Public community orthodontics in Italy. Description of an experience.

AIM: To assess the reliability and simplicity of a method chosen for selecting subjects to be treated in the orthodontic system and for the acceptance of the method by the community. MATERIALS AND METHODS: 490 orthodontic patients received full dental examination. For each patient a table was prepared for the detection of malocclusion in which the occlusal characteristics according to the Norwegian Orthodontic Treatment Index (NOTI), the molar class and the teeth present were recorded. The parents of the examined children completed a questionnaire aimed at identifying their social ranking. In the same questionnaire, how many siblings the patient had was also asked. Each of the three parameters were rated alphanumerically and a score of 1 was given to each child; the sum of three scores gave the final result for the subject. Acceptance of the procedure in the general community was evaluated by the number of complaints received by the Public Relations Office (URP). RESULTS: The social classes most represented in the sample are "blue collar class" (42.2%) and "white collar class" (35.6%). There was an average of 2.1 children per family (SD=0.6). The distribution of the type and grading of the treatment need was similar throughout the different social classes. CONCLUSION: The chosen method proved reliable for two reasons: no complaints with the local URP and ease of application of the selected criteria.

Bruxism in children: What do we know? Narrative Review of the current evidence.

BACKGROUND: Bruxism is a repetitive masticatory muscles activity whose definition is being thoroughly reviewed in recent years. As in adults, two different forms of bruxism exist in children, namely awake and sleep bruxism. Scarcity of data, however,still persists about paediatric bruxism and no clear consensus has been developed. Therefore, the current review overviews the literature on bruxism in children tries to outline the state of art about this condition METHODS: Bruxism affects from 5% to 50% of the worldwide paediatric population. Sleep disturbances, parafunctional habits and psycho-social factors emerged to be the most likely associated factors with paediatric bruxism. Bruxism is characterised by several signs and symptoms variously combined, such as tooth wear and fractures, teeth impressions on soft tissues, temporomandibular disorders, headaches, behavioural and sleep disorders. About diagnosis, the most reliable tool in children remains the report of teeth grinding by parents or caregivers which must be accompanied by oral interview and accurate clinical examination. Electromyography and sleep polysomnography, albeit suitable in the diagnostic process, are not easy-to-use in children and are not strongly recommended. Currently, no evidence exists to support any kind of therapeutic options for bruxism in children. Management should be based on the identification of the underlying condition and conservative approaches are recommendable. CONCLUSION: Notwithstanding the high prevalence, several aspects need to be further assessed in paediatric bruxism. Parental reports are still the most suitable diagnostic tool and conservative approaches are recommended in the management. Bruxism should be considered through a biopsychosocial model, and sleep, personality traits, stress and headaches are the factors towards whom research questions must be addressed to improve diagnosis and management.

A rare case of unerupted second deciduous molar located inferior to the second premolar: case report.

AIM: Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity [Massler et al., 1941]. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage [Andreasen et al., 1997]. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones [Walker et al., 2004; Otsuka et al., 2001; Amir et al., 1982; Broadway, 1976; Pinborg et al., 1970]. Of the primary teeth reported as unerupted, second primary molars are the teeth most frequently involved [Walker et al., 2004; Otsuka et al., 2001; Bianchi et al., 1991; Ranta et al., 1988; Tsukamoto et al., 1986; Amir et al., 1982], followed by primary central incisors [Otsuka et al., 2001]. CASE REPORT: This paper presents a case of inversion of the intraosseous position of a second unerupted deciduous molar and the succedaneous second premolar.

Caries experience in 14-year-olds from Northeast Italy. Is socioeconomic-status (SES) still a risk factor?

AIM: Prevalence and severity of dental caries in 14-year-olds of Northeast Italy were estimated, evaluating the dependence to SES. MATERIALS AND METHODS: An epidemiological survey was performed among a randomised cluster sample of 560 (290 M and 270 F) 14-year-olds attending secondary schools, to evaluate DMFS following WHO indications. Association between caries occurrence and SES was evaluated in a logistic regression model. To account for high proportion of zero scores (DMFS and DS distribution highly positively skewed) data was moreover modelled with negative binomial regression and zero-inflated models. RESULTS: Caries prevalence was 63.4% with a mean DMFS of 3.0 ± 3.8. A significant trend between means was observed regarding DS in the different SES levels: z = 2.22 p = 0.03 (occupational level) and z = 3.45 p<0.01 when SES was based on educational level. The Negative Binomial Regression model resulted more appropriate than the Poisson model because the dispersion parameter was significantly different from zero (alpha=1.5, 95% CI=1.3-1.8). Working class status showed significant association with DMFS (p=0.04) while using DS as dependent variable, working class subjects and subjects with medium-low and low educational level, showed a statistically significant association. CONCLUSION: Socioeconomic status is still a predictor for dental decay in the Italian 14-year-olds.

Experimental evaluation of two methodologies for the restoration of crown fracture in permanent anterior teeth.

AIM: The purpose of this study is to compare, by means of mechanical tests, the resistance of two types of dental restoration in the uncomplicated crown fracture of human permanent maxillary central incisor: rebonding of the fractured tooth fragment and application of ceramic veneers. MATERIALS AND METHODS: Thirty human maxillary central incisors were divided into three groups of ten teeth each. The teeth of the first group (Group A) were kept intact and used as controls, while the remaining teeth were sectioned, in order to simulate a crown fracture, and restored respectively with either the rebonding of the fragment (Group B) or with the use of ceramic veneers (Group C). All samples underwent mechanical tests by means of a universal test machine. RESULTS: The mean resistance to fracture recorded is respectively 425.2N for Group A, 233.3N for Group B, and 347.3N for Group C. One-way ANOVA analysis demonstrates statistical significance for at least one couple of values (Group B compared to Group A). The group of restorations with rebonding of fractured fragments has a mean value of resistance to fracture that is lower than both intact teeth and teeth restored with ceramic veneers. The resistance of teeth with rebonded restorations is 54.9% of that of, intact teeth, and resistance increases for teeth restored with ceramic veneers (81.8% of that of intact teeth). CONCLUSION: Ceramic veneers showed a higher resistance than rebonding and resulted to be more reliable in case of further trauma.

Long-term efficacy of onabotulinum toxin in treating persistent myofascial pain and masticatory muscles hypertone in an adolescent with bruxism. A 7-year follow-up case report.

BACKGROUND: Temporomandibular disorders (TMDs) represent a common chronic complaint, which includes myofascial pain (MP). Although several therapeutical options have been proposed to control bruxism-related muscle hyperactivity, there is not enough evidence to define a standard approach. The present article describes the case of a 14-year old male patient with a history of painful mandibular close lock. CASE REPORT: The patient was diagnosed with persistent myofascial pain in the left masseter, bilateral disc displacement with reduction, and retrodiscitis and capsulitis in the left temporomandibular joint. Awake and sleep bruxism were also present. Since first line treatments failed in managing the disorders, injections of onabotulinum toxin (BoNT-A ) were performed. After one month the pain decreased significantly and the jaw movements were restored. The patient was recommended to avoid hard and/or rubbery food, wide movements of the jaws and teeth clenching and to wear orthodontic appliance during the night since the joint damage was moderate. We report the 7-year follow-up demonstrating the long-term efficacy of a single injection of onabotulinum toxin in masseters and temporalis muscles in order to treat masticatory pain and dysfunctions. CONCLUSION: The authors suggest that BoNT-A could be an optimum treatment for persistent MP and bruxism in young adolescents when first-line therapies fail.

Acyl-CoA binding protein (ACBP) is highly expressed in the developing human kidney.

OBJECTIVE: Acyl-CoA-binding protein (ACBP), also known as diazepam binding inhibitor (DBI), is a small phylogenetically conserved protein. This ancestral peptide is multifunctional, performing intracellular activities as ACBP protein or extracellular roles as DBI. Several studies showed its endless facets, including a relevant activity as appetite stimulator and as anabolic factor. High levels of ACBP have been described in erythrocytes, liver, kidney, and gut cells. The aim of this study was to analyze, at immunohistochemical level, the expression of ACBP in fetal human tissues during development, focusing on the developing kidney. MATERIALS AND METHODS: Immunohistochemistry for ACBP was performed on 30 human fetal kidneys, from 15 fetuses of gestational age ranging from 13 to 19 weeks. At autopsy, all kidney samples were 10% formalin-fixed, routinely processed and paraffin-embedded. Five micron-thick paraffin sections were stained with Hematoxylin and Eosin and PAS stain for a morphological examination. RESULTS: ACBP was detected in all 30 kidneys analyzed in this study. No significant changes in ACBP expression were observed at different gestational ages. Immunostaining for ACBP was restricted to the epithelium covering the renal pelvis, the papillae, the collecting tubules, and the proximal and distal tubules. On the other hand, medullary regions and in the metanephric mesenchymal stem/progenitor cells did not show any reactivity for ACBP. CONCLUSIONS: According to our findings, ACBP should be considered as a new player in the complex field of human nephrogenesis, given that it was detected in all fetal kidneys immunostained. Its preferential localization in the renal structures derived from the Wolf duct, such as pelvis epithelium and collecting ducts, suggests a major role for ACBP in the induction of the metanephric mesenchymal cells toward the differentiation into glomerular structures. ACBP expression in proximal and distal tubules, two structures originating from the metanephric mesenchyme, indicates a further role of this protein in nephron development. In conclusion, ACBP should be added to the multiple molecules involved in human nephrogenesis.

Breastfeeding and sleep-disordered breathing in children: systematic review and proposal of underlying interaction models.

AIM: Paediatric sleep breathing disorders represent an emerging paediatric health concern. Despite risk factors are widely discussed in literature, evidences about protective factors are lacking. The aim of this systematic review was to examine the available evidence about the effect of breastfeeding on snoring and obstructive sleep apnea in childhood, and to methodically describe the underlying mechanism of interaction. METHODS: The study protocol was registered in advance in PROSPERO (CRD42020212529). Electronic search of the literature was performed up to October 10th, 2020 using four databases: PubMed, ScienceDirect, Medline and Scopus. Two authors independently retrieved potentially relevant articles to meet eligibility criteria. PRISMA guidelines were followed. Prospective, retrospective, case-control, cohort, clinical trial and cross-sectional studies investigating the association between breastfeeding and paediatric sleep-disordered breathing were included and data were extracted. No restrictions on language or date of publication were set. Subsequently, a search in the literature was further done to investigate underlying mechanisms of interaction. CONCLUSION: This review suggests that breastfeeding can effectively protect children and adolescents from sleep-disordered breathing, especially from habitual snoring, by preventing the associated risk factors. Future prospective studies with more efficient design are required.

Temporomandibular Disorders and Juvenile Idiopathic Arthritis: Scoping review with a case report.

BACKGROUD: Juvenile Idiopathic Arthritis (JIA) encompasses a wide range of mostly idiopathic autoimmune arthritis which affect growing individuals. Temporomandibular disorders are a diffuse spectrum of diseases which involve temporomandibular joint (TMJ) and associated structures. However, much more need to be defined in order to detect and manage these conditions. Albeit satisfying evidences exist about their impact on the adult population, there is great lack of information in children. The current study has been developed in order to overview what it is known about these disorders and their mutual interactions. A case report as support to the scientific evidence has been further described. CASE REPORT: A 7-year-old patient affected by an undifferentiated form of JIA developed arthritis to TMJs, complaining pain and functional impairments. After 2 years, the follow-up with combined pharmacological therapies and a modified oral stabilisation appliance shows no objective worsening of the joints' structures. However, the more complex symptomatic management of inflammation highlights the need for further knowledge. CONCLUSION: The present study shows that both literature and clinical activity highlight a strong relationship between JIA and TMDs, that can affect the quality of life of children and adolescents. Diagnosis and management of these conditions are extremely complex, thus additional studies and evidence are needed. However, the need of an interdisciplinary approach between rheumatologists, paediatricians and dentists has been demonstrated.

Human salivary peptides derived from histatins.

Human saliva from a healthy donor was subjected to fractionation by gel chromatography and six pools were collected and analysed by MALDI-TOF-MS and HPLC-ESI-MS. Three peptides, corresponding to 888.3, 687.3, and 524.1 amu and SNYLYDN, YLYDN, and LYDN sequences (determined by automated Edman sequencing), were isolated from pool 4. YLYDN was not previously described in human saliva. The peptides show the common C-terminal sequence of histatin 3 and histatin 1. To exclude the possibility that the three peptides were an artifact of the purification procedure, nine samples of human saliva were collected from healthy donors, immediately acidified with 0.2% TFA, and analysed by RP-HPLC-ESI-MS. The three peptides were detected in all the analyzed samples. SNYLYDN was always found at a concentration higher than that of YLYDN and LYDN. A correlation analysis performed on quantitative data indicated that the three peptides derive only from histatin 3. Other already known histatins also were searched for in the chromatogram. Histatins 1, 2, 3, 5, 6, 7, 8, and 10 were observed, although not in all samples analyzed, whereas other minor histatins were not detected.

Determination of the human salivary peptides histatins 1, 3, 5 and statherin by high-performance liquid chromatography and by diode-array detection.

A reversed-phase high-performance liquid chromatography (HPLC) method with diode-array detection for the quantification of several human salivary peptides is described. Sample pretreatment consisted of the acidification of whole saliva by phosphate buffer. This treatment produced precipitation of mucins, alpha-amylases and other high-molecular-mass salivary proteins, simultaneous inhibition of intrinsic protease activities and reduction of sample viscosity. Direct HPLC analysis by diode-array detection of the resulting acidic sample allowed one to quantify histatin 1, histatin 3, histatin 5, statherin, as well as uric acid, in normal subjects. Moreover, the groups of peaks pertaining to proline-rich proteins and cystatins were tentatively identified. The method can be useful in assessing the concentration of salivary peptides from normal subjects and from patients suffering oral and/or periodontal diseases.