Relationship between external and internal structures in deciduous teeth: a multidisciplinary study

AIM

The different dental structures of deciduous teeth have always been regarded with great interest in endodontics and restorative dentistry. Nevertheless, there are still few investigations on the morphology of deciduous teeth compared to the permanent ones, due to the difficulty in obtaining sound deciduous teeth suitable for measurement. The aim of this research is to evaluate and compare the internal and external structures of deciduous teeth from completely preserved hominid findings, using X-ray and micro-CT examination.

METHODS

Samples were photographed using a digital camera and were then analysed by X-ray and micro-CT. Different parameters of external and internal structures were calculated to obtain a normalisation coefficient, called the P-factor.

CONCLUSION

There is a constant correlation between external and internal structure, regardless of gender, type, shape or arch sector.

Nitrous oxide and hypnotherapy in paediatric dentistry

AIM

Patient compliance is of paramount importance for proper dental treatment, which can be difficult to achieve in children due to anxiety and fear, hindering the therapeutic procedure. In addition to well-known sedation methods (pharmacological and nitrous oxide), further methods of approach are being tested, such as hypnotherapy.

MATERIALS

The sample consisted of 150 children (90 males, 60 females). Paper questionnaires, frequency meter, nitrous oxide dispenser in association with the use of the television were exploited. At the end of treatment, subjective pain was assessed using the VAS scale, while objective pain was assessed using the FLACC scale and heart rate. This made it possible to compare two experimental groups, one treated with nitrous oxide, and the other with hypnotherapy. The control group was treated with classic behavioural approach techniques. The results obtained were analysed by SPSS Software (Statistical Package for Social Science, version 27) and the inferences between the results were calculated for confirmation.

CONCLUSION

Hypnotherapy can be a valid substitute for nitrous oxide in paediatric dentistry.

Effects of anti-epileptic drugs on the oral health of paediatric patients

AIM

To evaluate the effects of epilepsy therapy on the oral health in paediatrics patients.

MATERIALS

The test has involved 57 patients. The patients were stratified in three groups: monotherapy group, politherapy group and control group. They were examined and after that the test groups were compared with the control group.

CONCLUSION

Paediatric epileptic patients seem to have a greater risk of having a worse oral health status compared with healthy patients. However, if the patient is well monitored and undergoes regular dental checks, the oral condition is comparable to a healthy subject.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient

AIM

Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients.

METHODS

Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety.

CONCLUSION

Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

Duodenal Follicular Lymphoma: Track or Treat?

Duodenal follicular lymphoma (DFL) is a rare variety of non-Hodgkin's lymphoma of the gastrointestinal tract that usually carries a favorable course, recognized as a new entity in 2016. It is usually diagnosed at an early stage located predominantly in the second portion of the duodenum. We report the case of a 74-year-old male patient with epigastric pain in whom gastroscopy revealed white mucosal nodules that were pathologically diagnosed as grade 1-2 DFL. Staging investigations revealed secondary lesions in the spleen and at the base of the tongue together with latero-cervical adenopathy. The tumor was stage IV according to the Lugano staging system. We reviewed the recent (last five years) literature defining the importance of combination therapy in the advanced stage. The patient achieved complete remission of the disease through chemoimmunotherapy following the Rituximab-Bendamustine scheme.

Prosthetic rehabilitation of maxillary lateral incisors agenesis using dental mini-implants: a multicenter 10-year follow-up

Objectives

Implants are used to replace congenitally missing lateral incisors but often the space across the alveolar crest is too narrow to permit their use. This multicenter study (Dental Clinic of the University of Foggia, Odontostomatology Clinic of the University of L’Aquila) evaluated the efficacy of mini-implants in cases of maxillary lateral incisor agenesis with severe osseous atrophy in 10-year follow-up.

Materials and methods

Forty-seven mini-implants have been inserted in 35 patients affected by lateral incisors agenesis (23 single and 12 bilateral ageneses). All patients underwent orthodontic opening of the space of the upper lateral incisors. After the insertion of the implants, the immediate, non-functional loading, positioning of crowns, presence of pain during percussion and mini-implant function, horizontal and vertical movement when a force of 5 N was applied, ridge loss, and plaque index have been evaluated 1 month after loading, 1 year after loading, and then every 5 years in the following 10 years. Little’s test was used to evaluate the assumption that data of loss to follow-up implants are missing completely at random (MCAR) and that a complete-case scenario could be adopted. Wilcoxon test was carried out to look statistically significant differences between the various parameters resulting in the complete-case scenario and those assumed for the worst scenario. The software R (v. 3.6.1, 2019) was employed to perform the statistical analysis.

Results

The results obtained over 10 years range from 89% of success rate in a worst-case scenario to the 100% using a complete-case analysis with satisfactory values of marginal bone resorption and good conditions of the peri-implant tissue. Ten-year follow-up using complete-case analysis shows survival rates of 100% for implants with no signs of peri-implantitis, stability of the marginal bone levels and soft tissue around the dental implants.

Conclusions

The data collected show very good implant stability, absence of progressive peri-implantitis, and satisfactory aesthetical results in time (no signs of infraocclusion).

Clinical relevance

Mini-implants can be considered a valid and stable over time solution in the restorative treatment of maxillary lateral incisors agenesis.

The use of customized mouthguards during the training produced protective effects on salivary factors of young athletes

AIM

Custom-made mouthguards have many advantages compared to the stock and ready-made types, but sport treatments with custom made mouthguards involve changes in ecological factors of the oral cavity. In the present study we investigated the potential protective role of salivary factors, such as pH value, volume, prostaglandin E2 (PGE2) and 8-iso-prostaglandin F2? (8-iso-PGF2?) levels during training with customised mouthguards.

MATERIALS AND METHODS

A total of 80 subjects were selected: 40 athletes, of whom 20 practice volleyball and 20 basketball (test group), and 40 subjects who attend a gym at a non-competitive level (control group). The athletes (test group) were analyzed at baseline (T0), pre-training (T1), post-training with custom-made Ethylene-Vinyl-Acetate (EVA) mouthguards (T2), post-training without mouthguards (T3). The control group was analyzed only at baseline (T0). On each player, in the 4 time points, and on the control group at T0, we stimulated saliva for determining PGE2 and 8-iso-PGF2? levels by radioimmunoassay and pH value by a pH meter and volume/ml. Saliva pH was calculated with a pH meter.

RESULTS

We observed an inhibition of 8-iso-PGF2? salivary release induced by physical exercise and by use of custom-made mouthguard, while we found an increase in PGE2 salivary level in athletes after training and wearing the mouthguard. Furthermore, in the test of the volume of saliva produced in 5 minutes, a significant inhibition of saliva production emerged in the athletes who did not use the mouthguard during sports activities.

CONCLUSION

Sports activity could lead to a reduction in oxidative stress and the use of mouth guards seems even more effective for athletes.

Short lingual frenulum: From diagnosis to laser and speech-language therapy

AIM

To evaluate the effects of tongue frenulectomy performed with two therapeutic approaches: Laser frenulectomy and combined laser and speech-language therapy.

MATERIALS AND METHODS

The study involved 180 patients (90 males and 90 females) aged between 6 and 12 years. After examination and data collection, the patients were stratified according to three degrees of severity: mild, moderate and severe. After treatment, the test group (laser frenulectomy and combined laser and speech-language therapy) was compared with the control group (laser frenulectomy) in the pre-surgical phase, at one week, 1 month, 3 months, 6 months and 12 months after surgery.

RESULTS

Statistical analysis showed statistically significant differences between the pre-surgical and post-surgical values at 3 months, 6 months and 12 months after surgery (p<0,05).

CONCLUSIONS

It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech-language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.

Ponticulus posticus: clinical and CBCT analysis in a young Italian population

AIM

To evaluate the prevalence, the morphological characteristics and any related symptoms of Ponticulus Posticus (PP) in young Italian patients by means of cone-beam computed tomography.

MATERIALS ABD METHODS

A retrospective study was conducted on images derived from cone-beam CT scans of an Italian population in developmental age (mean age 12.61 ± 2.69); medical history was also evaluated from medical records. The total prevalence and morphology of PP, the prevalence by gender and according to age groups were calculated. For the statistical analysis the ?² test was used.

RESULTS

Total prevalence of PP was 28.24%, the prevalence by gender was 35.27% for males and 21.42% for females, with statistically significant differences. PP was bilateral in 74.33%, and monolateral in 25.67%. As regards symptoms, the cases with headache were 32.43%, tinnitus 6.08%, migraine 3.38%. Dividing by age, patients aged ? 11 years showed headache in 25% of cases, patients aged between 12 and 14 years in 54.17% of cases and patient aged between 15 and 17 years in 20.83%.

CONCLUSIONS

PP is not a rare anomaly in Italian young patients and should always be sought in the lateral cephalograms and CBCT, in patients whether or not symptomatic, irrespective of their age, for differential diagnosis and management of cranio-cervicofacial pain in developmental patients.

Mediterranean diet and physical activity improve posture, fat mass and salivary pH

Many researchers have revealed that diet and physical activity influence metabolic function and posture in various stages of life. This paper aims to combine them and demonstrate how they could promote a healthy lifestyle. For this purpose, 14 healthy subjects followed a three-month protocol combining physical activity with dietary advice. At the end of the protocol, the results of the study underlined a significant reduction in fat mass, an improvement in salivary pH, and a realignment and rebalancing of body segments. .

The use of casein in sport mouthguards: microbiological and ecological variations in oral cavity

Sport mouthguards have the potential to become a microbial reservoir, produce oral and systemic diseases and cause negative changes in the oral cavity. The aim of this study was to monitor oral environmental changes caused by casein and sport-mouthguard in vivo, through clinical, salivary and bacterial markers of young athletes. Forty-eight active young athletes in different disciplines were selected and analysed at different times: baseline (T0); after three months of casein application on the mouthguard (T1); and after six months of application (T2). The product used was GC Tooth Mousse®. At T0, clinical monitoring was performed and the following parameters were recorded: Decay-Missing-Filled Teeth (DMFT) index, Plaque index (PL+) and Gingival Bleeding (BOP+). Saliva-Check Buffer GC® and Saliva-CheckMutans GC® salivary tests were then performed. At T0 the athletes demonstrated DMFT 0.03±0.01. PL value was positive in 100% of subjects at T0, T1, and T2. The BI value was always negative. At the three time-points, a significant change in baseline hydration values was observed; baseline viscosity was normal in 50% of cases while it increased in the remaining 50% at T0; it was normal and constant at T1 and T2. The value of the baseline pH underwent an not statistically significant increase at T1 (7.6±0.08) while remaining constant at T2. The amount of saliva produced after 5-min stimulation ranged significantly and gradually from T0 to T1 and T2, with a statistically significant difference. Plaque indicator tests highlighted that at T0 a plaque with a pH of 6.0±0.5 prevailed; at T1 it was 6.25±0.75 while at T2, pH was equal to 6. Tests for the detection of S. mutans resulted constant in all subjects at the various observation times, resulting in 67% of patients in whom S. mutans was present. The application of casein, within custom-made ethylene- vinyl acetate (EVA) mouthguards, positively influences salivary flow, the increase of pH values, the amount of stimulated saliva and the buffering capacity of the athlete, improving their state of oral health, which is negatively affected by the use of common mouthguards.

The use of chlorhexidine in mouthguards

Sports mouthguards have the potential to become a microbial reservoir, to produce oral and systemic diseases and cause changes in environmental oral factors, inhibiting the protective effect of saliva. The aim of this study was to monitor, in vivo, oral environmental changes caused by chlorhexidine and sports mouthguards and in vitro, the effects of microbial strains, saliva and chlorhexidine on Ethylene-Vinyl-Acetate (EVA) material. Seventy-two athletes were analyzed at different time points: before training session (T0), post-training (TA), post-training with mouthguard (TB), post-training with mouthguard and chlorhexidine (TC). At each time of observation, saliva was collected and subjected to microbiological analysis. In vitro, EVA disks were incubated with bacterial cultures, saliva and clorexidine. Culture of supernatant solution, SEM and bacterial counts of EVA disks were performed. S. mutans and Candida spp. load decreased significantly in TC. The pH value significantly decreased in TB and improved in TC. In vitro, the analyzed bacteria were organized to form a biofilm on the EVA disk surface. The addition of chlorhexidine to the bacterial culture and saliva inhibited the growth in all tested conditions. In vivo, the use of chlorhexidine associated with the sports mouthguard inhibited the growth of pathogenic microbial species, and improved pH values. In vitro, EVA stimulated biofilm formation on its surface, but this action was contrasted by chlorhexidine. The effects found in vitro encouraged the use of chlorhexidine in vivo as a valuable tool in the use of mouthguards.

Black Stains: a microbiological analysis and a view on familiarity and susceptibility to tooth decay of patients in childhood

AIM

Assess prevalence, familial predisposition and susceptibility to caries of Black Stains (BS). Evaluate the microbiological composition of BS, saliva and subgingival plaque.

MATERIALS AND METHODS

Sixty nine subjects with BS (test group) and 120 subjects without BS (control group) were analysed for oral status. For each BS-patient, a BS-deposit, 1 ml of saliva and subgingival plaque were collected and microbiologically analysed. Five deciduous teeth with BS were observed under SEM.

RESULTS

This study showed a BS prevalence similar to that of the Mediterranean area and a familiality. The microbiological origin of BS was confirmed by SEM and culture method and the BS flora differ from that of supragingival plaque.

CONCLUSIONS

Predominance in BS and saliva of Actinomycetes and the low salivary prevalence of S. mutans and L. acidophilus may be related with low caries incidence in BS patients. The high presence of Actinomyces spp can be a causative factor for BS.

Microbiological Aspects and Inflammatory Response of Pulp Tissue in Traumatic Dental Lesions

Traumatic dental lesions are more frequently found in the pediatric population, with a major involvement, in 80% of the cases, of the superior central incisors. The exposure of the dental pulp leads to major morphological changes in dental tissue, such as discolouring, acute pulp inflammation, chronic inflammation and necrosis. This article reviews the various studies published on the different types of inflammatory response of the pulp tissue following traumatic events, from the microbiological and histological point of view of various techniques.

Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW): a non-randomized controlled trial

BACKGROUND

Many factors influence the return to work of workers with chronic low back pain (CLBP). They have been said to vary according to socio-professional group. This study first aimed to compare prognostic factors influencing the return to work of CLBP healthcare workers (HCWs) and other workers (non-HCWs) after rehabilitation coupled with an occupational intervention. The second objective was to improve the evolution of indicators such as clinical examination, psychosocial impact and pain impact.

METHODS

Between 2007 and 2012, a cohort of 217 CLBP workers (54.8 %-women; mean age = 41.3 ± 9.5 years, 118 non-HCWs; 99 HCWs mainly from the public sector) was included in an ambulatory rehabilitation program (standard physiotherapy or intensive network physiotherapy) coupled with an occupational intervention. Workers completed a questionnaire and had a clinical examination at baseline and after 24 months' follow up. Physical, social and occupational data was collected at the same time. Statistical analyses were performed to evaluate prognostic factors for return to work and compare the two worker populations.

RESULTS

There was no difference between groups for the rate of OP (occupational physician) intervention or type of physiotherapy. 77.3 % of workers returned to work after 2 years following inclusion. To be an HCW (OR 0.1; 95 % CI [0.03-0.34]), to have less than 112 sick- leave days (OR 1.00; 95 % CI [0.93-1.00]), a small fingertip-floor distance (OR 0.96; 95 % CI [0.93-0.99]), a low anxiety/depression score (OR 0.97; 95 % CI [0.95-1.00]), a low impact of CLBP on daily life (OR 0.96; 95 % CI [0.93-1.00]), and on quality of life (OR 0.98; 95 % CI [0.95-1.00]) at baseline were statistically associated with return to work after 2 years of follow up. Only the profession (workplace) was statistically associated with return to work after 2 years of follow up using multivariate analysis.

CONCLUSION

To our knowledge, this is the first cohort study concerning predictive factors of RTW among CLBP workers after 2 years of follow up. Interventions in the work environment did not seem to predict job retention significantly. But only 50 % of the employees in both groups (HCW and non-HCW) had one intervention at their workplace after 2 years. This study underlined the fact that the type of physiotherapy with a well-trained physiotherapist used to take care of CLBP could not impact on the RTW forecast. To develop these initial results, it might be interesting to study the comparison between private and public sectors and to randomize the physiotherapeutic intervention.

Hyaluronic acid-based medical device and oral disorders: can it be used in paediatric dentistry?

Due to its physical and biological characteristics and safety profile, hyaluronic acid is very widely used in numerous clinical conditions, ranging from its best-known use in cosmetic surgery (as a filler and for its ability to promote tissue regeneration and therefore minimise scarring) to lesser-known fields such as ophthalmic surgery, major abdominal surgery (where it is used to prevent the complication of adhesion bands) and intra-articular use. Studies were recently published in which this type of device was also used in paediatric patients for the management of inflammatory disorders of the oral cavity and teething symptoms. As this is a highly topical field for dentists, we felt it would be useful to review the efficacy and safety of the device in the paediatric population treated, and analyse any discrepancies with the results obtained in the adult population. The preparations of hyaluronic acid used in pediatric dentistry, thanks to their anti-inflammatory and angiogenic properties, proved to be very effective in therapy of oral diseases in children. Further clinical research is needed to confirm the effectiveness of these products to dispel doubts about any side effects.

Comparison of salivary antioxidant enzyme activity between ex-smokers and subjects who had never smoked

Smoke contains oxidants such as oxygen-free radicals which are probably the major cause of damage to biomolecules. A decrease of salivary antioxidant enzymes was detected in habitual smokers. However, the effects of cigarette smoke on salivary antioxidant enzymes may persist after withdrawal from smoking. The objective of this study was to assess salivary superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity in ex-smokers in comparison with that of subjects who had never smoked. The test group included 25 ex-smokers (13 males and 12 females; mean age: 48 ± 8 years) who had given up smoking for at least one year but for no more than 2 years, and a control group consisting of 25 subjects (14 males and 11 females; mean age: 50 ± 12 years) who had never smoked. Salivary samples were collected and SOD and GSH-Px activity was measured. Student’s t-test was used to evaluate differences between groups and significant differences were observed for p < 0.05. A significant decrease (p < 0.05) of GSH-Px (14.5 ± 2) was observed in the test group compared to the control group (30 ± 4). However, SOD was very similar in the two groups: 0.9 ± 0.3 in the test group and 0.8 ± 0.3 in the controls and no significant difference was detected (p> 0.05). Detoxification of hydrogen peroxide by the GSHPx was altered even after withdrawal from smoking, while the production of hydrogen peroxide, that is mediated by SOD, was not modified.

Third Class Resolver: a retrospective analysis

AIM

To evaluate the use of Third Class Resolver (TCR), a new fixed and functional orthopaedic appliance for the treatment of skeletal Class III malocclusion in adolescents and young adults.

MATERIALS AND METHODS

Study design: Retrospective analysis. Twenty subjects, 10 females and 10 males, affected by Class III malocclusion were treated with a new fixed orthopaedic appliance: the Third Class Resolver (TCR). The mean age was 7 years at the beginning of treatment and 9 years at the end of treatment. The mean treatment time was 6 months. Digital cephalometric superimpositions on lateral radiographs taken at the start and end of treatment were assessed. The cephalometric values were statistically analysed.

RESULTS

Cephalometric analysis of changes during treatment shows a statistically significant increase of ANB angle (mean 1°) (P = 0.045); increase of Witts Index (mean 3.5 mm) (P = 0.003); decrease of Maxillo-Mandibular angle (MM) (mean -2.3°) (P = 0.047); increase of Upper incisor-Maxilla Plane angle (angle mean 10.5°) (P = 0.02); increase of the distance between Upper Incisor and A-Pg line (mean 2.4 mm) (P = 0.021); increase of the mandibular branch length (mean 4.8 mm) (P = 0.004).

CONCLUSION

TCR can be used fully for treatment of Class III malocclusions.

Second Class Resolver: a retrospective analysis

AIM

To evaluate the use of Second Class Resolver (SCR), a new fixed orthopaedic appliance, for the treatment of skeletal Class II malocclusion in growing subjects.

MATERIALS AND METHODS

Design Retrospective analysis. Forty subjects were treated with Second Class Resolver (SCR). The mean age was 8 years at the beginning of treatment and 10 years at the end of treatment. Digital cephalometric superimpositions on lateral radiographs taken at start and end of treatment were assessed. The cephalometric values were statistically analysed.

RESULTS

Cephalometric analysis of changes during treatment shows reduction of ANB angle (mean 2°); reduction of Witts Index (mean 3 mm); reduction of Maxillo-Mandibular angle (MM) (mean 1°); reduction of SNA (angle mean 3°); reduction of gonial angle (mean 1.8°); increase of the mandibular branch length (mean 5 mm); increase of mandibular body (mean 2.9°).

CONCLUSION

The Second Class Resolver can be beneficially used for the treatment of Class II malocclusion.

Vascular endothelial growth factor (VEGF), mast cells and inflammation

Vascular endothelial growth factor (VEGF) is one of the most important inducers of angiogenesis, therefore blocking angiogenesis has led to great promise in the treatment of various cancers and inflammatory diseases. VEGF, expressed in response to soluble mediators such as cytokines and growth factors, is important in the physiological development of blood vessels as well as development of vessels in tumors. In cancer patients VEGF levels are increased, and the expression of VEGF is associated with poor prognosis in diseases. VEGF is a mediator of angiogenesis and inflammation which are closely integrated processes in a number of physiological and pathological conditions including obesity, psoriasis, autoimmune diseases and tumor. Mast cells can be activated by anti-IgE to release potent mediators of inflammation and can also respond to bacterial or viral antigens, cytokines, growth factors and hormones, leading to differential release of distinct mediators without degranulation. Substance P strongly induces VEGF in mast cells, and IL-33 contributes to the stimulation and release of VEGF in human mast cells in a dose-dependent manner and acts synergistically in combination with Substance P. Here we report a strong link between VEGF and mast cells and we depict their role in inflammation and immunity.

Role of vitamins D, E and C in immunity and inflammation

Inflammatory responses are operationally characterized by pain, redness, heat and swelling at the site of infection and trauma. Mast cells reside near small blood vessels and, when activated, release potent mediators involved in allergy and inflammation. Vitamin D modulates contraction, inflammation and remodeling tissue. Vitamin D deficiency has been linked to multiple diseases and several data have demonstrated a strong relationship between serum vitamin D levels and tissue function. Therapy targeting vitamin D3 signaling may provide new approaches for infectious and inflammatory skin diseases by affecting both innate and adaptive immune functions. Mast cells are activated by oxidized lipoproteins, resulting in increased expression of inflammatory cytokines and suggesting that the reduction of oxidation of low density lipoprotein by vitamin E may also reduce mast cell activation. Vitamin C is also an anti-oxidant well-known as an anti-scurvy agent in humans. Vitamin C inhibits peroxidation of membrane phospholipids and acts as a scavenger of free radicals and is also required for the synthesis of several hormones and neurotransmitters. In humans, vitamin C reduces the duration of common cold symptoms, even if its effect is not clear. Supplementation of vitamin C improves the function of the human immune system, such as antimicrobial and natural killer cell activities, lymphocyte proliferation, chemotaxis and delayed-type hypersensitivity. Vitamin C depletion has been correlated with histaminemia which has been shown to damage endothelial-dependent vasodilation. However, the impact of these vitamins on allergy and inflammation is still not well understood.

The effect of swimming on oral ecological factors

The aim of this study was to evaluate the oral health status in young swimmers, involving an assessment of salivary cariogenic bacteria, of S-IgA concentration, before and after training sessions. One hundred and eighteen swimmers and 48 sedentary individuals were selected. Before training sessions (T1), a clinical monitoring was performed and the following parameters were recorded: DMFT, Plaque Index (PlI), Gingival Index (GI). At T1 and after training sessions (T2), stimulated saliva was collected and subjected to microbiological and immunological analysis. The athletes trained 2 h x 5 days/week and showed a good state of oral health related to a low prevalence of parafunctional behavior, decay presence, lower GI values, compared to controls. The swimmers total bacterial count and the load of S. mutans, S. sanguis, L. fermentum and A. gerencseriae underwent a statistically significant increase at T2. S. mutans, S. mitis and L. acidophilus mean values were significantly higher in swimmers than in controls. Swimmers’ S-IgA average value decreased significantly at T2. Therefore, the single physical exertion is a period characterized by the most intensive intraoral growth of cariogenic bacteria and a time of less intensive salivary functions and physiologic response as a decrease in the level of S-IgA.

Impact of Immunity in Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are childhood psychopathologies characterized by having difficulties in social interaction, verbal and non-verbal communication as well as sensor motor movements. Evidence suggests that in ASDs environmental toxicant exposure, genetic and mitochondrial dysfunction are involved associated with abnormal immune response with allergic problems and elevated serum IgE. ASDs present the major cytokine and chemokine dysfunction in CNS and is mediated by an increase of pro-inflammatory cytokine levels in the brain, such as TNF, IL-1, IFN-γ, IL-6, IL-8 and others. Mast cells, which are also implicated in ASDs, are worsened by stress and produce proinflammatory cytokines and can be stimulated by neurotensin in the brain and gut, contributing also to the inflammatory response. However, the exact etiology of ASDs remains largely unknown.

Impact and Neuropeptide Substance Pan Inflammatory Compound on Arachidonic Acid Compound Generation

There is much evidence that neuropeptide substance P is involved in neurogenic inflammation and is an important neurotransmitter and neurmodulator compound. In addition, substance P plays an important role in inflammation and immunity. Macrophages can be activated by substance P which provokes the release of inflammatory compounds such as interleukins, chemokines and growth factors. Substance P is involved in the mechanism of pain through the trigeminal nerve which runs through the head, temporal and sinus cavity. Substance P also activates mast cells to release inflammatory mediators such as arachindonic acid compound, cytokines/chemokines and histamine. The release of these chemical mediators is crucial for inflammatory response. Among these mediators there are prostoglandins and leukotrines. Here we review the impact of substance P on inflammatory compounds.

Management of compound odontoma in a 10-year-old girl preserving the associated impacted permanent tooth

AIM

Compound odontoma has been reported to be the most common of all odontogenic neoplasms and tumor- like lesions. Only rarely the treatment of this lesion in association with an impacted tooth has been reported.

CASE REPORT

A compound odontoma in a 10-year-old girl, associated with an impacted permanent incisor is described, focusing on the diagnosis and the importance of early treatment of this lesion. The patient underwent surgical excision of the lesion and it was decided to wait for the spontaneous eruption of the impacted tooth. After 6 months no eruption was observed and thus the orthodontic treatment was deemed necessary. At the one-year follow-up, the tooth was brought into the maxillary arch.

Impact of IL-33 on PGD2 Generation by Activated Human Cord Blood-Derived Mast Cell: Lack of Effect on Tryptase Release

Mast cells are important not only in allergic reactions, but also in inflammation and are involved in a variety of responses including the immediate release of potent inflammatory mediators after activation by cross-linking of FcεRI molecules. Prostaglandin D2 (PGD2) is a major cyclooxygenase metabolite of arachidonic acid produced by mast cells and it is released following allergen challenge in allergic diseases. IL-33 is an iflammatory cytokine which is critically involved in the regulation of in vitro and in vivo cyclooxygenase production, providing a potential therapeutic target for inflammatory disorders. In this study, using human derived umbelical cord blood mast cells, we show that IL-33 (50 ng/ml), and calcium ionophore A 23187 (0.5 μg/ml), compound 48/80 (10−5 M) or anti-IgE (10 μg/ml), enhaced the production of PGD2 and this effect was inhibited by indomethacin. However, IL-33 was unable to induce tryptase release in these cells. These effects confirm the inflammatory property of IL-33 by stimulating PGD2 but not tryptase in human mast cells. The inhibitory effect of this new cytokine may have a potential therapeutic response in allergic and inflammatory diseases.

Endothelial cells, cholesterol, cytokines, and aging

It has been reported that high levels of cholesterol and triglycerides are associated with increased risk of developing atherosclerosis and shorter life. In fact, vascular endothelial dysfunction occurs during the human aging process. Accumulation of lipids in vascular endothelium activates leukocytes to produce cytokines and chemokines which recruit macrophages. On the other hand, macrophages augment inflammatory response and secrete vascular endothelial growth factor, a key cytokine that mediates angiogenesis and inflammatory response. In addition, hyperlipidaemia is one of the main risk factors for aging, hypertension and diabetes. Here, we review the interrelationship between endothelial cells, high level of cholesterol, and aging.

Dental and periodontal complications of labial and tongue piercing

Piercing is the practice of puncturing some parts of the body to apply ornamental objects. The presence of oral and perioral piercings are a risk factor for many acute and chronic complications, such as chipping of the dental enamel, periodontal lesions and infection. The aim of this study is to assess the prevalence of lip and tongue piercing complications in the dental and periodontal tissues in a sample of young adults. Twenty-five adult patients were examined (test group: 11 males and 14 females with an average age of 23.4+/-3.6 years) who had had a minimum of one labial or tongue piercing for at least 1 year and were compared with 25 subjects (control group: 11 males - 44 percent, and 14 females - 56 percent) without any lingual or labial piercing. A questionnaire was compiled for each patient and a clinical examination was performed. The following parameters were examined by the same operator: abnormal toothwear, tooth chipping or cracking, clinical attachment loss (CAL), probing pocket depth (PD) and gingival recession (GR, classified by using Miller s classification). The data were analyzed using X2 or Fisher s exact test for small numbers and non-parametric Mann-Whitney or Kruskal-Wallis tests to examine for differences in continuity; the level of significance was p less than 0.05. According to the results found in the present study the prevalence of abnormal tooth wear and tooth chipping was higher in the subjects with labial or lingual piercing. Moreover, patients with tongue or labial piercing exhibited a higher GR in comparison to control subjects without any oral piercing. No differences were observed between the two groups as regards CAL and PD. A significant association between the duration of piercing and dental defects was found in the group of patients with piercings with greater prevalence of tooth and periodontal defects in the group of 13 subjects who had had the piercings for a period less than or equal to 4 years.

Interleukin-9 and mast cells

Mast cells are granulated hematopoietic cells derived from stem cells that reside in nearly all tissues and are involved in protection of a host from bacterial infection with a protective and pathogenic activity. Mast cells are important for both innate and adaptive immunity in tissues which are in close contact with the environment. These cells express proinflammatory cytokines such as IL-1, IL-6, IL-8 and tumor necrosis factor which are necessary for innate immunity. Mast cells also produce interleukin-9 and enhance mast cell expression of several cytokines including IL-1beta, IL-5, IL-6, IL-9 and IL-13. In addition, IL-9 can induce mast cell production of TGF-beta which can have proinflammatory downstream effects. IL-9 can function as either a positive or a negative regulator of immune responses and can have a detrimental role in allergy and autoimmunity. Furthermore, IL-9 contributes to disease by promoting mast cell expansion and production of IL-13 which in turn contributes to airway hyperresponsiveness. Here, in this editorial we review the interrelationship between IL-9 and mast cells.

Enterococcus faecalis leakage of root canal sealers: an ex vivo study

The aim of this ex vivo study was to evaluate bacterial penetration after filling root canals using 3 different techniques. Three experimental groups of 25 teeth each, obturated with lateral-warm-vertical condensation of gutta-percha, Microseal technique and EndoREZ system, respectively, were tested in a split chamber model system using Enterococcus faecalis and monitored for 180 days to determine bacterial penetration. A statistical analysis was performed using the Kaplan-Meier method. Median survival time was 25 days for Microseal system, 41 for lateral-warm-vertical condensation and 81 for EndoREZ®. Significant differences were demonstrated between Microseal and EndoREZ (p less than 0.001) and between Microseal and lateral-warm-vertical condensation technique (p less than 0.05). No statistically significant differences were observed between EndoREZ and lateral-warm-vertical condensation. After 180 days of assessment, 20 percent of the EndoREZ samples resisted bacterial penetration and furthermore, the EndoREZ system has the potential to be a filler system compatible with other currently used systems.

Nutrition and Cancer Prevention

Cancer cells invade surrounding tissues and metastasize to distant sites. Diet high in fat is a strong link to, and perhaps causes, a high incidence of tumours. Trans-fatty acid might impair the function and it could be involved in the development of cancer. Cholesterol is also strongly suspected to be involved in the development of tumours, therefore it is important for everyone to eat well, especially for people with cancer to prevent the body tissues from breaking down and helping to rebuild the normal tissue that may have been affected by the treatments. Factors secreted by adipocytes and macrophages such as TNF-alpha and other inflammatory proteins are involved in inflammation in cancer. In addition, MCSF which up-regulates adipocyte tissue is also important for the stimulation of fat cell proliferation and is expressed by human adipocytes. Many cytokines, such as IL-1, IL-6, IL-8, IL-32, IL-33 and MCP-1, are biomarkers for cancer and chronic diseases along with transcription factors NFkB and AP-1; these last two factors are important bioactive substances on the molecular mechanism of the control of genes which in turn affect cellular metabolism. In this paper we revisit the interrelationship between cancer and metabolism.

Role of mast cells in innate and adaptive immunity

Mast cells play a central role in inflammatory and immediate allergic reactions and are necessary for allergic reactions. Mast cells play a role in the pathophysiology of autoimmune diseases and appear to be especially important in inflamed tissues, because they infiltrate tissues and produce a variety of cytokines. Mast cells are important for both innate and adaptive immunity in tissues that are in close contact with the environment, i.e. the skin, the airways and the lung, and the lining of the intestine. However, there are still many unsolved issues of mast cell functions, including their regulatory mechanism on cell differentiation in bone marrow; for example, the cytokines and transcription factors necessary for their differentiation and expansion, as well as the molecular mechanism underlying basophil migration from the bloodstream to peripheral tissues such as lymph nodes still need to be clarified.

Calcium Ionophore A23187 and Compound 48/80 Induce PGD2 and Tryptase in Human Cord Blood-Derived Mast Cells: Lack of Effect of IL-18

Immunological and biochemical reactions associated with inflammation are elicited in response to a physical or immunological challenge. Early in inflammation there is mobilization and infiltration of neutrophils, mast cells and macrophages to the site of inflammation. These cells release pro-inflammatory compounds icluding cytokines, vasoactive peptides (eg., histamine), and eicosanoids. The release of prostaglandin D2 (PGD2) and tryptase induced by anti-IgE, A23187 and compound 48/80 were studied using in vitro a good and valid model of human cord blood-derived mast cells (HCBDMC). Tryptase is a mast cell product and enhances vasopermeability with anticoagulant activities. In this study we measure the release of PGD2 and tryptase on mast cells activate by anti-IgE, calcium ionophore A23187, polybasic compound 48/80 (an agent containing a cationic region adjacent to a hydrophobic moiety, which works by activating G proteins) and IL-18. The generation of PGD2 was measured by radioimmunoassay. Release of PGD2 was detectable (after 12 h) following challenge with anti-IgE, A23187 and compound 48/80. Our data show that mature HCBDMC produce proinflammatory PGD2 following triggering with anti-IgE and with IgE-independent agonists, such as calcium ionophore A23187 and polybasic compound 48/80, while IL-18 was unable to stimulate the release of PGD2 or tryptase on HCBDMC. Although a great deal has been learned about the mediators produced by mast cells, the ultimate biologic function(s) of mast cells remains a mystery.

IL-36 a new member of the IL-1 family cytokines

Interleukin-36 (IL-36) is a pro-inflammatory cytokine which plays an important role in innate and adaptive immunity. IL-36 activates MAPK and NF-kB pathways and is produced by many different cells. This cytokine is a family member of interleukin-1 (IL-1) and plays an important role in the pathophysiology of several diseases. Here we summarise and review the new aspects of this important pro-inflammatory cytokine.

IL-37 (IL-1F7) the Newest Anti-Inflammatory Cytokine Which Suppresses Immune Responses and Inflammation

Cytokines such as interleukins, chemokines and interferons are immunomodulating and inflammatory agents, characterized by considerable redundancy, in that many cytokines appear to share similar functions. Virtually all nucleated cells, but especially epithelial cells and macrophages, are potent producers of cytokines. The objective of this study is to review the detailed mechanism of action and the biological profiles of IL-37, the newest anti-inflammatory cytokine. This review focuses on IL-37, a key cytokine in regulating inflammatory responses, mainly by inhibiting the expression, production and function of proinflammatory cytokines: IL-1 family pro-inflammatory effects are markedly suppressed by IL-37.

[The prevalence of latent tuberculosis infections among health-care workers--a three-country comparison]

INTRODUCTION

Health-care workers are regularly screened for tuberculosis. To date, there has been no systematic analysis of the results of such a screening. A TB network for company doctors was created when interferon-γ release assays (IGRAs) were introduced in order to systematically collate their experience with IGRAs in preventive check-ups.

METHOD

Data have so far been recorded from 2,028 preventive check-ups. There are also data from preventive check-ups in France (n=148) and Portugal (n=2,889) for the purposes of a combined analysis. QuantiFERON-TB® Gold In-Tube and the tuberculin skin test with RT23 were used in the three cohorts.

RESULTS

The prevalence of latent tuberculosis infections (LTBI) is dependent on age and country. Among young health-care workers (<25 years old), 3% had a positive IGRA in Germany, compared with 18% in Portugal. Among health-care workers aged 55 and over, 25% were positive in Germany and 45% were positive in Portugal. In the French cohort an increase from 23% to 33% was observed when the youngest and oldest age categories were compared. Active tuberculosis has so far been diagnosed in 12 health-care workers in Portugal, four of whom developed culturally confirmed TB within the first two years following a positive IGRA. The risk of progression subsequent to a positive IGRA was 0.2% per annum.

DISCUSSION

There is a low prevalence of LTBI among young health-care workers. In them a positive IGRA following close contact with an infectious patient is likely to indicate recent infection. Apart from that, older infections appear to prevail, as the IGRA results depend greatly on age, and the risk of progression following a positive IGRA appears to be low in the study groups. A positive IGRA should therefore be interpreted with caution as an indication of the need for chemotherapy.

Atherosclerosis: A Classic Inflammatory Disease

Atherosclerosis is an inflammatory disease due to a diet high in saturated fat, hypercholesterolemia, obesity, hypoglycemia, etc. mainly mediated by the infiltration of macrophage and T cells into the vascular wall. Once the endothelial is damaged monocytes penetrate the tissue and are transformed in scavenger cells. Upon stimulation of Th1 cells, a group of cytokines is released and contributes to the inflammatory response of atherosclerotic tissue. When macrophages proliferate they amplify inflammatory response through the secretion of growth factors and cytokines such as TNF and IL-1. In addition, chemokines such as RANTES and other C-C chemokines are generated, and matrix metalloprotinease 9 (MMP-9) are produced by activated monocytes. However, the immune system in atherosclerosis still remains unclear. Here, in this study we revisited the inter-relationship between atherosclerosis and inflammation.

Cholesterol and vitamins: revisited study

The link between low density lipoprotein and coronary heart disease has been widely studied. Oxidized LDL damages the artery wall, and a diet rich in vitamins and low in saturated fat and cholesterol may reduce this risk. Not only hypercholesterolemia but also low levels of high density lipoprotein cholesterol are critical risk factors for atherosclerosis and related diseases. It has been reported that high doses of B complex vitamin may be useful in lowering blood cholesterol and triglyceride levels in the body, however the use of this compound has been limited by an annoying flush and concern for toxicity. Niacin is a B-complex vitamin with anti-atherosclerotic properties and is an effective medication for raising high density lipoprotein. The combination of niacin with other lipid-lowering drugs, such as statins, reduces the dynamic of atherosclerosis disease. In addition, vitamin E is one of the most important lipid soluble anti-oxidants in humans, and reduces atherosclerosis plaque, coronary artery diseases and myocardial infarction. Vitamin E protects the integrity of membranes by inhibiting lipid peroxidation. In this study we revisited the interrelationship between cholesterol, low density lipoproteins and vitamins.

Platelet mitochondrial dysfunction is evident in type 2 diabetes in association with modifications of mitochondrial anti-oxidant stress proteins

OBJECTIVE

Mitochondrial dysfunction and oxidative stress in insulin responsive tissues is implicated in the pathogenesis of type 2 diabetes. Whether these perturbations extend to other tissues and contribute to their pathophysiology is less well established. The objective of this study was to investigate platelet mitochondria to evaluate whether type 2 diabetes associated mitochondrial dysfunction is evident in circulating cells.

METHOD

A pilot study of mitochondrial respiratory function and proteomic changes comparing platelets extracted from insulin sensitive (n=8) and type 2 diabetic subjects (n=7).

RESULTS

In-situ platelet mitochondria show diminished oxygen consumption and lower oxygen-dependent ATP synthesis in diabetic vs. control subjects. Mass spectrometric identification and confirmatory immunoblot analysis identifies induction of the mitochondrial anti-oxidant enzymes superoxide dismutase 2 and thioredoxin-dependent peroxide reductase 3 in platelets of diabetic subjects. As oxidative stress upregulates anti-oxidant enzymes we assessed mitochondrial protein carbonylation as an index of oxidative-stress. Platelets of diabetic subjects exhibit significantly increased protein carbonylation compared to controls.

CONCLUSIONS

As platelets are anuclear fragments of megakaryocytes, our data suggest that the bone marrow compartment in type 2 diabetic subjects is exposed to increased mitochondrial oxidative stress with upregulation of nuclear-encoded antioxidant mitochondrial enzymes. This 'stress-signature' in platelets of diabetic subjects is associated with a diminution of their mitochondrial contribution to energy production and support that mitochondrial perturbations in type 2 diabetes extends beyond the classical insulin responsive tissues. Platelets, as "accessible human tissue", may be useful to measure the mitochondrial modulatory effects of emerging anti-diabetic therapeutics.

Cholesterol: An Inflammatory Compound

Obesity is one of the main rising causes of health problems in modern society and is correlated to type 2 diabetes mellitus, hypertension, heart disease and atherosclerosis. Bacterial products, endogenous substances such as oxidized LDL (ox-LDL) and heat shock proteins mediate activation of Toll-like receptors and reinforce the view that the innate immune system plays a key role in the genesis of atherosclerosis. In addition, natural killer T (NKT) cells respond to lipids presented via CD1d on APCs, and may also be able to affect atherosclerosis. All the main cell types involved in atherosclerosis such as endothelial cells, macrophages, T cells, smooth muscle cells and platelets express proinflammatory cytokines. In addition, CD4 ligation triggers the expression of adhesion molecules, cytokines and matrix metalloprotinease. IL-6 cytokines travels to the liver where it elicits acute phase response resolving in the release of serum amyloid-A C-reactive protein, fibrogen and plasminogen activator inhibitor-1. Therefore increasing body fat mass is associated with high levels of inflammatory cytokines such as IL-1 and TNF. In this study we revisit the interrelationship between fat and inflammation.

Allergic inflammation: role of cytokines with special emphasis on IL-4

This review examines recent articles on the relationship of cytokines to allergy and inflammation with particular emphasis on interleukin (IL)-4. The objective of this article is therefore to review published studies to identify cytokines consistently involved in allergic inflammation. Proinflammatory cytokines, including IL-4, IL-5, IL-13 and GM-CSF along with TNF-alpha play a role in allergen-induced airway leukocyte recruitment and these cytokines can be generated by T mast cells and other cells. In addition, IL-9, IL-25, IL-33, IL-17, IL-27 and IFN-gamma are deeply involved in the regulation of asthma. Blocking the effect of these proinflammatory cytokines might provide new therapeutic approaches for the control of allergy and inflammation.

[Measles in the Nantes Teaching Hospital during the 2008-2009 epidemic]

OBJECTIVE

A recent measles epidemic in France incited us to report and describe measles cases requiring hospitalization, to raise the awareness of health professionals on under-diagnosis and frequent complications of this viral disease.

DESIGN

We carried out a retrospective and epidemiologic study of measles cases recorded in the Nantes Teaching Hospital between August 2008 and September 2009. All these cases where confirmed by biological diagnosis and recorded by the Teaching Hospital virological laboratory.

RESULTS

Thirteen cases of measles (11 adults and two children) were recorded during the study period. Adults were young (mean age 21.4 years); the oldest was 35 years old. We noted two severe cases with viral pneumonia and hypoxemia and one case with bacterial pneumonia. Two female patients were pregnant; one delivered prematurely, in the acute phase of measles, with no complication for the newborn. Two cases occurred in the nursing staff by documented nosocomial transmission. Sixty-nine percent of the patients were not vaccinated whereas the vaccinal status was not documented for 31%.

CONCLUSIONS

These cases underline the potential severity of this infection and the difficulty to diagnose measles at the early phase because of lack of awareness of medical staff. It will be necessary to reinforce prevention messages and promote measles vaccination in children as well as in young people and health workers.

Wear of dental sealing materials using the replication technique

AIM

The aim of the present study was an in vivo evaluation of the wear of different sealing materials using the replication technique.

MATERIALS AND METHODS

Four different sealing materials were randomly applied on 2 out of 4 caries-free permanent first molars of each patient. Impressions were taken at T0: before the sealing material was applied; T1: right after the application; T2: 6 months after the application, and T3: 1 year after the application. The impressions were then processed for scanning electron microscopy analysis of the wear of the examined materials. Statistical analysis was used to evaluate differences among and within the 4 groups.

RESULTS

At T2, the average ratio of residual material in all the groups was 62.37% ± 1.21%, while at T3 it was 49.63% ± 1.11%. At both T2 and T3 there were no statistically significant differences among the 4 groups examined (p=0.76 and p=0.50 respectively). Comparison within the same group at T2 and T3 showed that statistically significant differences were only detected in group D (p=0.015).

CONCLUSION

Sealing materials do not undergo a complete loss after 1 year of application, thus indicating that they are suitable for caries prevention.