cleft lip with or without cleft palate.

Non-syndromic cleft lip with or without cleft palate (nsCL/P) is a frequent orofacial malformation. The comparison of concordance rate observed in monozygotic and dizygotic twins supports high level of heritability and a strong genetic component. However, phenotype concordance for orofacial cleft in monozygotic twins is about 50%. The aim of the present investigation was to detect postzygotic events that may account for discordance in monozygotic twins. High-density SNP microarrays hybridization was used to genotype two pairs of monozygotic twins discordant for nsCL/P. Discordant SNP genotypes and copy number variants were analyzed to identify genetic differences responsible of phenotype discrepancy. A number of differences were observed, none involving known nsCL/P candidate genes or genomic regions. Considering the limitation of the study, related to the small sample size and to the large-scale investigation method, the results suggest that the detection of discordant events in other monozygotic twin pairs would be remarkable and warrant further investigations.

Influence of mandibular third molar surgical extraction on the periodontal status of adjacent second molars.

BACKGROUND: The periodontal health distal of second molars (M2) is often compromised because of third molar (M3) impactions. The aim of this study was to evaluate healing and periodontal status of mandibular M2 after M3 surgical extraction. METHODS: Eighty-nine consecutive patients with 89 asymptomatic M3 who needed surgical extraction of one fully- or semi-impacted M3 entered this study. Clinical measurements, probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP), were compared for M2 at baseline (T0) and 6-months (T1) postsurgical extraction. Multiple logistic regression analysis assessed different risk factors for postoperative changes of periodontal parameters. RESULTS: Six-month M2 PPD improved at disto-vestibular (T0-5.2/T1-3.0 mm) and disto-lingual (T0-5.4/T1-3.2 mm) sites. The average attachment gains at T1 were 1.9 and 2 mm, respectively (P < 0.05). BOP, PI, and GI showed significant clinical improvements after extractions. Fifty-three out of 72 (73.6%) M2 presenting a PPD ≥ 4mm at baseline healed at 6 months recall without periodontal pockets. Older age (mean 55 years, SD 16.7; range 26 to 81) and mean distal PPD at baseline of 7 mm was more likely to be associated with PPD ≥ 4 mm 6 months postextraction (P < 0.05). Past history of periodontitis patients were 41 times more likely to present PPD ≥ 4 mm after healing (OR = 41.4; 95% CI = 10.9 to 156.5, P < 0.05). CONCLUSION: Mandibular M3 extractions seem to improve overall periodontal health distal of M2. History of periodontitis, preoperative deep pockets and older age are independent risk factors for poorer healing and residual pockets after M3 surgical extraction.

Non-syndromic cleft palate: Association analysis on three gene polymorphisms of the folate pathway in Asian and Italian populations.

Periconceptional folic acid supplementation can reduce the risk of inborn malformations, including orofacial clefts. Polymorphisms of MTHFR, TCN2, and CBS folate-related genes seem to modulate the risk of cleft lip with or without cleft palate (CL/P) in some populations. CL/P and cleft palate only (CPO) are different malformations that share several features and possibly etiological causes. In the present investigation, we conducted a family-based, candidate gene association study of non-syndromic CPO. Three single nucleotide polymorphisms, namely, rs1801133 of MTHFR, rs1801198 of TCN2, and rs4920037 of CBS, were investigated in a sample that included 129 Italian and 65 Asian families. No evidence of association between the three genotyped polymorphisms and CPO was found in the Italian and Asian cases, indeed the transmission disequilibrium test did not detect any asymmetry of transmission of alleles. This investigation, although with some limitation, further supports that CL/P and CPO diverge in their genetic background.

Atopic dermatitis and dental manifestations.

BACKGROUND: Atopic dermatitis is a chronic skin disease associated with epidermal dysfunction commonly seen in children. The aim of this study was to evaluate the possible correlation between atopic dermatitis and dental diseases in paediatric patients. METHODS: An observational study was conducted by the Department of Paediatric Dentistry of the Policlinico Tor Vergata among a group of 300 children, between 2 and 17 years of age and of both genders, for a period of 6 months from January 2013 to June 2013. Socio-demographic data including race, gender, and age were collected. Clinical and dermatological examinations were performed in all patients; family and medical history of atopy was recorded for each patient and relatives. RESULTS: Three hundred patients, aged between 2 and 17 years, with mean age of 8.9 (±2.12), were enrolled; 90/300 (30%) were affected by atopic dermatitis. Of those, 69/90 (76.6%) had a medical history of spoil habit, 49/90 (54%) had caries, 58/90 (64.4%) had malocclusion disease, 13/90 (14.4%) had anatomical dental abnormalities. CONCLUSIONS: In conclusion, in the current investigation we found a higher prevalence of atopic dermatitis in pediatric dentistry patients compared to the general population suggesting that dental diseases could be involved in the pathogenesis of AD.

Aphthous, celiac disease and other dental disorders in childhood.

BACKGROUND: Oral conditions and dental disorders are frequent in childhood. Recurrent aphthous stomatitis (RAS) is a common inflammatory condition characterized by painful recurrent, single or multiple ulcerations of the oral mucosa induced by genetic and environmental factors. Celiac disease (CD) is a chronic small intestinal immunemediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals pathogenetically related to oral condition. The aim of the study was to evaluate the different prevalence of oral conditions in CD patients compared to a control group. METHODS: From January 2013 to June 2013, 166 patients, between 2 and 17 years of age and of both genders, were examined in order to evaluate the presence and the medical history of oral conditions. Clinical features of patients affected by CD were compared with those of a control group with similar socio-demographic features. RESULTS: We found that the more common lesions in both groups were RAS (69% in CD patients vs. 43% in the control group), followed by dental disorders (76% in CD patients vs. 65% in the control group). Prevalence of RAS between the two groups was significantly different (P<0.0006). Prevalences of caries and dental abnormalities were the same in the two groups (45% vs. 45% and 16% vs. 16% respectively). CONCLUSIONS: In celiac patients there was a significant higher prevalence of RAS compared to a control group. These findings could be possibly associated with common pathogenetic mechanisms.

Extraction treatment using a palatal implant for anchorage.

AIM: To describe the use of Straumann Orthosystem implants for orthodontic anchorage. METHODS: The Straumann Orthosystem consists of a titanium palatal implant and connected device, which can be used when absolute anchorage is required. In the present study the implant was placed in the midline at the junction of the alveolar process and hard palate. The implant was osseointegrated 13 weeks after placement. A palatal arch attached to the implant and upper first molar bands was used to provide stationary anchorage in a 23 year-old female with protruding upper anterior teeth and moderate crowding of both arches. CONCLUSION: A palatal implant provides stationary anchorage for retraction of anterior maxillary teeth.

Mandibular pendex spring appliance for use in mixed dentition.

Loss of space in the mandibular arch is a common occurrence due to several different causes such as caries, trauma or iatrogenic damage. This paper describes a new TMA spring used in mixed dentition for space regaining in the mandibular arch. A clinical report is presented and the advantages of the method are discussed.

Clinical treatment of oral manifestations of Beckwith-Wiedeman syndrome in a child.

Orthodontic treatment in a young patient with Beckwith-Wiedeman Syndrome (BWS) is reported and a multidisciplinary approach to the management of this syndrome is reviewed. The patient presented with a tendency to Class III malocclusion, an open-bite and a slight macroglossia, which was treated at an early age by glossotomy. It was decided to monitor growth without treatment and to wait for the best time to begin therapy. It was based only on functional rehabilitation, without any fixed appliances, in which optimum intercuspation of the teeth and the skeletal Class I relationship was achieved and maintained after the retention period of three years. In conclusion the treatment of BWS patients requires a multidisciplinary approach that includes orthodontics, orthopaedics and surgical intervention. It is also necessary to underline the significance of diagnosis at an early age and timely treatment to reduce the development of dento-skeletal alterations.

Association between Oro-Facial Defects and Systemic Alterations in Children Affected by Marfan Syndrome.

BACKGROUND: It is important to establish an early diagnosis of the Marfan Syndrome (MFS) for providing an adequate pharmacological or surgical therapy. Nevertheless, this diagnosis may be complex, given the multi-organic involvement of this disease. AIMS: In this work, we evaluated the oral phenotype in a group of paediatric patients with a clinical diagnosis of MFS, to quantify the association of the oro-facial defects with other systemic alterations. SETTINGS AND DESIGN: Paediatric subjects who were aged, with a clinical diagnosis of MFS, were selected from our regional Marfan monitoring unit. METHODS AND MATERIAL: All the patients were subjected to Paediatric Dentistry examinations and a radiological screening with Panoramic and Cephalometric X-Rays. The aortic dilation (Aortic Z-score value), the hyperlaxity of the ligaments and scoliosis were evaluated by cardio-surgical and orthopaedics specialists. STATISTICAL ANALYSIS: The correlations between the oral and systemic alterations were analyzed by using the chi square test for the nominal variables. RESULTS AND CONCLUSIONS: We found a significant correlation of the Aortic Z - score with multiple oral defects which included retrognathia, malar hypoplasia, cross bite, oral respiration and an ogival palate. An association of the oral defects with hyperlaxity of the ligaments and scoliosis was also found. Thus, the data suggested that dentists should be more involved in a multidisciplinary approach, to provide an early MFS diagnosis in paediatric patients.