Salivary Markers and Microbial Flora in Mouth Breathing Late Adolescents

A glimpse into the past of Hansen's disease - Re-evaluation and comparative analysis of cases with leprosy from the Avar period of the Trans-Tisza region, Hungary

Our knowledge of how society viewed leprosy and treated its victims in the past is still scarce, especially in geographical regions and archaeological periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of five previously described, probable cases with leprosy from the Avar-period Trans-Tisza region (Hungary). The five skeletons were subject to a detailed macromorphological (re-)evaluation. Where possible, the biological and social consequences of having leprosy were reconstructed based on the observed bony changes and mortuary treatment, respectively. The retrospective, macromorphology-based diagnosis of leprosy could be established in three cases only. Based on the detected skeletal lesions, all of them suffered from near-lepromatous or lepromatous leprosy. The disease resulted in aesthetic repercussions and functional implications, which would have been disadvantageous for these individuals, and limited or changed their possibilities to participate in social situations. They could have even required heavy time investment from their respective communities. The analysis of the mortuary treatment of the confirmed leprosy cases revealed no evidence of a social stigma. These findings indicate that the afflicted have not been systematically expulsed or segregated, at least in death, in the Early Middle Ages of the Carpathian Basin.

Caries assessment and salivary microbial analysis in patients diagnosed with mucopolysaccharidosis

BACKGROUND AND OBJECTIVES

Mucopolysaccharidosis (MPS) is a group of lysosomal storage disorders that cause the deposition of polysaccharides in cells. This causes systemic and oral manifestations, which can be observed clinically and radiographically. The present study aimed to assess dental caries, the effect of salivary pH, and the change of microflora on teeth in patients diagnosed with MPS.

MATERIALS AND METHODS

The study included children affected with mucopolysaccharidosis (n = 50) and healthy children (n = 50) in the control group between 3 and 15 years of age. The pH of saliva and decayed, missing, and filled teeth/decayed extracted and filled teeth index were noted and recorded. For the microbial analysis, saliva was inoculated into blood agar, MacConkey agar, Candida CHROMagar, and Mitis Salivarius agar, then inspected for colony-forming units, which were counted and recorded based on the colony characteristics and gram staining.

STATISTICAL ANALYSIS

Intergroup comparison of the test parameters was done using the Mann-Whitney test. P < 0.05 was considered statistically significant.

RESULTS

The results showed significantly higher total microbial load (P = 0.00008), streptococcus viridans species (P = 0.00001), and Candida species (P = 0.0038) in the study group. The caries incidence was also higher in the study group for both primary (P = 0.0096) and permanent dentition (P = 0.0251), and salivary pH was more acidic (P = 0.00001) in the patients diagnosed with MPS.

INTERPRETATION AND CONCLUSION

Patients diagnosed with MPS have a higher microbial load, more acidic saliva, and subsequently, a higher caries incidence than normal healthy children. Hence, regular dental evaluation, prevention, and treatment must be integrated into their health-care regimen.

Leprosy: The age-old companion of humans - Re-evaluation and comparative analysis of Avar-period cases with Hansen's disease from the Danube-Tisza Interfluve, Hungary

In recent years, our knowledge of leprosy in the past has substantially been enriched. Nonetheless, much still remains to be discovered, especially in regions and periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of eight Avar-period leprosy cases from the Danube-Tisza Interfluve (Hungary). In every case, to reconstruct the biological consequences of leprosy, the detected bony changes were linked with palaeopathological and modern medical information. To reconstruct the social consequences of being affected by leprosy, conceptualisation of the examined individuals' treatment in death was conducted. In every case, the disease resulted in deformation and disfigurement of the involved anatomical areas (rhinomaxillary region, feet, and/or hands) with difficulties in conducting certain physical activities. These would have been disadvantageous for the examined individuals and limited or changed their possibilities to participate in social situations. The most severe cases would have required continuous support from others to survive. Our findings indicate that, despite their very visible disease and associated debility, the examined communities did not segregate leprosy sufferers but provided and cared for them, and maintained a strong enough social network that made their survival possible even after becoming incapable of self-sufficiency.

Effect of face masks on salivary parameters and halitosis: Randomized controlled crossover trial

BACKGROUND

Face masking is associated with self-perceived dry mouth and halitosis. Aim of the study was to measure the effect of different face masks on salivary parameters and halitosis.

METHODS

The randomized controlled crossover clinical trial with four periods included 40 oral healthy participants using different face masks (cloth mask, surgical mask, filtering facepiece 2 [FFP2] mask) or no mask (control) for 4 h in random order. Unstimulated salivary flow rate (primary outcome) and stimulated salivary flow rate, salivary pH and buffer capacity of stimulated and unstimulated saliva (secondary outcomes, blinded), and volatile sulfur compounds (secondary outcome) were measured before and after the 4-h periods. Statistical analysis was performed by repeated measures ANOVA (p < 0.05).

RESULTS

Of 40 randomized participants, 39 completed the study. Unstimulated salivary flow rate prior to face masking amounted to 0.6 ± 0.3 ml/min. Face masking had no significant effect on unstimulated salivary flow (p = 0.550). Face masking had also no significant effect on the other salivary parameters (p ≥ 0.518). The concentration of volatile sulfur compounds (VSC) prior to face masking amounted to 157.3 ± 59.7 ppb. After face masking, the concentration of VSC increased slightly, but not significantly (p = 0.055): 168.1 ± 76.3 ppb (control), 199.3 ± 132.7 ppb (cloth masks), 188.5 ± 101.1 ppb (surgical masks), and 189.7 ± 90.1 ppb (FFP2 masks).

CONCLUSION

Four hours of face masking did not change the salivary flow rate, pH, and buffer capacity, and had no significant effect on VSC's levels. Wearing face masks does not seem to result in measurable side-effects on salivary parameters such as a reduced salivary flow rate or VSC's levels.

CLINICAL TRIAL REGISTRATION

The protocol was prospectively registered at ClinicalTrials.gov (NCT04914208) on June 4, 2021.

Reconstruction of nasal airway in patients of class IIId maxillary defect with vastus lateralis muscle-chimeric double skin paddle ALT flap

BACKGROUND

A reconstructive challenge in patients with class IIId maxillary defect is how to obliterate the defect and restore a patent nasal airway. The current strategy using the single anterolateral thigh (ALT) fasciocutaneous flap for reconstruction may result in permanent mouth breathing. As the ALT flap was a common option in reconstruction processes, this study aimed to evaluate the benefits of vastus lateralis (VL) muscle-chimeric double skin paddle ALT flap in simultaneous defect and nasal airway reconstruction.

METHODS

This study included 21 patients with class IIId maxillary defect who underwent free ALT flap reconstruction (n = 11, single ALT flap group; n = 10, VL muscle-chimeric double skin paddle ALT flap (chimeric ALT flap) group) at the China Medical University Hospital from August 2015 to September 2019. Associated parameters collected for analysis included gender, age, body mass index (BMI), operative time, hospitalization, clinical stage, preoperative treatment, flap/defect size, comorbidities, postoperative RT, mouth breathing and short/long term complications.

RESULTS

No significant differences were observed in age, BMI, hospitalization, clinical stage, preoperative treatment, defect size, comorbidities, and postoperative RT between the two groups; however, the chimeric ALT flap group as dominated by male patients (p = 0.009), and had longer operative times (12.1 h vs. 10.1 h, p = 0.002) and larger flap sizes (180 cm² vs. 96.7 cm², p = 0.013). Compared with the chimeric ALT flap group, the single ALT flap group suffered from permanent mouth breathing.

CONCLUSION

Nasal airway reconstruction should be considered in patients with class IIId maxillary defect. Compared to the single ALT flap, the chimeric ALT flap is a superior reconstructive option for patients with class IIId maxillary defect, although a longer surgical duration and larger flap size are required.

Prolonged mask wearing does not alter the oral microbiome, salivary flow rate or gingival health status – A pilot study

The COVID-19 pandemic has resulted in the widespread use of N95 respirators and surgical masks, with anecdotal reports among healthcare providers and the public of xerostomia, halitosis, and gingivitis, a consortium of symptoms colloquially termed “mask mouth”. However, this has not been scientifically verified. The aim of this study was to assess changes in salivary flow rate, gingival health status and oral microbiome associated with prolonged mask use. A total of 25 dental students (mean age = 26.36 ± 1.58) were included in the study and evaluated at three time points: T1, at the end of at least 2 months of full-day mask wear (7.26 ± 1.56 hours/day); T2, at the end of a period of minimal mask use (1.13 ± 1.13 hours/day); and T3, at the end of 2-3 weeks of resuming full-day mask wear (6.93 ± 1.80 hours/day). Unstimulated whole saliva (UWS) flow rate, xerostomia (on a quantitative scale of 10), gingival index (GI) and plaque index (PI) were assessed at each time point. The salivary microbiome was characterized using 16S rRNA gene sequencing. Overall, UWS flow rates were normal (mean of 0.679 ml/min) and xerostomia, PI and GI scores were low (Mean of 3.11, 0.33 and 0.69, respectively) with no significant differences as a result of prolonged mask wearing. Similarly, there were no significant microbial changes at a false discovery rate (FDR) ≤ 0.05. However, some trends were identified using a nominal p-value cut-off of ≤ 0.01, namely Gemella sanguinis, Streptococcus sp. Oral taxon 066 and Oral taxon 058 were associated with prolonged mask wear. Trends were also seen by gender, race and age, for example an increase in P. gingivalis and P. intermedia with age. In conclusion, we found no evidence that prolonged mask wear adversely affects oral health. The findings support that the oral microbiome of healthy individuals is resilient.

The impact of mouth breathing on dentofacial development: A concise review

Mouth breathing is one of the most common deleterious oral habits in children. It often results from upper airway obstruction, making the air enter completely or partially through oral cavity. In addition to nasal obstruction caused by various kinds of nasal diseases, the pathological hypertrophy of adenoids and/or tonsils is often the main etiologic factor of mouth breathing in children. Uncorrected mouth breathing can result in abnormal dental and maxillofacial development and affect the health of dentofacial system. Mouth breathers may present various types of growth patterns and malocclusion, depending on the exact etiology of mouth breathing. Furthermore, breathing through the oral cavity can negatively affect oral health, increasing the risk of caries and periodontal diseases. This review aims to provide a summary of recent publications with regard to the impact of mouth breathing on dentofacial development, describe their consistencies and differences, and briefly discuss potential reasons behind inconsistent findings.

Effect of specific training course for competency in professional oral hygiene care in the intensive care unit: a quasi-experimental study for developing a standardized learning curve

Background

The development of evidence-based training standards can help improve the quality of educational programs for novice intensive care unit (ICU) nurses. This study was conducted to assess the application of a training course on competency development of nurses in relation to oral hygiene care in ICU patients and to develop a checklist for evaluating the competence performance. In addition, to achieve a certain level of oral hygiene competence, as well as to assess the relative importance of predicting factors and learning competency patterns in oral hygiene care, we used standard learning curve.

Methods

This quasi-experimental study with time series design was conducted on newly registered ICU nurses of a teaching hospital affiliated with Tehran University of Medical Sciences, Iran, between 2016 and 2018. In the first phase of this study, we designed a checklist to assess nurses' professional competence in oral hygiene care in three stages: before, during, and after care. Then, in the second phase, the level of competence of nurses in repeated times of oral hygiene care was determined based on checklist items and recorded in the learning curve.

Results

The greatest increase of oral hygiene care competency due to repetition was observed in the first and fourth times of repetition in comparison to the subsequent and previous steps. In the linear regression model, demographic variables predicted 12–19% of changes related to skill scores in repetitions.

Conclusion

According to the learning curve, newly registered ICU nurses can reach an acceptable competency after 6 repetitions of oral hygiene care.

Life and death of a leprosy sufferer from the 8th-century-CE cemetery of Kiskundorozsma–Kettőshatár I (Duna-Tisza Interfluve, Hungary)—Biological and social consequences of having Hansen’s disease in a late Avar Age population from Hungary

The aim of our paper is to demonstrate a middle-aged male (KK61) from the 8^th-century-CE cemetery of Kiskundorozsma–Kettőshatár I (Duna-Tisza Interfluve, Hungary), who appears to represent the lepromatous form of Hansen’s disease. Leprosy has affected not only the rhinomaxillary region of his face but also his lower limbs, with severe deformation and disfigurement of the involved anatomical areas (saddle-nose and flat-foot deformity, respectively). Consequently, he would have experienced disability in performing the basic activities of daily living, such as eating, drinking, standing or walking; and thus, he would have required regular and substantial care from others to survive. Despite his very visible disease and associated debility, it seems that KK61 was accepted as a member of the community in death, since he has been buried within the cemetery boundaries, among others from his community. In addition, his grave has conformed to the mortuary practices characteristic of the Kiskundorozsma–Kettőshatár I cemetery (e.g., burial orientation, position of the body in the grave, and type and quantity of accompanying grave goods). Although distinction or segregation in life do not preclude normative treatment in death, the long-lasting survival of KK61 with Hansen’s disease implies that he would not have been abandoned but cared for by others. KK61 is one of the few published historic cases with leprosy from the Avar Age of the Hungarian Duna-Tisza Interfluve. His case gives us a unique insight into the biological consequences of living with Hansen’s disease and illustrates the social attitude toward leprosy sufferers in early mediaeval Hungary.

COVID-19 Pandemic: Effect of Different Face Masks on Self-Perceived Dry Mouth and Halitosis

Due to the COVID-19 pandemic, the use of face masks has increased, resulting in potential health-related side-effects. Therefore, the study aimed to analyse the effect of wearing face masks on self-perceived dry mouth and halitosis. A questionnaire addressing the daily wearing time of different face masks (community masks, surgical/medical masks and KN95-/N95-/FFP2-masks) and self-perceived dry mouth and halitosis was given to adults attending or working at a university hospital. Statistical analysis was performed using Wilcoxon signed-rank test and multiple linear regression analysis (p < 0.05). 3750 participants (age: 50.4 ± 15.5 years; 60.0% female) were included. During the pandemic, face masks were used for 4.7 ± 3.8 h per day: community masks: 0.9 ± 2.0 h, medical/surgical masks: 1.9 ± 2.8 h and KN95-/N95-/FFP2-masks: 1.9 ± 2.5 h per day. The use of face masks significantly increased self-perceived dry mouth and halitosis (both p < 0.001). Self-perceived dry mouth and halitosis increased with increasing wearing time (community masks: dry mouth: p < 0.001, halitosis: p = 0.014; medical/surgical masks: both: p < 0.001; KN95-/N95-/FFP2-masks: dry mouth: p < 0.001, halitosis: p = 0.011). The perception of dry mouth and halitosis was increased in females compared to males (both: p < 0.001). Participants used to wearing face masks prior to the pandemic perceived dry mouth to a higher extent (p = 0.043). Self-perceived halitosis was lower in older than in younger participants (p < 0.001). Due to the increased perception of dry mouth and halitosis, people might abstain from wearing face masks. Further studies need to analyse measurable changes in dry mouth or halitosis.

Dietary Sugar Exposure and Oral Health Status in Children with Autism Spectrum Disorder: A Case-control Study

This case-control study compared dietary sugar exposure and oral health status between children with and without Autism Spectrum Disorder (ASD), aged 5-12 years (n = 136, each). Data regarding socio-demographics, child's oral hygiene practices and behavior, diet-related behavior, oral habits and dental trauma were obtained. Child's diet on the previous day was recorded using 24-h recall method and sugar exposure was calculated using Dental Diet Diary (D3) mobile application. Oral Hygiene Index-Simplified (OHI-S), deft and DMFT were recorded. Results showed no significant differences in sugar exposure, deft and DMFT between the groups. Although oral hygiene practices were significantly better in children with ASD, their OHI-S was significantly worse. Significantly more children with ASD reported mouth-breathing, bruxism and self-injurious habits.

Catering Work Profession and Medico-Oral Health: A Study on 603 Subjects

The present observational prospective study analyzes the eating habits in association with the medico-oral health of catering workers, since they seem the category at higher risk of developing dental problems. Objective: To evaluate oral and medical health through a questionnaire in a total sample of 603 participants. Additionally, this article aims to provide information regarding the medico-oral implications of an unbalanced diet linked to this particular profession. Material and methods: A questionnaire created through Google Forms platform was sent to all members of the Italian Federation of Chefs (FIC). The mean age was 46.9 ± 32.6 ranging from 17 to 66 years old. Results: Catering workers’ years of service showed a significant impact on the presence of teeth pain (p < 0.05), missing teeth (excluding the third molars) (p < 0.01), treatment with prothesis (p < 0.01), dental fillings (p < 0.01), dental extractions (p < 0.01), diabetes (p < 0.05), high blood pressure (p < 0.01), joint pain (p < 0.01), back pain (p < 0.01), neck pain (p < 0.01), and gastroesophageal reflux (p < 0.05). Conclusions: A conspicuous part of the study sample was overweight, with a high BMI. Moreover, the years of service in this field showed significant impact on dental problems. Therefore, a very important role is that of preventing dental problems and giving information on the causes and effects unknown to many workers in the sector.

Orofacial Myofunctional Therapy and Myofunctional Devices Used in Speech Pathology Treatment: A Systematic Quantitative Review of the Literature

Purpose A growing number of speech-language pathologists (SLPs) are using orofacial myofunctional therapy (OMT) and/or myofunctional devices (MDs) in the treatment of their clients. However, governing bodies suggest SLPs carefully consider the availability and quality of evidence in the utilization of these therapies in speech-language pathology treatment. The purpose of this study was to review the existing evidence for OMT and MDs used by SLPs. Method A systematic quantitative review was conducted using key search terms in three electronic platforms housing multiple databases, along with a hand search, to identify additional literature. All studies published in English in full text were included if they reported pre- and posttreatment data of OMT and/or MDs provided by an SLP. Data were extracted and analyzed by the first author and confirmed by the co-authors. Results Twenty-eight studies met the criteria for inclusion in the review. Two thirds were published in the last decade and involved the use of OMT/MDs targeting multiple areas of speech pathology intervention within the same study, that is, swallowing, breathing, oral hygiene, and speech production. Majority of studies were rated as low level of evidence. All studies used OMT, with very few using MDs. While the assessment, treatment protocols, and outcome measures were highly variable, all of the studies reported an improvement in the function of the orofacial systems posttreatment. Few studies reported long-term follow-up data. Almost half of the studies recommended the use of OMT/MDs in a multidisciplinary/interdisciplinary team or in conjunction with other therapy. Conclusions There has been an increase in literature over the last decade in SLPs' use of OMT; however, there are only a small number of studies to date that explore the use of MDs. There is a growing body of evidence to support the use of OMT and MDs within a multidisciplinary team for people with communication and swallow difficulties. However, development of future research should consider investigating assessment and outcome measures, optimal dosage, and service delivery.

Can children's oral hygiene and sleep routines be compromised during the COVID-19 pandemic?

BACKGROUND

During COVID-19 pandemic, children are confined at home, with changes in family routines.

AIM

Evaluate sleep disorders among Brazilian and Portuguese children during social distancing, and its association with parental perception of child's oral hygiene.

DESIGN

In this cross-sectional study, Portuguese and Brazilian parents/caregivers of 3- to 15-year-old children, practicing social distancing due to COVID-19 pandemic, answered an online questionnaire, from April 24-26, 2020, evaluating sociodemographic characteristics, child's school activities online, child's sleep quality during social distancing. Two questions from the questionnaire, developed based on previous studies, evaluated the parental perception of child's oral hygiene quality and routine changes during social distancing. Parents/caregivers answered five domains of the Portuguese-language version of the Sleep Disturbances Scale for Children, evaluating sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence and sleep hyperhidrosis. Descriptive, Linear-by-linear association, Kruskal-Wallis and post hoc analysis were performed (P ≤ .05).

RESULTS

Participated in the study 253 parents/caregivers, 50.2% from Brazil. Most parents (72.2%) reported changes in child's routine during social distancing. Sleep breathing disorders (P = .019), sleep-wake transition disorders (P = .022), and disorders of excessive somnolence (P < .001) were associated with poor oral hygiene during social distancing.

CONCLUSION

Sleep disorders are associated with poor oral hygiene during social distancing.

Mouthwash Based on Ozonated Olive Oil in Caries Prevention: A Preliminary In-Vitro Study

(1) Background: Ozone (O3) proved to oxidize organic and inorganic compounds, and its efficacy against bacteria, viruses and fungi plasma membranes was of interest. Ozone vehicle can be a gaseous form, ozonated water or ozonized oil. The aim of this in-vitro study was to evaluate the efficacy of ozonated olive oil against Streptococcus mutans. (2) Methods: Two different commercial mouthwashes were tested: Ialozon Blu (IB) (Gemavip, Cagliari, Italy), with ozonated olive oil, and Ialozon Rose (IR) (Gemavip, Cagliari, Italy), with ozonated olive oil, hyaluronic acid and vitamin E. All formulates were analyzed in a dilution range from 2- to 256-folds in saline solution, as to reproduce the salivary dilution. Streptococcus mutans CIP103220 strain was used for the antimicrobial susceptibility test, and the Kirby-Bauer inhibition method was performed to evaluate the Minimum Inhibitory (MIC), Minimum Bactericidal (MBC), and Minimum Biofilm Inhibitory Concentration (MBIC). (3) Results: Both formulates showed the same antimicrobial activity. MIC, MBC, and MBIC were observed for dilution factors of 1/32, 1/8 and 1/8, respectively. The mean value of inhibition zone diameter was 16.5 mm for IB, and 18 mm for IR. (4) Conclusions: The results suggested that ozonized olive oil formulates were able to inactivate Streptococcus mutans avoiding the salivary dilution effect in the oral cavity.

Alterations in Oral-Nasal-Pharyngeal Microbiota and Salivary Proteins in Mouth-Breathing Children

Mouth breathing induces a series of diseases, while the influence on microbiota of oral cavity and salivary proteins remains unknown. In this study, for the first time, profiles of oral-nasal-pharyngeal microbiota among mouth-breathing children (MB group, n = 10) were compared with paired nose-breathing children (NB group, n = 10) using 16S ribosomal DNA (rDNA) (V3-V4 region) high-throughput sequencing. The differentially expressed salivary proteins were revealed using label-free quantification (LFQ) method, and their associations with bacterial abundance were measured by canonical correspondence analysis (CCA). The overall bacterial profiles differed between the two groups, and the differences were related to the duration of mouth breathing. The diversity of oral-pharyngeal microbiota was significantly higher, and the nasal-pharyngeal species tended to be consistent (unweighted UniFrac, p = 0.38) in the MB group. Opportunistic pathogens were higher in relative abundance as follows: Acinetobacter in the anterior supragingival plaque, Neisseria in unstimulated saliva, Streptococcus pneumoniae in the pharynx, and Stenotrophomonas in the nostrils. The expression level of oxidative-stress-related salivary proteins (lactoylglutathione lyase and peroxiredoxin-5) were upregulated, while immune-related proteins (integrin alpha-M and proteasome subunit alpha type-1) were downregulated in MB group. The differentially expressed proteins were associated with specific bacteria, indicating their potentials as candidate biomarkers for the diagnosis, putatively early intervention, and therapeutic target of mouth breathing. This study showed that mouth breathing influences the oral-nasal-pharyngeal microbiota and enriches certain pathogens, accompanied with the alterations in the salivary environment. Further research on the pathological mechanisms and dynamic changes in longitudinal studies are warranted.

Association of facial type with possible bruxism and its related clinical features in adolescents: A cross-sectional study

OBJECTIVES

The assessment of bruxism and its clinical characteristics is acknowledged in literature. This study aimed to evaluate the association of adolescents' facial patterns with bruxism and its related clinical features in the form of signs and symptoms.

MATERIALS AND METHODS

Four hundred and three adolescents answered a questionnaire evaluating sleep bruxism (SB) and awake bruxism (AB). Parents/caregivers answered a questionnaire evaluating the adolescents' sleep features (drooling on the pillow, snoring). Adolescents' facial (dolichofacial/brachyfacial/mesofacial) and clinical features (pain in masseter/temporal muscle, indentations marks on the tongue, linea alba, tooth attrition, mouth's maximum opening and masseter electrical activity) were evaluated. Multinomial regression was performed. Odds ratio (OR) and confidence intervals (CI) were provided.

RESULTS

Brachyfacial adolescents were less likely to present possible AB compared to mesofacials (OR=0.46, CI=0.21-0.98). Brachyfacial adolescents were more likely to present pain in the temporal muscle (OR=6.59, CI=2.18-19.87) and a higher number of posterior teeth with attrition (OR=1.25, CI=1.02-1.57) compared to mesofacials. Dolichofacial adolescents were more likely of not presenting pain in the masseter muscle (OR=2.23, CI=1.03-4.83), had a higher mouth's maximum opening (OR=1.43, CI=1.04-1.97), had a higher number of posterior teeth with attrition (OR=1.17, CI=1.00-1.37) and were more likely to drool on the pillow (OR=2.05, CI=1.15-3.67) compared to mesofacials. Dolichofacial adolescents were more likely of not presenting pain in the temporal muscle (OR=6.36, CI=2.30-17.54), to present themselves without marks on the tongue (OR=2.26, CI=1.09-4.69) and present a higher mouth's maximum opening (OR=2.09, CI=1.40-3.13) compared to brachyfacials.

CONCLUSION

Bruxism and its clinical features differ among dolichofacial, brachyfacial and mesofacial adolescents.

THE ROLE OF NEW TECHNOLOGIES IN DEFINING SALIVARY PROTEIN COMPOSITION FOLLOWING PLACEMENT OF FIXED ORTHODONTIC APPLIANCES - BREAKTHROUGH IN THE DEVELOPMENT OF NOVEL DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Human saliva is rich in proteins of variable functions (e.g., enzymes, immunoglobulins, cytokines) and origin (blood plasma, salivary glands, or oral microflora). Circadian dynamics, volume and composition (electrolytes, pH, protein, etc.) of secreted saliva vary with local and systemic physiological and pathophysiological conditions. Therefore, the composition of saliva, protein in particular, has been intensively investigated to identify the potential markers and/or mechanisms of systemic and local diseases. Proteomic techniques used for the analysis of biological fluids have enabled great advances in salivary protein stabilization (as the main precondition for their analysis) and detection of those found in saliva in very low concentrations, including small proteins and peptides. This review brings the main characteristics of current proteomic techniques such as liquid chromatography-mass spectrometry, two-dimensional electrophoresis-mass spectrometry, and surface-enhanced laser desorption ionization/time of flight/mass spectrometry. These techniques enable simultaneous identification of hundreds and thousands of protein molecules, as well as identifying those of a potential biological value in particular states. This literature review is focused on the state-of-the-art and possibilities offered by proteomic techniques in analyzing the effects of orthodontic appliances on salivary protein composition and searching for potential markers of therapeutic success/failure or for the molecules by which therapeutic effects are achieved.

Prevalence of Caries and Associated Risk Factors in a Representative Group of Preschool Children from an Urban Area with High Income in Milan Province, Italy

The present survey provides a quantitative assessment of caries prevalence, covering a group of 3–5 year-old children from an urban area generally with a high income in the province of Milan, and a comparison of the obtained results with the data presented by the W.H.O. A cross-sectional study was conducted in the period from March to September 2018 to investigate the prevalence of caries in a sample of 160 children (82 females and 78 males). The absence/presence of caries was defined as a dependent variable. Factors concerning lifestyle, diet, oral habits, oral hygiene, the presence and type of malocclusion and mouth breathing attitude were considered as risk factors. Data were analyzed by Chi-square (χ2) and regression tests using SPSS (version 25.0) software. In total, 84.38% of children (135 out of 160) showed no caries. A regression analysis demonstrated that children who had already received an early first dental visit were mostly those already affected by caries. Furthermore, children who had four meals daily or more were less exposed to the risk of developing caries compared to those who had only 1–3 meals daily. The caries prevalence of preschool children from urban areas with a high income in Milan province is relatively close to that considered acceptable by the W.H.O. in its proposed goals for the year 2020. Therefore, it can be concluded from the obtained results that there is a possibility for further improvement in preventing caries growth at its initial stage: it is necessary for the number of meals daily consumed by children to be controlled by parents, and conducting a dental visit early in childhood must not be neglected.

Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: An observational study

OBJECTIVE

This study aimed to investigate salivary levels of Streptococcus mutans (S. mutans) and Lactobacilli, and other salivary indices in subjects wearing clear aligners (CA) in comparison with multibrackets orthodontic appliances (MB).

MATERIALS AND METHODS

A sample of 80 participants (46 males and 34 females) was included in the study: 40 subjects (aged 20.4±1.7 years) were treated with CA, and 40 (aged 21.3±1.7 years) were treated with MB. Plaque index (PI), salivary flow, buffering power of saliva, and salivary levels of S. mutans and Lactobacilli were evaluated prior to start of orthodontic treatment (t0), after 3 months (t1) and 6 months (t2).

RESULTS

CA patients maintained PI at level 0 over time, while MB participants experienced a statistically significant increasing trend of PI over time. In addition, at t2, 37.5% of MB participants (15 subjects over 40) showed risky salivary levels (CFU/ml>105) of S. mutans (odds ratio = 7.40; 95% C.I. = 1.94-28.25; chi-square = 10.32; p = 0.001) as well as Lactobacilli (odds ratio = 23.40; 95% C.I. = 2.91-188.36; chi-square = 15.31; p = 0.0001).

CONCLUSIONS

Comparing all the data, subjects treated with CA achieved lower salivary microbial colonization after 6 months of treatment compared with MB. Different additional strategies for plaque control and salivary microbial colonization must be triggered considering the type of orthodontic appliance.

Evaluation of Lower Dental Arch Crowding and Dimension after Treatment with Lip Bumper versus Schwarz Appliance. A Prospective Pilot Study

Aim: The treatment of patients with mixed dentition, with inferior moderate dental crowding (the so-called borderline cases, between extraction and expansion) is not yet clear. Two examples of widely used appliances for increasing lower dental arch dimensions are the Schwarz’s appliance and lip bumper. The aim of this prospective study was to compare dental crowding and arch dimensions from pre- to post-treatment with lip bumper versus Schwarz’s appliance. Subjects and Methods: Pre- and post-treatment orthodontic records of twenty subjects (10 males and 10 females) were analyzed in the present study. Inclusion criteria were: first/second molar class malocclusion; crowding of the mandibular arch, from mild to moderate (4–6 mm); mixed dentition; age ≤ 9 years at the beginning of the treatment; stage CS1 or CS2 of maturation of the cervical vertebrae analysis (CVM) at the beginning of the treatment. Ten subjects were treated with a lip bumper, and ten with the removable Schwarz appliance. The primary outcomes were the variations in dental crowding and arch dimensions from pre- to post-treatment. Results: Both the two appliances caused a statistically significant mean improvement/reduction in crowding, of 3.5 mm and 2.9 mm, for the Schwarz appliance and lip bumper, respectively. The Schwarz appliance resulted more effective in increasing arch dimension at the intercanine level, and arch perimeter, while the lip bumper achieves a higher increase in arch length. Conclusions: A lip bumper and Schwarz appliance are both useful in reducing crowding in mixed dentition. This improvement is due to the increase in dental arch dimensions, although the distribution of space resulted slightly differently between the two appliances.

Oral Hygiene in a Sample of Children/Adolescents Living in Family-Homes from the Province of Milan (Italy): A Pilot Study

Objective: This pilot study is a prospective controlled clinical trial, designed to evaluate the short-term clinical results (the plaque index) of an educational/motivational program for home oral hygiene, directed to children and adolescents who live in family-homes. Methods: The setting of the project was the province of Milan (Italy), where two family-homes were selected. The study group included 26 children (16 females and 10 males) aged between 7 and 15 years, of Italian nationality, from the family-home communities. The control group included 26 children (15 females and 11 males, aged between 7 and 15 years) of Italian nationality, matched for age and gender distribution with the study group, that were not in a socially disadvantaged condition. Collection of the plaque index (PI) was performed at t0. Then, all basic oral hygiene instructions were given to all children/adolescents and their educators. Education and motivation were repeated in the same way after 4–7 weeks (T1), and after 10–12 weeks (T2). The PI was taken also at T1 and T2. Results: An improvement in the PI was generally found in both groups, but there was no statistically significant difference between the two groups over time. Multivariate analysis of variance (MANOVA) revealed a statistically significant effect of time [F (1, 52) = 90.73, p < 0.001], regardless of the assignment group, in consequence of which the plaque index presented a moderate and significant improvement. Conclusion: The present data confirm the validity of the educational/motivational program to improve oral hygiene in children/adolescents, regardless of the assignment group.

Salivary concentrations of Streptococcus mutans and Lactobacilli during an orthodontic treatment. An observational study comparing fixed and removable orthodontic appliances

AIM

This study aimed to investigate salivary concentrations of Streptococcus mutans (S. mutans) and some Lactobacilli, and plaque index (PI) in patients wearing fixed versus removable orthodontic appliances.

METHODS

A sample of 90 orthodontic patients (56 males and 34 females) was included in the study: 30 subjects (aged 21.5±1.5 years) were treated with removable clear aligners (CA), while for other 30 cases (aged 23.3±1.6 years) a fixed multibrackets appliance (MB) were utilized, and 30 patients (aged 18.2 ±1.5 years) wearied a removable positioner (RP). Salivary concentrations of S. mutans and Lactobacilli and PI were evaluated prior to start of the orthodontic treatment, after 3 months and 6 months.

RESULTS

After 6 months, 40% of MB patients (12 subjects over 30) showed a concentration of S. mutans associated to high risk of developing tooth decay (CFU/ml>105 ), differently from participants wearing removable appliances (odds ratio = 5.05; 95% C.I. = 1.72-14.78; chi-square = 9.64; p = 0.0019). The same trens was observed for the concentration of Lactobacilli (odds ratio = 4.33; 95% C.I. = 1.53-12.3; chi-square = 8.229; p = 0.004). In addition, over the duration of the study, CA patients maintained PI at 0 level, while MB patients experienced a statistically significant increasing trend of PI over time, and their PI became clinically/statistically relevant after 6 months, respect to CA and RP patients.

CONCLUSIONS

Comparing all the data, while, after 6 months, only about 10% of CA patients and 13.3% of RP patients achieved a microbial colonization which may lead to high risk of caries development, about 40% of MB patients - and 20% after 3 months - showed a high level of vulnerability to developing caries, which require additional strategies for plaque control and microbial colonization to be employed.

Dentoskeletal Class II Malocclusion: Maxillary Molar Distalization with No-Compliance Fixed Orthodontic Equipment

Dentoskeletal class II malocclusion due to a protruded upper dental arch is a major reason for an orthodontic treatment. In these cases, the correction of class II can be hindered by molar distalization, obtained with 'no-compliance therapy' that involves the use of appliances which minimize the need for such co-operation and attempt to maximize the predictability of results. The aim of this review was to outline the effectiveness of no-compliance fixed orthodontic devices in the molar distalization. After selection according to the inclusion/exclusion criteria, 16 articles from 2000 to 2019 were qualified for the final analysis. The literature shows various no-compliance fixed devices whose effect is to distalize the maxillary molars. The present revision allows to conclude that there is a need to increase the number of studies, especially with regard to the most recently introduced devices in the literature. The analysed studies allow to hypothesize that these appliances act with a minimal variability of molar distalization and disto-inclination among them, although different effects among the appliances can be observed as regards to the anchorage.

CAD/CAM Customized Glass Fiber Post and Core With Digital Intraoral Impression: A Case Report

Background

After endodontic treatment, a proper restorative technique is necessary to ensure coronal seal and protection of residual dental structure; teeth which have lost two or more walls need to be restored with posts to increase retention and stability of final restoration. Posts can be distinguished in prefabricated and customized, which are manufactured by lost wax technique or CAD-CAM.

Purpose

Digital dentistry has been developed to increase workflow precision and to accelerate production process; use of CAD-CAM to realize customized posts was limited to scanning plaster models obtained from traditional impressions.

Patients and Methods

In the reported case an intraoral scan was used to mill a post and core restoration on an endodontically treated inferior premolar; this operative protocol was based on previous in vitro experiments that confirmed the ability of 3shape Trios scanner to read post-space up to 9 mm in depth.

Results

The digital technique allows us to convert the concave surface of the root canal into the convex surface of the post, and realize an anatomical post and core that improves the biomechanics of the endodontically treated tooth reducing the possibility of root fractures.

Conclusion

The use of an intraoral digital scanner represents an opportunity for the clinician as it speeds up the production of an anatomical post and core restorations.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/W9qD2b7Eg4o

Allergic rhinitis, rather than asthma, might be associated with dental caries, periodontitis, and other oral diseases in adults

BACKGROUND

The association between asthma (AS), allergic rhinitis (AR) and oral diseases remains inconclusive in adults. AS and AR often coexist. However, studies that investigate AS, AR together and their association with oral diseases are scarce.

METHODS

Data from 22,898 men and 28,541 women, aged 21 to 25 years, were collected from a national database in Taiwan. Five common oral diseases: dental caries, periodontitis, pulpitis, gingivitis, and stomatitis/aphthae were studied. Differences in the incidence of the five oral diseases in AR vs. non-AR, and AS vs. non-AS groups were compared. The incidence of the five oral diseases in men/ women, urban/country citizen, and high/low income groups was studied. The frequencies of clinical visits and impact of topical steroid use between the groups were also studied. The confounding factors included sex, socioeconomic status, urbanization, dentofacial anomalies, disease of salivary flow, diabetes mellitus, and esophageal reflux.

RESULTS

The incidence and the frequencies of clinical visits for all five oral diseases were higher in those with AR than in the non-AR group after adjusting for confounding factors and AS. Similar observation was made for the AS group, without adjusting for AR. However, if AR was included for adjustment, no relationship was found between AS and oral diseases. In the AR group, those with higher incomes, and country residents had a high risk of developing oral disease. Intranasal steroids, rather than inhaled steroids, were also associated with oral diseases.

CONCLUSION

AR, rather than AS, may be associated with oral diseases in young adults.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children

Background

Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition.

Methods

A sample of 198 pre-school children, aged 3–5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children’s parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic.

Results

Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04–0.47, p = 0.0004).

This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42–5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17–4.37).

Conclusions

Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Obstructive sleep apnea severity and dental arches dimensions in children with late primary dentition: An observational study

Objective: The aim of this study was to compare the dimensions of the upper and lower arches in children affected by OSAS with different levels of severity of obstruction.Methods: Twenty-seven Caucasian children (14 males, 13 females; mean age 6, range 5.2-6.1 years) with a diagnosis of OSAS determined by polysomnography were enrolled in this study. The dimensions of both dental arches were measured, and the data were compared among children affected by severe, moderate, and mild OSAS.Results: Statistically significant differences among the three groups revealed that children with severe OSAS had the highest values of upper intercanine and intermolar distances in the sample.Discussion: A severe OSAS grade (AHI > 10) is associated with statistically significantly higher upper intercanine and intermolar distances compared with mild and moderate grades. An early approach to OSAS in children with late primary dentition is auspicated in order to prevent an influence on dental arches growth.

Microbial species associated with dental caries found in saliva and in situ after use of self-ligating and conventional brackets

Objectives

Enamel demineralization is among the main topics of interest in the orthodontic field. Self-ligating brackets have been regarded as advantageous in this aspect. The aim of this study was to evaluate the break homeostasis in the oral environment and the levels of microorganisms associated with dental caries among the different types of brackets.

Material and Methods

Twenty patients received two self-ligating brackets: In-Ovation^®R, SmartClip^TM, and one conventional Gemini^TM. Saliva was collected before bonding (S0), 30 (S1) and 60 (S2) days after bonding. One sample of each bracket was removed at 30 and 60 days for the in situ analysis. Checkerboard DNA-DNA Hybridization was employed to evaluate the levels of microbial species as-sociated with dental caries. Data were evaluated by nonparametric Friedman and Wilcoxon tests at 5% significance level.

Results

The salivary levels of L. casei (p=0.033), S. sobrinus (p=0.011), and S. sanguinis (p=0.004) increased in S1. The in situ analyses showed alteration in S. mutans (p=0.047), whose highest levels were observed to the In-Ovation^®R.

Conclusions

The orthodontic appliances break the salivary homeostasis of microorganisms involved in dental caries. The contamination pattern was different between self-ligating and conventional brackets. The In-Ovation^®R presented worse performance considering the levels of cariogenic bacterial species.