Treatment options of periapical cysts of deciduous teeth: report of a case and systematic review of the literature

AIM

Periapical cysts of primary teeth are pathologic entities which are seldom encountered in the clinical practice. Most frequently, these lesions arise in correspondence with primary teeth presenting previous pulp therapy, severe carious lesions, or a history of previous trauma. The aim of the present study is to systematically review the treatment modalities of periapical cysts of the deciduous, along with the reporting of a clinical case.

MATERIALS

A case of periapical cyst treated with marsupialization occurring in an 11-year-old patient is described. A literature search was devised to retrieve studies reporting the treatment of periapical cysts, and involved papers published in the Cochrane Oral Health Group specialist trials, MEDLINE via PubMed, and EMBASE up to March 2023. A total of 39 articles were retrieved. Following title and abstract analysis, 27 articles were selected for full-text analysis, with the final inclusion of 24 articles.

CONCLUSION

Periapical cysts of primary teeth present an overall good prognosis irrespective of the treatment option adopted. The performance of a prompt diagnosis appears of utmost importance, as the extraction of the primary teeth involved implies the management of the residual space for the correct positioning of the corresponding permanent teeth.

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.

Parental attitude toward children's oral health during COVID-19 pandemic: a cross-sectional study in Italy

AIM

During the COVID-19 pandemic, restrictive rules were imposed around the world to limit the spread of the virus. The present study aims to investigate how the pandemic and the consequent restrictions have affected the lives and oral health of Italian families with children aged 0-14 years.

MATERIALS

Through a questionnaire distributed online from December 2020 to March 2021 the following aspects were investigated: family income during the pandemic, fear of the pandemic, dietary habits, perceived risk of infection in a dental practice and perceived children oral health status during the pandemic.

CONCLUSION

The pandemic has not drastically changed the socio-economic conditions, the dietary habits and the oral health condition of most Italian children. Nevertheless, the pandemic seems to have highlighted significant macro-regional differences regarding the satisfaction with the response of the regional health services to the pandemic. The continuation of the pandemic and the possible socio-economic effects could favour new changes in lifestyles, oral health and discrepancies regarding health care access, which deserve to be the subject of further investigation.

Predisposing factors involved in the aetiology of Molar Incisor Hypomineralization: a case-control study

AIM

The aetiology of Molar Incisor Hypomineralisation (MIH) is currently unclear. Over time, several aetiological hypotheses have come forward, including pre- and perinatal medical problems and postnatal illness. The aim of this case-control study is the identification of possible predisposing factors involved in MIH aetiology.

METHODS

Methods Study Design: By hypothesising the probability of at least one predisposing factor present 2.5 times more in MIH cases than in controls, with an estimated prevalence of MIH patients requiring therapy equal to 30%, at a unilateral alpha level of 5% and a power of 80%, 63 couples of subjects are needed with an allocation ratio of 1:1; individual matching for age and gender was carried out. After clinical examination, 78 children with MIH (EAPD criteria) were recruited (mean age 9.36 years). An anamnestic form filled-in by a parent was used to collect data on possible predisposing factors including demographic characteristics, pregnancy, birth, childhood medical illness and medications' intake.

STATISTICS

One-tail McNemar chi square test was used to evaluate the significance of the association between predisposing factor and MIH; odds ratio and 95% confidence intervals were computed.

CONCLUSION

A multifactorial aetiology may be advocated for MIH development; in particular, further investigations are required to confirm and clarify the role of genetic factors.

Oral Health Preventive Program in Patients with Autism Spectrum Disorder

The aim of the study was to evaluate clinical hygienic parameters, patient collaboration, and dental habits in patients with ASD (autism spectrum disorder) before and after a tailored prevention program. A total of 100 patients (78 males and 22 females, mean age 8 ± 0.7 years old) was recruited, with ages ranging from 7 to 16 years old, and diagnoses of ASD. We evaluated the plaque index (IP), gingival index (IG), the dmft/DMFT, the frequency of tooth brushing, and the frequency of snacks for each patient. Patient behaviour was evaluated with the Frankl scale, and each patient was individually reassessed after five visits from the first one by the same operator. The t test was used to compare the parameters before and after the inclusion in the dedicated dental pathway. From T1 to T2 we found a significant improvement of the IP (p < 0.001), IG (p < 0.001), and the frequency of tooth brushing (p < 0.001). Concerning the frequency of snacks and the parameter dmft/DMFT, the differences in the observed averages were not significant (p > 0.05). The difference in collaboration between T1 and T2 evaluated by the Frankl scale was statistically significant (p < 0.001). It was found that the prevention program allowed a significant improvement in both clinical parameters and patient behaviour. The personalized digital supports can have a key role for success in familiarization and desensitization processes of patients affected by ASD, leading an increase in their collaboration.

One-Year Clinical Performance of Activa™ Bioactive-Restorative Composite in Primary Molars

Restorative procedures for caries affecting primary molars are a daily challenge for pediatric dentistry, and one of the main factors influencing the results of these restorative procedures is the choice of dental material used: bioactive materials were recently introduced, combining the strength of composites and the benefits of glass ionomers. The present study’s objective is to clinically evaluate the aesthetic, functional and biological properties of Activa™ Bioactive composite in approximal and occlusal carious lesions for 1 year using the FDI criteria for evaluating direct dental restorations. Forty-five children with occlusal or approximal caries in first or second primary molars were included in the study: the cavities were then randomized to be restored with either Activa BioActive or SDR Bulk-fill and evaluated over time according to Federation Dentaire Internationale (FDI) criteria. Results showed that Activa BioActive composite has similar performance over time compared to Bulk-fill composite, for both functional and aesthetic properties. Thus, within the limitations of this study, including the short follow-up period, it can be concluded that bioactive materials might be the material of choice to restore primary molars. A longer follow-up period is desirable to confirm these findings.

Development and validation of the Italian version of the 'Parental Perceptions of Silver Diamine Fluoride Dental Color Changes' questionnaire

BACKGROUND

The original English version of the questionnaire 'Parental Perceptions of SDF Dental Color Changes' was used among parents in the New York City metropolitan area.

AIM

To develop an Italian version of the questionnaire and to assess its validity.

DESIGN

The construct validity and the internal consistency were assessed in a convenience sample of Italian parents of 251 young healthy children seen at the University of Bologna and Pisa. Forward-backward technique was carried out for the translation of the questionnaire. Kaiser-Meyer-Olkin measure of sampling adequacy was equal to 0.91, and Bartlett's test of sphericity was statistically significant (P = .001), so the items were treated with the exploratory principal component analysis (PCA).

RESULTS

Cronbach's alpha ranged from 0.69 to 0.95. PCA demonstrates that all the items load on the first component (87% of explained variance). All the Spearman correlation coefficients between each subscale (positive scenario: 0.563; negative scenario: 0.665) and the general acceptability showed significant correlation (P = .0001). Different age, educational level, and family income of the parents did not produce statistically significant different scores on any of the subscales (P > .05; Mann-Whitney test).

CONCLUSION

The Italian version of the questionnaire showed high internal consistency and construct validity and was appropriate to be used in an Italian population.

Oral health status of Italian children with Autism Spectrum Disorder

AIM

Autism Spectrum Disorder (ASD) is characterised by communication deficits and repetitive unusual behaviours. The behaviour guidance of these children represents a challenge for the dental team. The aim of the study was to evaluate the oral health status in a group of Italian children with ASD.

MATERIALS AND METHODS

Study Design: Sixty-four Italian children with ASD and 64 controls were included. Data were collected by means of questionnaires and clinical examinations.

RESULTS

Dental trauma (p=0.007), bruxism (p=0.001) and biting objects habit (p=0.021) were more frequent in the study group; fluoride exposure was lower (p=0.001) (chi-square test). The mean plaque index was 1.48 ±0.75 in the study group and 0.81±0.56 in the control group (p=0.001; Mann-Whitney U test); the mean dmft/DMFT was 3.00 ±1.2 and 2.3 ±1.8 in the study group and 1.8 ±1.1 and 1.0 ±1.1 in the control group (p<0.001; Mann-Whitney U test). Anterior open bite was more frequent in the study group (p=0.013; Chi-square test). No significant differences were found for enamel defects, molar relationship, posterior crossbite and deep bite. Significantly more children with ASD showed a negative behaviour (80% vs 35%: p =0.001; Chi-square test). CONCLUSION Children with ASD have a poorer oral health status than healthy children. The early establishment of a home dental hygiene should be encouraged.

Craniofacial and occlusal features of individuals with Turner Syndrome: A cephalometric study

Craniofacial features of 18 individuals with Turner Syndrome (TS) were compared with age and gender matched healthy individuals. Dental history, panoramic radiograph, dental casts and cephalometric measurements were assessed. The dental casts analysis showed a significantly higher PH/PW ratio in individuals with TS under GH therapy compared to healthy individuals (p=0.004; paired t-test). This data objectively supported the definition of a high-narrow palate. The ANB angle and the Wits index were similar in the two group, showing a skeletal class I malocclusion. The vertical characteristics did not differ between the two groups, showing a mesofacial growth pattern. Our results showed similar cephalometric characteristics in individuals with TS treated with GH and healthy controls.

Impact of self-ligating orthodontic brackets on dental biofilm and periodontal pathogens in adolescents

The aim of the present prospective study was to evaluate periodontal health and subgingival microbiological alterations in adolescents treated with fixed self ligating orthodontic brackets in comparison to subject without any orthodontic appliance. A total of 40 adolescents (23 females and 17 males; mean age: 13.2 ± 3.2 years) were included: 30 subjects with self ligating brackets (test group) and 10 patients without orthodontic appliances (control group). Follow-ups were as follows: T1 (1 month), T2 (3 months), T3 (6 months) from the beginning of the orthodontic therapy. Clinical parameters (plaque index, gingival index and clinical attachment level) were measured for every patient and a microbiological analysis was performed. Mann Whitney test was performed to evaluate clinical parameters between test and control group and Friedman test and Fisher test were adopted to evaluate intra group differences at different follow-ups. Student T-test was performed to compare clinical attachment level between the two groups. Significance level was set at p<0.05. No periodontal pathogens and no clinical attachment loss were found in the whole sample. A slightly higher plaque index and gingival inflammation were recorded in the test group in comparison to the controls.

Oral manifestations in paediatric patients with hepatobiliary diseases: a review

It is well known that greenish pigmentation of the teeth is seen in children following remission of severe jaundice and clinical and serum bilirubin, a degradation product of haemoglobin, may be permanently trapped in forming dental hard tissues causing discolouration and enamel and dentine hypoplasia. Neonatal jaundice is the most common cause of hyperbilirubinemia and pigmentation of the deciduous teeth is the consequence of this condition. Various hepatobiliary pathologies may have a clinical finding in the oral cavity; furthermore, oral manifestations of hepatic pathologies are not just limited to the pigmentation of the deciduous teeth but also the permanent dentition and the mucous membranes can be affected.

Effects of audiovisual distraction in children with Down syndrome during dental restorations: a randomised clinical trial

AIM

To evaluate the effect of audiovisual distraction on the dental chairside behaviour of children with Down syndrome (DS) during dental restorations and its influence on the operator stress and the duration of the appointment.

MATERIALS AND METHODS

Study design: This randomised controlled trial included 48 children with DS requiring dental restorations. The study group was treated while wearing video eyeglasses, the control group with conventional behaviour management techniques. The child behaviour was evaluated using the revised Face, Leg, Activity, Cry, Consolability scale (r-FLACC) and the Frankl scale. The operator stress was evaluated using a VAS scale and the duration of the appointment was recorded.

RESULTS

In the study group 64% of the children refused to wear the video eyeglasses during the whole duration of the dental treatment, the median r-FLACC score was significantly higher (p= 0.01552; Mann Whitney U test) and significantly more children showed a negative behaviour (68%vs 30%: p =0.011; Chi-square test).

CONCLUSION

Audiovisual distraction using video eyeglasses is not useful in managing the dental chairside behaviour of children with DS.

Application of IBM Watson to Support Literature Reviews: A Preliminary Experience in Restorative Dentistry

Literature reviews are crucial in the choice of the best personalized material type and restauration type in restorative dentistry. We developed an IBM-Watson based system to support literature search for restorative dentistry, and compared its results to a literature search performed by a trained professional. We found that our system could assist the researcher in performing a literature review, but the grounding semantic model needs to be refined in order to provide more extensive results.

Simplified basic periodontal examination in adolescents before and after a tailored treatment dental program

BACKGROUND

The aim of this study was to evaluate the effectiveness of a tailored treatment dental program in adolescents in combination with a professional oral hygiene.

METHODS

Ninety-three adolescents (43 males and 50 females; mean age: 14±1.1 years) were included in this study and Plaque Index (PI) and simplified basic periodontal examination (BPE) were measured for each patient at T0 (screening) and at T1 (after 30 days). At T0 a professional dental hygiene treatment was performed and a tailored oral hygiene instruction protocol was adopted. All data were statistically analyzed using Student's t-test and the level of significance was set at P<0.05.

RESULTS

A statistically significant decrease of PI was found from T0 (2.3±0.6) to T1 (0.9±0.3) (P<0.05). Moreover, also a significant decrease (P<0.05) of BPE was observed after 30 days. Girls exhibited a higher significant BPE index improvement (0.47±0.2) in comparison to boys (0.3±0.1) at the end of the follow-up (P<0.05).

CONCLUSIONS

A tailored oral hygiene instruction protocol has resulted in a decreased plaque accumulation and gingival inflammation.

Impact of Sjögren's syndrome on oral health and quality of life: an observational cross-sectional study

Sjögren's Syndrome is a complex disease, due to an autoimmune physiopathology, that strongly impacts both patients' primary needs (nutrition and speaking), and patients' relationship life related factors (psychological health and quality of life). In Literature, few studies had investigated oral health status in Sjögren's syndrome and its impact on patients' quality of life, so the aim of this study was to analyse that issue. 30 patients were enrolled, within the Department of Rheumatology (University of Pisa), both first diagnosis patients' and both patients who had been diagnosed with Sjögren's syndrome in the past. For each patient, a medical record was filled out together with the compilation of the Oral Health Impact Profile questionnaire. Then, during a specialistic rheumatologic visit, Sjögren's Syndrome Disease Damage Index Score (SSDDI) was determined. Results showed a direct proportion between years from diagnosis and severity of oral health issues. It was found that these issues were related to soft tissue damage and an overall worse, reported quality of life and psychological health.

Use of extra-oral scanner for the study of arch form in a sample of Italian adolescents with ideal occlusion

The aim of this study was to evaluate the shape and the average size of the maxillary and mandibular arch in an Italian adolescents' sample with correct occlusion, using the digital technology. The study sample was composed, after the use of an extra-oral scanner and after the application of inclusion and exclusion criteria, by the digitized dental casts of 79 Italian adolescents (39 females and 40 males), aged 14±1 years, with correct occlusion. On each model, both upper and lower, the reference points of the dental arches (FA), of the alveolar bone (WALA ridges) and of the incisal edge of the central incisors were identified. With these points, using a software, fourteen parameters were evaluated for each cast: basal and dental intermolar and inter-canine width, basal and dental molar and canine depth, basal and dental molar and canine ratio, overjet, overbite. Finally, the shape of the arches was assessed, dividing it into ovoid, triangular or square. Chi-square test and Student's T-test for each parameter were adopted with a p<0,05 significance level. The results showed that the ovoid form was the most frequent, followed by the triangular one for the upper arch and by the rectangular one for the lower arch. On the canine level, both upper and lower, both for dental and for basal references, the triangular shape showed the lowest width and ratio values and the highest depth values in comparison with the other two groups. The square one showed the opposite situation, and the ovoid one presented in the intermediate value. On the molar level the trend is quite similar to the canine one. The results obtained maybe suggest that on a significant percentage of the patients of the sample is expected to use a preformed ovoid arch wire, and the data found could be useful to study the adequacy of the arch wires currently on the market or to design new ones. .

The dentist's role in diagnosis and treatment of obstructive sleep apnea syndrome: a literature review

The purpose of this work was to present a review of the literature concerning obstructive sleep apnea syndrome, and the role of the dentist in this pathology, both to identify elements useful for a good diagnosis and to apply the available therapeutic strategies. In literature there is no unanimous opinion on the treatment of OSAS. The multidisciplinary approach is necessary, creating teams made up of dentists, otolaryngologists and medical experts in sleep disorders, in order to develop a cooperation-based treatment plan for the disease. In this review, the importance of early diagnosis, orthodontic therapy in order to restore normal function is underlined, since OSAS is linked to a high risk of hypertension, cardiovascular diseases, daytime sleepiness, domestic and work accidents, with consequent deterioration of the quality of life.

State-of-the-art on MIH. Part. 1 Definition and aepidemiology

Molar incisor hypomineralization (MIH) is one of the most pressing issues in paediatric dentistry. It is a qualitative enamel defect of systemic origin that affects at least one first permanent molar and can also be associated with permanent incisors. However, the same defects have also been observed on primary molars and other permanent teeth. Hypomineralised enamel has less distinct prisms edges and crystals and the interprismatic space is more marked. Children with MIH undergo dental treatment nearly 10 times more than unaffected children. Preventive treatment following the diagnosis of MIH should take into account patient's age and collaboration, patient's caries risk, type and extension of demarcated lesions and hypersensitivity. Risk assessment and early diagnosis are key factors to an effective and conservative treatment.

[Treatment of varices of the lower extremities during pregnancy]

The authors studied 500 pregnant women suffering from varicose pathology, they had the opportunity to observe in the years 1979, 1980, 1981. The range of age hit was between 18 and 46 years. A higher prevalence occurred in pluriparae (82.8%) in respect of primiparae (17.2%). As to the type of varicose pathology observed, 40% showed diffused teleangectasies; 30% essential varices weighing on small and large saphena; 20% associations of the two former types; 6.4% post-phlebitic syndromes with insufficiency of the deep communicating vessels, and 3.6% pudendae venous ectasies. The medical treatment, aiming to avoid venous stasis and rise in weight, was effected in 94% of cases: in 40% of cases a choice was also done for a pharmacologic treatment with synthetic glucofuranoside compounds, interrupted in 3.5% of the patients for the arising of more or less various symptoms of gastric intolerance. In the remaining 6% of cases, it was essential to adopt the surgical treatment, always performed after the 4th month of pregnancy and in epidural anaesthesia. As to the surgical indications, the authors remarked the higher frequency for the post-phlebitic syndromes with incompetence of the deep communicating vessels and serious tropic alterations, affecting in the rate of 40% the operated patients and 2.4% the varicose pathology they aggregately had the opportunity to observe. The other indications were the surface thrombophlebites (33.4%), varices with remarkable subjective troubles and cutaneous alterations of average and serious importance (6,6%) and larger caliper varices in pluriparae (20%). The authors, in the several middle and long term follow-up, never recorded any relapses in the patients surgically treated.

[Surgical treatment of superficial thrombophlebitis]

A series of 38 cases of superficial thrombosis occurring during the period 1-12-1979 to 1-12-1981 was examined. The series included 10 cases of iatrogenic thrombophlebitis of the upper limbs, one case of Mondor's thrombophlebitis, and 27 cases of superficial thrombophlebitis of the lower limbs in subjects with essential varices of the legs. A particular predilection for women and for advanced age was noted, as well as particular frequency in the area of distribution of the Great versus and Small Saphenous Vein, and a sharp prevalence of segments below the knee as compared with the thigh. Treatment was always surgical, mainly directed to preventing any thromboembolic complications, shortening the healing times and eliminating the Varicose Disease, which is well known to constitute the basic aetiopathogenetic moment of superficial thrombophlebitis. In all cases where it was possible to follow this schedule the result was excellent, and no effects on the deep venous system or thromboembolic complications occurred. The 5 patients treated with simple ligature of the Saphenous Vein according to Cross had a recurrence of varicose disease in a period varying from 6 months to 1 years; two of them also had a relapse of the thrombophlebitic process.

[Surgical treatment of inguinal hernias, using the McVay technic]

The Authors operated on a series of 173 patients with direct, indirect or relapsing hernia and crural hernia by Mc Vay's surgical procedure, of which they outlined the salient aspects. The study led to some statistical considerations with regard to the rate and time of appearance of the various types of subject hernia in the two sexes and also evidenced two cases of post-operative complication very probably due to the technique used. The follow-up evidenced only one case of relapse. Despite the small number of cases and the restricted nature of the follow-up, which varied from two years to six months, the Authors consider that Mc Vay's plastic surgery constitutes a highly reliable technique for treatment of both primitive and relapsing hernias. Particular practical interest attaches to the observation that 90% of patients were operated under epidural anaesthesia, which, given parity of results from the surgical standpoint, involves a considerably lower anaesthesiological risk than other types of anaesthesia.