Is there any correlation between otitis media and dental malocclusion in children? A systematic review

PURPOSE

This study aims to evaluate whether there is a correlation between otitis and dental malocclusions.

METHODS

Electronic databases were searched for observational studies published until July 2021 without language or time restrictions.

PROSPERO

CRD42021270760. Observational studies on children with and without OM and/or malocclusion were included. After removing duplicates and excluding not-eligible articles, two reviewers screened relevant articles independently. Two reviewers independently extracted data and assessed data quality and validity through the Newcastle-Ottawa Scale (NOS) quality assessment tool for non-randomized studies.

RESULTS

Five studies met the selection inclusion criteria and were included in the studies for a total of 499 patients. Three studies investigated the relationship between malocclusion and otitis media, while the remaining two studies analyzed the inverse relationship and one of them considered eustachian tube dysfunction as a proxy of OM. An association between malocclusion and otitis media and vice versa emerged, although with relevant limitations.

CONCLUSION

There is some evidence that there is an association between otitis and malocclusion; however, it is not yet possible to establish a definitive correlation.

Non-specific oral and cutaneous manifestations of Coronavirus Disease 2019 in children

BACKGROUND

Coronavirus Disease 2019 (COVID-19) seems to affect children only marginally, as a result, there is less knowledge of its manifestations in childhood. The purpose of this retrospective cross-sectional study was to investigate the oral and cutaneous manifestations in children affected by COVID-19.

MATERIAL AND METHODS

All the medical records of children with COVID-19 admitted to the Pediatric Clinic- ASST Spedali Civili of Brescia from March to April 2020 were reviewed. The following data were recorded: age, temperature, clinical presentation, oral mucosa lesions, taste alteration and cutaneous lesions.

RESULTS

The medical records of twenty-seven pediatric patients (mean age 4,2 years + 1,7) were analyzed. The clinical presentation of the disease mainly included elevated body temperature and cough. The following oral lesions were recorded: oral pseudomembranous candidiasis (7.4 %), geographic tongue (3.7%), coated tongue (7.4 %) and hyperaemic pharynx (37 %). Taste alteration was reported by 3 patients. Six patients presented cutaneous flat papular lesions.

CONCLUSIONS

As for our paediatric sample, COVID-19 resulted to be associated with non-specific oral and cutaneous manifestations.

Taste sensitivity in healthy adults: gustatory test validation and observational study

Gustatory sensitivity has important biological functions and taste disorders are generally difficult to diagnose and treat. The aim of this study was to investigate taste sensitivity on a sample of adult healthy patients through the validation and administration of a gustatory test, to describe a possible baseline of reference. A gustatory test was performed following a standardized protocol, using primary flavors solutions at 4 known increasing concentrations for a total of 16 sapid solutions. Taste sensitivity was investigated considering (a) the threshold of the flavor identification and (b) the intensity of stimulus perception. Seventy-one healthy patients were included in the study. Reliability measures were evaluated, supporting the validity of the test itself. Sweet, bitter, and salty flavors could be identified within the first concentration, sour flavor was detected within the second concentration in the majority of cases (p<0.05). Sour flavor showed the lowest value of perceived intensity for the less concentrated solution, sweet flavor showed the highest value. Regarding the most concentrated solution, bitter flavor showed the highest intensity value, while sour remained the lowest one. Both gender-based and age-based differences regarding threshold and intensity of perception were not statistically significant. However mean threshold averagely increased along with age. Within its limitations, this study validates a useful, easy-to-use tool for assessing taste function and it provides a possible baseline for perception of primary flavors in a healthy adult population, which can be used as a reference for future studies considering specific cohorts of patients.

Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study

BACKGROUND

Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP.

MATERIAL AND METHODS

Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded.

RESULTS

All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant.

CONCLUSIONS

Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.

Photobiomodulation therapy for the management of recurrent aphthous stomatitis in children: clinical effectiveness and parental satisfaction

Background

This study aims to evaluate the effectiveness of the photobiomodulation therapy (PBMT) in the treatment of minor recurrent aphthous stomatitis (MiRAS) in children, in terms of pain relief, lesion size reduction and the parental satisfaction of the therapy.

Material and Methods

This randomized controlled study was carried out on 60 children with clinical diagnosis of MiRAS. Patients were randomized into two groups: group A receiving laser therapy and group B receiving sham therapy (placebo). Laser therapy (diode laser, λ: 645 nm) was administered on day 1 (T0) for three consecutive days. Patients were evaluated also on day 4 (T1), on day 7 (T2) and on day 10 (T3). Oral aphthous lesions size was assessed through a periodontal probe to measure the diameter length (mm); pain was evaluated through the Visual Analogue Scale (VAS); parental satisfaction was assessed through a questionnaire.

Results

The difference in the reduction of ulcers diameters between the two groups resulted statistically significant at T1 and at T2 (p<0.05). A statistically significant difference in pain reduction between two groups was found at T1 (p<0.05). No statistically significant difference between the two groups of parents was found as concerns the parental acceptance of the procedure and the discomfort for the need of multiple appointments.

Conclusions

PBMT is to be considered effective in the treatment of MiRAS in children and well- accepted by the parents of the children themselves.

Key words:Ulcers, children, lasers

Efficacy of the photobiomodulation therapy in the treatment of the burning mouth syndrome

Background

This study aims to evaluate the efficacy of the photobiomodulation therapy (PBMT) - in terms of pain and of quality of life- in patients affected by burning mouth syndrome (BMS).

Material and Methods

This study was designed as a randomised double-blinded prospective study. Patients diagnosed with BMS in the period from June 2015 to June 2018 were recruited. The patients were randomised into two groups and each received treatment once a week for ten weeks: group A received laser therapy (K Laser Cube 3®) while group B was given sham therapy (placebo). Pain was evaluated through the Visual Analogue Scale (VAS) and quality of life was assessed with the short form of the Oral Health Impact Profile (OHIP-14). Assessment was done at baseline and after every therapy session. The researchers were blind to the randomised allocations.

Results

A total of 85 patients were analysed. Group A (laser treatment) was composed of 43 patients while group B (sham therapy) of 42 patients. Patients treated with PBMT showed a significant decrease in symptoms (p=0.0008) and improved quality of life related to oral health (p=0.0002).

Conclusions

PBMT has demonstrated to have a positive effect in relieving BMS symptoms and in improving a patient’s overall quality of life.

Key words:Burning mouth syndrome, oral cavity, lasers, life quality.

Long-term evaluation of the efficacy on the podalic support and postural control of a new elastic functional orthopaedic device for the correction of Class III malocclusion

AIM

Correlations between occlusion and posture are open to new perspectives, which include treatment of functional alterations traditionally approached separately. The aim of this study is to evaluate whether the treatment of Class III malocclusion, through an innovative elastic functional orthopaedic device, allows an overall improvement of the podalic support.

MATERIALS AND METHODS

A 5½-year-old patient with Angle Class III malocclusion and c anterior ross bite in deciduous dentition has been treated for 7 years with a functional orthopaedic device (MSB Class III). Assessment of frontal and lateral postural plumb line was performed with stabilo-baro-podometric platform analysis, in order to record the podalic support discrepancy between feet, both in static phase and in dynamic phase. The patient has been posturally re-evaluated at nine and twelve years old.

RESULTS

The functional device allowed the restoration of the correct intermaxillary relationship, favourably conditioning also the posture. In particular, the correction of the valgus flat foot and a significative reduction of the podalic support discrepancy between feet has been obtained.

CONCLUSIONS

A global approach to the patient can successfully address both malocclusion and postural alterations.

Effectiveness of a spray containing 1% malic acid in patients with xerostomia induced by graft-versus-host disease

Background

To evaluate the clinical effectiveness of a topical sialogogue spray (malic acid, 1%) in the treatment of xerostomia in patients with chronic Graft versus Host Disease (cGVHD).

Material and Methods

This study was designed as a randomized double-blind clinical study. Twenty-eight patients with cGVHD suffering from xerostomia were divided into 2 groups: the first group (14 patients) received a topical sialagogue spray containing malic acid 1% (SalivAktive®) whereas the second group (14 patients) received a placebo. Both groups received treatment for 2 weeks. Dry Mouth Questionnaire (DMQ) scores and unstimulated salivary flows rate were collected before and after treatment.

Results

DMQ scores increased significantly from 1.3 ± 0.4 to 3.5 ± 0.4 points (p <0.05) after two weeks of treatment with malic acid, whereas in the control group DMQ scores increased from 1.2 ± 0.7 points to 1.4 ± 0.6 (p >0.05). The unstimulated salivary flow rate in patients treated with malic acid increased significantly from 0.15 ± 0.06 mL/min to 0.24± 0.08 mL/min, while that of the patients treated with placebo went from 0.16 ± 0.07 mL/min to 0.17 ± 0.09 mL/min (p >0.05).

Conclusions

Malic acid 1% spray can be considered effective in the treatment of GVHD induced xerostomia.

Key words:Xerostomia, malic acid, transplantation.

A new emerging oral infection: Raoultella planticola in a boy with haematological malignancy

BACKGROUND

Oral mucositis is a common complication in pediatric cancer patients, affecting up to 80% of children. Due to neutropenia and disruption of the mucosal barrier, chemotherapy-induced oral mucositis is often complicated by super-infections.

CASE REPORT

A 16-years old male with stage 3 Burkitt's lymphoma developed chemotherapy induced oral mucositis grade 3 (according to WHO scale). Ulcers were quickly growing (reaching a maximum diameter of 3 cm) and became greyish in colour, resulting in dysphagia and pain. A swab of the lesions was taken and microbiological tests were performed. The sample grew for Raoultella planticola, an encapsulated Gram-negative bacterium whose full pathogenic potential still needs to be defined.

TREATMENT

The patient received antibiotic combination therapy with Amikacin and Ceftazidime for 8 days. Complete healing of the lesions and resolution of the symptoms were reached and he completed his antineoplastic therapy without further complications.

FOLLOW-UP

Twelve months after the infection, he is alive and well, with no oral complaints.

CONCLUSION

This is the first report of a Raoultella planticola infection in a patient with chemotherapy induced oral mucositis. This type of infection must be added to the list of organisms to be considered when caring for these patients.

Oral hygiene grade and quality of life in children with chemotherapy-related oral mucositis: a randomized study on the impact of a fluoride toothpaste with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol

AIM

The aim of this study was to assess the impact of the use of a fluoride toothpaste (Bioxtra^® , Biopharm, Milan, Italy) with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol on the oral hygiene grade and on the quality of life (QoL) of children with oral mucositis (OM) grade 1 or 2 receiving chemotherapy for Acute Lymphoblastic Leukaemia (ALL).

METHODS

Patients between 6 and 14 years with OM were randomly assigned to two groups, group A (Bioxtra^® toothpaste) and group B (fluoride toothpaste without menthol). The patients were instructed to brush their teeth at least twice a day using a soft toothbrush with a small head. Oral hygiene grade was assessed using the simplified oral hygiene index (OHI-s); quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14) questionnaires. The patients were evaluated on day 1(diagnosis of OM-T0) and on day 8 (T1). Statistical analysis was performed.

RESULTS

A total of 64 patients were enrolled. A significant difference (P < 0.001) between the mean of the OHI-s in group A (0.9 ± 1.2) and in group B (1.5 ± 1.3) was found; the overall OHIP-14 scores were not associated with the use of one or the other toothpaste (P = 0.33).

CONCLUSIONS

Although the use of Bioxtra^® toothpaste does not affect the QoL of children undergoing chemotherapy, it may be recommended as clinically effective in improving the oral hygiene grade.

Occlusal traits in children with neurofibromatosis type 1

OBJECTIVES

Literature is poor of data about the occlusion in children affected by neurofibromatosis type 1 (NF1). This case-control study investigated the occlusal traits in a group of children with NF1.

SETTING AND SAMPLE POPULATION

A hundred and fifteen children with NF1 were enrolled; non-NF1 controls were sequentially selected among subjects referred to the Pediatric Dentistry Department.

MATERIAL AND METHODS

All patients underwent a clinical dental examination and a panoramic radiography. The following orthodontic variables were considered: molar relationship, overjet, overbite, cross-bite, scissor bite, and crowding/spacing.

RESULTS

Class III molar relationship resulted significantly (p = 0.01) more common in children with NF1 than in the control group as well as the unilateral posterior cross-bite (p = 0.0017). Forty-three children with NF1 (37.3%) showed radiographic abnormalities; in one case, a plexiform neurofibroma was detected.

CONCLUSIONS

An early orthodontic evaluation might be planned in the management of children with NF1 to prevent or decrease the need for extensive orthodontic interventions.

Management of paediatric maxillofacial fractures: conventional methods and resorbable materials

AIM

To compare the outcomes between the use of resorbable plates and screws and the conventional methods in children with paediatric maxillofacial fractures.

STUDY DESIGN

a retrospective observational study was designed reviewing the clinical records from June 2007 and June 2011. Data collected included aepidemiological data, type of treatment, outcome and satisfaction questionnaire. Descriptive statistics and bivariate analysis were performed.

RESULTS

A total of 1122 children (0-17 years old) were studied. Children treated by conventional methods were 912, while children treated by resorbable materials were 210. The frequency of complications during recovery was similar and no statistically significant difference was noted. The satisfaction questionnaire revealed similar percentages of satisfaction, with a high degree of satisfaction.

CONCLUSION

Our experience suggests that resorbable devices should be considered as a treatment option, which avoids the need of further surgery to remove metallic fixation, limits hospital spending and increases children's quality of life.

Rare case of desmoid-type fibromatosis of the mandibular region in a child: diagnosis and surgical management

AIM

Desmoid-type fibromatosis is a broad group of rare disorders that originate from musculoaponeurotic structures. They represent less than 0,1% off all tumors and the annual incidence is 2-4 cases per million, with two peaks between 6 and 15 years of age and between puberty and age 40. They are rare in the oral and maxillofacial regions. Its pathogenesis is multifactorial. The treatment is still mainly represented, both in children and adults, by surgical excision.

CASE REPORT

A case is reported of a 8-year- old girl with desmoid fibroma in the mandible who presented at the Department of Pediatric Dentistry with a swelling measuring 4x4 cm on the lower edge of the right mandible which had appeared a few months earlier and slowly developed. The family dentist had initially diagnosed it as an odontogenic abscess from the lower right deciduous molars, but the antibiotic therapy was unsuccessful. After x-ray examination, which showed a large osteolytic lesion, mandibular CT revealed a solid expanding mass. The child was referred to the Department of Paediatric Maxillofacial Surgery where the whole mass was surgically removed. At the 2-year follow-up no relapse was noted.

CONCLUSION

This case stresses the importance, especially for paediatric dentists, of further diagnostic steps if suspect lesions do not heal after conventional treatment.

Risk factors for oral mucositis in children receiving hematopoietic cell transplantation for primary immunodeficiencies: a retrospective study

OM is a frequent complication for patients undergoing HSCT. The aim of this study was to evaluate the possible risk factors for OM in children undergoing HSCT for PI. A retrospective study was carried out on 55 consecutive medical records of patients with PI (including osteopetrosis) who underwent HSCT. Age at the time of HSCT, gender, diagnosis, type of donor, conditioning regimen, engraftment, graft-versus-host disease, and severity and duration of OM were collected at the beginning of the conditioning until day 100 post-HSCT or death. OM was measured using the WHO scale. Patients' age range at the time of HSCT was quite wide; 59.2% of the patients who were under nine months (n = 13) developed OM vs. 87.8% of the patients older than nine months (n = 29) (p = 0.01). T-cell positive patients had a statistically significant higher risk of developing OM (p = 0.04), as did those receiving a more intensive conditioning regimen (p < 0.01). PI patients undergoing HSCT are at higher risk of developing OM if the PI is a T-lymphocyte-positive disease and/or if the HSCT recipient is over nine months of age.

Oral findings in 50 children with neurofibromatosis type 1. A case control study

AIM

The scientific literature is poor of data concerning NF1-related oral manifestations in children. The purpose of this study was to investigate the oral findings in a group of children with NF1.

MATERIALS AND METHODS

This study was designed as a clinical research. A total of 50 children affected by NF1 were enrolled. Non-NF1 controls were selected among subjects referred to the Paediatric Dentistry Department of the Dental Clinic at the University of Brescia, Italy. The craniofacial and all the dental examinations were carried out. The following parameters were investigated: dental caries, dental abnormalities, periodontal status, oral and perioral neurofibromas, orthodontic features, mandible and temporomandibular joint abnormalities. Statistics Unpaired Student's t test was calculated for Gaussian distributed variables; Fisher's test for non-Gaussian distributed binomial variables was used. The values inferior to p <0.05 (threshold) were considered significant for the study.

RESULTS

Children with NF1 showed poorer oral hygiene conditions, more frequent Class III dental malocclusions and severe alterations of the mandible and the temporal mandibular joint, if compared with the control group.

CONCLUSION

NF1 related-oral manifestations are evidenced also during childhood, even if some of the best known, like the neurofibromas, are not yet developed. It is important to keep a long-term follow-up to monitor the possible development of other oral lesions.

Oral cavity lymphomas in immunocompetent and human immunodeficiency virus infected patients

Oral cavity lymphoma (OCL) seems to occur more frequently in HIV-positive patients, but it is presently unknown whether HIV-related immune deficit plays a role in modifying the prevalence and the characteristics of these lymphomas. To clarify this issue, we compared OCL occurring in immunocompetent and HIV-positive patients. A comparison was made between cases of OCL occurring among 543 and 123 NHL consecutively diagnosed at a single center in immunocompetent and HIV-positive patients respectively. The prevalence of oral cavity involvement at diagnosis was significantly lower in the immunocompetent subgroup (HIV-negative: 1.66%; HIV-positive: 7.3%, P = 0.002). Extranodal T/NK nasal-nasal-type lymphoma (ET/NK-NL) was observed in 3 of 9 immunocompetent patients, whereas plasmablastic lymphoma (PBL) was observed in 3 of 9 HIV-positive patients. EBV expression correlated with HIV-positivity. Response to treatment was similar between the two subgroups, but the overall prognosis was significantly worse among HIV-positive patients. Median survival was 34 months in immunocompetent vs. 9 months in HIV-positive patients (P < 0.01). A higher frequency of oral cavity lymphoma was associated with HIV infection. ET/NK-NL and PBL seemed to be clinical entities characteristically related to immunocompetent and HIV-positive subgroups, respectively. Chemotherapy was feasible and effective in both subgroups, although a poor prognosis was associated with immunodeficiency.

Surgical removal and immediate reattachment of coronal fragment embedded in lip

This case describes a patient with a traumatic crown fracture of an upper incisor, associated with a laceration wound in the lower lip, showing local oedema. While palpating the tissues of the lower lip we felt the presence of a foreign body. This was confirmed by a radiograph of the lip that showed a radiopaque material, being similar to the coronal fragment of the fractured incisor. It was successfully surgically removed and immediately reattached using a composite adhesive technique. At the follow-up of 1 year later the vitality test on the teeth was positive and neither one of the two traumatized teeth showed any sign of discoloration.

Effectiveness of oral hygiene protocol in patients with post-traumatic splinting

AIM

In dental trauma with severe periodontal tissue involvement, as dental avulsion and severe luxation, the splinting procedure requires the patient to maintain a scrupulous hygiene of the affected zone, so to allow an effective tissue healing. The aim of this study was to assess the effectiveness of a specific oral hygiene protocol in the treatment of patients with post-traumatic splinting, comparing the plaque indexes of dental hygienist-helped patients versus not helped.

MATERIALS AND METHODS

This study was carried out on 82 selected patients with post-traumatic splinting due to traumatic avulsion and severe luxation. They were divided into 2 groups, comparable for age, sex, type of trauma and splinting. The group A patients underwent an oral hygiene protocol, managed by a dental hygienist, while the group B patients were followed without the help of the hygienist. Plaque indexes were observed and compared in all cases during 6 weeks-follow up.

RESULTS

Our results showed that at the 6th week follow up the plaque indexes of dental hygienist-assisted traumatized patients were significantly (p=0.001) lower than those of not assisted patients.

CONCLUSION

Therefore, the role of dental hygienists is essential in the management of dental trauma with periodontal damage, which needs specific oral hygiene protocols.

Root resorption in dental trauma: 45 cases followed for 5 years

We aimed to: (i) study the prevalence of root resorption after luxation or avulsion injuries on permanent teeth referred to our dental clinic over a 3-year period; (ii) study the relationship between type of injury and resultant type of resorption complication; and (iii) evaluate success of treatment protocols for various resorption complications. We observed 1943 patients with dental trauma, aged between 2 and 26 years, referred to the Accident and Emergency Department of the Dental Clinic, University of Brescia, from 1st September 1997 to 31st December 2001. Of these, 261 permanent teeth had sustained luxation (n = 188) or avulsion (n = 73) injuries. Permanent teeth luxation and avulsion injuries occurred most often in upper incisors (75%) of patients mostly aged 12-21 years, with males more commonly affected than females (68.3% vs. 31.7%). These cases were followed for 5 years, and complications and response to treatment were recorded. Root resorption was observed in 45 (17.24%) of these cases. Of the 45 cases with resorption, 9 were associated with luxation injury (20%) while 36 (80%) with avulsion. We distinguished 30 cases of inflammatory root resorption (18 transient and 12 progressive) and 15 cases of ankylosis and osseous replacement. When resorption was recognized, quick and effective treatment could still result in an excellent functional and aesthetic outcome for these teeth.

Clinical and epidemiological study of traumatic root fractures

The aim of this work was to study the prevalence and clinical presentation of root fractures in a series of patients with dental trauma. Treatment strategies were classified and outcomes after a 6-month period presented. The study population comprised 76 patients (between the ages of 2 and 55 years) with 93 root fractures in their teeth (18 primary, 75 permanent). Data were collected following the taking of a detailed clinical history, objective clinical examination and photographic and radiological investigation. Since most of the primary teeth were extracted, only cases with root fracture of permanent teeth were followed-up: in all, 24 patients with 31 teeth with root fractures. The prevalence of root fractures in permanent teeth was 7.7% of all injuries, while in primary teeth it was 3.8%. The most frequently involved teeth were the maxillary incisors with a percentage of 75% in permanent teeth. Moreover, 40% of root fractures in permanent teeth were associated with fracture of the alveolar bone and of the soft tissues and in 45% of cases, the adjacent teeth were also injured. The results of this study reaffirm the necessity for scrupulous diagnosis of teeth after a traumatic injury. Adjacent teeth and those in the opposing arch should not be ignored. Treatment is multidisciplinary, requiring surgical, orthodontic, operative and prosthetic compliance. Periodic check-up is essential.

Non neoplastic tongue diseases. An epidemiological investigation and diagnostic criteria

BACKGROUND

Few clinical-epidemiological data regarding tongue diseases were showed in recent literature. The aim of this study was to evaluate the prevalence of non neoplastic tongue pathologies, and to perform an epidemiological, clinical and etiopathogenetic comparable data system on Non-Neoplastic Glossitis (NNG).

METHODS

A total of 215 subjects (90 males and 125 females, age range: 6-72 years) have been examined) at the Dental Clinic of the University of Brescia over a period of 2 years. From this group, patients with tongue non neoplastic lesions were selected. Each selected patient with NNG was examined, following the Diagnostic Protocol of the "Department of Oral Pathology and Medicine" of the Dental Clinic of Brescia University.

RESULTS

84 cases of NNG (39%) were observed from January 1997 to October 1998.

CONCLUSIONS

The selected group of patients with NNG has been stratified following clinical and etiological criteria, and the results discussed, emphasizing the importance of careful and correct examination of the tongue, in order to bring to light morphological and pathological changes often neglected or misdiagnosed. One should never exclude, moreover the possibility of malignant evolution of some lingual lesions requiring a close follow-up.

Serum lipid levels during interferon therapy in patients with chronic hepatitis C

Interferon-alpha (IFN-alpha) may affect lipid metabolism by stimulating hepatic fatty acid synthesis. The aim of this study was to evaluate serum lipid levels during IFN-alpha therapy in patients with biopsy-proven chronic active hepatitis C. A total of 22 patients (18 males and 4 females; age 25-55 years) received 3 MU of recombinant IFN-alpha 2b 3 times a week for 6 months. Serum lipids were determined at baseline and then every month until the end of therapy. All patients had normal serum lipid levels at baseline. No significant level of modification occurred in patients during the therapy. An increase in serum lipid levels during low-dose IFN-alpha therapy seems to be uncommon in hepatitis C virus-infected patients with baseline normal levels.

Detection of anti-HCV IgM antibodies in patients with chronic hepatitis C treated with interferon

OBJECTIVE

To assess the role of IgM antibodies to hepatitis C virus core protein (anti-HCV IgM) as a marker of chronic HCV infection and as a predictor of successful interferon (IFN) treatment.

DESIGN

Anti-HCV IgM levels were evaluated at baseline, during IFN therapy and during a follow-up period.

METHODS

Anti-HCV IgM levels were evaluated in 62 patients (47 men and 15 women, aged 25-65 years) with biopsy-proven chronic active hepatitis C. Fifty-one of the patients received alpha-IFN 3 MU three times a week for 6 months and 11 received the same therapy for 12 months. Twenty patients showed a long-term response; fourteen responded but subsequently suffered a relapse; twenty-eight did not respond to the treatment. Follow-up in all patients lasted for at least 6 (mean +/- SD 9.8 +/- 5.4, range 6-29) months after the end of the therapy.

RESULTS

Anti-HCV IgM were detected in 35 patients (56.4%) at baseline; no significant differences were observed between the three groups studied. Almost all members of the groups showing a relapse or no response remained positive at the end of therapy and follow-up. In contrast, we observed a progressive disappearance of anti-HCV IgM in patients responsive to interferon therapy over the long term.

CONCLUSION

The loss of anti-HCV IgM positivity in patients positive at baseline can predict the long-term response to IFN therapy.

Caffeine clearance in subjects with constitutional unconjugated hyperbilirubinemia

To investigate the behaviour of caffeine (CAF) in patients with Gilbert's Syndrome (GS), a combined oral loading test of caffeine and chenodeoxycholic acid was performed in 14 healthy subjects and 71 patients with GS. Indocyanine green (ICG) kinetics was tested in 50 subjects with GS and in all control subjects. Fasting serum bile acids (SBA) and clearance after CDCA loading were within normal range in normal and GS subjects. No significant difference in levels either of bilirubin or of SBA was observed in GS cases with normal (52 cases, 488 +/- 63 ml/min) or impaired (19 cases, 338 +/- 30 ml/min) caffeine clearance. Eleven GS cases showed altered ICG clearance. No correlation was found between bilirubin and bile acids, CAF or ICG. Fasting SBA were normal even in cases of CAF or ICG altered kinetics, thus excluding structural damage in unconjugated hyperbilirubinemia. CAF altered kinetics in 27% of GS cases may suggest multiple deficits in the hepatocellular metabolism, thus confirming the heterogeneity of this syndrome.

Lymphoblastoid interferon therapy in chronic hepatitis C: biochemical, virological and histological evaluation of two different doses

Sixty patients of both sexes with biopsy-proven chronic hepatitis C were randomized to receive lymphoblastoid interferon 3 MU or 6 MU three times weekly for 6 months. A follow-up period of 3 months at the end of the therapy was scheduled. Thirty-two patients (53.3%) normalized alanine aminotransferase at the end of the therapy. Of these, 17 received 3 MU (56.7%) and 15 (50%) received 6 MU. Eighteen of the 32 patients (56.2%) relapsed in the follow-up period after treatment. No significant difference in relapse rate was observed between the two groups. The overall percentage of the non-responder patients was 36.6%. The treatment was discontinued because of non-compliance and/or side effects in six patients (10%): three in the 3-MU group and three in the 6-MU group. An improvement in liver histology was observed in about a quarter of chronic active hepatitis patients whose overall diagnosis changed to chronic persistent hepatitis. Knodell's score system showed a significant improvement (p < 0.05) with regard to peripheral necrosis, fibrosis and total score. HCV-RNA was positive at the beginning in all patients and it became undetectable in almost all responder patients. In some cases there was no correlation between viraemia and biochemical signs of liver disease. Our study shows that 6 MU does not increase the response rate compared to 3 MU. Moreover, the lower dose is able to improve the liver histology and to abolish the HCV viraemia in responder patients.

Modifications in the serum concentrations of prolyl hydroxylase in patients with chronic hepatitis B during and after interferon therapy

A total of eight patients with chronic active HBsAg-positive hepatitis was treated with recombinant interferon-alpha 2b for 12 months and serum aspartate aminotransferase, alanine aminotransferase, gamma-globulin and prolyl hydroxylase concentrations were determined every 3 months. Liver biopsies after 12 months' treatment revealed a significant (P less than 0.05) reduction in the histological activity score. After 6 months, alanine aminotransferase (P less than 0.01) and aspartate aminotransferase (P less than 0.05) concentrations fell significantly compared with baseline concentrations. Serum prolyl hydroxylase concentrations declined significantly (P less than 0.05) after 15 months and remained depressed. It is concluded that interferon-alpha 2b therapy reduced fibrogenetic activity in chronic active hepatitis B.