The impact of temporomandibular joint arthritis on functional disability and global health in patients with juvenile idiopathic arthritis

Deletion of vitamin D receptor exacerbated temporomandibular joint pathological changes under abnormal mechanical stimulation

AIMS

Temporomandibular disorder can cause degenerative pathological changes by aseptic inflammation in the temporomandibular joint (TMJ). Vitamin D (VD) is known for maintaining calcium homeostasis, and recent studies indicated that VD and the vitamin D receptor (VDR) are important in inflammatory responses. In this study, we explored the anti-inflammatory effect of VD-VDR signaling axis in TMJ pathological degeneration.

MAIN METHODS

Mice ablated for Vdr (Vdr-/-res) were fed with a rescue diet to avoid hypocalcemia. With abnormal mechanical stimulation, unilateral anterior crossbite (UAC) induced temporomandibular disorders in mice. Histological staining, immunohistochemistry staining, and micro-CT analysis were performed to evaluate TMJ pathological changes. To identify the mechanisms in the aseptic inflammatory process, in vitro experiments were conducted on wild-type (WT) and Vdr-/- chondrocytes with compressive mechanical stress loading, and the related inflammatory markers were examined.

KEY FINDINGS

Vdr-/-res mice did not develop rickets with a high calcium rescue diet. The TMJ cartilage thickness in Vdr-/-res mice was significantly decreased with mechanical stress stimulation compared to WT mice. UAC-induced bone resorption was obvious, and the number of osteoclasts significantly increased in Vdr-/-res mice. The proliferation was inhibited and the gene expression of Il1b, Mmp3, and Mmp13 was significantly increased in Vdr-/- chondrocytes. However, WT chondrocytes showed significantly increased Tnfa gene expression as a response to mechanical stress but not in Vdr-/- chondrocytes.

SIGNIFICANCE

VD-VDR is crucial in TMJ pathological changes under abnormal mechanical stimulation. Deletion of Vdr exacerbated inflammatory response excluding TNFα, inhibited chondrocyte proliferation, and promoted bone resorption in TMJ.

Loss of Slc39a12 in hippocampal neurons is responsible for anxiety-like behavior caused by temporomandibular joint osteoarthritis

Background

An evident association between mood disorders and TMJ dysfunction has been demonstrated in previous studies. This study observed both the behavioral changes and the pathological changes in hippocampal tissue of rats in an animal model of TMJ-OA by injecting MIA into TMJ.

Methods

Eighteen SD rats were randomly assigned to the NC group and the MIA groups. A TMJ-OA model was established to assess the HWT in the TMJ region, and the rats were subjected to the OFT and EPM. HE, O-fast green staining, qRT-PCR and immunofluorescence were used to detect condylar damage. Serum and hippocampal oxidative stress levels were detected. Functions of genes obtained by RNA-Seq were investigated using H2O2, ZnCl2 and transfection of siRNA on HT22 cells.

Results

Injection of MIA resulted in disorganization of the chondrocyte layer on the condylar surface of rats, with reduced synthesis and increased degradation of the condylar cartilage matrix and reduced HWT. The results of the OFT and EPM showed that the rats in the MIA group developed anxiety-like behavior during the sixth week of MIA injection. Increased Nox4 expression, decreased SOD2 expression, elevated MDA level, and reduced GSH level were detected in serum and hippocampal neurons in the MIA group, with nuclear pyknosis and reduced Nissl bodies observed in neurons. The expression of Slc39a12 in hippocampal neurons of rats in the MIA group decreased. Slc39a12 knockdown in HT22 cells induced increased Nox4 expression, decreased SOD2 expression, increased MDA level, and reduced GSH and intracellular Zn2+. Oxidative stress in HT22 cells after transfection and H2O2 stimulation was reversed when ZnCl2 was added.

Conclusion

Loss of Slc39a12 in hippocampal neurons results in cellular oxidative stress, further leading to neuronal damage. This may potentially explain how TMJ-OA triggers anxiety-like behavior in rats.

Pregnancy related factors and temporomandibular disorders evaluated through the diagnostic criteria for temporomandibular disorders (DC/TMD) axis II: a cross sectional study

INTRODUCTION

Temporomandibular disorder (TMD) is a multifaceted condition impacting the chewing system, with its frequency varying across different age groups and showing a higher incidence in women. The involvement of estrogen in TMD has been examined due to the presence of estrogen receptors in the TMJ area. However, the exact effect of estrogen on TMD is complex. During pregnancy, marked by significant hormonal fluctuations, the impact on TMD has been hypothesized but remains unclear due to inconsistent results from various studies.

METHODS

In this cross-sectional study, we enrolled 32 pregnant women consecutively. We gathered information on demographics, TMD evaluations (using the Graded Chronic Pain Scale, Jaw Functional Limitation Scale-20, and Oral Behaviors Checklist), and mental health assessments (including Patient Health Questionnaire-9, Patient Health Questionnaire-15, and Generalized Anxiety Disorder-7). We employed descriptive statistics to summarize continuous and categorical data and used t-tests and chi-square tests for comparisons. We also conducted multivariate linear regression, adjusted for demographic factors, to investigate correlations.

RESULTS

The study group mainly consisted of women aged 30-35 (40.6%) and 25-30 (18.8%). Most participants had completed high school (50%) and were married (71.9%). A notable association was found between younger women (under 30) and higher levels of somatic symptoms (p = 0.008) and generalized anxiety (p = 0.015). Women in their second trimester showed lower severity of somatic symptoms (p = 0.04). A significant link was also observed between depression severity and somatic symptom severity (p = 0.01). However, we found no significant correlations with other TMD-related health aspects.

DISCUSSION

Our study identified significant associations between psychosomatic and psychological symptoms with variables like age and pregnancy trimester in pregnant women. However, it notably failed to establish a clear relationship between pregnancy-related factors and the severity of temporomandibular disorders (TMD). More comprehensive studies with larger participant pools are necessary to further validate and expand these findings.

Oral health-related quality of life, impaired physical health and orofacial pain in children and adolescents with juvenile idiopathic arthritis - a prospective multicenter cohort study

BACKGROUND

Knowledge on oral health-related quality of life (OHRQoL) in children and adolescents with juvenile idiopathic arthritis (JIA) is limited, and longitudinal studies are lacking. We aimed to describe OHRQoL in children and adolescents with JIA compared to controls, and to explore the validity and internal consistency of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Child Oral Impact on Daily Performance (Child-OIDP). Furthermore, we wanted to investigate associations between OHRQoL and orofacial pain, physical health, disease activity, and temporomandibular joint (TMJ) involvement in JIA.

METHODS

The Norwegian prospective, multicenter cohort study recruited participants with JIA between 4 and 16 years of age and corresponding controls from three pediatric university hospital departments and public dental health services. In the present study, we analyzed OHRQoL in all children < 12 years with the ECOHIS and adolescents ≥ 12 years with the Child-OIDP at the first visit and the two-year follow-up. Associations between OHRQoL and JIA characteristics, collected in clinical exam and questionnaires, were analyzed in logistic regressions.

RESULTS

The same OHRQoL questionnaire was completed both at first visit and two-year follow-up in 101 children < 12 years (47 JIA, 54 controls) and 213 adolescents ≥ 12 years (111 JIA, 102 controls). The frequency of OHRQoL impacts in children was similar at the first visit and the two-year follow-up (ECOHIS > 0: JIA group 81% and 85%, p = 0.791; control group 65% and 69%, p = 0.815), while adolescents with JIA reported fewer impacts at the two-year follow-up (Child OIDP > 0: JIA group 27% and 15%, p = 0.004; control group 21% and 14%, p = 0.230). The internal consistency of the OHRQoL instruments was overall acceptable and the criterion validity indicated that the instruments were valid at both visits. Orofacial pain was more frequent in children and adolescents with JIA than in controls. We found associations between OHRQoL impacts and orofacial pain, impaired physical health, disease activity, and TMJ involvement.

CONCLUSIONS

Children and adolescents with orofacial pain or impaired physical health were more likely to report impacts on daily life activities than those without. Pediatric rheumatologists and dentists should be aware of impaired OHRQoL in individuals with JIA with active disease or temporomandibular joint involvement.

TRIAL REGISTRATION

Registered on clinicaltrials.gov (NCT03904459, 05/04/2019).

Advanced Applications in Pediatric Dentistry: A Worldwide Perspective of the Last 13 Years

The enhancement of the clinical management of growing patients has always been a great challenge for orthodontists and pediatric dentists [...].

Oral health-related quality of life in patients with osteoarthritis of the temporomandibular joint-Results of a systematic review

OBJECTIVES

The aim of this systematic review was to assess the oral health-related quality of life (OHRQoL) of patients with osteoarthritis (OA) of the temporomandibular joint (TMJ).

METHODS

This systematic literature search applied the search terms "oral health-related quality of life AND osteoarthritis of jaw OR arthritis of temporomandibular joint AND oral health-related quality of life" in PubMed, Medline, Web of Science and Scopus. Eligibility criteria were publication until 31 August 2021, examination of children or adults with OA of TMJ, reporting of any OHRQoL measurement and a full text in English language. Two different, independent and experienced reviewers performed this systematic literature search. The analysis of respective data was qualitative. For quality appraisal, the available checklist from the Agency for Healthcare Research and Quality (AHRQ) was applied.

RESULTS

Out of 102 findings, eight studies were included in qualitative analysis. Seven clinical investigations were performed in adults aged between 34 and 43 years. The other included study was performed on children. The quality of two studies was moderate, and six studies were evaluated as of high quality. Most studies applied the 14-item short form of the oral health impact profile (OHIP 14) for assessment of OHRQoL. OHIP 14 ranged between 9.24 and 38.86 points in means of sum score. Comparison with healthy individuals revealed worse OHRQoL of OA patients in two studies. Associations between OHRQoL with either oral health, general quality of life or disease-related parameters were rarely reported and heterogeneous. Five of the included studies reported subscales of OHIP 14, showing an impairment in all subscales.

CONCLUSIONS

There are hints that patients with OA of the TMJ show a reduced OHRQoL. More studies are needed, especially regarding oral health, disease-related parameters and pain intensity and its potential influence on OHRQoL.

Oral health-related quality of life in 4-16-year-olds with and without juvenile idiopathic arthritis

BACKGROUND

Few studies have investigated oral health-related quality of life (OHRQoL) in young individuals with juvenile idiopathic arthritis (JIA). Aims were to investigate whether OHRQoL differs between children and adolescents with JIA compared to controls without JIA, while adjusting for socio-demographic-, behavioral- and oral health-related covariates. Furthermore, to explore whether socio-behavioral and oral health-related covariates of OHRQoL vary according to group affiliation and finally, specifically for individuals with JIA, to investigate whether disease-specific features associate with OHRQoL. We hypothesized that participants with JIA have poorer OHRQoL compared to participants without JIA.

METHODS

In this comparative cross-sectional study participants with JIA (n = 224) were matched to controls without JIA (n = 224). OHRQoL was assessed according to Early Childhood Oral Health Impact Scale (ECOHIS) (4-11-years-olds) and the child version of Oral Impacts on Daily Performances (Child-OIDP) (12-16-years-olds). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-demographic, behavioral and self-reported oral health information collected by questionnaires. Index teeth were examined for caries by calibrated dentists. Multiple variable analyses were performed using logistic regression, reporting odds ratio (OR) and 95% confidence interval (CI). Two-way interactions were tested between group affiliation and the socio-behavioral- and oral health-related variables on the respective outcome variables.

RESULTS

In total, 96 participants with JIA and 98 controls were evaluated according to ECOHIS, corresponding numbers for Child-OIDP was 125 and 124. Group affiliation was not associated with impaired ECOHIS or Child-OIDP in adjusted analyses (OR = 1.95, 95% CI 0.94-4.04 and OR = 0.99, 95% CI 0.46-2.17, respectively). Female adolescents with JIA were more likely than males to report oral impacts according to Child-OIDP. Continued activity or flare was found to adversely affect Child-OIDP, also self-reported outcome measures in JIA associated with Child-OIDP.

CONCLUSIONS

This study did not provide consistent evidence to confirm the hypothesis that children and adolescents with JIA are more likely to have impaired OHRQoL compared to their peers without JIA. However, female adolescents with JIA were more likely than males to report impacts on OHRQoL. Furthermore, within the JIA group, adolescents with continued disease activity, flare or reporting pain, physical disability, had higher risk than their counterparts of impaired OHRQoL.

MRI in the Assessment of TMJ-Arthritis in Children with JIA; Repeatability of a Newly Devised Scoring System

RATIONALE AND OBJECTIVES

The temporomandibular joint (TMJ) is commonly involved in children with juvenile idiopathic arthritis. The diagnosis and evaluation of the disease progression is dependent on medical imaging. The precision of this imaging is under debate. Several scoring systems have been proposed but transparent testing of the precision of the constituents of the scoring systems is lacking. The present study aims to test the precision of 25 imaging features based on magnetic resonance imaging (MRI).

MATERIALS AND METHODS

Clinical data and imaging were obtained from the Norwegian juvenile idiopathic arthritis study, The NorJIA study. Twenty-five imaging features of the TMJ in MRI datasets from 86 study participants were evaluated by two experienced radiologists for inter- and intraobserver agreement. Agreement of ordinal variables was measured with Cohen´s linear or weighted Kappa as appropriate. Agreement of continuous measurements was assessed with 95% limit of agreement according to Bland-Altman.

RESULTS

In the osteochondral domain, the ordinal imaging variables "loss of condylar volume," "condylar shape," "condylar irregularities," "shape of the eminence/fossa," "disk abnormalities," and "condylar inclination" showed inter- and intraobserver agreement above Kappa 0.5. In the inflammatory domain, the ordinal imaging variables "joint fluid," "overall impression of inflammation," "synovial enhancement" and "bone marrow oedema" showed inter- and intraobserver agreement above Kappa 0.5. Continuous measurements performed poorly with wide limits of agreement.

CONCLUSION

A precise MRI-based scoring system for assessment of TMJ in JIA is proposed consisting of seven variables in the osteochondral domain and four variables in the inflammatory domain. Further testing of the clinical validity of the variables is needed.

The Temporomandibular Joint in Juvenile Idiopathic Arthritis

Patients with juvenile idiopathic arthritis (JIA) often have involvement of the temporomandibular joint (TMJ) during their disease course. Active arthritis of the TMJ remains difficult to assess. Clinical signs and symptoms alone are unreliable, and active TMJ arthritis needs confirmation by gadolinium-enhanced MRI. In recent years, changes in treatment approach have occurred. This article discusses the latest evidence on diagnosis and treatment of JIA-associated TMJ arthritis.

Temporomandibular joint disorders in patients with rheumatoid arthritis

Objectives

The aim of this study is to draw the attention of patients, doctors and therapists to the importance of temporomandibular joint (TMJ) problems in rheumatoid arthritis (RA).

Material and methods

The research was conducted at the National Institute of Geriatrics Rheumatology and Rehabilitation in Warsaw. The study involved 60 subjects. The test group consists of 30 patients with diagnosed RA. The control group (n = 30) consisted of healthy participants of similar age. The study analyzed the occurrence of problems in TMJ joints, acoustic phenomena and the level of pain. Masseter muscle development, range of abduction motion and pain during palpation of soft tissues were assessed on the basis of the joint pain map of Prof. Mariano Rocabado.

Results

In the RA group, more than half (56.7%) had problems with the TMJ, 70% of them had masseter hypertrophy and clicks in the TMJ, and 46.7% had tinnitus (in the control group: 10%, 30%, and 30%, respectively). Patients also had a limited range of abduction movement in the TMJ (38.0 ±6.1 mm). Analysis of the pain map of Prof. Mariano Rocabado in RA patients indicates a significantly greater number of pain structures. In the control group no pain was observed in structures such as the posterosuperior synovial and bilaminar zone, posterior ligament, or retrodiscal area.

Conclusions

Temporomandibular joint problems in RA patients were more serious than in the control group and these differences were statistically significant for most tests. The awareness of the problem with the TMJ in RA patients is very low; participants of our study were 100% unaware that the function of the TMJ could be improved. Additionally, there are no guidelines for the treatment and rehabilitation of these joints.

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report

The aim of this study was to analyse the structural characteristics of the temporo-mandibular joint (TMJ) and the dysfunctional consequences induced by disease in subjects with juvenile idiopathic arthritis (JIA). The study was conducted in 25 patients with JIA (median age (IQR), 13.9 (10.9-15.3)) and 26 healthy controls (median age (IQR), 14.3 (11.6-17.2)) years. All enrolled patients were subjected to anamnestic evaluation, laboratory parameters, JIA subclass, and type of therapy for the disease. A clinical-gnathological evaluation, anamnestic and dysfunctional index (Ai and Di), and magnetic resonance imaging of TMJs were performed in all patients. The test group showed a significant reduction (p < 0.001) regarding the clinical findings such as maximal mouth opening, left and rightward laterotrusion and protrusion, and a significant difference in the reported symptoms (TMJ sounds, reduced mouth opening and pain), and Ai and Di (p < 0.001) compared to healthy patients. Correlation analysis showed a significant correlation between the median duration of disease and the maximum mouth opening and between visual analogue scale (VAS) score and maximum mouth opening, leftward laterotrusion, rightward laterotrusion, and protrusion. The results obtained in this study suggest that patients with JIA presented a cohort of symptoms in TMJs in comparison with healthy controls. Moreover, a careful TMJs evaluation and an early diagnosis of TMJs dysfunction and regular follow-ups are recommended in order to prevent and reduce functional and chewing problems in patients with JIA.

Maximum bite force in children with juvenile idiopathic arthritis with and without clinical established temporomandibular joint involvement and in healthy children: a cross-sectional study

Background

In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved, resulting in dysfunction of the masticatory system. Bite force is one of the variables that reflects the function of the masticatory system. The aim of this study was to compare maximum bite force in children with JIA, with and without TMJ involvement and with healthy children.

Methods

Children with JIA and healthy children between the ages 6 and 18 were included in this cross‐sectional study. The clinical examination consisted of measuring the anterior maximum voluntary bite force (AMVBF), assessment of the TMJ screening protocol items and TMJ, masseter and temporal muscle palpation pain. Unadjusted linear regression analyses were performed to evaluate the explanatory factors for AMVBF. Two adjusted models were constructed with corrections for age and gender differences: model 1 to compare children with JIA and healthy children and model 2 to compare children with JIA with and without TMJ involvement.

Results

In this cross‐sectional study, 298 children with JIA and 169 healthy children participated. AMVBF was 24 Newton (N) lower in children with JIA, when compared with healthy children (95%CI: −35.5–−12.4, p = .000). When children with JIA also had clinically established TMJ involvement, AMVBF was reduced 42 N (component JIA:−16.78, 95% CI −28.96–−4.59, p = .007 and component TMJ involvement:−25.36, 95% CI −40.08–−10.63, p = .001). Age and male gender increased AMVBF.

Conclusion

Children with JIA had a reduction in the AMVBF compared with healthy children. In children with JIA and clinically established TMJ involvement, AMVBF was more reduced.

Juvenile idiopathic arthritis of the temporomandibular joint - no longer the forgotten joint

Juvenile idiopathic arthritis (JIA) of the temporomandibular joint (TMJ) is common in children, with an increasing awareness of the condition in all healthcare professionals. TMJ involvement presents a challenge in both diagnosis and treatment, as late presentation can still occur as the disease often develops asymptomatically. This can result in facial deformity and/or functional difficulties including obstructive sleep apnoea. Early diagnosis is therefore essential, requiring a high index of clinical suspicion coupled with the judicious use of gadolinium contrast magnetic resonance imaging (MRI). Long-term management is best provided by a multidisciplinary team as patients often need a combination of pharmacological management, surgical interventions, orthodontics, and psychological support. End stage deformity can be treated by different surgical options, each with their own risks and benefits, however recently there is increasing recognition for the role of total alloplastic TMJ replacement. This review focuses on the diagnosis and management of TMJ arthritis and aims to highlight the important role of maxillofacial surgeons in JIA treatment.

Recent progress in the treatment of non-systemic juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease affecting the joints and other organs that occurs in 1 in 1,000 children in the United States. Given the various categories of JIA, interpretation of the literature can be difficult. In this review, new developments in understanding non-systemic JIA and its treatment will be covered. Recent advances in the journey toward personalized treatment in JIA will be highlighted, including a review of currently available biologic modifiers. Uveitis and the temporomandibular joint will be discussed as particularly challenging treatment issues. Recent guideline updates and literature-guided treatment decisions will be reviewed.

Clinical Features and Physical Properties of Gummetal Orthodontic Wire in Comparison with Dissimilar Archwires: A Critical Review

Objective

Gummetal is a novel multifunctional alloy which possesses distinctive properties with the potential to refine and amend the efficacy of orthodontic treatment. The objective of this critical literature review was to investigate scientific evidence concerning the mechanical and clinical features of this recently manufactured beta-titanium orthodontic wire.

Materials and Methods

Electronic databases: PubMed, PMC, Google Scholar, Ovid, and Cochrane Library were searched. Studies investigating the properties of Gummetal orthodontic wire including in vitro and clinical studies were selected, validity was assessed, and data was extracted. The risk of bias was assessed by the Cochrane risk of bias Tool 2.0 in a randomized clinical trial. Results and Discussion. Among 322 papers, 13 papers were selected and divided into two groups: prospective double-blinded randomized clinical trial and in vitro studies.

Conclusions

The results of this review should be interpreted with caution because of the heterogeneity of the studies. Only single clinical trial paper was found in the literature. The studies reported different characteristics obtained by various methods; thus, it was difficult to objectively compare the results. Low bending strength, low fatigue limit, and high resilience have been confirmed. Gummetal provides lower force than Nitinol and TMA but higher than Supercable wire. Plastic deformation of Gummetal questions its superelasticity. Friction of Gummetal wire is comparable to SS and CoCr wires. Because of its nontoxic chemical composition, Gummetal might be useful in the initial phase of orthodontic treatment for patients suffering from nickel allergy. Further studies are necessary to assess the usefulness of Gummetal in the clinical practice.

Association of vitamin D in patients with periodontitis: A cross-sectional study

BACKGROUND AND OBJECTIVE

Vitamin D has been considered to possess anti-inflammatory and antimicrobial activity, which may be a link for the known interaction of periodontitis (CP) and coronary heart disease (CHD). This study investigated the association between serum vitamin D levels and periodontitis in patients with CP and with CHD. Furthermore, the objective was to determine whether periodontitis and CHD had an impact on serum vitamin D levels.

MATERIAL AND METHODS

Using a cross-sectional design, a total of 46 patients with CP, 45 patients with CHD, 45 patients with both CP and CHD, and 43 healthy patients were enrolled in the present study.

RESULTS

Patients in the CP (17.4 ± 5.2 ng/mL) and in the CP + CHD (16.5 ± 5.6 ng/mL) group presented a significantly lower mean serum level of 25(OH)vitamin D compared to patients in the CHD (24.6 ± 3.7 ng/mL) and healthy control groups (29.9 ± 5.4 ng/mL) (P < .001). 25(OH)vitamin D levels were positively correlated with the number of teeth and negatively with C-reactive protein (CRP) and all periodontal parameters (P < .001). In all patients, there was a proportional increase of 25(OH)vitamin D levels with a progressive increase in number of teeth (P-trend <.001) while there were a proportional decrease in 25(OH)vitamin D levels with a progressive increase in clinical attachment level (CAL, P-trend = .001), probing depth (PD, P-trend = .006), and bleeding sites (BOP, P-trend <.001) levels.

CONCLUSION

Patients with CP and CP + CHD presented significantly lower serum levels of vitamin D compared to CHD and healthy controls. Moreover, the presence of CP negatively influenced serum vitamin D levels.

Oral Conditions and Oral Health-Related Quality of Life of People with Ehlers-Danlos Syndromes (EDS): A Questionnaire-Based Cross-Sectional Study

Background and objective: To date, there have only been a few studies on oral health-related quality of life (OHRQoL) of people with Ehlers-Danlos syndromes (EDS) and oral conditions. The aim of this study was, therefore, to analyze the OHRQoL of people with EDS from their own point of view as well as obtain information about their age at the time of the diagnosis, the period of time until diagnosis, and the presence of oral conditions (if any) and their association with oral health quality. Methods: The study was designed as an anonymous questionnaire-based cross-sectional study. We conducted a descriptive analysis of the Oral Health Impact Profile-14 (OHIP-14) scores, age of the participants, age at diagnosis, and the time-period between the first signs of the disease and the diagnosis of EDS. To verify the differences in OHIP-14 scores between patients with and without oral conditions, a Mann-Whitney U test was performed. A multivariate quantile (median) regression analysis was performed to evaluate the effect of different general characteristics (gender, age, and the presence of oral conditions) on the OHIP 14 scores. Furthermore, using a Mann-Whitney U test, the influence of different oral conditions was verified by testing the differences between patients without any oral conditions and patients with a specific diagnosis. Results: A total of 79 evaluable questionnaires from 66 female (83.5%) and 13 male (16.5%) participants were analyzed. On average, after the first condition, it takes 18.36 years before EDS are correctly diagnosed. Oral conditions were described by 69.6% of the participants. The median (interquartile range) OHIP-14 score was eight (ten) points for patients without oral conditions and 19 (15) for patients with oral conditions. The multivariable quantile regression shows a statistical notable association between OHIP-14 score and oral conditions (p < 0.001). OHIP-14 scores for dysgnathia, periodontitis, TMD (Temporomandibular dysfunction), a high-arched palate, malocclusion, and the anomaly of tooth formation were statistical notably different between the participants with and the participants without oral conditions. Conclusions: Long diagnostic pathways seem to be a typical problem in patients with EDS. Oral conditions associated with the underlying disease occurred regularly and showed a negative correlation with OHRQoL.

Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review

OBJECTIVE

To study the proportion of patients with temporomandibular joint (TMJ) involvement among patients with juvenile idiopathic arthritis (JIA), as well as associated clinical characteristics and signs/symptoms.

METHOD

We performed a retrospective chart review on consecutive patients followed in the Hamburg Centre for Paediatric and Adolescent Rheumatology Eilbek between January 2010 and July 2012. TMJ involvement was diagnosed based on clinical examination; a subgroup of patients was also assessed by magnetic resonance imaging (MRI).

RESULTS

The study included 2413 patients with JIA (52.1% girls, mean age at JIA onset 9.5 years). The most frequent JIA category was oligoarthritis (46.6%), followed by enthesitis-related arthritis (ERA; 38.1%). TMJ involvement was diagnosed in 843/2413 patients (34.9%) (677 MRI-confirmed, four not MRI-confirmed, no MRI examination in 162). Female gender (p = 0.017), higher number of additional joints with active arthritis (p < 0.001), anti-nuclear antibody (ANA) positivity (p = 0.005), higher age (p = 0.020), and oligoarthritis (persistent and extended; p = 0.043) were significantly associated with TMJ involvement. Human leucocyte antigen-B27-positive patients were less likely to have TMJ involvement (p = 0.023). Pain on palpation and pain while chewing were statistically significantly associated with TMJ involvement (p = 0.008 and p = 0.020, respectively).

CONCLUSIONS

Based on our findings, to identify TMJ involvement special attention should be paid to JIA patients with female gender, ANA positivity, and oligoarthritis, as well as those with a higher number of additional joints with active arthritis; and regular examinations of the TMJ should be performed.

Scientific Production in Dentistry: The National Panorama through a Bibliometric Study of Italian Academies

Background

The academic scientific research in the field of dentistry has rapidly increased in the last 20 years under the pressure of the multidisciplinary technological advancements and the growing demand for new predictable and cost-effective techniques and materials. The aim of the present investigation was to analyze the academic scientific production conducted by Italian Academies and Dental Schools.

Methods

The list of MED/28 academic researchers, associate and full professors, and academic affiliations was collected from the national database of CINECA to evaluate the scientific output of the Italian Universities. The complete list of scientific contributions and the bibliometric parameters were recorded in the Scopus database.

Results

The scientific production of 37 Italian Universities, 416 researchers, and 23689 papers was evaluated. The measurement of total academic papers, citations, h-index, and relative citation ratio (RCR) was calculated. The study data showed an increase of the academic scientific production over the last 5 years.

Conclusions

The results presented show how scientific research is increasingly pursued by dental clinicians.

Evaluation of salivary and serum asymmetric dimethylarginine (ADMA) levels in patients with periodontal and cardiovascular disease as subclinical marker of cardiovascular risk

BACKGROUND

Asymmetric dimethylarginine (ADMA) plays a crucial role in endothelial function and maybe a link for the known interaction of periodontitis and coronary heart disease (CHD). In this pilot study, we compared the impact of gingival health, periodontitis (CP), CHD, or of both diseases (CP + CHD) on salivary and serum ADMA levels.

METHODS

The clinical and periodontal characteristics, serum, and saliva samples were collected from 35 patients with CP, 33 patients with CHD, 35 patients with both CP + CHD, and 35 healthy subjects. Levels of ADMA and C-reactive protein (CRP) were assessed with a commercially available kit.

RESULTS

The median (25% and 75% percentile) concentrations of salivary and serum ADMA were significantly higher in the CHD group [serum: 1.5 (1.2 to 1.8) μmol/L; salivary 1.3 (1 to 1.7) μmol/g protein, P < 0.01] and in the CP + CHD [serum: 1.8 (1.4 to 2.0) μmol/L; salivary 1.5 (1.2 to 1.7) μmol/g protein, P < 0.001] group compared to CP patients and controls. In univariate models, CP (P = 0.034), CHD (P < 0.001), and hs-CRP (P < 0.001) were significantly associated with serum ADMA, whereas in a multivariate model, hs-CRP remained a significant predictor of serum ADMA (P < 0.001). In a multivariate model, the significant predictors of salivary ADMA levels were hs-CRP (P < 0.001) and education socioeconomic status (P = 0.042).

CONCLUSIONS

Patients with CHD and CP + CHD presented higher levels of salivary and serum ADMA compared to healthy subjects and CP patients. hs-CRP was a significant predictor of increased salivary and serum ADMA levels.

Association between periodontitis and glycosylated haemoglobin before diabetes onset: a cross-sectional study

OBJECTIVES

The aim of the present cross-sectional study was to investigate the association between serum glycosylated haemoglobin (HbA1c) levels and periodontal status in patients with periodontitis (CP) and periodontally healthy controls. Furthermore, the objectives were to determine if the periodontitis influenced the serum HbA1c levels.

MATERIALS AND METHODS

A total of 93 patients with CP and 95 periodontally healthy subjects were enrolled in the present study using a cross-sectional design. At baseline, patients were examined and characterized on a regular basis for blood serum parameters and non-fasting blood samples levels. In all patients, a full periodontal examination was performed and clinical attachment loss (CAL) was the primary outcome variable chosen. The spearman correlation, a stepwise multivariable linear regression, and Jonckheere-Terpstra tests were applied in order to assess the relationship between HbA1c levels and periodontitis.

RESULTS

Patients in the CP group presented a significantly higher median serum level of HbA1c [40.9 (31.2; 45.6) mmol/mol)] compared to patients in the healthy control group [35.3 (29.6; 38.6) mmol/mol)] (p < 0.001). HbA1c levels were negatively correlated with the number of teeth and positively correlated with C-reactive protein levels and all periodontal parameters (p < 0.001). Moreover, there was a significant decrease in the number of teeth when HbA1c levels increased (P-trend < 0.001), while there was a significant increase in periodontal parameters (CAL, p = 0.002); PD, p = 0.008; BOP, p < 0.001) when levels of HbA1c increased.

CONCLUSIONS

Patients with CP and undiagnosed diabetes presented significantly higher serum levels of HbA1c compared to periodontally healthy controls. Moreover, the presence of periodontitis was positively correlated with serum HbA1c levels before diabetes onset.

CLINICAL RELEVANCE

HbA1c levels were positively correlated with the severity of periodontitis before diabetes onset.

Oral Health and Related Factors Associated with General Health and Quality of Life

Oral well-being is an integral part of individual general health. The mouth and teeth are, in fact, part of our body, increasingly characterizing personal identity. Oral diseases are a public health problem that has a growing prevalence. Oral pathologies can occur in childhood, and as they have a chronic and progressive course, if not properly treated, they can affect the relational, psychological, and social skills of an individual. The population most affected are those with a low socio-economic level, so much so that the presence of diseases of the oral cavity is considered a marker of social disadvantage. In this regard, much effort is needed from scientists, and their applied sciences, in order to give the knowledge required for public health personal to take note of the seriousness of the situation and to start changing the way we deal with the problem.

One Step before 3D Printing-Evaluation of Imaging Software Accuracy for 3-Dimensional Analysis of the Mandible: A Comparative Study Using a Surface-to-Surface Matching Technique

The accuracy of 3D reconstructions of the craniomaxillofacial region using cone beam computed tomography (CBCT) is important for the morphological evaluation of specific anatomical structures. Moreover, an accurate segmentation process is fundamental for the physical reconstruction of the anatomy (3D printing) when a preliminary simulation of the therapy is required. In this regard, the objective of this study is to evaluate the accuracy of four different types of software for the semiautomatic segmentation of the mandibular jaw compared to manual segmentation, used as a gold standard. Twenty cone beam computed tomography (CBCT) with a manual approach (Mimics) and a semi-automatic approach (Invesalius, ITK-Snap, Dolphin 3D, Slicer 3D) were selected for the segmentation of the mandible in the present study. The accuracy of semi-automatic segmentation was evaluated: (1) by comparing the mandibular volumes obtained with semi-automatic 3D rendering and manual segmentation and (2) by deviation analysis between the two mandibular models. An analysis of variance (ANOVA) was used to evaluate differences in mandibular volumetric recordings and for a deviation analysis among the different software types used. Linear regression was also performed between manual and semi-automatic methods. No significant differences were found in the total volumes among the obtained 3D mandibular models (Mimics = 40.85 cm³, ITK-Snap = 40.81 cm³, Invesalius = 40.04 cm³, Dolphin 3D = 42.03 cm³, Slicer 3D = 40.58 cm³). High correlations were found between the semi-automatic segmentation and manual segmentation approach, with R coefficients ranging from 0,960 to 0,992. According to the deviation analysis, the mandibular models obtained with ITK-Snap showed the highest matching percentage (Tolerance A = 88.44%, Tolerance B = 97.30%), while those obtained with Dolphin 3D showed the lowest matching percentage (Tolerance A = 60.01%, Tolerance B = 87.76%) (p < 0.05). Colour-coded maps showed that the area of greatest mismatch between semi-automatic and manual segmentation was the condylar region and the region proximate to the dental roots. Despite the fact that the semi-automatic segmentation of the mandible showed, in general, high reliability and high correlation with the manual segmentation, caution should be taken when evaluating the morphological and dimensional characteristics of the condyles either on CBCT-derived digital models or physical models (3D printing).

Oral Health-Related Quality of Life in People with Achalasia

Background and Objective: The oral health-related quality of life (OHRQoL) of patients with achalasia has not been evaluated to date. Therefore, the aim of this study was to assess the OHRQoL of patients with achalasia and to get information about the time taken for diagnosis and oral symptoms. Materials and Methods: The study was conceived of as an anonymous epidemiological survey study in people with achalasia in order to assess their OHRQoL in each case. For this, a questionnaire was developed consisting of free-text questions and of the standardized German version of the OHIP-14 questionnaire. Results: In total, forty-four questionnaires were analyzed including 31 female and 13 male participants. Regardless of gender, the mean age was 50.57 years (range: 17–78). Of the surveyed individuals, seventy-nine-point-five-five percent had been diagnosed between 25 and 60 years of age. The period from the first signs of the disease to diagnosis was 6.15 years, irrespective of gender. The overall OHIP-14 score without gender differentiation was 8.72 points (range 0–48); the mean score of female participants was 11.13 (range: 0–48), and the OHIP score of male participants was 3.15 on average. Two participants reported oral symptoms. Conclusions: The already known problem of the delayed diagnosis of rare diseases was also confirmed in the case of achalasia. Females with achalasia seemed to be significantly affected by lower OHRQoL than males with achalasia and women of the general population. Demineralization of the tooth structure was described in two participants.

Craniomandibular Disorders in Pregnant Women: An Epidemiological Survey

Temporomandibular joint (TMJ) disorder has been reported to be 1.5 to two times more common in women than men. Such a gender-based difference could be attributed to behavioral, hormonal, anatomical, and psychological characteristics. Physiological hormonal differences between genders could be one of the possible explanations for the higher incidence of temporomandibular disorder (TMD) in women. As the plasma level of certain female hormones increases during gestation, it could be assumed that there is a higher prevalence of dysfunctional signs and symptoms in pregnant women. We performed an epidemiological survey based on screening for TMD in a group of 108 pregnant women and found that 72% of young women reported significant signs of TMJ disorders, 9% of the young women reported mild signs of TMJ disorders, and 19% of the included subjects reported no signs or symptoms of TMD. The presence of estrogen receptors in the temporomandibular joint of female baboons could be the basis of an explanation for the increased prevalence of dysfunction in young women reported in the literature and the high feedback we have seen of joint noises in pregnant women. On the basis of the present findings, it could be assumed that gestation period could represent a risk factor for craniomandibular dysfunctions.

Myofunctional Trainer versus Twin Block in Developing Class II Division I Malocclusion: A Randomized Comparative Clinical Trial

This study aimed to evaluate and compare the dentoalveolar effects of the myofunctional trainer T4K^TM versus twin block in children with class II division I malocclusion. Two parallel arm randomized comparative clinical trial was conducted, including twenty healthy children, 9–12 years old, showing Angle’s class II division I malocclusion due to mandibular retrusion. Children were randomly assigned into two groups according to the appliance used; Group 1: T4k, and Group II: twin block. Follow-up was done every 4 weeks for 9 months. Postoperative cephalometric X ray, study casts and photographs were taken for measurements and comparison. T4K showed a statistically significant reduction in the overjet (−2.50 ± 1.00 mm) (p < 0.0001), and a significant increase in the lower arch perimeter (LAP) (1.19 ± 0.96 mm) (p = 0.01). The twin block showed a statistically significant reduction in the overjet (−3.75 ± 1.10 mm) (p < 0.0001), a significant reduction in the overbite (−16.22 ± 17.02 %) (p = 0.03), and a significant increase in the LAP (1.69 ± 0.70 mm) (p < 0.0001). The overjet showed a higher significant decrease in the twin block group than in T4K (p = 0.03). The mean values of the overbite were significantly decreased in twin block than in T4k (p < 0.0001). Both groups showed significant dentoalveolar improvements toward class I occlusion; however, the twin block showed significantly better results than T4K appliance.

A Full Diagnostic Process for the Orthodontic Treatment Strategy: A Documented Case Report

The need for extractions in orthodontic treatment has always been a controversial topic. However, to date there is not a specific clinical guideline that can help the clinicians deciding to plan an extractive or a non-extractive orthodontic treatment. In this respect, clinicians must deal with patients’ occlusal, functional, periodontal and aesthetics characteristics before planning an orthodontic treatment including extraction. Considering the absence of specific guidelines, the choice to extract teeth or not is complicated, particularly in borderline cases. In this case report, we present a borderline case of a patient with the skeletal Class III pattern and significant crowding in both arches that could be treated with or without extraction, illustrating the diagnostic and decision-making processes that were conducted for the orthodontic treatment strategy.

The Efficacy of Retention Appliances after Fixed Orthodontic Treatment: A Systematic Review and Meta-Analysis

The purpose of this article is to evaluate the amount of the relapse of anterior crowding and the efficacy of retention appliances by reviewing the best available scientific evidence. A survey of articles published up to November 2019 about the stability of dental alignment and retention after fixed orthodontic treatment was performed using seven electronic databases. Study Selection: Only randomized clinical trials investigating patients previously treated with multi-bracket appliances with a follow-up period longer than 6 months were included. Data Extraction: Two authors independently performed the study selection, data extraction, and risk of bias assessment. All pooled data analyses were performed using a random-effects model. Statistical heterogeneity was evaluated. In total, eight randomized clinical trials (RCTs) were included, grouping data from 987 patients. The ages of the patients varied across the studies, ranging between 13 and 17 years. The observation period ranged between 6 and 24 months. The data showed no significant intercanine width modifications during the retention period with both fixed and removable retainers. A significant modification of Little’s Index was found for the mandibular removable retainers with a mean difference of 0.72 mm (95% Cl, 0.47 to 0.98) and for the maxillary removable retainers with a mean difference of 0.48 mm (95% Cl, 0.27 to 0.68). No significant changes were found by evaluating Little’s Index modification for the mandibular fixed retainers. The results of this meta-analysis showed that all the considered retainers were effective in maintaining dental alignment after fixed orthodontic treatment. However, fixed retainers showed greater efficacy compared to removable retainers.

2D vs. 3D Radiological Methods for Dental Age Determination around 18 Years: A Systematic Review

The age of a living human being can be determined by applying a number of different methods; the most diffused are skeletal and dental methods, both principally based on X-rays examinations. This systematic review assesses the current evidence regarding the accuracy and reliability of Cone Beam Computed Tomography (CBCT) vs. Orthopantomography (OPG) in age determination. A computerized systematic literature search of studies published up to January 2020 was conducted without language restrictions in order to identify articles comparing CBCT vs. OPG in dental anatomy evaluation, articles evaluating the accuracy of dental methods for age estimation, both with CT and OPG exams, and articles comparing CBCT vs. OPG in terms of radiation dose. CBCT was found to be more accurate compared to OPG in dental anatomy evaluation. When analyzing young adults, an estimation error of two years is considered forensically acceptable. The radiation dose of a CBCT exam is higher compared to an OPG exam. However, the difference is not as marked with small Fields Of View (FOV) and low-resolution protocols. Final conclusion was that a small FOV CBCT centered on the mandibular angle of a young patient is an accurate and safe method for dental age estimation around the age of 18.

Single Nucleotide Polymorphisms (SNPs) of COL1A1 and COL11A1 in Class II Skeletal Malocclusion of Ethnic Javanese Patient

Background

The prevalence of malocclusion cases in the orthodontic specialist clinic in Airlangga University’s Dental Hospital in Surabaya, Indonesia, in 2014–2016 is fairly high, as 55.34% of the occurrences were identified as class II skeletal malocclusion. This type of skeletal malocclusion, which is usually recognized in adults, occurs as a result of variation during growth and development. Lately, there have been many reports on gene polymorphisms of COL1A1 and COL11A1, which are assumed to be associated with class II skeletal malocclusion in Caucasians.

Purpose

This study aims to analyze the relationship between single nucleotide polymorphisms (SNPs) of COL1A1 and COL11A1 with class II skeletal malocclusion in Javanese ethnic group patients with mandibular micrognathism.

Materials and Methods

The diagnosis of class II skeletal malocclusion was established using the lateral cephalometric radiographs (ANB angle ≥4°) (n=50). DNA was extracted from the patient’s peripheral blood. After that, PCR, electrophoresis, and DNA sequencing were conducted on the extracted DNA based on COL1A1 and COL11A1 primers.

Results

The SNPs in COL1A1 are c.20980G/A in 27 patients and c.20980G>A in 8 patients, whereas SNPs in COL11A1 are both c.134373C/A and c.134555C/T in 8 patients and both c.[134373A>C] and c.134582G>A in 10 patients. All samples show the deletion (c.[134227delA]) in COL11A1.

Conclusion

SNPs in COL1A1 and COL11A1 have been found in class II skeletal malocclusion of Javanese ethnic group patients. Seventy percent of SNPs in COL1A1 occur in rs.2249492, whereas 36% of newly discovered SNPs appear in COL11A1. All samples also have deletion in COL11A1.

Effects on the Facial Growth of Rapid Palatal Expansion in Growing Patients Affected by Juvenile Idiopathic Arthritis with Monolateral Involvement of the Temporomandibular Joints: A Case-Control Study on Posteroanterior and Lateral Cephalograms

BACKGROUND

Juvenile idiopathic arthritis (JIA) affecting temporomandibular joints (TMJ) in growing patients results in maxillofacial deformities, especially if only one condyle has been affected by the rheumatic disease. Mandibular hypoplasia is the most common issue and it may be associated with maxillary hypoplasia. The aim of this retrospective case-control study is to evaluate the effects of rapid maxillary expansion (RME) in these patients.

METHODS

25 growing patients affected by maxillary hypoplasia, currently in a quiescent phase of JIA for at least one year and monolateral involvement of the TMJs, were treated with RME. Data gathered from posteroanterior and lateral cephalograms before and after 1 year from RME were compared to those of 25 non-JIA controls.

RESULTS

Nasal cavity width, maxillary width and upper and lower intermolar width statistically increased. Maxillary and mandibular symmetry indexes presented a statistically significant increase, so did the skeletal class. No signs or symptoms of TMJ activity of JIA occurred according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) criteria. No difference was found when comparing JIA and non-JIA patients apart from the better improvement of several mandibular symmetry indexes in the affected TMJ side of JIA patients. This event is allegedly due to a worse baseline asymmetry in JIA patients that underwent a bigger relative improvement after treatment.

CONCLUSIONS

Results suggest that solving maxillary hypoplasia and, therefore, premature contacts are likely to have allowed mandibular repositioning and condylar growth. RME is a safe and effective solution that can substantially improve maxillary and mandibular symmetry in growing patients affected by JIA with TMJ involvement.

Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander

The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient's anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow.

Effect of Tooth Types on the Accuracy of Dental 3D Scanners: An In Vitro Study

The purpose of this study was to evaluate the accuracy of dental three-dimensional (3D) scanners according to the types of teeth. A computer-aided design (CAD) reference model (CRM) was obtained by scanning the reference typodont model using a high-precision industrial scanner (Solutionix C500, MEDIT). In addition, a CAD test model (CTM) was obtained using seven types of dental 3D scanners (desktop scanners (E1 and DOF Freedom HD) and intraoral scanners (CS3500, CS3600, Trios2, Trios3, and i500)). The 3D inspection software (Geomagic control X, 3DSystems) was used to segment the CRM according to the types of teeth and to superimpose the CTM based on the segmented teeth. The 3D accuracy of the scanner was then analyzed according to the types of teeth. One-way analysis of variance (ANOVA) was used to compare the differences according to the types of teeth in statistical analysis, and the Tukey HSD test was used for post hoc testing (α = 0.05). Both desktop and intraoral scanners showed significant differences in accuracy according to the types of teeth (P < 0.001), and the accuracy of intraoral scanners tended to get worse from anterior to posterior. Therefore, when scanning a complete arch using an intraoral scanner, the clinician should consider the tendency for the accuracy to decrease from anterior to posterior.

Antibacterial Activity of Indolicidin-Coated Silver Nanoparticles in Oral Disease

(1) Background: In dentistry, silver nanoparticles (AgNPs) have progressively earned great interest as antimicrobial drugs and are widely used in several biomedical fields. Recent progress in the analysis of complex bacterial communities has demonstrated the richness of the oral microbiota and the presence of numerous previously unexplained strains. Several efforts have been dedicated to the investigation of antimicrobial peptides (AMPs). Those peptides are a widespread group of small peptides against invading microbes. We report the production of a hybrid molecule composed of AgNPs and indolicidin, a well-known antibacterial peptide. (2) Methods: Spectroscopy and microscopy were used to analyze the optical features and to determine the size of the generated AgNPs. The AgNP antibacterial activity was evaluated versus oral Gram-positive and Gram-negative bacteria. (3) Results: The coated nanoparticles’ antibacterial activity strongly inhibited the growth of microorganisms, with very low minimum inhibitory concentration (MIC) values in the range of 5–12.5 μg/mL. We hypothesize that this effect depended on the specific characteristics of the metal surface coated with indolicidin. The second result was that the coated nanoparticles observed cellular toxicity, was lower with respect to the toxicity of peptide and the naked AgNPs when used individually. (4) New investigations regarding antimicrobial effect of AgNPs coated with AMPs in oral infections are an urgent task.

Midpalatal Suture Density Evaluation after Rapid and Slow Maxillary Expansion with a Low-Dose CT Protocol: A Retrospective Study

Background and objectives: The aim of the present paper is to use low-dose computed tomography (CT) to evaluate the changes in the midpalatal suture density in patients treated with rapid maxillary expansion (RME) and slow maxillary expansion (SME). Materials and Methods: Thirty patients (mean age 10.2 ± 1.2 years) were retrospectively selected from the existing sample of a previous study. For each patient, a low-dose computed tomography examination was performed before appliance placement (T0) and at the end of retention (T1), seven months later. Using the collected images, the midpalatal suture density was evaluated in six regions of interest. Results: No significant differences were found between the timepoints in the rapid maxillary expansion group. Three out of six regions of interest showed significant decreases between the timepoints in the slow maxillary expansion group. No significant differences were found in comparisons between the two groups. Conclusions: The midpalatal suture density showed no significant differences when rapid maxillary expansion groups were compared to slow maxillary expansion groups, suggesting that a similar rate of suture reorganization occurs despite different expansion protocols.

A Comparative Assessment of Pain Caused by the Placement of Banded Orthodontic Appliances with and without Low-Level Laser Therapy: A Randomized Controlled Prospective Study

Patients still refuse or discontinue orthodontic treatment due to related pain and discomfort. In this study, we investigate if low-level laser therapy (LLLT) can reduce pain caused by orthodontic bands. Sixty subjects who needed bands placed on the upper permanent first molars were assigned randomly to the LLLT group, placebo, and control groups. Inclusion criteria were: age range 10–14 years, fully erupted upper first molars in healthy condition, presence of tight mesial proximal contact. Exclusion criteria were: systemic or metabolic diseases, chronic pain or neurological or psychiatric disorders, use of pharmacological agents interfering with pain perception, previous orthodontic treatment or the simultaneous presence of other devices in the patient’s mouth. The assessment of pain was performed by using a numeric rating scale (NRS) considering different time intervals, i.e., immediately after bands placement, 6 h, 24 h, and from day 2 to day 5. Differences in the maximum pain and in pain experienced at each time-point, among the three groups, was assessed by using the Kruskal–Wallis H. The final sample included 56 patients, 29 males, and 27 females, with a mean age of 12.03 ± 1.3 years. Patients were randomly allocated into three groups (tested, control, and placebo group) with each group consisting respectively of 19, 20, and 17 individuals. Subjects in the LLLT experienced less pain at each time interval as well as the maximum pain score being lower in the LLLT compared to control and placebo groups. These findings were all statistically significant (p < 0.05). LLLT can alleviate the intensity of pain after the placement of orthodontic bands.

New Materials in Oral Surgery

Currently, in the field of dentistry literature, one of most active research topics is clearly related to implants, bone materials, and regenerative strategies for the reconstruction of different oral tissues. Biomaterials and related technologies used with these purposes could only be derived from the integration of the knowledge of different disciplines, which together are skilled in generating innovation and research development, with extensive support of basic sciences and intense international cooperation. The combination of these resources, associated with the greater need for increasingly comprehensive and predictable therapeutic protocols, brings a substantial change in the treatment of oral rehabilitations.

Current Evidence of Natural Agents in Oral and Periodontal Health

Oral and periodontal diseases, chewing disorders, and many destructive inflammatory diseases of the supporting tissues of the teeth are usually caused by an imbalance between host defense and environmental factors like smoking, poor nutrition, and a high percentage of periodontopathogenic bacteria. For these reasons, it is important also to focus attention on plaque control and also on improving host resistance through smoking and stress reduction, and a healthy diet. During the last decades, the importance of micronutrients has been extensively reviewed, and it was concluded that the prevention and treatment of periodontitis should include correct daily nutrition and a correct balance between antioxidants, probiotics, natural agents, vitamin D, and calcium. Recently, there has been growing interest in the literature on the impact of nutraceutical dietary aliments on oral and general health. This Special Issue provides a current and thoughtful perspective on the relationship of diet and natural agents on oral and periodontal diseases through a correct clinical approach with the last and most important evidence that may determine good oral conditions and high quality of life.

Antibiotics and Antimicrobials for Treatment of the Oral Microbiota: Myths and Facts in Research and Clinical Practice

In the dental field, the most common oral diseases include periodontitis, apical periodontitis, abscesses, phlegmons and pulpits, all of which are determined by the same aetiological factor, bacterial infections. For these reasons, it is important to choose the right approach through a target antibiotic therapy against oral bacteria. More specifically, during periodontitis, antibiotics are used, often in association with periodontal debridement, to reduce disease-associated periodontopathogens. However, international guidelines are not unanimous in recommending the use of local and/or systemic antimicrobials to reduce infection by oral bacteria, especially in cases in which there is a danger of spreading systemic infection such as cellulitis, diffuse swelling, and abscesses. The lack of consensus is mainly due to the side effects of antibiotic therapy in dentistry, maybe due to recent scientific evidence regarding the development of bacterial resistance to antibiotics. Therefore, the purpose of this editorial is to analyze the therapeutic effects of antibiotics against the main forms of oral and periodontal diseases, and whether there is a significant clinical benefit, especially in the long term, of antimicrobial therapies in dentistry. The most recent evidence regarding antimicrobial agents will also be discussed.

Comprehensive Assessment of Orofacial Health and Disease Related Parameters in Adolescents with Juvenile Idiopathic Arthritis-A Cross-Sectional Study

Background: The aim of this cross-sectional study was to investigate oral health and functional status of adolescents with juvenile idiopathic arthritis (JIA) and its possible link to disease specific parameters. Methods: Patients with JIA were recruited (November 2012–October 2014) and disease specific information was extracted from patients’ records. Oral examination included: dental findings (decayed-, missing- and filled-teeth-index (dmf-t/DMF-T)), gingival inflammation (papilla-bleeding-index (PBI)) and periodontal screening index (PSI). Functional examination followed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Additionally, modified Helkimo’s Clinical Dysfunction Index and radiographic scoring were recorded. Results: 59 JIA patients were included. The mean dmf-t/DMF-T was 2.6. Only one patient showed no signs of gingival inflammation, while 57.6% had a maximum PSI of 2 or less. Positive functional findings were assessed clinically in more than half of the patients. Major diagnosis by RDC/TMD was osteoarthrosis. Patients with at least one positive anamnestic or clinical functional finding revealed significantly higher radiographic scores (CI = 0.440, p = 0.022). Patients with increased c-reactive-protein had a significantly higher PBI (Z = –2.118, p = 0.034) and increased radiographic scores (CI = 0.408, p = 0.043). Conclusions: Adolescents suffering from JIA show high levels of caries experience and gingival inflammation. Temporomandibular joint dysfunction is often seen in JIA patients. Consequently, special dental care programs would be recommendable.

Analysis of Endothelin-1 Concentrations in Individuals with Periodontitis

Endothelin 1 (ET-1) has been shown to have a key role in homeostasis and function of endothelium and maybe fundamental in the relationship between coronary heart disease (CHD) and periodontitis. In this trial, we assessed the influence on serum and salivary ET-1 levels of gingival health, CHD, periodontitis, or a combination of periodontitis-CHD. Clinical and periodontal parameters, were collected from periodontitis patients (n = 34), CHD patients (n = 34), periodontitis + CHD patients (n = 34), and from healthy patients (n = 34) together with saliva and serum samples. The median concentrations of salivary and serum ET-1 were significantly higher in the CHD patients [serum: 1.4(1.1-1.6) pg/ml; saliva 1.2 (0.9-1.6) µmol/g, p < 0.01] and in the periodontitis + CHD patients [serum: 1.7 (1.2-21.8) pg/ml; salivary 1.4(1-1.6) µmol/g, p < 0.001] respect to periodontitis and control patients. Through a univariate regression analysis, c-reactive protein (CRP) and CHD (both p < 0.001) and periodontitis (p = 0.029) were statistically correlated with ET-1 in serum. The multivariate regression analysis demonstrated that only CRP was the statistically predictor of ET-1 in serum(p < 0.001). The multivariate regression analysis in saliva demonstrated that, regarding ET-1 levels the only predictor were CRP (p < 0.001) and total cholesterol (p = 0.042). The present study evidenced that subjects with CHD and periodontitis plus CHD had higher serum and salivary levels of ET-1 compared to subjects with periodontitis and healthy controls. Moreover, only CRP remained a major predictor of increased ET-1 concentrations in both serum and saliva.

Evaluation of a Digital Protocol for Pre-Surgical Orthopedic Treatment of Cleft Lip and Palate in Newborn Patients: A Pilot Study

The aim of this study was to evaluate the accuracy, invasiveness and impact on clinical results of a digital oral impression protocol in the pre-surgical orthopedic treatment (PSOT) of newborn cleft lip and palate (CLP) patients undergoing primary alveolar surgical repair. Six patients were divided, according to impression technique used, into a digital (intraoral scanner (IOS)) and a non-digital (tray and putty (T&P)) group. Parents considered IOS impressions to be less invasive, compared to T&P impressions. The clinician that took all the impressions considered the IOS to be less stressful compared to the T&P method. In two T&P patients, the impression was repeated because some important anatomical details were missing, in one case due to patient regurgitation during the first attempt. No impression was repeated, and any adverse event was reported in the IOS group. There were no significant differences between these two protocols in pre-surgical alveolar gap reduction and surgical challenge. The study results indicate that this digital protocol can accelerate the production process of the passive molding plate with an instantaneous transmission of the digital impression to the dental lab, maintaining the same accuracy level and clinical outcomes of classical techniques and reducing the invasiveness of impression taking, avoiding any risk of impression material ingestion or inhalation.

Periodontitis and Tooth Loss Have Negative Systemic Impact on Circulating Progenitor Cell Levels: A Clinical Study

The aim of the present study was to investigate the association and impact of periodontitis and tooth loss on a subtype of endothelial progenitor cell (EPC) levels (CD133+/KDR+). Furthermore, the objective was to determine if the periodontal status influenced CD133+/KDR+ levels. In all, 88 patients with periodontitis and 79 healthy controls (HCs) were enrolled in the study. Enrolled patients were examined and characterized by clinical and blood sample analysis. Spearman's correlation test was applied in order to assess the interdependence between CD133+/KDR+ levels and all periodontal parameters. In order to estimate a statistically significant trend (p-trend) for ordered CD133++/KDR+ quartiles, the Jonckheere-Terpstra test was applied for all variables. Patients in the periodontitis group presented significantly lower CD133+/KDR+ levels (66.4 (45.5-269.6 cells/µL)) compared to the HC group (76.7 (24.3-313.2 cells/µL), p < 0.001). Lower CD133+/KDR+ levels negatively correlated with C-reactive protein (CRP), with the number of teeth, and with all periodontal parameters (p < 0.001). Moreover, there was a proportional increase in CD133+/KDR+ levels with a progressive increase in number of teeth (p-trend < 0.001), while there was a proportional decrease in CD133+/KDR+ levels with a proportional increase in clinical attachment level (CAL, p-trend = 0.003), probing depth (PD, p-trend = 0.007), and bleeding sites (bleeding on probing (BOP), p-trend < 0.001) as an extent measure of periodontitis. This study demonstrated that patients with periodontitis presented significantly lower CD133+/KDR+ levels compared to HCs. Moreover, all patients presented an increase in the CD133+/KDR+ EPC levels with an extended level of periodontitis and tooth loss.

A Retrospective Study on Insertion Torque and Implant Stability Quotient (ISQ) as Stability Parameters for Immediate Loading of Implants in Fresh Extraction Sockets

Background

To date, insertion torque value (ITV) and implant stability quotient (ISQ) obtained by the Osstell instrument are common clinical methods to assess the initial stability of an implant for a predictable loading procedure. The aim of this current study is to evaluate the ITV and ISQ as stability parameters as part of the decision-making protocol in the adoption of immediate loading in fresh extraction sockets.

Materials and Methods

A total of 41 tapered implants were allocated into two groups: the test group (n = 11; 3 males and 8 females; mean age: 62.8 ± 10.7) which received 18 implants as type 1 fresh extraction sockets after teeth removal and the control group (n = 7; 4 males and 3 females; mean age: 65.4 ± 9.7) which received 23 implants placed in healed sockets for a period of at least 3 months. Both the ITV and ISQ data were recorded at the time of insertion (t₀). Since ITV (test group) and ITV/ISQ (control group) values were useful for the immediate loading protocol, a screw-retained temporary crown was immediately loaded. ISQ values were recorded after a healing period of 4 months (t₁).

Results

ITV mean values at t₀ in test and control groups were, respectively, 48.61 ± 15.39 and 70.47 ± 14.71, whereas ISQ mean values were 57.55 ± 1.93 and 72.86 ± 5.25, respectively, showing a statistically significant difference (p value < 0.001). ISQ mean values at t₁ in either the test or the control group were 68.68 ± 4.20 and 74.54 ± 4.17, not showing a statistical difference. The implant survival rate was 100% in both groups, and no surgical and prosthetic complications were reported during the study.

Conclusion

In conclusion, this study remarked the presence of a residual gap that influenced the ISQ during implant insertion in fresh extraction sockets making this parameter not sufficient for a conclusive decision in the immediate loading, whereas the ITV alone showed to be the best parameter for a final substantial decision.

Effectiveness of Low-Level Laser Therapy during Tooth Movement: A Randomized Clinical Trial

The present study evaluated the effects of low-level laser therapy (LLLT) by means of a diode laser in accelerating orthodontic tooth movement (OTM). After extraction of the first upper premolars for orthodontic purpose, 82 maxillary canines which needed distalization were analyzed in 41 enrolled patients (21 males, 20 females, mean age 13.4 ± 2.1 years). On all experimental sites, an orthodontic force of 50/N was applied by a nickel-titanium (NiTi) closed coil spring (G&H, Franklin, IN, USA) in order to obtain the space closure. Using a split mouth randomized design, the test side was treated using a diode laser (Wiser Laser Doctor Smile, Brendola, Italy) operating at 810 nm wavelength in continuous wave mode at both the buccal and palatal side on three points/side (distal, medial and mesial) (1 W output power, continuous wave of 66.7 J/cm², energy density of 8 J) at baseline and at 3, 7, and 14 days and every 15 days until the space closed. On the control side, the opposite selected canine was treated only using orthodontic traction. The primary outcome chosen was the overall time needed to complete the levelling and closing space, measured on a study cast. The secondary outcome chosen was the evaluation of pain levels related to tooth traction, using a Visual Analogue Scale (VAS), recorded at 3, 7, and 14 days after treatments. The mean space closures of the maxillary canines were comparable between groups [Test, 4.56 mm (95% CI 3.9-4.8); Control, 4.49 mm (95% CI 3.8-4.7), p = 0.456]. The laser group yielded less mean time [84.35 ± 12.34 days (95% CI 79.3-86)] to accomplish space closure compared to the control group [97.49 ± 11.44 days (91.7-102.3)] (p < 0.001). The test side showed a significant reduction in the average range of dental pain at 3 [Test, 5.41 (95% CI 5.1-5.6); Control, 7.23 (95% CI 6.9-7.6), p < 0.001], 7 [Test, 4.12 (95% CI 3.8-4.7); Control, 5.79 (95% CI 5.4-5.8), p < 0.001], and at 14 days [Test, 2.31 (95% CI 1.8-2.3); Control, 3.84 (95% CI 3.3-4.2), p < 0.001] after treatment (p < 0.001). This study demonstrates that the use of LLLT therapy was effective in accelerating tooth movement and reducing pain levels related to OTM.

Oral Health-Related Quality of Life in Dutch Children Diagnosed with Oligodontia. A Cross-Sectional Study

There is need to get insight into condition-specific oral health-related quality of life in Dutch children with oligodontia. Between October 2014 and March 2017, 11–17-year-old oligodontia patients were approached to join a study assessing the impact of oligodontia on condition-specific oral health-related quality of life (OHrQoL). The patients received a condition-specific OHrQoL questionnaire prior to the start of orthodontic treatment. Non-oligodontia children in the same age group, but also requiring orthodontic treatment, were approached to serve as a control. The Fisher’s Exact Test was used for comparison purposes with the control group because of the small group sizes. Furthermore, subgroup analyses were performed for gender, age, number of congenitally missing teeth, tooth agenesis in the aesthetic region, orthodontic classification and microdontia via independent t-tests. p-values of <0.05 were considered statistically significant. Twenty-eight oligodontia patients and 23 controls agreed to participate. The oligodontia patients’ scores were comparable to the controls except for the items about dental appearance and treatment complexity. The impact of oligodontia on OHrQoL in youngsters is limited and mainly concerns dental appearance and the complexity of the treatment.

Effect of an Oral Health Programme on Oral Health, Oral Intake, and Nutrition in Patients with Stroke and Dysphagia in Taiwan: A Randomised Controlled Trial

No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group (n = 33) and a control group (n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI =−2.69 to −1.25, Wald χ² = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = −0.16 to 0.89, Wald χ² = 1.86, p > 0.05), MNA-SF (95% CI =−0.35 to 0.53, Wald χ² =−0.17, p > 0.05), and nasogastric tube removal (p > 0.05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake.

Influences of Masticatory Function Recovery Combined with Health Guidance on Body Composition and Metabolic Parameters

Background:

Tooth loss reduces masticatory function. Insufficient masticatory function causes an increase in carbohydrate intake while decreasing the intake of foods with a low Glycemic Index (GI) and high in protein, antioxidants, dietary fiber, vitamins, and minerals. Protein-energy malnutrition may lead to metabolic syndrome, frailty, and faster onset of Non-Communicable Diseases (NCDs). Individuals with tooth loss resulting in problematic eating habits require behavior modification and health guidance.

Objective:

This report aims to evaluate the influence of dental prostheses combined with health guidance on body composition and metabolic parameters.

Methods:

Data were collected from three subjects: Two with molar loss and one with edentulism. Masticatory function was restored in each subject through prosthodontic treatment. Masticatory performance was evaluated before and after the prosthodontic treatment by having the subjects chew a gummy jelly and measuring the glucose extraction. Questionnaires were used to assess food intake and lifestyle habits. Health guidance based on the results of the questionnaires was conducted simultaneously with the prosthodontic intervention. Body composition and blood pressure were measured and blood tests were performed at baseline and around 90 days after the first health guidance session.

Results:

Masticatory ability, body-mass index, basal metabolism standard value, body-fat percentage, and intake of certain nutrients improved in all cases. Blood pressure and hemoglobin A1c improved in two cases.

Conclusion:

Masticatory function recovery combined with health guidance was effective in preventing the onset or deterioration of NCDs in patients with masticatory dysfunction.

Temporomandibular Disorders and Oral Features in Early Rheumatoid Arthritis Patients: An Observational Study

Aims: Temporomandibular disorders (TMD) represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. Rheumatoid Arthritis (RA) is an autoimmune polyarthritis characterized by the chronic inflammation of synovial joints and oral implications such as hyposalivation, difficulty in swallowing and phoning, feeling of burning mouth, increased thirst, loss of taste or unpleasant taste and smell, dental sensitivity. The aim of this observational study was to investigate the prevalence of TMD symptoms and signs as well as oral implications in patients with Early Rheumatoid Arthritis (ERA), that is a RA diagnosed within 12 months, compared with a control group. Methods: The study group included 52 ERA patients (11 men, 41 women) diagnosed according to the 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis. A randomly selected group of 52 patients not affected by this disease, matched by sex and age, served as the control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) by means of a questionnaire and through clinical examination. Results: Regarding the oral kinematics, the left lateral excursion of the mandible was restricted in statistically significant way in ERA patients (p=0.017). The endfeel values were significantly increased in ERA group (p=0.0017), thus showing the presence of a higher muscle contracture. On the other side, the study group complained less frequently (67.3%) of TDM symptoms (muscle pain on chewing, pain in the neck and shoulders muscles, difficulty in mouth opening, arthralgia of TMJ, tinnitus) than controls (90.4%) (χ²= 8.301 p=0.0039). The presence of TMJ noises was significantly lower in the study group (χ²= 3.869 p=0.0049), as well as presence of opening derangement (χ²= 14.014 p=0.0002). The salivary flow was significantly decreased in the study group respect to the control one (p<0.0001). Conclusions: The data collected show a weak TMJ kinematic impairment, a paucisymptomatic muscle contracture (positive endfeel) and a remarkable reduction of salivary flow in ERA patients. Myofacial pain (MP) evoked by palpation was more frequent and severe in the control group than in the study one, this result being highly significant.