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.

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. .

Facial growth and morphology of cleft lip and/or palate patients after corrective surgery according to P.I.S.A. technique

Cleft lip and/or palate patients (CLP) undergo corrective surgery that can affect facial growth. The aim of this study was to analyze facial growth and maxillary development of CLP subjects after surgery according to P.I.S.A. technique (Peri osteoplasty Improves Symmetry and Aesthetic). Cephalometric tracings of 55 patients were performed, thirty-three of which belonged to the test group, while the lasting twenty subjects were part of the control group. The test group was formed by cleft lip and/or palate patients after surgical repair according to P.I.S.A. technique. The control group included patients unaffected by this malformation, with an Angle's first class, selected from the Michigan Growth Study sample. Facial growth and upper maxilla development analysis was carried out by comparing the data obtained from the cephalometric traces of cleft patients who performed an early surgery, with the values of the same parameters measured in non-cleft subjects, providing the normal values. The results of this study showed, in the test group, a maxillary and mandibular bi-retrusion, a more negative facial convexity, the absence of a marked discrepancy in the skeletal relationships, a slight tendency towards hyper-divergence. .

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.

Micro- and Nanopatterned Silk Substrates for Antifouling Applications

A major problem of current biomedical implants is the bacterial colonization and subsequent biofilm formation, which seriously affects their functioning and can lead to serious post-surgical complications. Intensive efforts have been directed toward the development of novel technologies that can prevent bacterial colonization while requiring minimal antibiotics doses. To this end, biocompatible materials with intrinsic antifouling capabilities are in high demand. Silk fibroin, widely employed in biotechnology, represents an interesting candidate. Here, we employ a soft-lithography approach to realize micro- and nanostructured silk fibroin substrates, with different geometries. We show that patterned silk film substrates support mammal cells (HEK-293) adhesion and proliferation, and at the same time, they intrinsically display remarkable antifouling properties. We employ Escherichia coli as representative Gram-negative bacteria, and we observe an up to 66% decrease in the number of bacteria that adhere to patterned silk surfaces as compared to control, flat silk samples. The mechanism leading to the inhibition of biofilm formation critically depends on the microstructure geometry, involving both a steric and a hydrophobic effect. We also couple silk fibroin patterned films to a biocompatible, optically responsive organic semiconductor, and we verify that the antifouling properties are very well preserved. The technology described here is of interest for the next generation of biomedical implants, involving the use of materials with enhanced antibacterial capability, easy processability, high biocompatibility, and prompt availability for coupling with photoimaging and photodetection techniques.

Allergic manifestations to local anaesthetic agents for dental anaesthesia in children: a review and proposal of a new algorithm

AIM

The purpose of this review was to evaluate allergic manifestations to dental local anaesthetic (LA) in children and to propose an algorithm for the diagnosis of LA allergy, in order to minimise the number of children who are wrongly categorised as allergic.

MATERIALS AND METHODS

A comprehensive literature survey was performed on LA allergy in children before a dental treatment. In proposing a diagnostic algorithm, evidences from literature have been integrated with personal experience.

RESULTS

Data from literature showed that overall less than 1% of young patients tested for suspected LA have a positive subcutaneous test and have a positive diagnosis. A complete diagnostic procedure should include: clinical history reported by patients, objective medical records, results of skin tests and provocation test with the suspected drug. Patients with negative skin tests should perform a subcutaneous challenge, while patients with a positive skin test should be tested for a different unrelated LA.

CONCLUSION

Allergy to LA is a rare condition. A complete diagnostic algorithm will allow to identify paediatric patients correctly.

Longitudinal study on the effect of oral hygiene measures on the salivary count of microbial species with cariogenic potential

The effect of oral hygiene education measures and professional tooth cleaning on the salivary levels of microbial species with high cariogenic potential (i.e. Streptococcus mutans, Lactobacillus spp. and Candida albicans) was evaluated at different time points. At time 0, high salivary carriage rates were recorded in the study group (n=30). Fifty percent of the subjects harbored all three species in their saliva, 27% harbored 2 species, and 23% only one species. At 3 months after oral hygiene measures, a statistically significant reduction was observed in salivary count of S. mutans and Lactobacillus spp. The percentage of subjects harboring all three species was also highly reduced, along with an overall improvement of clinical and risk factors parameters. At 8 months after oral hygiene measures, S. mutans and Lactobacillus spp. load was still statistically lower than that recorded at time 0, although an increment in bacterial load and a partial worsening of clinical and risk factors parameters were observed. S. mutans count in saliva inversely correlated with salivary pH, while it positively correlated with C. albicans salivary levels. The results obtained suggest that strengthening of the motivation and administration of oral hygiene instructions and professional tooth cleaning every 6-8 months, might be necessary to control salivary levels of cariogenic species.

Breast Cancer Screening in an Urban Population in Northern Italy

A mammographic and clinical screening for breast cancer started in June 1987 in the Health District of Brescia, Northern Italy, including the town and 23 surrounding municipalities. This paper describes the organization and the results of the first 12 months of screening. Of 7791 invited women aged 50–60 years, 5217 (67 %>) agreed to participate. There was a trend for response rates to decline with increasing age and education. Of the 5217 women examined, 66 (1.3%) were referred for biopsy and 64 (1.2%) underwent this procedure. A histologically confirmed malignancy was found in 42 women, corresponding to a prevalence of 8.1/1000. Positive predictive value of the screening was 65.6 %. Among the 42 breast cancers, 4.8% were carcinoma in situ and 42.9 % invasive tumors up to 10 mm in size. According to the p-TNM classification, 92.9 % of all cancers were either TIS or in stage T1, 4.8 % were in T2 and one tumor was classified in T4. Lymph node involvement was assessed in 41 cases, and 71.4% of all cancers detected by screening were negative for lymph node metastasis. In comparison, the classification of tumors found in women of the same age group and living in Brescia, histologically diagnosed in the urban hospitals during 1986, one year before the beginning of the screening, was as follows: 7.1 % carcinoma in situ, and 16.7 % invasive tumors up to 10 mm in size. 38.1%, 2.4% and 2.4% of all tumors were in stages T2, T3 and T4 respectively.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

The process of mineralisation in the development of human tooth

Tooth development and mineralisation are processes that derive from different tissues interactions, in particular ectodermal and mesenchymal layers. These interactions are responsible for the formation of unique structures with a particular chemical composition. Despite differences, mineralised tissues are similar and they derive by highly concerted extracellular processes that involve matrix proteins, proteases, and mineral ion fluxes that collectively regulate the nucleation, growth and organisation of forming mineral crystals. This review aims at explaining mineralisation, its stages and when damage occurs and alters the hard tissues structure.

Craniofacial morphology in pediatric patients with Prader-Willi syndrome: a retrospective study

OBJECTIVE

To investigate craniofacial characteristics in pediatric patients with Prader-Willi syndrome (PWS).

SETTING AND SAMPLE POPULATION

A retrospective sample of 20 consecutive patients with PWS who had lateral and antero-posterior (AP) cephalograms (14 males and six females; average age 10.2 ± 3 years) was compared to 20 controls matched for age and sex (14 males and six females; average age 10.5 ± 3.7 years).

MATERIALS AND METHODS

Cephalometric skeletal measurements were performed twice at a 1-week interval by one calibrated operator, and random error was calculated using Dahlberg's formula. Mean values and standard deviations were computed for all variables. Student's t-test for independent samples was used to determine significant differences between PWS and controls. The level of significance was set at p < 0.05.

RESULTS

Cephalometric values for the length of the maxilla (p < 0.01), mandibular length (p < 0.05) at both the ramus (p < 0.05) and the mandibular body (p < 0.01), and posterior and anterior facial height (p < 0.01) were significantly lower in patients with PWS compared to controls. The AP cephalometric analysis revealed a significant reduction (p < 0.01) in maxillary skeletal width, mandibular skeletal width, and interzygomatic distance.

CONCLUSIONS

Pediatric patients with PWS seem to have a general reduction in certain craniofacial skeletal parameters (i.e., maxillary and mandibular length) compared to controls, but this study did not assess the overall craniofacial characteristics.

Investigation of periodontal status in type 1 diabetic adolescents

AIM

The purpose of this study was to evaluate the effects of type 1 diabetes and the possible role of metabolic control on the periodontal status of diabetic adolescents.

MATERIALS AND METHODS

Three groups of 40 patients each were examined: diabetic subjects with a good metabolic control (well controlled WC) (glycated haemoglobin HbA1c ≤ 7%) (20 males and 20 females; mean age: 14.1 ± 1.5 years); diabetic subjects with poor metabolic control (poorly controlled PC) (glycated haemoglobin HbA1c> 7%) (20 males and 20 females; mean age: 14.5 ± 1.3 years); and patients in good general health, which constituted the control group (20 males and 20 females; mean age: 14.1 ± 1.2 years). For each subject, a periodontal evaluation was performed and the following parameters were assessed: Plaque Index (PI), Gingival Index (GI), Bleeding on probing (BOP), Probing Depth (PD), Clinical Attachment Level (CAL). Chi-square was used to compare categorical variables. Kruskal-Wallis one-way ANOVA by ranks was used to compare the quantitative variables (GBI, PD) among the 3 groups. Post-hoc comparison between pairs of groups was assessed by Wilcoxon's rank sum test, with a downward adjustment of the alpha level to compensate for multiple comparisons.

RESULTS

The levels of PI in WC subjects (1.9 ± 0.8) and in PC subjects (2.1 ± 0.6) were significantly higher compared to healthy subjects in the control group (0.8 ± 0.7) (p <0.0001). Similarly, the GI in both PC (1.9 ± 0.8) and WC subjetcs (1.7 ± 0.9) was significantly higher (p <0.05) compared to controls (0.9 ± 0.8). GBI in the PC (60.2 ± 23.6%) and the WC (57.4 ± 22.5%) groups was significantly higher compared to healthy subjects (35.9 ± 18.7%) (p <0.05). The PD parameter was found significantly higher (p <0.05) in the PC group (26.7 ± 12.6) and WC group (23.5 ± 11.3%) compared with controls (8.3 ± 6.2%). Regarding the CAL, no significant differences were found between the groups (p> 0.05). In addition, the comparisons between groups PC and WC were not statistically significant (p> 0.05).

CONCLUSIONS

Adolescents affected with type 1 diabetes show a higher level of bacterial plaque, gingival inflammation with bleeding on probing and probing depth, compared to healthy subjects. There were no significant changes with regard to the accumulation of plaque and periodontal status among diabetic patients both with good control and with poor metabolic control.

Photo-Physical Behaviour of CdSe Nanocrystals/Bis(dithiocarbamate) Linker Multilayered Hybrid Systems

Multilayered films composed by CdSe Nanocrystals (NCs) interlinked by ethylene-1,2-bis(dithiocarbamate) or adipate anions were prepared on ITO glass via layer-by-layer alternation. The films were analyzed by UV-vis, TEM, Photoluminescence (PL) emission and Pump-Probe spectroscopy. While the PL emission of the two samples present no differences, femtosecond Pump-probe experiments reveal an higher charge generation efficiency in bis(dithiocarbamate) based films than in dicarboxylate ones.

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

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

Association between obesity and periodontal disease in children

AIM

The objective of this study was to analyse the relationship between obesity and periodontal disease in children. The null hypothesis is that obese and normal weight children show no different degree of periodontal status.

MATERIALS AND METHODS

The sample for this case control study consisted of 20 males and 24 females with a mean age of 9.43±2.05 years old and mean body mass index standard deviation score (BMI-SDS) of 2.16±0.37 in the test group, and 33 males and 26 females with a mean age of 9.67±1.46 years old and BMI-SDS of 0.22±1.79 in the control group. The periodontal status was assessed using plaque accumulation, bleeding on probing (BOP) index, probing depth (PD) and clinical attachment level (CAL).

RESULTS

The test group showed higher plaque deposits and BOP and the difference between the two groups was statistically significant (p< 0.05). No significant difference between the two groups was found regarding the loss of clinical attachment, though it was worse in obese children. Categorical variables described as frequency and percentage were compared using the Fisher's exact test or test chi square. Continuous variables were analysed using the Mann-Whitney test.

CONCLUSION

The study showed an association between obesity and periodontal risk indicators in children that in the long term may lead to oral conditions. The oral health of overweight/obese subjects should be more carefully supervised and checked in order to prevent oral alterations.

Evaluation of cephalometric, hormonal and enzymatic parameters in young obese subjects

AIM

The aim of the present investigation was to analyse cephalometric skeletal structures and hormonal and enzymatic parameters in young obese subjects in comparison with those of normal weight subjects.

MATERIALS AND METHODS

The whole sample consisted of 50 Caucasian patients (28 males and 22 females) whose lateral radiographs, laboratory hormonal and enzymatic analyses were already available. The test group included 25 obese patients (11 females and 14 males, average age: 9.8 +/- 2.11 years old), while the control group included 25 normal weight subjects matched for age and sex (11 females and 14 males, 9.9 +/- 2.5 years old). Data were statistically analysed: Student's t-test for independent samples was adopted and the level of significance was set at: p < 0.05.

RESULTS

As regards cephalometric records, the anterior cranial base length was significantly greater in the test group (S-N: 69.9 +/- 4 mm) compared to the controls (S-N: 68.1 +/-2.7 mm). Moreover, the maxillary lenght was higher in the test group (Pm-A: 48.5 +/- 2.5 mm) in comparison to the control group (Pm-A: 46.1 +/- 1.9 mm). As regards skeletal class and vertical dimension, no significant differences were found between the two groups, with the exception of the intermaxillary plane angle, which was significantly lower in the obese subjects in comparison to the controls. Laboratory analysis showed significant (p < 0.05) higher levels of leptin and insulin in the test group in comparison with control subjects. Furthermore, LH, FSH, IGF-1 values were significantly (p < 0.05) lower in the test group in comparison with the control group.

CONCLUSION

Obese subjects exhibited an increase of some craniofacial parameters and alteration of some laboratory parameters that may be involved in the process of skeletal maturation, in comparison to normal weight subjects. These findings may be of interest in orthodontics, as young obese subjects may need a different orthodontic treatment plan in comparison to normal weight subjects of the same age.

Dental and periodontal complications of labial and tongue piercing

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

Correlation between otitis media and dental malocclusion in children

AIM

To determine the possible correlation between otitis media and dental malocclusion in children.

METHODS

Fifty subjects (26 males and 24 females; mean age: 7.8 +/- 1 years) were assessed: 25 patients, with otitis media formed the study group, while 25 healthy subjects formed the control group. An otolaryngological examination and dental cast measurements were performed in order to evaluate adenoids, tonsils and dental relationships, respectively.

RESULTS

A significant correlation (p<0.05) was found between otitis media and enlargement of adenoids (13 patients, 52% in the study group) and tonsils (11 patients, 44% in the study group). Furthermore, a significant predominance (p<0.05) of posterior crossbite was found in the study group (19 children, 76%), in comparison to the control group (4 children, 16%). No correlation between otitis media and overjet, overbite, Angle Class relationship, or inadequate oral habits were found.

CONCLUSIONS

Posterior cross-bite and adenoids-tonsils enlargement are factors significantly associated with otitis media in children.

Inflammatory and Immunitary Modifications in Saliva of Subjects with Labial and Tongue Piercing

Piercing is the practice of puncturing some parts of the body, including the area of the stomach, to apply ornamental objects. The presence of oral and perioral piercings are a risk factor for numerous acute and chronic complications, such as chipping of the dental enamel, lesions of the gums and infection. The presence of piercings in the oral cavity may also act as a stimulant for inflammation and determine modifications in the components of the saliva. The aim of this study is to evaluate whether there is a variation in the inflammatory or immunitary components of the saliva of adult patients with labial and tongue piercings. Twenty-five adult patients were examined (11 males and 14 females with an average age of 23.4±3.6 years) who had had a minimum of one labial or tongue piercing for at least 1 year. A questionnaire was compiled for each patient and the composition of the saliva was examined, before and for the 72 hours after removal of the piercings. The data was analyzed using the student's t-test for independent samples and the level of significance was placed at p< 0.05. The examination of the saliva showed a statistically significant increase (p< 0.05) of interleukin-1 and −8, of lysozyme and amylase. A more basic value of pH (p< 0.05) was also found and a decrease in the immunoglobulins, in particular of IgA (p< 0.05). After the removal of the piercings, the parameters of the saliva returned to the reference values, with the exception of the immunoglobulins, whose values remained the same as in the first saliva examination. The presence of piercings in labial areas or in the tongue is accompanied by chronic inflammation in the components of the saliva, with an increase in the level of the interleukins. Furthermore, in patients who have had an oral piercing for a longer period, the level of interleukins is even higher. This inflammatory situation, however, may recede in a few days after the removal of the irritating agent. Labial or tongue piercings also determine an increase in the flow of saliva, an increase in saliva enzymes, of lysozyme in particular, and a more basic pH value.

Effects of cigarette smoke on salivary superoxide dismutase and glutathione peroxidase activity

Cigarette smoke contains oxidants such as oxygen-free radicals and volatile aldehydes, which are probably the major causes of damage to biomolecules exposed to cigarette smoke. However, saliva has an antioxidant defense system able to counter toxic activities of radical species that is formed by antioxidant enzymes, including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). The purpose of this study is to verify the possible effects of cigarette smoke on SOD and GSH-Px. Forty-four patients (25 males and 19 females) were enrolled in this study. The participants were 20 smokers (12 males and 8 females) and 24 non-smokers (13 males and 11 females). Furthermore, 10 subjects of the control group were ex-smokers (9 males and 1 female). Their mean age plus or minus standard deviation (SD) was 58.8 plus or minus 15.9 years for the case group and 73.8 plus or minus 10.6 years for the control group. All patients were underwent a careful anamnestic investigation and examination of the oral cavity. After rinsing the mouth with water, each subject put 3 cc of non-stimulated saliva inside a test tube. The saliva was centrifuged and oral peroxidase and superoxide dismutase activity was measured according to a specific assay. Statistical analysis was performed to evaluate differences between the groups and significant differences were observed for p less than 0.05. A significant decrease of GSH-Px activity was detected in the smoking group (p less than 0.05), while the SOD activity was similar in the control and case groups. According to the sex, a significant decrease of GSH-Px activity was noted in males of the smoker group (p less than 0.05), while in the sample of females no significant difference of the enzymatic activity was found. Moreover, among ex-smokers, there was a significant difference in the values of GSH-Px between those who had not smoked for less than ten years and those who had not smoked for more than ten years. Cigarette smoke may alter the detoxification of hydrogen peroxide through a decrease of GSH-Px activity. The overproduction of H2O2 may lead to an oxidative stress that is involved in a large number of diseases, including precancerous and neoplastic lesions of the oral cavity. The effects of cigarette smoke on salivary antioxidant enzymes decrease after withdrawal from smoking and the benefits become more evident with the passage of time.

Sjögren's syndrome: correlation between histopathologic result and clinical and serologic parameters

AIM

Sjögren's syndrome (SS) represents a challenging illness to diagnose properly and, because of the serious complications such as lymphoma, it is important to reach a correct diagnosis in early stages. Aim of this retrospective study was to evaluate the correlation between histopathologic result of minor salivary gland biopsy and clinical and serologic parameters for the diagnosis of SS.

METHODS

We evaluated 360 biopsies, taken from the lower lip, of 360 patients (18 males) on suspicion that they were suffering from SS. The Chisolm and Mason classification was used to state the diagnosis of SS. For each patient, the medical history and the symptoms were evaluated, and diagnostic tests were performed. The revised rules of the American-European Consensus Group Criteria were used to diagnose primary and secondary SS. For the statistical analysis we used the Chi(2) test; a difference of P<0.05 was considered significant.

RESULTS

Considering the statistical correlation between a focal score > or =1 and the serological data, it was noted that a positive score was significantly correlated to all serological parameters examined (P<0.0001). A significant correlation was also found between a positive biopsy score and Schirmer's test and Rose Bengal test (P<0.0001). However, with regard to the clinical data, a significant correlation was found only for two parameters: xerostomia (P<0.0001) and parotid swelling (P<0.05).

CONCLUSION

Minor salivary gland biopsies are of great diagnostic value in detecting SS. However, for the diagnosis of SS both clinical and serologic parameters should be considered. The data obtained from the present survey reveal that the serologic markers are more predictive than clinical parameters for a positive biopsy score.

Correlations between transversal discrepancies of the upper maxilla and oral breathing

AIM

The aim of the study was to evaluate the relationship between malocclusion with cross-bite and permeability of the upper airways, and to observe the cephalometric changes of the rhinopharyngeal space after rapid palatal expansion therapy.

MATERIALS AND METHODS

The sample consisted of 17 patients (age 9-12) of which 10 were males, followed up for a period of 1 year at the Department of Paediatric Dentistry of the Dental Clinic of the University of Pisa. Clinical, radiographical and otolaryngological examinations were carried out before treatment with palatal expansor. After expansor activation, each patient underwent an otolaryngological and orthodontic evaluation followed by rhinomanometry, and, in the cooperating children, endoscopy was also performed. After 6 and 12 months from the beginning of the treatment, each patient was examined again and the radiographic examination was repeated.

RESULTS AND CONCLUSION

The cephalometric analysis exhibited an increase of the rhinopharyngeal space in 16 children. Furthermore all the 17 patients showed, after therapy, an increase of the transverse dimension of the upper jaw, measured on the postero-anterior teleradiography. On the other hand, the otolaryngological examination, and in particular rhinomanometry, exhibited an improvement of the flow and of right and left nasal resistance only in 3 children, while in 6 children the graph remained unchanged, and in 8 children it worsened. The results show that the rapid palatal expansion produces an improvement of the transversal skeletal discrepancy, and an improvement of the permeability of the upper airways. To make a correct diagnosis lateral and postero-anterior teleradiography, and a cephalometric analysis are needed; instead the otolaryngological examination in our opinion it is not an essential diagnostic examination for this kind of pathology.

Evaluation of efficacy of estrogen and phytotherapy in oral cavity alterations of women in menopause

AIM

Hypo-estrogenism during menopause is the cause of numerous disturbances affecting various structures such as the oral cavity which can present with the following symptoms: changes in salivary secretion, gingivitis, bleeding and altered taste sensation. The object is to study whether hormone replacement therapy prescribed for female patients in menopause have any beneficial effect on the oral discomfort which affects the quality of life of these patients.

METHODS

The study enrolled 95 female patients; 14 were the control group and received no hormone replacement therapy while 81 patients underwent two types of therapy: 38 were prescribed estrogen therapy and 43 phytotherapy. The main outcome measures were alterations of the oral cavity: salivary change, gingivitis, bleeding and taste changes.

RESULTS

It was observed that the patients receiving treatment had an improvement or disappearance of symptoms in the oral cavity and that estrogen was more effective than phytotherapy regarding the salivary change while the gingivitis, bleeding and taste changes was the same for both therapies.

CONCLUSIONS

Estrogen and phytotherapy have beneficial effect on oral discomfort in women in menopause. The proposed treatment can have a beneficial effect on osteopenia and osteoporosis and therefore also on possible increase of future tooth loss during menopause.

Longitudinal study on a rehabilitative model for correction of atypical swallowing

AIM

The aim of the study is to analyse the prevalence of anomalous function of the orofacial muscles and their aetiological factors in a small sample of paediatric patients, to evaluate the correlation between anomalous functions of the orofacial muscles and malocclusions, and finally to verify the effects of a myofunctional protocol, composed of a series of exercises aimed at correcting the anomalous function and position of the tongue.

METHODS

The protocol that has been used in this research is a re-elaboration of the diagnostic and therapeutic methods set by two authors, Daniel Garliner and Aurelio Levrini. A group of 57 children (aged 5 to 13, mean age 8.2) with atypical swallowing diagnosis, has been treated for almost 3 years.

RESULTS

Physiologic swallowing was achieved in 47% of the children treated.

CONCLUSION

The results show the benefits of the myofunctional therapy in the treatment of children with abnormal swallowing.

"Safe" Coulomb excitation of 30Mg

We report on the first radioactive beam experiment performed at the recently commissioned REX-ISOLDE facility at CERN in conjunction with the highly efficient gamma spectrometer MINIBALL. Using 30Mg ions accelerated to an energy of 2.25 MeV/u together with a thin (nat)Ni target, Coulomb excitation of the first excited 2+ states of the projectile and target nuclei well below the Coulomb barrier was observed. From the measured relative deexcitation gamma-ray yields the B(E2;0(+)gs-->2(+)1) value of 30Mg was determined to be 241(31)e2 fm4. Our result is lower than values obtained at projectile fragmentation facilities using the intermediate-energy Coulomb excitation method, and confirms the theoretical conjecture that the neutron-rich magnesium isotope 30Mg resides outside the "island of inversion."

Proper names in patients with early Alzheimer's disease

The objective of this study was to seek evidence of the particular sensitivity of proper name retrieval and to check the usefulness of proper names as diagnostic material in the early stages of Alzheimer's disease (AD). Whether a generalized naming deficit is an early symptom of AD it is not yet clear. Previous studies suggest that proper names might be the category of names that is indeed more sensitive to AD. Seventy AD patients (subdivided into "very mild", "mild" and "moderate") and 47 control subjects participated in the study. The performances in two short distinct tests requiring proper name retrieval (Naming People on Definition and Naming Faces), one test of common name retrieval, short (MMSE, 3MS) and long (MODA) batteries for the detection of dementia were compared. Proper name retrieval tests were shown to be more sensitive to early AD than any other tests and batteries that failed to distinguish "very mild" AD from controls. These findings suggest that proper name retrieval tasks might be profitably included in diagnostic tools for the early diagnosis of AD.

Hemispheric specialization in quantification processes

Three experiments were carried out to study hemispheric specialization for subitizing (the rapid enumeration of small patterns) and counting (the serial quantification process based on some formal principles). The experiments consist of numerosity identification of dot patterns presented in one visual field, with a tachistoscopic technique, or eye movements monitored through glasses, and comparison between centrally presented dot patterns and lateralized tachistoscopically presented digits. Our experiments show left visual field advantage in the identification and comparison tasks in the subitizing range, whereas right visual field advantage has been found in the comparison task for the counting range.

Executive deficits appearing in the initial stage of Alzheimer's disease

The presence of executive deficits has been sought at a stage of Alzheimer's disease where currently used neuropsychological batteries could not yet distinguish Alzheimer's patients from normal age- and education-matched controls. This study shows that, at this early stage, those patients that 6 months later are found to show clear signs of Alzheimer's had been significantly worse than normal controls in an executive function task adapted from the Brown-Peterson procedure.

Proper names in the early stages of Alzheimer's disease

A short proper name retrieval test was found to discriminate between unselected subjects and age- and education- matched patients affected by Alzheimer's type dementia at a stage where the Mini-Mental State Examination could not detect a difference between these groups. The proper name retrieval task also compared favorably with the 3MS, a more sensitive, modified version of the MMSE. These findings suggest that proper name retrieval could be used to an advantage and become a routine component of short batteries for the early detection of Alzheimer's disease.

Optimal PPI-based triple therapy for the cure of Helicobacter pylori infection: a single center comparison of four 14-day schedules

BACKGROUND

Helicobacter pylori eradication is accomplished using a wide array of drugs combined in a multitude of dosage schedules. The aim of the present study was to define the best 14-day eradication schedule using a PPI plus either two antibiotics or one antibiotic and bismuth.

MATERIAL AND METHODS

For this study, 367 subjects (198 males, 169 females, age 22-87 years) with document H. pylori infection of the stomach were recruited from out-patients of the Gastroenterology Department of the Venezia Hospital. In all patients, H. pylori infection was identified by histology and the CLO-test. Patients were treated as follows: 1) PPI (P) plus clarithromycin (C) 250 mg plus amoxicillin (A) 1000 mg bid (P + C + A); 2) P plus C plus bismuth subcitrate (B) 120 mg qid (P + C + B); 3) P plus C plus tinidazole (T) 500 mg bid (P + C + T); and 4) P plus A plus T bid (P + A + T). After two months, an upper gastrointestinal endoscopy was repeated for end point histological evaluation and the CLO- test. Positivity of one of the two methods was considered sufficient to define H. pylori as "not eradicated".

STATISTICS

Chi-squared test and Fisher exact test.

RESULTS

Thirty-three subjects dropped out (six due to adverse events). P + C + B was proven significantly less effective than P + C + A, P + C + T and P + A + T, eradication rates being, respectively, 75.0%, 90.5%, 87.6%, 92.0%, (p = .005, per protocol analysis).

CONCLUSIONS

All PPI-based triple therapies tested in this study were effective in curing H. pylori infection; however, P + C + B resulted in rates too low (< 85%) to be recommended. P + C + A and P + A + T resulted in the high cure rates and thus may be considered the treatment of choice.

[Intestinal anastomosis with biodegradable ring]

The authors report their experience using biofragmentable anastomosis ring (BAR) in bowel anastomosis. Starting January 1993 to February 1994, 46 intestinal anastomoses were performed using BAR, and particularly 39 end-to-end colo-colostomies, 2 end-to-side colo-colostomies and 5 end-to-side ileo-colostomies. 35 patients were affected by colonic neoplasm, 5 patients by diverticular colonic complications- and 5 patients by several unusual bowel diseases. Four emergency operations were performed, while 42 patients had an accurate bowel preparation before surgery. In this series of patients one case of preoperative mortality is reported, due to massive pulmonary embolism. Instead several minor complications occurred in other patients, such as paroxysmal atrial fibrillation (one case), basal pleuritis (one case), hyperpyrexia (three cases), temporary subocclusion or delayed canalization (five cases). Only one patient suffered from intestinal occlusion induced by adhesions and a second laparotomy was required. Delayed canalization seems to be caused by the small size of the BAR employed (25 mm) or by inadequate intestinal preparation, that usually occurs in emergency operations. After surgery all patients were followed up and 18 of them were examined by coloscopy six months after surgery. No clinical problem connected with bowel anastomosis was reported and all anastomosis looked quite previous and resilient. No anastomotic stenosis was found. In our experience and from recent reviewed reports, BAR seems to be a rapid, effective and safe device for sutureless bowel anastomosis.

[Role of surgery in the treatment of acute hemorrhagic non-variceal lesions in the upper gastrointestinal tract]

From January 1993 to December 1994, out of 244 cases of upper gastrointestinal hemorrhage observed 25 patients underwent surgical treatment. Twenty-nine bleeding varices were excluded from this study. Early endoscopy revealed the source of bleeding almost in all cases (84%). All patients received, at the time of admission, medical treatment associated in 7 cases (28%) to endoscopic injection therapy. Emergency surgery indications were massive bleeding persistent bleeding, rebleeding and macroscopic findings of lesions. The aim of this report is to verify the respective roles of medical, endoscopic and surgical therapies in relation to the nature of the bleeding lesion and the entity of the hemorrhage. Results with regard to indication, clinical data, surgical technique were compared with literature data.

[Thyroid carcinoma in hyperthyroid syndromes]

The relationship between hyperthyroidism and carcinoma of the thyroid is still uncertain. The incidence of thyroid carcinoma ranges from 0.3 to 16.6%. Between 1984 and 1994 the Authors observed 9 patients affected with thyroid cancer and toxic nodular goiter (4 patients) or Basedow disease (2 patients) or scintigraphic evidence of single hyperfunctioning nodule (3 patients). Six out of the 9 cases were diagnosed as papillary cancer, while three as follicular cancer. A carcinoma was diagnosed before operation in only one case, while in the other 8 patients, the diagnosis was obtained by histological examination of the specimen. Four patients underwent subtotal thyroidectomy, while five patients underwent radical lobectomy. All patients are alive and in good health; the average follow-up was 48 months.

Carbohydrate-induced thermogenesis in liver cirrhosis: glucose vs. fructose

Reduced thermic response after a glucose load has been reported in liver cirrhosis. To determine the mechanism and the site of this phenomenon, the effects of glucose and fructose on energy expenditure (EE) were measured in seven well-nourished cirrhotic patients and in six healthy control subjects. EE and fuel utilization were measured via indirect calorimetry for 3 h after oral glucose or fructose administration (1 g/kg body wt). After a glucose load, plasma glucose and insulin concentrations were higher in cirrhotic patients than in control subjects (p < 0.05). During the glucose trial, the cumulative incremental changes in EE over the 3-h measurement period were lower (p < 0.01) in patients than in the control subjects (0.98 +/- 0.13 vs. 1.70 +/- 0.23 kJ.kg-1.3 h-1). After fructose ingestion, the cumulative changes in the EE of control subjects (1.76 +/- 0.24 kJ.kg-1.3 h-1) and cirrhotic patients (1.59 +/- 0.15 kJ.kg-1.3 h-1) were similar. In cirrhotic patients, the EE increase after fructose was higher than after glucose (p < 0.05). After glucose and fructose ingestion, no difference was observed between the carbohydrate oxidation in cirrhotic patients and that in control subjects, and lipid oxidation was suppressed to the same extent in both groups. We conclude that glucose-induced thermogenesis is impaired in liver cirrhosis, whereas fructose can normalize the thermic response. Because fructose is chiefly metabolized in the liver, these findings suggest that extrahepatic tissues are the site of defective thermogenesis in liver cirrhosis.