Poor glycemic control impairs oral health in children with type 1 diabetes mellitus - a systematic review and meta-analysis.

OBJECTIVE: There are more than one million children and adolescents living with type 1 diabetes mellitus, and their number is steadily increasing. Diabetes affects oral health through numerous channels, including hyposalivation, immune suppression, and the inflammatory effect of glycation end-products. However, patients with type 1 diabetes must follow a strict sugar free diet that is proven to be carioprotective. Therefore, the aim of this systematic review and meta-analysis is to investigate whether children with type 1 diabetes have a difference in Decayed, Missing, Filled Teeth index (DMFT), salivary function, and periodontal status than children without diabetes, with an emphasis on glycemic control. MATERIALS AND METHODS: PubMed, Embase and Cochrane libraries were screened for articles, using predefined search keys without any language or date restrictions. Two independent authors performed the selection procedure, extracted data from the eligible articles, carried out a manual search of the reference lists, and assessed the risk of bias using the Newcastle-Ottawa scale. Meta-analysis was performed in R using the random-effects model. Effect sizes were mean differences; subgroup analysis was performed on glycemic control. RESULTS: 33 studies satisfied the eligibility criteria. 22 studies did not show a significant difference regarding the DMFT index between the diabetes and non-diabetes groups; six studies found that children living with diabetes had higher DMFT scores, compared to five studies that found significantly lower scores. Meta-analysis found no statistically significant differences in plaque, gingival, and calculus indexes, however it found significant differences in pooled DMFT indexes, and salivary flow rate. Subgroup analysis on glycemic control using DMFT values found significant differences in children with good and poor glycemic control with results of 0.26 (CI95%=-0.50; 1.03) and 1.46 (CI95%=0.57; 2.35), respectively. CONCLUSIONS: Children with poor glycemic control face higher risk of developing caries compared to good control and non-diabetes children. Regular dental check-ups and strict control of glycemic levels are highly advised for children living with type 1 diabetes, further emphasizing the importance of cooperation between dentists and diabetologists.

Maternal factors in the origin of cleft lip/cleft palate: A population-based case-control study.

OBJECTIVES: Orofacial clefts are among the most common birth defects, with an estimated worldwide incidence of around 1.5-1.7 per 1000 live-born babies. The most frequent form of orofacial clefts is cleft lip with or without cleft palate (CL ± CP). The role of environmental factors in the development of clefts is unclear in most patients, thus the aim of this study was to estimate possible maternal risk factors in the origin of CL ± CP. MATERIALS AND METHODS: 1648 CL ± CP cases, 2654 matched controls and 57 231 population controls were evaluated from The Hungarian Case-Control Surveillance of Congenital Abnormalities. Maternal factors during the critical period in cases and controls were compared. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated in a multivariable conditional logistic regression model. RESULTS: Among socio-demographic data, we have found significant differences between maternal employment. The proportion of unskilled mothers (6.5%) were higher in the CL ± CP group than in controls (3.5%). Medically recorded maternal anaemia, excessive vomiting and threatened abortion were associated with a higher risk of CL ± CP. An elevated risk was also found in various acute illnesses such as influenza (OR: 2.4, 95% CI: 3.0-5.8), acute bronchitis (OR: 4.5, 95% CI: 1.6-12.6) and urinary tract infections (OR: 3.5, 95% CI: 2.0-6.0). Maternal migraine and essential hypertension occurred more frequently in the mothers of cases than in controls. CONCLUSION: The findings of this study suggest that maternal diseases and lifestyle factors during the first trimester play a significant role in the development of CL ± CP.

Effect of Chitosan on the Number of Streptococcus mutans in Saliva: A Meta-Analysis and Systematic Review.

We conducted a meta-analysis and systematic review to investigate the efficacy of chitosan-containing chewing gums, and to test their inhibitory effects on Streptococcus mutans. The systematic search was performed in three databases (Cochrane Library, EMBASE, and PubMed) and included English-language randomized-controlled trials to compare the efficacy of chitosan in reducing the number of S. mutans. To assess the certainty of evidence, the GRADE tool was used. Mean differences were calculated with a 95% confidence interval for one outcome: bacterial counts in CFU/mL. The protocol of the study was registered on PROSPERO, registration number CRD42022365006. Articles were downloaded (n = 6758) from EMBASE (n = 2255), PubMed (n = 1516), and Cochrane (n = 2987). After the selection process, a total of four articles were included in the qualitative synthesis and three in the quantitative synthesis. Our results show that chitosan reduced the number of bacteria. The difference in mean quantity was -4.68 × 105. The interval of the random-effects model was [-2.15 × 106; 1.21 × 106] and the prediction interval was [1.03 × 107; 9.40 × 106]. The I2 value was 98% (p = 0.35), which indicates a high degree of heterogeneity. Chitosan has some antibacterial effects when used as a component of chewing gum, but further studies are needed. It can be a promising antimicrobial agent for prevention.

Maternal-related factors in the origin of isolated cleft palate-A population-based case-control study.

OBJECTS: Isolated cleft palate (CPO) is the rarest form of oral clefting affecting 1-25 per 10 000 newborns worldwide. There is increasing evidence for the different pathogenetic backgrounds of CPO and cleft lip with or without cleft palate. The role of environmental factors in the origin of non-syndromic and syndromic CPO is unclear in most patients. The aim of this study was to estimate possible maternal risk factors in the origin of CPO. SETTING AND SAMPLE POPULATION: The Hungarian Case-Control Surveillance of Congenital Abnormalities contains data of 32 345 birth defect cases and 57 231 control newborns. The study samples included 751 cases with isolated CPO, 1196 matched controls and 57 231 population controls. MATERIAL AND METHODS: Maternal diseases during pregnancy in cases and population controls were compared, and adjusted ORs with 95% CI were calculated in a multivariable unconditional logistic regression model. RESULTS: Beyond the well-known robust female excess (58.9%)-maternal smoking (OR with 95% CI: 2.34, 1.94-2.81) medically recorded maternal anaemia, threatened abortion and excessive vomiting in pregnancy were associated with a higher risk for CPO in the offspring. An elevated risk was found in Graves' disease (OR: 4.30, 1.74-10.62), epilepsy (OR: 4.64, 2.44-8.82), migraine (OR: 2.82, 1.18-6.76) and essential hypertension (OR: 2.33, 1.32-4.10). Among acute diseases common cold (OR: 4.94, 3.48-7.03), acute respiratory infections (OR: 4.20, 1.49-11.82), influenza (OR: 2.95, 1.75-4.95), pulpitis (OR: 7.85, 2.80-22.03), cholecystitis (OR: 3.15, 1.16-8.60), acute urinary tract infections (OR: 4.08, 2.22-7.49) and pelvic inflammatory diseases (OR: 3.93, 1.62-9.53) during pregnancy also were associated with an increased risk for developing CPO. CONCLUSION: The findings of this study suggest that maternal diseases and lifestyle factors during the first trimester play a significant role in the development of isolated cleft palate.

[Incidence of type 2 diabetes among oral cancer patients in Hungary]. / A 2-es típusú diabetes mellitus prevalenciájának változása szájüregi carcinomás betegek körében.

INTRODUCTION: Data proves that Hungary has a leading role in the statistics of oral cancer and patients living with type 2 diabetes. AIM: Our aim was to understand the statistical correlation between oral cancer and metabolic disorder (diabetes mellitus and impaired fasting glucose) due to the valuable data from the Semmelweis University. METHOD: We analyzed the data of 835 patients diagnosed with malignant oral cancer and 587 tumor-free control patients. We investigated the incidence and location of oral cancer among patients living with diabetes, and compared these datasets with our previous data from 14 years earlier. RESULTS: We found that in oral cancer patients, 26.1% had diabetes and 20.8% had impaired fasting glucose; in the control group these ratios were 10.8% and 11.1%. This difference is significant (p<0.05). 14 years ago in the tumor group 14.6%, in the control group 5.6% had diabetes, while 9.7% and 5.5% had impaired fasting glucose. Lip cancer had the biggest incidence. CONCLUSIONS: The rise of type 2 diabetes in the tumor group was significant. This could be a burden for the health care system. We want to highlight the importance of interdisciplinary cooperation between health care professionals. Orv Hetil. 2018; 159(20): 803-807.

A novel image processing procedure for the quantitative evaluation of dental enamel prism arrangement.

Enamel prism is the main microstructural unit of mammalian enamel which composed of hundreds of bioapatite nanocrystals. Prism structure plays a key role in the excellent mechanical performance of dental enamel during millions of chewing cycles without significant remodeling. Thus, quantitative understanding of prism architecture is of utmost importance for biomechanical materials design. To characterize enamel prism orientation quantitatively, a novel image processing method has been developed. Our method is based on scanning electron microscopy images of etched enamel surface and consists of an ellipse fitting procedure, which provides a numerical approximation of prism shape and orientation in the studied cross section. The obtained analytical data allow to construct color coded orientation maps, which provide quick and useful insight into the microstructure of enamel. Besides striking visualization, orientation maps allow to extract and plot the rich information on the azimuthal and inclination angles of the prisms as function of location. Numerical data on prism arrangement can be analyzed using statistical tools over large areas, which paves the way towards quantifying comparative investigation of prism arrangement either in dentistry research or evolution biology. The application of the method is demonstrated for a distal-mesial cross-section of sound human tooth enamel. HIGHLIGHTS: Scanning electron microscopy images of etched enamel surface are analyzed using ellipse fitting. Geometrical parameters of the fitted ellipses provide numerical data of thousands of prisms. Prism arrangement is visualized on color coded orientation maps and analyzed using statistical tools.

Oral Health Knowledge and Habits of Hungarian Monozygotic and Dizygotic Twins: A Pilot Study.

OBJECTIVE: The aim of this research was to collate and analyse the data on the oral health knowledge and the related habits of a Hungarian cohort of monozygotic (MZ) and dizygotic (DZ) twins using the newly developed World Health Organisation Oral Health Questionnaire for Adults (Annex 7). METHOD: A total of 15 sets of MZ twins and 14 sets of DZ twins (58 individuals) aged between 18 and 71 years were enrolled in the study. Each participant had to fill out a web-based questionnaire which comprised 23 questions (Google Forms). The data were collated and the oral health/hygiene habits of MZ and DZ twins were compared. RESULTS: No significant differences were detected between MZ and DZ twins with regards to their daily tooth-cleaning habits or the tooth-cleaning products used by the 2 groups. For instance, when asked how often they clean their teeth, 80% of MZ twins and 71% of DZ twins responded similarly. Further, both groups provided similar responses when questioned about the use of fluoride toothpaste, frequency of dental visits, and dental counselling received as well as a number of other parameters such as snacking of sweets and fear of visiting dentists. CONCLUSIONS: Our pilot analysis of the questionnaire responses from MZ and DZ twins in Hungary did not indicate any significant differences in their oral care habits in general. Further studies with a large cohort are required to confirm or refute our findings.

Prosthetic rehabilitation of a patient with ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome through a hybrid workflow: A case report with 2-year follow-up.

AIM: Ectrodactyly-ectodermal dysplasia-cleft lip/palate (EEC) syndrome is a rare genetic disorder that affects ectodermal derived structures, including teeth, nails, hair, and sweat glands. Prosthetic rehabilitation of patients with EEC syndrome is essential towards improving their overall quality of life. METHODS AND RESULTS: In the case shown, a telescopic retained overdenture was made on the lower jaw based on digital impression of a patient with EEC syndrome associated with cleft lip and cleft palate. Due to the congenital anomalies and limited mouth opening, the impression was taken with intraoral scanner, and after designing the telescopes on the digital model, the primary and secondary telescopes were confectioned by selective laser sintering. CONCLUSION: Combining digital dental technology and conventional clinical prosthetic treatment methods, results in a well-functioning overdenture even in such complicated situations. The prosthodontic rehabilitation of patients with ECC helps to restore the masticatory and phonetic functions, increases the patient's self-esteem, and prevents further psychological trauma caused by hypodontia.

[The role of probiotics in oral health.] / A probiotikumok szerepe az orális egészségben.

INTRODUCTION: The World Health Organization defines probiotics as: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host." Probiotics maintain the balance of the normal intestinal flora and prevent the proliferation of pathogenic bacteria. Its therapeutic use in oral health is increasing. The literature reports successful results considering the treatment of caries and periodontal disease with probiotics. In these cases, probiotics effect the oral flora causing the disease. Our research investigates how caries and type I diabetes effect the normal oral flora. OBJECTIVE: To summarize the literature on this topic and to present our research, which compares the oral microflora of children with or without caries and of healthy children with those having type 1 diabetes. Our research also determines the total oral bacterial and Lactobacillus count, and its species composition. METHOD: A 0.5 ml saliva sample is collected from the participants (20 participants/group). The total bacteria count is determined on blood agar, the Lactobacillus is cultured on Rogosa agar. A MALDI-TOF (matrix-assisted laser desorption/ionization-time-of-flight) device is used to identify the different Lactobacillus species. RESULTS: The total bacterial count of the two test groups did not show a significant difference compared to the control groups (109 vs. 108 CFU/mL). In the groups of children with caries and with diabetes, there was a significant difference in the Lactobacillus count compared to the control groups (102 vs. 103 CFU/mL). The species composition of the Lactobacillus differed in each group. DISCUSSION: Cariogenic oral flora can displace the probiotic strains in the oral cavity. Diabetes in childhood can affect the composition of the oral flora. CONCLUSION: Restoring the normal oral flora of the oral cavity with probiotics is a possible way of preventing the development of oral diseases. Further research is needed examining the function of individual probiotic strains. Orv Hetil. 2023; 164(24): 942-947.

Preoperative HbA1c and Blood Glucose Measurements in Diabetes Mellitus before Oral Surgery and Implantology Treatments.

Diabetes mellitus has become a worldwide epidemic and is frequently accompanied by a number of complications proportional to the duration of hyperglycemia. The aim of this narrative review is to assess the most up-to-date guidelines on DM provided by both diabetes and dental associations. Furthermore, to gather evidence on the uni/bidirectional relationships of elevated HbA1c levels on dental surgery, implantology, bone augmentation, and periodontology and to demonstrate the importance of measuring HbA1c levels before invasive dental treatments. HbA1c and blood glucose measurements are a minimally invasive method for preventing complications in diabetes mellitus. The authors conducted a literature review to determine which oral conditions are affected by diabetes mellitus. MEDLINE served as a source with the use of a specific search key. Regarding oral complications of diabetes, prevention is the most vital factor. With this publication, we hope to assist physicians and dentists to make prompt diagnoses and to help in recognizing various oral manifestations of diabetes and follow the existing guidelines.

Oral Health Status of Children Living with Type 1 Diabetes Mellitus.

BACKGROUND: Diabetes is a well-known predisposing factor for oral diseases, so prevention in an early age is mandatory. OBJECTIVE: To provide oral screening for children living with type 1 diabetes. We aimed to investigate the oral and general health indexes of T1DM children and compare these data to healthy siblings and controls. METHODS: In this cross-sectional study, 120 DM patients and 78 siblings, thereafter 80 DM children and 95 controls, took part. A detailed questionnaire, panoramic radiographs, and lateral cephalograms were obtained in every orthodontic consultation. We used Pearson's chi-square test for statistical analysis and compared the data of the study and control groups. RESULTS: The oral health values of DM children were significantly better (DMF-T 0.83-1.3) than the national average (3.8-4.5). A total of 75% (n = 60) of the children needed orthodontic treatment for orthodontic or skeletal anomalies. The prevalence of skeletal anomalies was significantly (p < 0.05) higher among patients with diabetes mellitus (DM) than in the control group. The frequency of coeliac disease was significantly elevated compared to any literature data (1-3.5%) in the study (15%) and in the control sibling group (13%). CONCLUSIONS: Co-morbidities such as CD should get more attention as a prognostic factor for a future higher incidence of diabetes. T1DM children can be motivated and health-conscious patients with excellent oral hygiene and dental status. Orthodontic treatment can help eliminate the oral complications of DM. Special diabetes ambulances may help provide oral care for patients with DM.

Root-crown ratios of permanent teeth in healthy and young Hungarian, German, and Japanese populations / A maradó fogak gyökér-korona aránya egészséges, fiatal magyar, német és japán populációkban.

Összefoglaló. Bevezetés: A maradó fogak gyökér-korona arányának meghatározása nagy jelentoséggel bír a fogászati kezelési terv kialakításában és késobbi módosításában. Célkituzés: Egészséges magyar, német és japán fiatalok maradó fogai gyökér-korona arányának meghatározása és összehasonlítása. Módszer: Hölttä módszerét alkalmaztuk. A mérés 95 magyar, 104 japán és 110 német fiatal páciens 2001 és 2006 között készült panorámaröntgen-felvételén történt. Eredmények: A gyökér-korona arány különbsége a nemek között nem szignifikáns, az egymásnak megfelelo antagonista fogak között sok esetben, de nem mindig, szignifikáns. A legnagyobb gyökér-korona arányt mindhárom populációban az alsó szemfogakon és az alsó második praemolaris fogakon mértük; a felso molarisok esetén a legkisebb az arány. A három nemzetet összehasonlítva szignifikáns különbséget (p≤0,001) nem találtunk egyetlen fogtípus esetében sem. A japán és a német populáció között minden fogtípus esetén szignifikáns volt a különbség a gyökér-korona arányokban. A japán és a magyar populáció összehasonlításakor a fogtípusok felénél találtunk szignifikáns különbséget. A magyar és a német populációt összehasonlítva nagyon kevés fogtípusnál találtunk szignifikáns különbséget. Megbeszélés: Az alsó állcsont fogainak gyökér-korona arányértékei nagyobb mértékben térnek el a populációk között, mint a felso állcsont fogainak esetében. A gyökér-korona arány átlagértéke a német populációban a legnagyobb. A második legnagyobb arányértékkel a magyar populáció rendelkezik, utána pedig a japán, néhány fogtípus kivételével: felso kismetszok, felso szemfogak és felso elso molarisok. Következtetés: A legnagyobb gyökér-korona arány különbséget a német és a japán populáció között, a legkisebbet a magyar és a német populáció között találtuk. Cikkünk megmutatja az egyes fogtípusok gyökér-korona arányának normálértékét fiatal, egészséges magyar, német és japán populációban. Orv Hetil. 2021; 162(46): 1848-1855. INTRODUCTION: Defining the root-crown ratio of the permanent teeth is important in making or changing proper treatment plans in dentistry. OBJECTIVE: To define and compare the root-crown ratios of the permanent teeth of healthy, young Hungarian, German, and Japanese populations. METHOD: We adapted Hölttä's method. 95 Hungarian, 104 Japanese and 110 German young patients' panoramic X-rays (made between 2001 and 2006) were involved in the investigation. RESULTS: Difference between the genders was found non-significant; between the corresponding antagonists many times, but not all significant. The highest root-crown ratios were found in all investigated populations by the lower canines and premolars, the lowest by the upper molars. P≤0,001 was not found among the three populations. Significant differences were found between Japanese and German populations by all tooth-types; between Japanese and Hungarian populations by near half of the tooth-types; between Hungarian and German populations by only a few tooth-types. DISCUSSION: More significant differences were found in root-crown ratios in the lower jaw among the populations. The mean value of the root-crown ratios was the highest in the German population; medium in the Hungarian population; and the least in the Japanese population, with a few exceptions: upper lateral incisors, canines and first molars. CONCLUSION: The biggest differences were found between the German and Japanese populations; the least between the Hungarian and the German populations. Our paper describes the control values of the root-crown ratios of the tooth types in young, healthy Hungarian, German, and Japanese populations. Orv Hetil. 2021; 162(46): 1848-1855.

Magnesium incorporation into primary dental enamel and its effect on mechanical properties.

Cross-sectional study of sound primary dental enamel revealed hardness zonation and, in parallel, significant change in the Mg content below the prismless layer. Mg content is known to play an important role in enamel apatite biomineralization, therefore, Mg ion exchange experiments were carried out on the outer surface of sound primary molars and on reference abiogenic Ca-phosphates using MgCl2 solution. Effects of Mg incorporation on crystal/particle size, ionic ratio and morphology were compared and the observed changes were explained by parallel diffusion and dissolution/reprecipitation processes. Based on depth profile analysis and high resolution electron microscopy of the Mg-exchanged dental enamel, a poorly ordered surface layer of approximately 10-15 nanometer thickness was identified. This thin layer is strongly enriched in Mg and has non-apatitic structure. Below the surface layer, the Mg content increased only moderately (up to ~3 at%) and the apatite crystal structure of enamel was preserved. As a common effect of the Mg exchanged volume, primary dental enamel exhibited about 20% increase of nanohardness, which is intrepreted by strengthening of both the thin surface layer and the region below due to the decreased crystallite size and the effect of incorporated Mg, respectively. STATEMENT OF SIGNIFICANCE: Dental enamel is the most durable mineralized tissue in the human body, which, in spite to be exposed to extreme conditions like mastication and acidic dissolution, is able to fulfill its biological function during lifetime. In this study we show that minor component magnesium can affect hardness properties of human primary dental enamel. Then, through Mg incorporation experiments we provide an additional proof for the poorly ordered Mg-containing intergranular phase which has been recently observed. Also, we report that the hardness of dental enamel can be increased by ca. 20% by Mg incorporation. These results contribute to a deeper understanding of sound primary dental enamel structure and may inspire new pathways for assisted remineralization of enamel and regenerative dentistry.

Patterns of Facial Profile Preference in a Large Sample of Dental Students: A Cross-Sectional Study.

The objective of this study was to explore dental students' facial profile preferences in a large sample of students. Nine hundred and nineteen dental students of four dental schools were involved. As part of a larger study on dentofacial esthetics, six photo series consisting of one unaltered and four altered variants of the same female profile were distributed among the students. The altered features were ones that are esthetically significant according to the literature. The students had to indicate the photo in each series that they preferred. The data were analyzed in a regression model in which preference in the given photo series was the dependent variable and gender, grade of studies, and dental school were the factors. Eight hundred and sixty-one students (93.7%) responded. Gender and dental school were not associated with the observed preferences, but the grade of studies was associated for three of the modified parameters: chin prominence, the sagittal position of the maxillary dental arch, and the simultaneous modification of the prominence of the chin and the nose. This study has confirmed several earlier observations, and new observations have also been made. We have demonstrated that the anteroposterior position of the maxillary incisors may be an important determinant of profile esthetics, even if this position does not influence the situation of the soft tissues and if the forehead cannot be used as a reference. We have also shown that the harmony between the nose and the chin overrides the importance of their individual dimensions.

Dentofacial mini- and microesthetics as perceived by dental students: A cross-sectional multi-site study.

BACKGROUND: How dental education influences students' dental and dentofacial esthetic perception has been studied for some time, given the importance of esthetics in dentistry. However, no study before has studied this question in a large sample of students from all grades of dental school. This study sought to fill that gap. The aim was to assess if students' dentofacial esthetic autoperception and heteroperception are associated with their actual stage of studies (grade) and if autoperception has any effect on heteroperception. METHODS: Between October 2018 and August 2019, a questionnaire was distributed to 919 dental students of all 5 grades of dental school at all four dental schools in Hungary. The questionnaire consisted of the following parts (see also the supplementary material): 1. Demographic data (3 items), Self-Esthetics I (11 multiple- choice items regarding the respondents' perception of their own dentofacial esthetics), Self-Esthetics II (6 Likert-type items regarding the respondents' perception of their own dentofacial esthetics), and Image rating (10 items, 5 images each, of which the respondents have to choose the one they find the most attractive). Both the self-esthetics and the photo rating items were aimed at the assessment of mini- and microesthetic features. RESULTS: The response rate was 93.7% (861 students). The self-perception of the respondents was highly favorable, regardless of grade or gender. Grade and heteroperception were significantly associated regarding maxillary midline shift (p < 0.01) and the relative visibility of the arches behind the lips (p < 0.01). Detailed analysis showed a characteristic pattern of preference changes across grades for both esthetic aspects. The third year of studies appeared to be a dividing line in both cases, after which a real preference order was established. Association between autoperception and heteroperception could not be verified for statistical reasons. CONCLUSION: Our findings corroborate the results of most previous studies regarding the effect of dental education on the dentofacial esthetic perception of students. We have shown that the effect can be demonstrated on the grade level, which we attribute to the specific curricular contents. We found no gender effect, which, in the light of the literature, suggests that the gender effect in dentofacial esthetic perception is highly culture dependent. The results allow no conclusion regarding the relation between autoperception and heteroperception.

Licensing the first reduced, 6 µg dose whole virion, aluminum adjuvanted seasonal influenza vaccine - A randomized-controlled multicenter trial.

INTRODUCTION: Shortages of vaccine supplies repeatedly occur, limiting our abilities to prevent influenza. Therefore, increasing production volume remains a priority. The presently licensed seasonal influenza vaccines contain 15 µg of viral hemagglutinin per strain in adult, and up to 60 µg in elderly patients. Decreasing the amount of viral parts while maintaining efficacy is one way of increasing production capacity. METHODS: This was multicenter, stratified (18-60 years and >60 years of age), prospective, randomized, double-blind, active-controlled, parallel-arm, non-inferiority clinical trial, conducted in the European Union, involving 1206 patients. We used hemagglutination inhibition assay to assess the immunogenicity of a newly developed, whole virion, seasonal trivalent influenza vaccine, containing 6 µg hemagglutinin per strain (FluArt, Hungary) and to assess whether it is non-inferior to the presently licensed vaccine containing 15 µg hemagglutinin per strain. Safety and tolerability of both vaccines were assessed based on EMEA guidelines. RESULTS: The reduced dose vaccine containing 6 µg of hemagglutinin per strain was safe and non-inferior to the currently licensed 15 µg vaccine, not only in adult, but also in elderly patients, according to the immunogenicity criteria by the FDA and EMEA (seroconversion, seroprotection and post/pre vaccination GMT ratios), and it fulfilled all applicable licensing requirements for both age groups. CONCLUSIONS: Based on the results, the reduced dose vaccine was licensed in the EU member state Hungary and safely administered in over 1.5 million cases so far. The amount of viral hemagglutinin needed can be reduced by using a whole virion vaccine with aluminum phosphate adjuvants. REGISTRATION: This study was registered by the European Clinical Trials Database, EudraCT, number: 2011-003314-16.

Safety and immunogenicity of a prepandemic influenza A (H5N1) vaccine in children.

BACKGROUND: The avian influenza A (H5N1) virus is considered to be a potential cause of the next influenza pandemic. Children may be particularly vulnerable to the pandemic virus, and they may react differently than adults to vaccines. We report the results of the first clinical trial of an H5N1 vaccine in children. METHODS: Twelve healthy children (mean age +/- SD: 12.73 +/- 2.77 years) received a single dose of 6 microg of the inactivated whole virus vaccine Fluval. Twenty-one days after vaccination, immunogenicity was assessed by hemagglutination inhibition and microneutralization assays. Safety information was collected for 180 days. RESULTS: No side-effects were observed, and the vaccine fulfilled all applicable U.S. and European immunogenicity criteria for licensure. The post/prevaccination geometric mean titer ratio was 16.95, the rate of seroconversion was 75% and the rate of seroprotection was also 75% 21 days after vaccination. CONCLUSIONS: We confirmed our earlier findings of the present vaccine in adults showing encouraging safety and immunogenicity properties in children. Studies with the present vaccine in elderly subjects are underway.

Prevalence of hypodontia and hyperdontia in paedodontic and orthodontic patients in Budapest.

Various publications have reported the prevalence of accessory teeth to be between 1 and 3%. In contrast, hypodontia has a much higher prevalence. In the current work, the authors studied OP radiographs on 2,219 patients aged 6 to 18 years who presented at the Department of Paedodontics and Orthodontics at Semmelweis University in Budapest (patients with systemic disease were excluded). The examined radiographs revealed a prevalence of accessory teeth of 1.53%. The sequence of prevalence was as follows: mesiodens > second incisor > first incisor. 77.5% of the accessory teeth were located in the upper jaw, with 97.5% of those being present in the incisor region. Hypodontia was detected in 326 patients (14.69%); missing wisdom germs were not considered. The sequence of prevalence of missing germ was as follows: upper second incisor > lower second premolar > upper second premolar > lower first incisor. Hypodontia in the molar region was observed in 15 cases (0.68%). The prevalence of oligodontia was 1.04%.

Effects of variable attachment shapes and aligner material on aligner retention.

OBJECTIVE: To evaluate the retention of four types of aligners on a dental arch with various attachments. MATERIALS AND METHODS: For this study, three casts were manufactured, two of which contained attachments (ellipsoid and beveled), and one without any attachments to serve as a control. Four types of aligners were thermoformed: Clear-Aligner (CA)-soft, CA-medium, and CA-hard, with various thicknesses, and Essix ACE. Measurements of vertical displacement force during aligner removal were performed with the Gabo Qualimeter Eplexor. Means and standard deviations were next compared between different aligner thicknesses and attachment shapes. RESULTS: CA-soft, CA-medium, and CA-hard did not present a significant increase in retention, except when used in the presence of attachments. Additionally, CA-medium and CA-hard required significantly more force for removal. Essix ACE demonstrated a significant decrease in retention when used with ellipsoid attachments. The force value for Essix ACE removal from the cast with beveled attachments was comparable to that of CA-medium. Forces for aligner removal from the model without attachments showed a linear trend. Essix ACE did not show a continuous increase in retention for each model. Overall, ellipsoid attachments did not present a significant change in retention. In contrast, beveled attachments improved retention. CONCLUSIONS: Ellipsoid attachments had no significant influence on the force required for aligner removal and hence on aligner retention. Essix ACE showed significantly less retention than CA-hard on the models with attachments. Furthermore, beveled attachments were observed to increase retention significantly, compared with ellipsoid attachments and when using no attachments.

[Retention of Ultra Seal XT third generation fissure sealant in systematic pedodontic care]. / A szervezett gyermekfogászati ellátás keretein belül alkalmazott Ultra Seal XT harmadik generációs barázdazáró anyag retenciójának vizsgálata.

The aim of the present study was to clinically evaluate Ultra Seal XT third generation light cured fissure sealant on the occlusal pits and fissures of permanent first and second molars for a period of two years. The examined population consisted of 112 Hungarian school-children, aged 8 to 14 years who presented for treatment at the Department of Dentistry for Children and Orthodontics in Budapest. The 1120 participants had a total of 247 permanent molars sealed. All teeth were monitorized and controlled after 6 months, 1 year and 2 years. Retentivity of fissure sealants were after 6 months 92.7%, one year 87.8%, two years 79.9%. These results are in accordance with data of literature. This longitudinal study showed that modern pit and fissure sealants can be applied during childhood in systematic pedodontic care. It has high retentivity and a directly proportional optimal caries-preventive effect.