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The National Immunization Plan 2017-2019 has been approved on January 2017. This official document contains the new Italian guidelines to improve vaccination coverage in the country. We conducted an accurate and critical analysis of the document, highlighting its key points and critical issues, in order to offer an practical tool for writing the Regional Plans. The new immunization schedule and the establishment of a restricted panel for the vaccine vigilance are the most significant innovations of the Plan. The Plan addresses also the issues of mandatory vaccination and of penalties for physicians who advise against vaccinations. Together with the presence of qualifying aspects as information about the ethical value and the benefits of vaccination, the Plan contains other interesting proposals, such as the introduction of a computerized vaccination register and the targeted use of new technologies to reach the population extensively. The Plan is set up as a conceptually rich tool, suitable for the development of regional operational plans.

Rubella is a contagious disease that can be very serious, especially in unvaccinated pregnant women. The best way to be protected is getting vaccinated: MMR vaccine is very effective at protecting people against measles, mumps, and rubella, and preventing the complications caused by these diseases. According to PASSI 2012-2015 (the Italian behavioral risk factor surveillance system) in the territory of ex ASL Roma C only 56% of women between 18 and 49 years were immunized against rubella, thanks to vaccination (34%) or past infection detected by rubeotest (22%); 2% was susceptible and 42% of respondents did not know their immune status against rubella. The Italian National Plan for the Elimination of Measles and Congenital Rubella (PNEMoRc) 2010-15 had the aim to reduce the prevalence of rubella susceptibility in young women (<5%), to reduce the prevalence of congenital rubella and to increase MMR vaccination coverage. This plan suggested to promote actions to spread correct information about MMR vaccine in the general population and healthcare workers and to offer this vaccine to susceptible women during every appropriate contact with the Family planning clinics. In order to ensure and monitor these recommendations, a recovery procedure for MMR vaccine was activated in 2015 for women who contacted the health facilities for their first child vaccination. A form was developed in order to collect information about women's immune status against rubella and measles. According to this tool all women who stated they had never been vaccinated for rubella or MMR and/or did not remember vaccination and/or had never had a rubeotest were considered susceptible to rubella. Women susceptible to rubella were invited to undergo vaccination. Data collected during one year activity were recorded and analyzed with Epinfo 7.0 software. We collected 1801 correctly filled forms; 88.6% (1595) of women were evaluated immune to rubella and 11.4% susceptible. The prevalence of susceptibility seems to be influenced by age, from 16% in the youngest age group to 9% in the >35 years. Among 206 women susceptible to rubella: 38% were vaccinated, 31% preferred to wait, 11% refused vaccination and for 20% data is missing. The protocol of MMR vaccine recovery was effective, and allowed to reach a good number of women who had a contact with the health facilities and we hope this number to be bigger, adding a part of those women who preferred to wait. However, data of a year activity indicate that vaccine recovery initiatives should be proposed and implemented, in consideration of the proportion of rubella susceptibility in women who were recently pregnant.

The procedures that allow identification have evolved during the time inevitably, as a consequence of ever new technologies that can simplify and widen their own application. Nevertheless, it is interesting to focus the attention on how, although time goes by and the use of complex tools, these techniques are based on principles already used by our predecessors and able to resist to the changes imposed by our age. Indeed, if DNA studies can be considered to be recent discovery, the other identification techniques find their reason in past ages; for example dactyloscopy science, identification through bones, forensic odontology that represent milestones of this discipline. Our study underlines that a few aspect of this science have been completely abandoned, some of them are used in the recent identification inquires, other represent a milestone in the development of this science.

In recent years the high number of malpractice lawsuits in dentistry has attracted closer attention of dental practitioners to its medico-legal aspects. Implantology, in particular, presents many points of medico-legal concern connected with the difficulties inherent to dental procedures and objectives (both functional and esthetic), as well as full patient collaboration as an essential part of successful treatment. An accurate assessment of each case by the clinician is fundamental, especially in circumstances where esthetic considerations are preponderant as, for instance, in the frontal sectors. In such cases, the options of implantology or of a traditional fixed prosthesis need to be carefully weighed in light of the patient's anatomic condition. The patient should therefore receive complete information and be made fully aware of the risk of treatment failure, as well as possible complications, limits to the procedures, and the fact that successful outcome will also depend on her/his scrupulous observance of the practitioner's instructions. In short, the aim is to make the patient an active ''accomplice'' in treatment. To this end, the use of an extremely detailed information leaflet is strongly advised; after careful clarification of any doubts the patient may have, the patient's written informed consent should be obtained. Nevertheless, there is the risk that excessive intrusion of bureaucracy into medical procedures in defence of the practitioner against malpractice suits may hinder the principal aim of traditional medicine, i.e. to provide the best care for the patient through mutual trust fostered within the doctor-patient relationship.

Aim: Burning mouth syndrome (BMS) is a chronic painful syndrome in clinically normal oral mucosa. There are many local, systemic and/or psychogenic pathological conditions that may clinically appear as burning and painful sensation of the oral mucosa. There are essential or idiopathic BMS and organic or secondary BMS. A diagnostic and therapeutic protocol is proposed by the authors evaluating, the effectiveness of the estroprogestinic replacement therapy in post-menopausal women suffering from idiopathic BMS., Methods: A total of 28 patients suffering from persistent burning and painful oral sensation underwent to careful clinical and laboratory examination in order to distinguish primary forms from secondary ones. Patients suffering from primary BMS underwent to incisional biopsy for the research of estrogens receptors., Results: Only 8 out of the 28 studied patients (28.5%) were negative to the clinical oral and laboratory examinations listed in our protocol and they were diagnosed for primary BMS. All of them were females., Conclusions: The use of a valid diagnostic and therapeutic protocol allows a better management of patients suffering from oral pain and a reduction if not a disappearance of the burning symptomatology in most of them. In post-menopausal patients suffering from idiopathic BMS good results may be obtained by an estroprogestinic replacement therapy.

The main characteristics of oral necrotic lesions in leukemia and the treatment and consequence of these pathologies are described. These lesions are classified as noma-like lesions, necrotic gangrenous ulcers of the oral cavity mucosa appearing in severe organic diseases. A new therapeutical approach in the treatment of oral necrotic lesions in chronic leukemia by the use of CO2 laser is tried and a case with the results obtained is presented.

Background and Aims: Some authors have shown that increased blood levels of adrenaline do not have any effect on cardiovascular function. Others have documented major changes in arterial blood pressure and heart rate even following non-maximal doses of adrenalin in association with anesthetics. The aim of this study was to evaluate the toxicity of local anesthetics when used with/without associated vasoconstrictors., Methods: The authors studied the hemodynamic, cardiac and respiratory changes in two groups of patients respectively undergoing general and local anesthesia for a variety of pathologies of the oro-maxillo-facial district. At a preoperative stage, 4 ml of mepivacaine (carbocaine) 2% with 1:100,000 adrenaline was administered to patients in the first group. Data were compared to changes in the same parameters recorded in the second control group undergoing local anesthesia for day-hospital surgery who received the same quantities of local anesthetic (2 tubes of mepivacaine 2% with 1: 100,000 adrenaline or 3% without adrenaline)., Results: The comparison between the two groups of data showed no significant change in cardiorespiratory parameters, except in patients with an abnormal response to dentistry stress., Conclusions: No elements were found to support the systemic toxicity of local anesthetic or its association with adrenaline.

A case of parotidomegaly associated with anorexia is described, and the psychoneurological and etiopathogenetic theories of main feed disorders (anorexia/bulimia) are discussed. Particularly, a rare pathology of maxillofacial interest is presented: parotidomegaly associated with anorexia. The diagnosis and differential diagnosis of this pathology is discussed.

The authors review the literature on the role of human papilloma virus in premalignant and malignant oral tumours. They describe the biomolecular mechanisms of action and report the data of other authors regarding the incidence of the DNA of HPV in both normal mucosa of healthy subjects and in patients affected by disease, in tissues taken from benign and malignant lesions of the oral cavity. Having commented on these findings, they discuss the possible interference of analysis techniques, various kits and clinical conditions may have on the final results.

In this note I, the authors point out the uncertainty and confusion which exists in the bioceramics field. They then list the calcium phosphate biomaterials today in use.

The authors value the distribution of some parameters such as age, sex, life habits, kind of clinical diagnosis and its relation to histological diagnosis in a population of 110 patients heterogeneous for rank and provenance. After describing the kind of casualty department aid, they explain the meaning of the word leukoplakia and underline the difficulties of clinical diagnosis: the macroscopic appearance of the white patch (according to WHO definition) is often comparable to other oral diseases either classified as precancerous lesions or not.

In the oro-maxillo-facial pathology it may be useful to perform hematochimical and saliva tests which can clarify the kind of the pathology and which can be used in the post-surgical follow-up because of incidental modifications. Saliva compliance and viscosity and blood hemorrheology variations always result lower than in normal population. The Authors are going to value which kind of oro-maxillo-facial pathologies shows a significant reduction of saliva elastoviscosity and blood hemorrheology. Yet, in a further study, they will try to explain that reduction and the connection with the specific pathology and the medical and/or surgical treatment.