A Systematic Review of Oral Modifications Caused by the Prolonged Application of Continuous Positive Airway Pressure (CPAP) and Intraoral Appliances in Patients with Obstructive Sleep Apnea (OSA)

Objective

Prolonged use of oral devices as a substitute for traditional treatments has been studied in relation to the dental and skeletal changes associated with obstructive sleep apnea syndrome (OSA), which is a sleep-breathing disorder.

Materials and Methods

A review of articles indexed in PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, and CINHAL databases in September 2022 based on MeSH-based keywords with "dental and skeletal" and "oral appliance" and "obstructive sleep apnea" was examined to ensure that the keywords alone or cross-linked, depending on which base of the searched data, were used. 16 articles out of 289 articles were included in the research, and 273 articles were excluded due to lack of study.

Conclusions

CPAP treatment has limited dental or skeletal effects in short-term or long-term use. OAs and MADs show significant dental changes with prolonged use. MAS and TSD are more effective in short-term goals than CPAP. OAs' increase may cause dental and skeletal changes. MPD shows notable cephalometric alterations.

A Cross-Sectional Study of the Dental Arch Relationship and Palatal Morphology after Cleft Surgery in Italian Children with Unilateral Cleft and Lip Palate

Dental arch relationships (DARs) and palatal morphology (PM) were evaluated in in non-syndromic complete unilateral cleft lip and palate (UCLP) Italian patients after surgery. Pre- and postnatal factors affecting the results were investigated. Sixty-six children with UCLP (40 boys and 26 girls, with a mean age of 10.1 ± 2.9 years), predominantly Caucasian (77%), were consecutively enrolled in this cross-sectional study. Twenty children had received a one-stage protocol consisting of an early periosteal palate surgical repair and lip closure and forty-six were submitted to a staged surgical protocol with delayed palate repair (DPR). A single clinician collected data on their medical history and carried out a dental examination. The DAR and PM were graded on dental casts according to the Eurocran index and dichotomised as favourable and unfavourable based on the treatment outcome. Multiple logistic regression analyses demonstrated that female sex (OR = 6.08, 95% CI: 1.47-25.23, p = 0.013), DPR (OR = 4.77, 95% CI: 1.14-19.93, p = 0.032) and the use of a neonatal plate (OR = 4.68, 95% CI: 1.27-17.16, p = 0.020) increased the odds of having favourable DAR, while only DPR (OR = 9.76, 95% CI: 2.40-39.71, p = 0.001) was significantly associated with a favourable PM. Based on these findings, only DPR had a significantly favourable effect on both DAR and DM in Italian children with complete UCLP.

Prevalence and association of dental anomalies and tooth decay in Italian childhood cancer survivors

The aim of this cross-sectional study was to assess the prevalence and severity of dental anomalies according to age at cancer treatment and type of antineoplastic protocol using the Modified Dental Defect Index (MDDI) and to explore the association between MDDI scores and caries experience in Italian childhood cancer survivors (CCS). A total of 88 CCSs (age range 6-20 years) treated with chemotherapy and/or radiotherapy for malignant diseases and in remission from at least 2 years were consecutively recruited from March 2019 to July 2022. All participants were examined for dental caries and enamel defects in the permanent dentition according to the decayed-missing-filled teeth (DMFT) index and the Aine rating scale. Dental abnormalities were diagnosed using panoramic radiographs and graded for severity according to the MDDI. The MDDI values were categorized as normal (MDDI, 0), moderately abnormal (1 ≤ MDDI < 16), and severely abnormal (MDDI ≥16). None of the enrolled children had normal MDDI score. MDDI and DMFT values were higher in CCSs submitted to cancer treatment before 5 years of age, while no statistically significant association was found with anticancer protocols. A significant positive correlation emerged between DMFT and MDDI values (p < 0.001). CCSs with moderately abnormal disturbances had statistically significant lower DMFT scores (p < 0.001) than those with severe dental abnormalities. These findings suggest that children in remission from malignant diseases with MDDI values ≥16 have poorer dental health and should be strictly monitored by dental specialists.

Dentoskeletal features and growth pattern in Beckwith-Wiedemann spectrum: is surgical tongue reduction always necessary?

OBJECTIVES

The role of tongue reduction surgery (TRS) in preventing excessive mandibular growth and anterior open bite in children with Beckwith-Wiedemann Spectrum (BWSp) is still controversial. This cross-sectional study aimed at comparing craniofacial growth pattern in children affected by BWSp either treated or not treated with early TRS for severe macroglossia. Considering the invasive nature of such surgery, the present study could help in clarifying the need for TRS to reduce or prevent growth disturbances.

MATERIALS AND METHODS

Orthopantomography and lateral skull x-ray images were taken either from surgically treated or non-surgically treated patients, aged 5 to 8 years, to compare dentoskeletal features and craniofacial growth by cephalometric analysis. Molecular testing results were collected from their medical records.

RESULTS

Eighteen BWSp patients were consecutively recruited: 8 underwent TRS at 14.9 ± 2.2 months of age, while 10 did not. Anterior open bite and dental class III were more frequently observed in the surgically treated group, but none showed skeletal class III. No statistically significant differences were observed in growth pattern, but children treated with TRS showed a tendency towards both maxillary and mandibular prognathism with protruding lower lip. Growth pattern seemed to be not related to molecular subtypes.

CONCLUSIONS

These preliminary data suggest that early TSR does not improve craniofacial growth pattern and dentoskeletal features in BWSp children.

CLINICAL RELEVANCE

Reductive glossectomy may not be justified for preventing or avoiding oro-facial deformities in BWSp; therefore, early monitoring of maxillofacial development of each affected child has a great clinical significance.

Early orthodontic treatment need in paediatric age: a prospective observational study in Italian school-children

AIM

This study evaluates the prevalence of Interceptive Orthodontic Treatment Need (IOTN) in Italian school-children.

METHODS

A prospective observational study was conducted to assess the prevalence of IOTN in patients undergoing a first visit at the Santa Chiara Hospital Paediatric Dentistry Unit in Pisa, Italy. Two thousand, one hundred ninetynine subjects met the inclusion criteria and were enrolled in the study; data on age, gender and concomitant systemic pathologies were collected from medical records. All participants were examined for individual IOTN: the presence of anterior and/or unilateral/bilateral crossbite with or without midline deviation, bad habits (finger, sucking habits, mouth breathing, and tongue thrust), overjet > 3 mm, lack of space for 1.2 and 2.2 eruption were investigated. The presence of one of the above mentioned parameters was considered positive for IOTN. Chi-square test was used to evaluate any statistically significant difference (p < 0.05).

CONCLUSION

The study confirms the presence of a significant percentage of paediatric patients who need IOTN; early treatment is highly recommended to reduce malocclusion outcomes in the adult population.

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.

Age, gender and degree of inclusion are predictors of timing for spontaneous repositioning of intruded primary teeth in pre-school children

AIM

To investigate the timing for spontaneous repositioning of primary teeth with intrusive luxation in relation to degree of inclusion, gender and age of injured children.

METHODS

This retrospective study analysed records of 1- to 6-year-old children referred to the Section of Paediatric Dentistry, C.I.R. Dental School, University of Turin (Italy) between January 2009 and December 2020 for traumatic intrusion of primary teeth. Time to the total re-eruption was calculated, and related factors were explored using Cox and Kaplan-Meier analyses.

CONCLUSION

Timing for spontaneous re-eruption seems to be associated to age, particularly as far as total intrusion of primary teeth is concerned. This observation could be related to the degree of bone mineralisation, which is modified during growth.

Mechanics of facial growth in young patients

AIM

The aim of this work is to focus on the impact of occlusion on facial development.

METHODS

Literature was searched using Medline, Embase and Cochrane Library. The key words and mesh used were bone remodelling, facial growth, masticatory muscles, children. Only articles written in English were included in the study.

CONCLUSION

Disturbances in the harmonious interplay of the masticatory muscles may result in facial alteration and asymmetries. If not treated, the dysplastic pattern of growth continues and worsens with time.

Impairment of salivary function in juvenile idiopathic oligoarticular arthritis is a sign of early onset disease

AIM

Recent evidences of the presence of reduced stimulated salivary flow rate and altered saliva composition in oligoarticular juvenile idiopathic arthritis (o-JIA) suggest a specific damage to the salivary glands. The aim of this cross-sectional study was to investigate whether reduced salivary flow rate could be related to age and gender at disease onset in o-JIA.

METHODS

A total of 57 Caucasian patients (41 females and 16 males) aged 5 to 16 years affected by o-JIA were consecutively enrolled in the study. Information on medication intake, dietary and oral hygiene habits were gathered through a standardised questionnaire. All patients underwent oral and sialometry examination.

CONCLUSION

Early onset disease would seem to be associated with salivary glands impairment. Regular dental and salivary gland function assessments may be highly recommended in o-JIA patients considering that saliva collection is a non-invasive and inexpensive procedure.

Oral-Health-Related Quality of Life among Non-Syndromic School-Age Children with Orofacial Clefts: Results from a Cross-Sectional Study in Northern Italy

The aim of this cross-sectional study was to determine the influence of orofacial clefts on the oral-health-related quality of life (OHRQoL) in a group of Italian children and adolescents and to examine whether gender, age, cleft type, and surgical protocol were associated with patients’ OHRQoL. A total of 71 patients with cleft lip and/or cleft palate (CLP) and 71 age- and gender-matched controls (aged 8 to 18 years) were asked to complete the Child Oral Health Impact Profile (COHIP), a validated and reliable questionnaire to assess self-reported OHRQoL in children and teenagers. Children with orofacial clefts showed statistically significant lower quality of life scores than controls for total OHRQoL and for each of the subscales. Gender, the type of cleft, and the type of surgical protocol had no significant influence on OHRQoL. The negative impact of CLP on the area of self-image was greater in 12–18-year-olds, indicating a higher need for psychosocial counselling. These findings suggest that Italian CLP children and adolescents experience a poorer OHRQoL in comparison to their non-cleft peers.

Long-term effect of anticancer therapy on dentition of Italian children in remission from malignant disease: A cross-sectional study

AIM

To investigate the effects of anticancer therapy on dental development and caries formation in Italian childhood cancer survivors compared to healthy controls.

METHODS

A total of 52 children treated with chemotherapy and/or radiotherapy when younger than 10 years and in remission from at least 2 years, and 52 healthy age- and gender-matched children were consecutively enrolled in this cross-sectional study. All participants were examined for dental caries and enamel defects according to the decayed-missing-filled teeth (dmft/DMFT) index and the Aine rating scale. Panoramic radiographs were taken to estimate dental age and to assess dental abnormalities using the Höltta Defect Index.

CONCLUSION

These children are at high risk for tooth developmental abnormalities and poor dental health and should be closely monitored by a specialist dentist.

Salivary glands involvement: a new indicator of juvenile idiopathic oligoarticular arthritis (preliminary results)

OBJECTIVE

Early diagnosis is critical to reduce long-term disability in patients with JIA by ensuring prompt treatment. The aim of this cross-sectional study was to evaluate the salivary gland function in JIA, addressing specifically oligoarticular (JIA1) and polyarticular (JIA2) subtypes, compared with healthy controls. This may contribute to the identification of salivary risk indicators of the disease that may help diagnosis at an early stage or even before the onset of other clinical evidence.

METHODS

Twenty-eight patients with JIA1, 28 patients with JIA2, according to the ILAR criteria, and 28 healthy controls (C) were included in the study. Exclusion criteria were any concurrent medical condition. Data on medication, dietary and oral hygiene habits were collected using a questionnaire. All patients underwent oral examination and saliva measurement.

RESULTS

While stimulated salivary flow rate (SFR) was significantly lower in JIA1 compared with JIA2 and C (P < 0.001), both salivary buffer capacity and pH were similar in the two JIA groups but statistically different from C (P = 0.002 and P = 0.010, respectively). Children with very low SFR (<3.5 ml) exhibited a 16-fold higher likelihood of being affected by JIA1 rather than JIA2 (P = 0.003), while no association was observed between low flow rate and JIA subtype (P = 0.744).

CONCLUSION

These preliminary data suggest impairment of salivary gland function as a risk indicator for JIA1 with no association with dietary habits and drug intake.

An Innovative Strategy for Oral Biofilm Control in Early Childhood Based on a Resveratrol-Cyclodextrin Nanotechnology Approach

The purpose of this randomized controlled study was to evaluate the clinical efficacy of a novel oral spray containing resveratrol (RV) in controlling bacterial biofilm and gingival inflammation in early childhood. RV, a natural polyphenol, known for its anti-inflammatory and anti-infective activities, was included in a nanovector of 2-hydroxypropyl-beta-cyclodextrins (HPβCD) to improve its bioavailability. A total of 64 children between two and five years of age with plaque-induced gingivitis were randomly included in two equal groups. Both groups were enrolled in a mechanical plaque control program for a period of four weeks, while the test group was also instructed to use the RV-HPβCD mouthwash (in spray formulation) once daily, after toothbrushing. All children underwent three oral hygiene motivation sessions, 14 days apart, during which the full-mouth presence of bacterial plaque, gingival inflammation, dental stain and salivary pH were recorded. At two-week appointment, they also received professional plaque removal. The use of RV-based oral spray significantly reduced the amount of dental plaque and the percentage of bleeding sites and improved salivary pH compared to the control group at both two- and four-week examinations. Based on these promising results, the local delivery of RV-HPβCD via oral spray could enhance the control of dental biofilm in early childhood, when antiseptic mouthwashes are not recommended.

Evaluation of Biodentine in Pulpotomies of Primary Teeth with Different Stages of Root Resorption Using a Novel Composite Outcome Score

This study aimed to assess the success of pulpotomy in primary molars using Biodentine, new-developed tri-calcium, di-calcium-based silicate cement, at 6 and 12 months. The hypothesis was that stages of root resorption could influence the treatment success. A novel composite score was used based on five clinical and radiographic outcomes: soft-tissue pathology, pain to percussion, pathologic mobility, radiolucency and pathologic root resorption. Patients’ compliance and intraoperative pain experience were recorded using the Frankl scale and the Wong–Baker scale. A total of 22 primary molars, 9 in stage S (stability) and 13 in stage R (resorption) were submitted to pulpotomy using Biodentine and restored with composite resin. The success rate was 92.3% in the R group compared to 100% in the S group at both 6 and 12 months (p = 0.850). There was no statistically significant effect of type of molar, tooth position and type of carious lesions on the composite outcome (all p > 0.05). Overall, 73% of the children experienced no or mild/moderate pain and 77% had a cooperative attitude. Children younger than 7 years old experienced more pain (p = 0.04). Biodentine is a promising biomaterial for pulpotomy of primary teeth regardless of the stage of root resorption.

The effect of an oral spray containing an aqueous extract of Triticum vulgare on dental plaque and gingival inflammation in schoolchildren: A randomized controlled trial

AIM

To investigate whether the daily use of a spray containing an aqueous extract of Triticum vulgare (TV), belonging to the family of Graminaceae, associated with supervised toothbrushing may improve gingival health in schoolchildren with mixed dentition.

MATERIALS AND METHODS

Study design: Randomised, controlled, single-centre, examiner blind, parallel-group study. The study population included 57 schoolchildren with plaque-induced gingivitis randomly allocated to test (n = 29) and control (n = 28) group. Both groups were enrolled in a mechanical plaque control programme for a period of 2 weeks. The test group was also instructed to use a gluten free spray formulation of TV spray twice daily after toothbrushing. Evaluations of plaque index, modified gingivitis index (GI), salivary pH and whole stimulated saliva quantity took place at baseline and after 1 and 2 weeks of study product use.

RESULTS

No side effects were observed. Plaque accumulation and GI statistically significantly improved compared with baseline in both groups (all P-values < 0.005), while salivary pH remained nearly unchanged. Between-group differences in index reduction were statistically significant only for GI favouring the test group (P = 0.013).

STATISTICS

Repeated-measures ANOVA and the Friedman test were applied to evaluate the influence of time on quantitative variables within each treatment group. Differences between test and control groups were tested using the unpaired t test or the Mann-Whitney U-test with Bonferroni correction.

CONCLUSIONS

This study found that TV in spray formulation is safe and effective in controlling gingival inflammation. Thus, it may be a potential adjuvant in the treatment of gingivitis in combination with mechanical plaque control in schoolchildren.

Italian guidelines for the prevention and management of dental trauma in children

Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.

Correction to: Best practice management guidelines for fibrous dysplasia/McCune-Albright syndrome: a consensus statement from the FD/MAS international consortium

The original version of this article [1] unfortunately included an error to an author's name. Paul Arundel was inadvertently presented as Paul Arunde.

Best practice management guidelines for fibrous dysplasia/McCune-Albright syndrome: a consensus statement from the FD/MAS international consortium

Fibrous Dysplasia / McCune Albright syndrome (FD/MAS) represents a wide spectrum of diseases due to somatic gain-of-function mutations of the GNAS gene. The mutation leads to overactivity in the target tissues and to a wide phenotype of clinical features that vary in severity and age of onset. The rarity of the disease and its variable presentation to multiple specialities often leads to misdiagnosis and inappropriate variability in investigations and treatments. To address this, our international consortium of clinicians, researchers, and patients’ advocates has developed pragmatic clinical guidelines for best clinical practice for the definition, diagnosis, staging, treatment and monitoring for FD/MAS to empower patients and support clinical teams in both general and specialised healthcare settings. With the lack of strong evidence to inform care, the guidelines were developed based on review of published literature, long-standing extensive experience of authors, input from other healthcare professionals involved in the care of FD/MAS patients and feedback from patients and patient groups across the globe. This has led to the formulation of a set of statements to inform healthcare professionals, patients, their families, carers and patient groups of the best practice of care. It is anticipated the implementation of these recommendations will lead to improvement in the care of patients with FD/MAS internationally.

Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis: International, Multidisciplinary Consensus-based Recommendations

OBJECTIVE

To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA).

METHODS

Using a sequential expert group-defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus.

RESULTS

Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction. CONCLUSION: Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.

Multicenter randomized, double-blind controlled trial to evaluate the efficacy of laser therapy for the treatment of severe oral mucositis induced by chemotherapy in children: laMPO RCT

OBJECTIVES

To demonstrate the efficacy of laser photobiomodulation (PBM) compared to that of placebo on severe oral mucositis (OM) in pediatric oncology patients. The primary objective was the reduction of OM grade (World Health Organization [WHO] scale) 7 days after starting PBM. Secondary objectives were reduction of pain, analgesic consumption, and incidence of side effects.

METHODS

One hundred and one children with WHO grade > 2 chemotherapy-induced OM were enrolled in eight Italian hospitals. Patients were randomized to either PBM or sham treatment for four consecutive days (days +1 to +4). On days +4, +7, and +11, OM grade, pain (following a 0-10 numeric pain rating scale, NRS) and need for analgesics were evaluated by an operator blinded to treatment.

RESULTS

Fifty-one patients were allocated to the PBM group, and 50 were allocated to the sham group. In total, 93.7% of PBM patients and 72% of sham patients had OM grade < 3 WHO on day +7 (P = 0.01). A significant reduction of pain was registered on day +7 in the PBM versus sham group (NRS 1 [0-3] vs. 2.5 [1-5], P < 0.006). Reduced use of analgesics was reported in the PBM group, although it was not statistically significant. No significant adverse events attributable to treatment were recorded.

CONCLUSIONS

PBM is a safe, feasible, and effective treatment for children affected by chemotherapy-induced OM, as it accelerates mucosal recovery and reduces pain.

Odontoiatric perspectives and osteonecrosis of the jaw as a possible adverse effect of bisphosphonates therapy in fibrous dysplasia and McCune-Albright syndrome

BACKGROUND

McCune-Albright syndrome (MAS) is characterized by the triad of polyostotic bone fibrous dysplasia (PFD), endocrine disorders, and café-au-lait skin pigmentation. Ninety percent of MAS patients have fibrous dysplasia (FD) craniofacial lesions. Osteonecrosis of the jaw (ONJ) has been described as an adverse side effect of bisphosphonate therapy. The aim of the study was to investigate evidence of clinical and/or radiological signs of ONJ in FD/MAS pediatric patients due to bisphosphonate therapy and describe odontoiatric tools in this population.

METHODS

Thirteen FD/MAS patients were enrolled. All patients during pediatric age have been treated with pamidronate infusions. They underwent complete oral clinical examination. Ortopantomography and/or CT were evaluated in all cases.

RESULTS AND CONCLUSIONS

No patient developed ONJ. None of them showed radiological signs different from jaw FD. In spite of the low number of patients enrolled, results confirm that, in this population, ONJ can be ruled out as a chronic adverse side effect of bisphosphonate therapy.

Professional oral hygiene as a therapeutic option for pediatric patients with plasma cell gingivitis: preliminary results of a prospective case series

BACKGROUND

Plasma cell gingivitis (PCG) is a rare, benign inflammatory condition of unclear etiology with no definitive standard of care ever reported to our knowledge. The aim of this case series is to ascertain the clinical efficacy of professional oral hygiene and periodontal therapy in younger individuals with a histologically confirmed diagnosis of PCG.

METHODS

All patients received non-surgical periodontal therapy, including oral hygiene instructions, and thorough supragingival scaling and polishing with the removal of all deposits and staining combined with the use of antimicrobials in a 9-week cohort study. Clinical outcome variables were recorded at baseline and 4 weeks after the intervention and included, as periodontal parameters, full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), the clinical extension of gingival involvement, and patient-related outcomes (visual analog score of pain).

RESULTS

A total of 11 patients (six males and five females; mean age: 11 ± 0.86 years) were recruited. Four weeks after finishing the oral hygiene and periodontal therapy protocol, a statistically significant reduction was observed for FMPS (P = 0.000), FMBS (P = 0.000), reported pain (P = 0.003) and clinical gingival involvement (P = 0.003).

CONCLUSION

Standard, professional oral hygiene procedures and non-surgical periodontal therapy including antimicrobials were associated with a marked improvement of clinical and patient-related outcomes in pediatric cases of PCG.

180-day screening study for predicting the risk factors for developing acute oral Graft-versus-Host disease in paediatric patients subjected to allogenic haematopoietic stem cells transplantation

AIM

In this study, 58 paediatric patients were prospectively evaluated with a number of screening studies performed between 0 and 180 days after allogenic hematopoietic stem cells transplantation (HSTC) to detect any risk factors for developing oral manifestations of acute Graft-versus-Host Disease (a-GvHD).

MATERIALS AND METHODS

A total of 58 paediatric allogenic HSTC patients (37 males aged 1 to 15, and 21 females aged 4 to 18), entered the study and were observed by a trained dental team for a period of 6 months following transplantation while assuming cyclosporine, an immunosuppressive agent with a-GvHD prophylactic activity. Mean age at transplantation was 7.2 years old. Screening studies included physical examination, complete blood counts and liver function tests. Complete extraoral and intraoral clinical examinations were performed for all patients to detect oral lesions. Furthermore, some variables (sex, number of HSTC performed in the same patient, degree of HLA disparity and the positive/negative result of cytomegalovirus antigenemia test during the three months after engraftment) were investigated in the attempt to evaluate their predictive and/or diagnostic value in paediatric HSTC recipients. The resulting data were analysed with the Fisher's exact test.

RESULTS

Twenty-two percent of the patients developed oral manifestations of a-GvHD. Oral symptoms frequently are the major complaints of the patients during the follow-up period. The oral changes included mucositis, erosions and/or ulcerations; xerostomia, pain and bleeding were also referred. The variables investigated for predictive and/or diagnostic value in paediatric HSTC recipients included: sex (relative risk 0.494, 95% confidence interval 0.119-2.052, P=0.1242); number of HSTC performed in the same patient (relative risk 5.4, 95% confidence interval 0759-3.843; P=0.0714); degree of HLA disparity (relative risk 0.24, 95% confidence interval 0.058-0987, P=0.0428); and the result to cytomegalovirus (CMV) antigenemia test during the three months after engraftment (relative risk 0.86, 95% confidence interval 0.273-2.712, P=1).

CONCLUSION

Patients presenting two or more risk factors should be closely monitored for development of clinical oral a-GVHD, as oral complications are a significant cause of morbidity and potential mortality for children undergoing HSTC and can interfere significantly with transplant recovery.

Clinical evaluation of temporomandibular disorders in children and adolescents: a review of the literature

AIM

The abbreviation TMD (temporomandibular disorders) has been used to signify the variety of symptoms, signs and combinations that have often been assigned to the TMJ (temporomandibular joint) and its related structures (muscles, bone and facial structures). The prevalence of temporomandibular disorders in children and adolescents varies widely in literature. The most common signs and symptoms of TMD are: temporomandibular joint sounds, impaired movement of the mandible, limitation in mouth opening, preauricolar pain, facial pain, headaches and jaw tenderness on function. Many studies have shortcomings in their method of assessing or measuring TMD: the problem is probably due to the fact that temporomandibular disorders have multiple aetiological factors. The aim of this article is a review of the literature about the diagnostic procedures used to assess signs and symptoms of temporomandibular disorders in children and adolescents.

MATERIALS AND METHODS

Literature was searched using Medline, Embase, and Cochrane Library from 1992 to February 2008. Only articles written in English were included in the study. The key words and mesh used were: temporomandibular disorders, mandibular dysfunction, children, adolescents. The inclusion criteria were: symptoms and signs of TMD, questionnaire, clinical protocol examination. Clinical studies as well as cross-sectional studies, longitudinal and epidemiological researches were considered. The articles reviewed were grouped according to the diagnostic procedure used.

RESULTS

Out of the 37 articles selected, the Helkimo Clinical Dysfunction Index was used in 6 studies (16.22%), the CMI Index in 1 (2.70%), the RCD/TMD in 9 (24.33%) and a clinical protocol examination in 21 (56.75%) articles.

CONCLUSION

The review of the literature shows that clinical examination protocols without reproducible items and a measurable and reproducible classification into diagnostic subgroups was the type of investigation used in most of the cases. This ended in a multitude of different results depending on the criteria used and the method of data collection. Such methodological problems should be acknowledged in studies relating to TMD in order to obtain a reliable diagnostic procedure.

Absence of soluble CD14 in saliva of young patients with dental caries

It is generally accepted that salivary components are important for dental health, but to date no clear correlation has been found between one or more of these components and the outcome of dental caries. The identification of salivary factors preventing, favoring or signaling dental caries might help to control the disease. In the present study, western blotting analysis of whole saliva from 20 healthy caries-free children showed the presence of the soluble form of CD14, a bacterial pattern-recognition receptor for many bacterial components that is involved in the innate immune response. The identity of the protein was confirmed through N-terminal sequencing by Edman degradation, and by partial sequencing with mass spectrometry of tryptic peptides. Conversely, CD14 was completely absent in the saliva of 20 age-matched patients affected by two to eight carious lesions, but appeared in their saliva a few weeks after dental restoration. These results suggest that the absence of salivary soluble CD14 could represent an useful index of caries activity, and might be used to detect early carious lesions not visible by oral inspection.

TMJ internal derangement treatment in the growing patient: effect of functional appliance therapy on condyle and fossa relocation

New biodynamic factors seem to be involved on condyle and fossa remodeling and relocation, conditioning to mandibular growth direction, size and morphology. The understanding of the mechanism of action is critical for treatment of TMJ dysfunction in children and youths for those who hope to treat and retain the achieved correction during growth. The purpose of this article is to describe a specific, non-muscular hypothesis that explains the way the condyle modifies and the fossa remodels and relocates to achieved a new therapeutic, stable position, creating an anatomical base for long-term retention of the results. A case report of a young patient will be illustrated and available clinical data will be discussed.

The importance of early recognition of condylar fractures in children: a study of 2 cases

Maxillofacial fractures in general and mandibular fractures in particular seem to be less common in children than in adults; however, this finding might be influenced by the fact that condylar fractures in children are often undiagnosed and so the true incidence is likely to be higher than that reported in literature. Traumatic lesions of the temporomandibular joint often are overlooked as they can apparently occur with relatively little pain, few clinical signs, and insufficient reaction by the child to alert an adult to the seriousness of the injury. Only 1 to 2 years later, when growth disturbances appear, are they perceived as a problem, but by that time, the dysplastic growth pattern has stabilized and will continue over a period of years. The problem is frequently underestimated because of the difficulties inherent in pediatric pain assessment. The fact that the mechanisms of pain perception in children differ somewhat from adult pain perception mechanisms is one factor that can make pediatric pain assessment difficult. This paper outlines 2 case reports that draw attention to pain in children in the case of temporomandibular joint injury. The inability to assess pain adequately may lead to a delay in diagnosis and treatment and possibly result in future growth disturbances and facial asymmetries.

Scleroderma: a case report of possible cause of restricted movement of the temporomandibular joint with effects on facial development

Scleroderma is a rare abnormality in which fibrosis of the skin, subcutaneous tissues and muscle may occur. All forms of scleroderma are rare in childhood: the most common form is localized scleroderma. Localized scleroderma is often benign, but may cause significant deformity, if it occurs on the face or extends across joint surfaces. Structural changes may occur in the osseous tissue and result in mandibular joint restriction (pseudoankylosis) and facial and occlusal disharmonies. This article describes a case of facial linear scleroderma in a nine-year-old child and the treatment performed to minimize consequences on occlusion and face development. Available clinical data will be illustrated.

Biology and mechanics of facial asymmetries in children and youths

There is a need for further knowledge about the normal and abnormal growth patterns of bones and teeth. Genetic make-up, as well as various types of diseases and injuries such as trauma, inflammation, radiation and chemicals may affect skeletal and dental growth sites, thereby causing faulty growth. The degree of the subsequent deformity depends not only on the type, intensity, extent and chronology of the noxious agent, but also on the site and its particular involvement in growth activity. The knowledge of what happens to the stomatognathic system when some of its parts are altered is very important. Dentists are challenged to visualize the entire system in all its relationships: they must visualize the dynamics of how the system works. The relationship of the maxilla to the mandible and the mechanics of the stomatognathic system must be considered as a whole when considering the occlusion. The aim of this paper is to focus attention on the biologic basis of facial asymmetries and the functional reasons for their stabilization.

Post-traumatic TMJ internal derangement: impact on facial growth (findings in a pediatric age group)

Many clinical studies have shown how jaw injuries sustained during impact trauma to the face or mandible are the single most important cause of TMJ subsequent internal derangement. Proper function of the masticatory system is certainly the most influential variable in the TMJ remodelling; once a TMJ is internally deranged, adaptative or degenerative osteocartilagineous processes take place in the mandible, temporal bones and muscles. To evaluate relationships between consequences of post-traumatic TMJ internal derangement and disturbed facial skeleton growth in children, 25 patients (16 boys 9 girls), 14 year of age or younger, were selected out of a group of 74 and analysed. They all had been treated by physiotherapy and had undergone combined clinical and radiographic examination for five years. Symptoms included either individually or in various combination, pain, mechanical TMJ dysfunction and facial skeletal abnormalities, such as mandibular retrognathia and lower facial asymmetry manifested by chin deviation from the midline. Seventeen patients were found to have at least one abnormal and internally deranged TMJ on imaging studies; in twelve of them a mandibular asymmetry with chin deviation from the midline to the smaller or more degenerated TMJ was evident. Of the eight retrognathic patients, five were found to have bilateral TMJ derangement. In three patients both TMJ(s) were normal with normal facial structure. These data suggest that TMJ derangement in children may potentially have an impact on facial growth and lead to the development of retrognathia, with or without asymmetry, in many cases.

TMJ fractures in children and adolescents: treatment guidelines

TMJ fractures must be focused not only as a cause of direct damage to osseous structures, but also of future disturbances of dentofacial development. Treatment is aimed at restoring normal joint function, occlusion and symmetry. Any disturbance of condylar cartilage will result in alteration of mandibular development. The subsequent deformity of jaw and face will depend not only on the type, intensity extent and chronology of the noxious agent, but also on the particular time of occurrence and growth activity. Thus the effect will be more decided if the disturbance occurs early in life, during childhood, when growth activity is greater and mandibular shape and size have not been assumed yet. This report will include basic information on both prevention and first aid in these types of injuries. The correct application of these precautions immediately following the trauma should improve the short and long-term outcome. Information on diagnosis and treatment of lesions of the bone and soft tissues, which may coexist with dental trauma, a critical first step in the overall management of traumatized patients, will be given. Follow-up procedures of these patients will be illustrated. The guidelines described in this paper for the treatment of traumatic TMJ fractures in children and youths are based on our clinical experience. They are intended as an aid to practioners in the management and treatment of these traumas, by professional must always use professional judgement. There are no guarantees of any positive results associated with the use of these guidelines, although it is felt that time and proper treatment will maximize the chances of success.

[The role of saliva in maintaining oral health]

It is now established that saliva is important for the health of both soft and hard oral tissues. This article focuses on the role played by saliva in influencing oral structures: the most important factors related to it will be illustrated. The action of saliva and the multifunctional aspects of its components in both detrimental and beneficial effects on oral health are underlined.

TMJ fractures in children: importance of functional activation of muscles in preventing mandibular asymmetries and facial maldevelopment

Normal development of the mandible as well as some portions of the upper jaw and face are related to good function of the masticatory apparatus: the integrity and interaction of bony and soft-tissue structures may be highly disturbed by injury of the TM joints and result in facial and occlusal disharmonies. When the neuromuscular system is in harmony, the mandibular muscles collectively exert their effect on both position and movement of the jaw and the loading of forces on the TM joints is optimal and balanced. Unfortunately, TMJ fractures may alter completely this balance with loss of the support to the mandible against the temporal component and loss of the functional effect of the lateral pterygoid muscle on the mandible. Disturbances in the harmonious interplay of the masticatory muscles may result in facial alteration and asymmetries. If not treated, the dysplastic patterns of growth continues and worsens during the years.

Treatment of condylar fractures in children and youths: the clinical value of the occlusal plane orientation and correlation with facial development (case reports)

The relative position of the plane of occlusion to the cranial base determines the direction of the forces generated in the cranium during occlusal function. When the plane of occlusion is level and when the neuromuscular system is in harmony, the vectors of forces created by the closing muscles are directed to the central area of the cranium in a symmetrically balanced way. Unfortunately, TMJ fractures may alter completely this balance with loss of the support to the mandible against the temporal component and loss of the functional effect of the lateral pterygoid muscle on the mandible. Changes in orientation of the occlusal plane may result in facial alteration and asymmetries. In our experience, the restoration of a plan of occlusion orthogonally aligned to the forces of occlusion for a correct transfer of forces through the maxilla to the rest of the cranial bones is essential to allow proper face development. Two, quite similar cases of unilateral, dislocated condylar fracture treated in a different way, will be reported to demonstrate how this can occur. Available clinical data will be illustrated.

Condylar fractures treatment in children and youths: influence on function and face development (a five year retrospective analysis)

To evaluate relationship between consequences of TMJ fractures in children and disturbed facial skeleton growth, 46 children (18 girls, 28 boys), who were 14 years of age or younger and had undergone combined clinical and radiolographic examination for five years were retrospectively analyzed. Imaging studies were performed to investigate symptoms that included, either individually or in various combinations, pain, mechanical TMJ disfunction and facial skeleton abnormalities. The children were divided into two groups: those belonging to the former had been treated by functional orthopedic method alone, while the others had just been treated by physiotherapy. Both TMJs were normal in the patients treated functionally and they all showed normal facial structure, while different types of alterations (ranging from inflammatory to mechanical and structural ones) were observed in the others. We concluded that therapeutic procedures adopted after TMJ fractures in children are essential in minimizing consequences on occlusion and facial development.

Ankyloglossia and its influence on maxillary and mandibular development. (A seven year follow-up case report)

The consequences of not treating improper tongue function may be very important as this organ can influence face development and dental therapy. The role of the tongue in the development of the skeletal structures of the face has been considered in different perspectives over the years. For some, the tongue adapts to the "tongue box," for others the "tongue box" has been created and stabilized by the morphogenetic action of the tongue during development and growth. A case of ankyloglossia treated with lingual frenectomy and followed clinically and radiologically for seven years is reported. Spontaneous upper arch expansion occurred and therefore orthodontic treatment following surgical intervention was unnecessary.

The marginal seal of various restorative materials in primary molars

The use of resin composite restorations in posterior teeth has become an accepted clinical procedure. Microleakage at the posterior composite/tooth interface is a major problem. The in vitro quality of the marginal seal was tested in eighty teeth extracted for orthodontic reasons using a glass-ionomer cement reinforced with amalgam, two light self-curing glass-ionomer cements and a compomer. All the teeth were subjected to thermocycling to simulate clinical situation. Compomers showed the best mechanical and esthetic properties combined with a good marginal seal.

Apexification in the endodontic treatment of pulpless immature teeth: indications and requirements

The problems of performing the apexification technique, the indications and requirements for apexification are discussed. A case report is shown as an example.

[Dilacerations: the clinical, diagnostic and therapeutic problems]

The authors consider the problems connected with diagnosis and prognosis of dilaceration. Case reports of varying prognosis importance are given as examples.

A SEM investigation on pulpal-periodontal connections in primary teeth

The ideal goal of pulpotomy procedure in a primary tooth is to maintain space length, preserve masticatory function, and remove infection and chronic inflammation from the oral cavity. From a population of 150 patients between the ages of four and seven years, we collected a sample of 30 primary (nine maxillary and twenty-one mandibular) molars used in this investigation. The aim was to observe the presence of accessory channels on the pulpal floor; they were found in twenty-one of the thirty teeth examined. The scanning electron microscope proved to be an excellent means of evaluating the pulpal floor, where failure of pulp treatment often has its cause.

[The illustration of a health education program directed at children in the 1st and 2d elementary grades. Preliminary notes]

The paper describes an experimental health education plan for children in the first and second years of primary school. The plan focuses on nutritional and dietary aspects and the correlations between diet, oral hygiene and dental health.

[Space maintenance: indications and limits]

Space maintainers are very important in the prevention of malocclusions. Their indications and limits are described.

[The long-term clinical follow-up of a group of patients subjected to surgical intervention for the extraction of supernumerary impacted teeth]

A long-term clinical control carried out on 34 patients subjected to surgery for the removal of included extra teeth at the Odontostomatological Clinic of the University of Turin is reported. The patients had mostly been treated at ages between 7 and 12 followed up between 4 and 8 years later. Long-term damage, from an orthodontic viewpoint also, is not frequent and when present is not of particular importance. The operation, carried out early and with correct technique, does not cause particular damage to teeth or adjacent bone or nerve structures and does not create psychological traumas for the young patient. It is therefore advisable for the surgical removal of extra included teeth which are causing damage to adjacent structures to be programmed as early as possible so as to permit maximum functional and aesthetic recovery and to minimise to the utmost the consequences of the operation.

[Comparison of the P.C.F. orthodontic device and Bassani's orthodontic plate in the correction of malocclusion class II, division II]

We have described and compared the P.C.F. of protusiva and the plaque of Bassani in the correction of the II class and II division by mentioning the advantages of the first one.

[Clinico-surgical evaluation of supernumerary dental anomalies]

The pathology of extra teeth is evaluated on the basis of clinico-operative statistics for the years 1981-1985 and comprising 88 patients for a total of 115 treated teeth. The data obtained confirm the higher frequency of extra teeth in male patients. The most frequent site is easily the frontal sector of the upper arch. At that level, especially in males, two more or less symmetrical extra teeth are not infrequent. These data are in substantial agreement with the epidemiological data reported in the literature. Extra teeth are usually treated by surgical removal followed by orthodontic treatment to correct malformations caused by them and to recover the functional and aesthetic role of the upper front teeth.

[Recent findings on amelogenesis and mineralization of dental enamel]

The latest thinking reported by the literature on the amelogenesis and enamel mineralisation process has been synthesised.