Search

Background: Understanding of socioeconomic context might enable more efficient evidence-based preventive strategies in oral health., Aim: The study assessed the caries-related socioeconomic macro-factors in 12-year-olds across European countries., Design: This systematic review involved epidemiological surveys on the caries status of 12-year-olds from 2011 to 2022. DMFT was analyzed in relation to gross national income (GNI), United Nations Statistical Division geographical categorization of European countries (M49), unemployment rate, Human Development Index (HDI), and per capita expenditure on dental health care. A meta-analysis was performed for countries reporting data on DMFT, stratified by GNI, and geographical location of European countries, using a random-effects model., Results: The study involved 493 360 children from 36 countries in the geographic region of Europe. The analysis confirmed a strong negative correlation between income and caries experience (p < .01). Children living in higher-income countries showed 90% lower odds of poor oral health than in middle-income countries. Children living in West Europe showed 90% lower odds of poor oral health than children living in East Europe., Conclusion: The strong effect of macro-level socioeconomic contexts on children's oral health suggests favoring upstream preventive oral health strategies in countries with economic growth difficulties, Eastern and Southern parts of Europe., (© 2024 The Author(s). International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

Objectives: This randomised clinical trial was designed and carried out with the aim to evaluate the capacity of fluoride-substituted hydroxyapatite (HAF) toothpaste to modulate oral microflora composition and biofilm acidogenicity in schoolchildren., Methods: In all, 610 children (4 to 5 and 6 to 7 years) were enrolled. Four toothpastes were randomly administered during 24 months: 2 contained fluoride-substituted hydroxyapatite (HAF 1000 and HAF 1450 ; 1000 and 1450 ppmF) and magnesium-, strontium-, and carbonate-substituted hydroxyapatite in a chitosan matrix, and 2 were monofluorophosphate fluoridated toothpastes (F 1000 and F 1450 ; 1000 and 1450 ppmF). Caries lesions were assessed by International Caries Detection and Assessment System scores, supragingival plaque was sampled from the approximal sites between primary molars using sterile Gracey curettes for microbiological analysis, and plaque pH curves after sucrose challenge were assessed at baseline and reevaluated after 1 year and after 2 years. The minimum and maximum pH decrease was calculated for caries-free patients and participants with a caries lesion(s) at baseline and at the end of the experimental period (24 months). Differences amongst measurements were analysed with 1-way analysis of variance., Results: During the trial, the minimum pH value increased statistically significantly in all groups; in HAF 1000 and HAF 1450 , the increase was greatest. At the end of trial, in the 2 HAF groups all primary cariogenic bacteria were statistically significantly lower with respect to F groups (P = .03 for Streptococcus mutans and sobrinus, for Lactobacillus casei, and for Lactobacillus fermentum)., Conclusions: The trial provides robust but still inconclusive evidence on the efficacy of HAF toothpastes compared to traditional fluoridated toothpastes to reduce caries risk factors and to prevent caries lesions., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This study aimed to evaluate the fatigue performance of simplified ceramic restorations (leucite-reinforced glass ceramic) adhesively cemented onto substrates of different resin composites. Three options from the same commercial line were selected (Tetric N-Line, Ivoclar), classified as Conventional (CRC), Bulk-fill (BRC) and Flowable (FRC), which were used to make discs using a cylindrical metallic device (n = 19; Ø = 10 mm, thickness = 2.0 mm). A total of 57 discs (Ø = 10 mm, thickness = 1.0 mm) were made from CAD/CAM prefabricated blocks of a leucite reinforced glass-ceramic (Empress CAD, Ivoclar) to simulate a monolithic restoration, then were randomly distributed to be bonded on 19 discs of each three different resin composite substrates (CRC; BRC; or FRC) with a dual resin cement (Multilink N; Ivoclar). The samples were subjected to a compression test with a hemispherical stainless-steel piston (Ø = 40 mm) at a monotonic regimen (n = 4; 1 mm/min loading rate and 500 kgf loading cell until fracture). The cyclic fatigue test was performed underwater at a frequency of 20 Hz (n = 15). The first step was applied using 200N for 5000 cycles, followed by increments of 50N at each step of 10,000 until failure. The outcome considered for both tests was the occurrence of radial crack. Specific statistical tests (α = 0.05) were performed for monotonic (One-way ANOVA; Tukey's test) and fatigue data (Kaplan-Meier test; Log-rank test). Fractography of fractured samples were also performed. The FRC group had the lowest failure load in both test regimes (p < 0.05; monotonic: 726.64N; fatigue: 716.67N). There were no differences between the CRC and BRC groups (p > 0.05; monotonic: 989.30 and 990.11N; fatigue: 810.00 and 833.33N, respectively). The same result was obtained considering cycles for fatigue failure (FRC < CRC=BRC). Leucite glass-ceramic bonded to substrates made of flowable resin composite behaves worse mechanically than bonding to conventional or bulk-fill resin composite substrates., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The study was aimed to describe caries prevalence and severity and health inequalities among Italian preschool children with European and non-European background and to explore the potential presence of a social gradient., Methods: The ICDAS (International Caries Detection and Assessment System) was recorded at school on 6,825 children (52.8% females). Caries frequency and severity was expressed as a proportion, recording the most severe ICDAS score observed. Socioeconomic status (SES) was estimated by mean a standardized self-submitted questionnaire filled-in by parents. The Slope Index of Inequality (SII) based on regression of the mid-point value of caries experiences score for each SES group was calculated and a social gradient was generated, children were stratified into four social gradient levels based on the number of worst options. Multivariate regression models (Zero-Inflated Negative Binomial logistic and logistic regression) were used to elucidate the associations between all explanatory variables and caries prevalence., Results: Overall, 54.4% (95%CI 46.7-58.3%) of the children were caries-free; caries prevalence was statistically significant higher in children with non-European background compared to European children (72.6% vs 41.6% p < 0.01) and to the area of living (p = 0.03). A statistically significant trend was observed for ICDAS 5/6 score and the worst social/behavioral level (Z = 5.24, p < 0.01). Children in the highest household income group had lower levels of caries. In multivariate analysis, Immigrant status, the highest parents' occupational and educational level, only one kid in the family, living in the North-Western Italian area and a high household income, were statistically significant associated (p = 0.01) to caries prevalence. The social gradient was statistically significant associated (p < 0.01) to the different caries levels and experience in children with European background., Conclusions: Data show how caries in preschool children is an unsolved public health problem especially in those with a non-European background., (© 2022. The Author(s).)

Objectives: The aim of this RCT was to compare the caries preventive efficacy and the slowing down of previous caries lesions of toothpastes containing fluoride biomimetic hydroxyapatite (HA) complex compared to sodium monofluorophosphate fluoridated toothpastes in Italian schoolchildren. To validate this hypothesis a triple-blind randomized clinical trial was designed., Methods: In total 610 children (4-5 and 6-7 years) were enrolled. Four toothpastes, two containing fluoride-substituted hydroxyapatite (HAF) (1000 and 1450 ppmF) and magnesium-, strontium-, carbonate-substituted hydroxyapatite, in a chitosan matrix and two Mono fluoridated toothpastes (1000 and 1450 ppmF) were randomly administered during 24 months to two groups with younger children (G young ) and to two groups with older children (G old ), those containing 1450 ppmF. ICDAS was used to score lesions as initial (up to score 2), moderate (scores 3-4) and severe (scores 5-6). The children were instructed to brush for two minutes three times/day. Caries examination was repeated at 12 and 24 months. The efficacy of the treatment was assessed by calculating the reduction in Risk Ratio (RR) and the number needed to treat (NNT). Results; Overall, 518 patients (G young  = 268; G old  = 250) concluded the trial. The drop-rate was 11.84% for G young and 17.22% for G old . The caries increment at 24-month evaluation was statistically lower in the primary dentition in the HAF arms compared to the traditional fluoridated arms (0.18 vs 0.27 p = 0.04 in G young and 0.16 vs 0.30 p = 0.01 in G old for severe lesions). In the permanent dentition (G old ), caries increase was also statistically lower in the HAF arm, both for initial and severe lesions (0.09 vs 0.17 p = 0.02 and 0.18 vs 0.28 p = 0.01, respectively). In primary dentition, children receiving HAF Toothpaste had a RR of 39% (G young ) and 38% (G old ), compared to children receiving traditional Toothpastes. The RR in the permanent dentition was 29% in children treated with HAF toothpaste. Conclusions; The use of toothpastes containing biomimetic hydroxyapatite and fluoride reduces caries increment in children over a period of 2 years more than traditional fluoridated toothpastes., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Xylitol use is reported to be able to reduce dental plaque amount and cariogenic bacteria and, as a consequence, the caries increment. Only few data on the oral health of Ladakh's population are available. The aim of the present protocol will be to record the caries prevalence of primary and permanent molars of schoolchildren living in Ladakh and to implement a school-based Xylitol programme, named the Caries Prevention Xylitol in Children (CaPreXCh) trial, using chewing gums., Methods: The protocol is designed as a triple-blind randomized, controlled, parallel-group clinical trial in children aged 5-14 years. The study should have been carried out from August 2021 to August 2024 in Zanskar Valley (Ladakh), but the COVID-19 pandemic does not allow today to make predictions on the exact start. Participants will be randomly allocated into two groups: subjects who will receive a chewing gum with Xylitol (70% w/v) as only sweetener, and those who will receive a sugared chewing gum containing Maltitol (23% w/v). The subjects will be instructed to chew a total of 6 pellets for 5 min divided into 3 intakes a day (2 in the morning, 2 after the midday meal and 2 in the afternoon) for one school year. Clinical examination will comprise an oral examination in which caries index (ICDAS scores), bleeding on probing and plaque pH evaluation after sucrose challenge will be recorded at baseline (t 0 ); the clinical examination will be repeated after 12 months since the beginning of the chewing gum administration period (t 1 ), after another 12-month period (t 2 ) and finally after further 12 months (t 3 ) (24 months from the end of the chewing gum use). The primary outcome will be the caries increment measured both at enamel and dentinal levels on primary and permanent molars. Data analysis will be conducted through Kaplan-Meyer graphs to evaluate caries increment. A comparison of the methods will be carried out with Cox regression with shared frailty. The net caries increment for initial, moderate and severe caries levels, using ICDAS (Δ-initial, Δ-moderate and Δ-severe), will be calculated., Discussion: This trial will be the first trial conducted in India assessing the efficacy of a school-based caries preventive programme through the use of chewing gum containing only Xylitol as a sweetener. The findings could help strengthen the evidence for the efficacy of Xylitol use in community-based caries prevention programmes in children., Trial Registration: Clinical trials.gov NCT04420780 . Registered on June 9, 2020., (© 2021. The Author(s).)

Background: The aim of this survey was to evaluate the severity of dental caries among children living in Zanskar Valley (Ladakh, India) and its association with anthropometric and background variables., Methods: This cross-sectional survey was conducted on schoolchildren divided into four age groups (< 6, ≥ 6 < 11, ≥ 11 < 14 and > 14 years of age). A total of 1474 schoolchildren (607 males, 41.2%) were examined. Actual caries prevalence (dt/DT) and gingival bleeding were recorded by four calibrated dentists. An ad hoc questionnaire evaluated general health, eating habits, oral hygiene and the self-perception of oral conditions. Height, weight, waist circumference, heart-rate and oxygen-saturation were also collected directly by examiners. Responses to questionnaire items were treated as categorical or ordinal variables. The relationship between children's caries data, gingival bleeding, gender, Body Mass Index (BMI) following the International Obesity Task Force, waist circumference and questionnaire items was assessed using the Kruskal-Wallis test and Pearson correlation. Conditional ordinal logistic regression was used to analyse associations among caries severity, gender, BMI, waist circumference, oxygen saturation and questionnaire items. A forward stepwise logistic regression procedure was also carried-out to estimate the ORs of gingival bleeding prevalence and the covariates derived from examination or questionnaire., Results: Caries was almost ubiquitarian with only 10.0% of caries-free children (dt/DT = 0). Caries severity, in both primary and permanent dentitions, was statistically significantly related to gender, waist circumference, BMI, oral hygiene frequency and self-reported chewing problems (p < 0.01 in both dentitions). An increasing relative risk for caries in permanent dentition compared to caries-free subjects was observed in children with a low BMI (RRR = 1.67, 95% CI = 1.54/2.83 for subjects with 1-3 caries lesions and RRR = 1.52, 95% CI = 1.36/1.74 for subjects with > 3 caries lesions); also, children with reduced waist circumference had a higher relative risk to have 1-3 caries lesions (RRR = 2.16, 95% CI = 1.84/2.53) and an even higher risk to have more than 3 caries lesions (RRR = 4.22, 95% CI = 3.33/5.34)., Conclusions: A significant impact of untreated caries lesions was observed in Ladakh schoolchildren; low BMI values and reduced waist circumference showed to be the main caries risk predictors. Preventive and intervention programmes should be implemented to improve children's oral health.

Objective: The short-term effect (60 days) of Lactobacillus brevis CD2 lozenges vs placebo on variables related to caries and gingivitis in type 1 diabetic children was evaluated., Material and Methods: Eight diabetics (4-14 years old) were assigned to two groups (n = 34 subjects each), probiotic lozenges and placebo. Stimulated saliva for microbiological analysis and plaque pH were assessed at baseline (t 0 ), 30 days (t 1 ), 60 days (t 2 ) and in the follow-up period (90 days from baseline, t 3 ). Gingival status was assessed at t 0 , t 2 and t 3 . Two-way ANOVA assessed differences between groups., Results: In the probiotic group, Streptococcus mutans bacterial density mean scores dropped from 3.11 ± 1.13 at baseline to 1.82 ± 0.72 (t 2 ) and to 2.06 ± 0.56 (t 3 ), while in the placebo group, the scores were 3.09 ± 0.8 (t 0 ), 2.82 ± 0.47 (t 2 ) and 3.11 ± 0.43 (t 3 ) (p < 0.01). Lowest and maximum pH fall increased in the probiotic group, from 5.37 ± 0.41 at baseline to 5.49 ± 0.24 at t 3 (p < 0.01) and from 1.20 ± 0.46 to 0.98 ± 0.29 (p = 0.02). Bleeding score decreased significantly in both groups, showing a statistically significant lower bleeding score at t 2 in the probiotic group (25.6%, 95% CI 21.5-32.7 vs 29.5%, 95% CI 25.2-34.9, p = 0.02)., Conclusions: Lactobacillus brevis CD2 has shown to improve caries-related risk factors and gingival health in diabetic children., Clinical Relevance: Lactobacillus brevis CD2 might contribute to improved oral health in type 1 diabetic children.

This study presents the result of the second National pathfinder conducted in Italy on children's oral health, reporting the prevalence and severity of caries in 12-year old children and describing the caries figure related to the socioeconomic inequalities, both at individual level and macroeconomic level. The two-digit codes related to ICDAS (International Caries Detection and Assessment System) for each tooth and the gingival bleeding score were recorded at school on 7,064 children (48.97% males and 51.03% females). The Gross National Product (GNP) per capita, the Gini Index and Unemployment rate in each Italian section, parents' educational levels, working status, smoking habit and their ethnic background were recorded. Zero-inflated-negative-binomial (ZINB) models were run, using caries-free teeth, teeth with enamel lesions, cavitated lesions and restorations as functions of socioeconomic explanatory variables, to evaluate the effects of justifiable economic factors of geographical distribution. The mean number of enamel lesions, cavitated lesions and filled per teeth were statistically significant (p < 0.01) dissimilar among the Italian section. GNP per capita, Gini Index and Unemployment rate were significantly correlated to ICDAS scores and filled teeth. Important differences in ICDAS score values remain among children from different socioeconomic backgrounds. Efforts should be made to improve awareness and knowledge regarding oral health practice and to implement preventive programs and access to dental services in Southern Italy where the disease is still unresolved.

The present work focuses on the characterization of brass surfaces after contact with artificial saliva solution at pH 7.4 and phosphate buffer solution at pH 7 simulating two extreme conditions that might occur when playing ancient brass wind instruments in the context of historically informed performance practice. The composition and the morphology of the film formed following the contact with the solutions for 1, 3, and 16 h were investigated by ex situ X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM) to shed a light on the surface changes upon time. In situ electrochemical impedance spectroscopy (EIS) was used to study the mechanism of corrosion and protection of the alloys. The results could be interpreted using a reliable equivalent electrical circuit; they provided evidence that the alloys behave differently when in contact to the various solutions. In saliva solution the formation on the brass surface of a thick surface film was observed, composed of crystallites of about 200 nm size mainly composed of CuSCN and Zn 3 (PO 4 ) 2 . This layer hinders the alloy dissolution. The contact of the alloys with the buffer solution originated a much thinner layer composed of Cu 2 O, ZnO, and a small amount of Zn 3 (PO 4 ) 2 . This film is rapidly formed and does not evolve upon time in a protective film., (Copyright © 2020 Fantauzzi, Elsener, Cocco, Passiu and Rossi.)

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities <0.5 and underestimates the risk for forecast probabilities >0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required., (© 2020 S. Karger AG, Basel.)

Caries measurement methods vary considerably in terms of the stages of lesion considered making the comparison problematic among different surveys. In this cross-sectional study, four caries measurement methods, the WHO-DMFT, the International Caries Detection and Assessment System (ICDAS), the Caries Assessment Spectrum and Treatment (CAST), and the Nyvad Criteria were tested in a sample of children. Five-hundred 12-year old children (236 males and 264 females) were examined four times by four calibrated examiners. The calibration process showed that Cohen's Kappa exceeded the criterion of K = 0.75 and K = 0.80 for inter/intra-examiner agreement, respectively. In the survey, the total number of misclassification errors for the four methods amounted to 312 observations (67.94% regarding enamel lesions). The greatest difference among methods was shown by number of sound teeth ( p < 0.01): WHO-DMFT n = 9505, 74.14%; ICDAS n = 2628, 20.49%; CAST n = 5053, 39.41%; and Nyvad Criteria n = 4117, 32.11%. At the level of dentinal Distinct/Active Cavity lesions, no statistically significant difference was observed ( p = 0.40) between ICDAS ( n = 1373, 10.71%), CAST ( n = 1371, 0.69%), and Nyvad Criteria ( n = 1720, 13.41%). In the severe caries levels, all methods were partially in agreement, while no accordance was found for the initial (enamel) lesions. A common language in caries detection is critical when different studies are compared.

A large number of disorders may affect the oral cavity, including genetic diseases, infections, cancers, blood diseases, skin diseases, endocrine and metabolic disorders, autoimmune and rheumatologic diseases, local lesions, to name a few. Oral mucosa shows a considerable variation in its normal structure and a wide range of conditions may affect it. Such conditions are often harmless or minor and could be primary or secondary to systemic disease. Several of them are quite rare and, hence, the diagnosis is not easy. Clinically, lesions may appear as ulcers, discoloration of the oral mucosa and alterations in size and configuration of oral anatomy. Genetic disorders have specific manifestations and can be caused by a derangement of one or more components of the tissue. Many of them follow the skin or systemic signs of the underlying genetic disease, but in a few cases oral signs could be the first manifestation of the disorder. Among them genodermatoses are prominent. They are inherited disorders characterized by a multisystem involvement. This review describes chondro-ectodermal dysplasia, dyskeratosis congenita, Ehlers-Danlos syndrome, hereditary benign intraepithelial dyskeratosis, keratosis follicularis, lipoid proteinosis, multiple hamartoma syndrome, pachyonychia congenita, Peutz-Jeghers syndrome, tuberous sclerosis and white sponge nevus. Other genetic disorders not included in the genodermatosis group and reported in the present review are: acanthosis nigricans, angio-osteo-hypertrophic syndrome, encephalotrigeminal angiomatosis, familial adenomatous polyposis, focal dermal hypoplasia, focal palmoplantar and oral mucosa hyperkeratosis syndrome, gingival fibromatosis, Maffucci's syndrome, neurofibromatosis (type 1) and oro-facial-digital syndrome (type 1). Disorders during embryonic development might lead to a wide range of abnormalities in the oral cavity; some of them are quite common but of negligible concern, whereas others are rare but serious, affecting not only the oral mucosa, but also other structures of the oral cavity (ie palate, tongue and gingiva). Fordyce's granules, leukoedema, cysts of the oral mucosa in newborns, retrocuspid papilla, geographic tongue, fissured tongue, median rhomboid glossitis, hairy tongue, lingual varices and lingual thyroid nodule are described. This review may help dentists, dental hygienists, but also general internists and pediatricians to diagnose different disorders of the oral mucosa, to understand the pathogenesis and to schedule a treatment plan., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Aim of this study was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of chronic oral mucosal pain (COMP). Patients and methods: Twenty-two patients affected by COMP were treated with standardized pharmacological protocols in association with Bioptron light (90 W; light wavelength = 480-3400 nm; degree of polarization = 95%; specific power density = 40 mW/cm 2 ; energy density = 2.4 J/cm). The outcome measures were intensity of pain [measured by visual analog scale (VAS) score] and signs reduction (measured by Eisen score) recorded at baseline ( t 0 ), after 4 weeks ( t 1 ), and after 8 weeks ( t 2 ). Signs and symptoms scores were compared with those of a cohort of comparable patients selected from institutional medical record files. Results: Patients in pharmacological treatment associated with Bioptron showed a significant VAS score decrease at t 1 and t 2 ( t 0  = 6.9, t 1  = 3.9, t 2  = 1.8, p  < 0.05), whereas the patients in exclusive pharmacological treatment showed a significant VAS score improvement only at t 2 . Comparing the VAS score at t 1 and t 2 in the two groups, a significant improvement was recorded in patients undergoing Bioptron adjunctive treatment ( t 1  = 3.9 vs. 5.9; p  < 0.05 and t 2  = 1.8 vs. 3.6; p  < 0.05). In both groups Eisen score improved at t 1 and t 2 , but in the Bioptron-treated patients the improvement was statistically better at t 1 (1.9 vs. 0.8; p  < 0.05) and at t 2 (2.7 vs. 1.4; p  < 0.05). Conclusions: In COMP patients, Bioptron use associated with pharmacological treatment allows a better and faster signs and symptoms reduction when compared with the exclusive pharmacological treatment. Further controlled studies are needed to establish the relative and absolute effectiveness of Bioptron in COMP management.

In this work PM 2.5 was collected during winter and summer in a Sardinian village (Gonnostramatza, Italy) highly affected by biomass burning emissions. A multi-technique approach was adopted for the complete PM chemical characterization. The bulk characterization was performed by IC (Ion Chromatography), HPAEC (High-Performance Anion-Exchange Chromatography), TOT (Thermal Optical Transmittance) and ED-XRF (Energy-Dispersive X-Ray Fluorescence) while XPS (X-ray Photoelectron Spectroscopy) was used for the surface characterization. Using levoglucosan as specific tracer of biomass burning emissions, the assessment of the impact of this source was carried out and it represent the major PM source at the investigate site during winter. In winter the average levoglucosan concentration is 2096 ± 324 ng/m 3 while during summer its concentration is negligible (18 ± 7 ng/m 3 ). Levoglucosan content in PM 2.5 during winter is on average 13.7%; it is estimated that 65% of PM 2.5 is due to wood burning. XPS has been exploited in this work aiming at highlighting possible differences between surface and bulk composition of PM 2.5 . The surface of the particulate matter resulted enriched in carbon compared to the bulk. Among the components of XPS C1s signals recorded on the samples collected during winter, it was found that the signal at 286.5 eV, which is due to the presence of COH, reflects the bulk composition of levoglucosan., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the effect of sugar-free snacks on caries-related factors in 6- to 9-year-old schoolchildren., Materials and Methods: Two hundred seventy-one children at risk for caries as measured through the Cariogram were randomly assigned to three groups consuming twice-daily snacks containing Stevia, maltitol or sugar for 42 days. Parents filled out a standardised questionnaire regarding personal, medical and oral behavioural information. Bleeding on probing, plaque pH and salivary mutans streptococchi (MS) and lactobacilli (LB) were assessed at baseline (t0), 42 days of snack use (t1) and 120 days after the end of use (t2). The Cariogram calculation was repeated at t1. Treatment effects were estimated using linear mixed-effects regression models., Results: At t2, a decrease in cariogenic bacteria (MS X2 = 8.01, p < 0.01 and LB X2 = 4.60, p = 0.03) and an increase of the minimum pH (F = 4.48, p < 0.01), maximum pH (F = 2.88 p < 0.01) and pH drop (F = 2.95 p < 0.01) was recorded in the Stevia group compared to baseline. In the maltitol group, an improvement effect was noted: LB concentration decreased (p = 0.04) and maximum pH (F = 3.16 p < 0.01) increased. Subjects classified by the Cariogram as have a low probability of developing caries increased in the Stevia and maltitol groups (X2(4) = 25.44, p < 0.01, C*sV = 0.38 and X2(4) = 12.85, p = 0.01, C*sV = 0.27, respectively). Regression analysis underlines the effect of Stevia snacks on the cariogenic microflora, mainly on MS and plaque pH variations., Conclusion: The short-term administration of Stevia or maltitol snacks improves some important factors related to caries. This preventive strategy might be an additional means of combatting this common childhood disease.

Background: Assessing caries risk is an essential element in the planning of preventive and therapeutic strategies. Different caries risk assessment (CRA) models have been proposed for the identification of individuals running a risk of future caries. This systematic review was designed to evaluate whether standardized caries risk assessment (CRA) models are able to evaluate the risk according to the actual caries status and/or the future caries increment., Methods: Randomized clinical trials, cross-sectional studies, cohort studies, comparative studies, validation studies and evaluation studies, reporting caries risk assessment using standardized models (Cariogram, CAMBRA, PreViser, NUS-CRA and CAT) in patients of any age related to caries data recorded by DMFT/S or ICDAS indices, were included. PubMed, Scopus and Embase were searched from 2000 to 2016. A search string was developed. All the papers meeting the inclusion criteria were subjected to a quality assessment., Results: One thousand three-undred ninety-two papers were identified and 32 were included. In all but one, the Cariogram was used both as sole model or in conjunction with other models. All the papers on children (n = 16) and adults (n = 12) found a statistically significant association between the risk levels and the actual caries status and/or the future caries increment. Nineteen papers, all using the Cariogram except one, were classified as being of good quality. Three of four papers comprising children and adults found a positive association. For seven of the included papers, Cariogram sensibility and specificity were calculated; sensibility ranged from low (41.0) to fairly low (75.0), while specificity was higher, ranging from 65.8 to 88.0. Wide 95% confidence intervals for both parameters were found, indicating that the reliability of the model differed in different caries risk levels., Conclusions: The scientific evidence relating to standardized CRA models is still limited; even if Cariogram was tested in children and adults in few studies of good quality, no sufficient evidence is available to affirm the method is effective in caries assessment and prediction. New options of diagnosis, prognosis and therapy are now available to dentists but the validity of standardized CRA models still remains limited.

Objectives: To investigate if, in Mexican adolescents, body weight and caries severity are associated, and if this association differs between rural and urban populations., Methods: Adolescents from the rural area of Tepancan and the city of Veracruz were enrolled. Caries was recorded using the International Caries Detection and Assessment System and the body mass index (BMI) was calculated. Oral habits (toothbrushing, flossing, dental check-ups) and dietary patterns (sweets intake) were assessed. A dummy variable between BMI and living area (BMI/Area) was generated. Data were analysed using STATA and a multinomial logistic regression model was run, using caries severity as the dependent variable., Results: Four-hundred and sixty-four subjects, 12-15 years of age, participated (rural = 240; urban = 224). The BMI and area of residence were significantly associated (χ 2 = 12.59, P < 0.01). Area was also associated with caries severity (χ 2 = 24.23, P < 0.01), with the highest number of caries in dentine recorded in participants from the rural area. The dummy variable BMI/Area was related to caries severity (χ 2 = 27.47, P < 0.01): overweight adolescents with caries in dentine were most frequently found in the rural area. A higher prevalence of caries in enamel and a lower prevalence of caries in dentine (P < 0.01) were recorded in adolescents from the urban area, where better oral habits, but higher sweets intake (P = 0.04), were encountered. According to the multinomial logistic regression model, BMI/Area was significantly associated with caries severity (P < 0.01)., Conclusions: Overweight was not associated with caries severity in the overall population, but it became a statistically significant risk indicator in adolescents living in the rural area., (© 2018 FDI World Dental Federation.)

Background: This survey aims to evaluate the prevalence and severity of tooth loss in the Italian elderly population living in nursing homes and to associate the oral data with demographic, socioeconomic factors, the Mini-Mental State Examination (MMSE), the Body Mass Index (BMI) and the Mini Nutritional Assessment (MNA) scores., Methods: A cluster sample method was performed using each nursing home as a cluster. Twenty-three nursing homes located in the five areas of the Italy (North-West, North-East, Centre, South and Islands) were selected. An informed consent to participate was distributed by the personnel of the selected nursing homes and signed directly by subjects/caregivers; 2114 forms were distributed, 1998 forms signed and finally 1976 subjects were examined. Chewing ability was scored as good (≥10 functional units (FUs)), sufficient (7-10 FUs), and insufficient (< 7 FUs). The presence of prosthetic dental restorations was summarized as: absent of prosthesis, fixed prosthesis, removable prosthesis, combined prosthesis. Age, gender, socioeconomic status, MMSE, BMI and MNA were obtained from medical charts., Results: Almost three quarters of the subjects were ≥ 80 years old (74.37%) and women (74.04%). The prevalence of edentulism was 42.10% with a large variation among the five areas of Italy (from 34.43% in Centre to 53.46% in North-West). Insufficient presence of FUs was preeminent in each age group (prevalence 42.10%) and statistically associated to age and to female gender (p <  0.01). Overweight/obese (7.47%) subjects showed the highest FUs. Area of living, MMSE (both < 0.01), BMI (p = 0.01) were statistically significant associated to the type of prosthetic dental restorations in the oldest group. Subjects with no mental impairment showed the highest percentage of prosthetic dental restorations (32.36%)., Conclusions: More than half of the sample has an insufficient number of functional units for chewing and this is more pronounced in females. The presence and the type of prosthetic dental restorations are linked to cognitive impairment: the higher is the mental impairment the higher is the number of subjects with absence of prosthetic restorations. The findings of this national survey highlight the need for public health policy, aiming to increase awareness regarding oral health though health education.

Objectives: The caries preventive effect of long-term use (1 year) of low-dosage (2.5 g/die) of xylitol chewing gum in a high-caries-risk adult population was evaluated., Materials and Methods: In this randomized clinical trial, 179 high-caries-risk adults were assigned to two experimental groups, xylitol and polyols. Caries status, salivary mutans streptococci (MS), and plaque pH were re-evaluated after 2 years from baseline in 66 xylitol and 64 polyol subjects. Outcomes (the net caries increment for initial, moderate, and extensive caries lesions and for the caries experience) were evaluated using the nonparametric Mann-Whitney U test., Results: The total caries experience increment was 1.25 ± 1.26 in the xylitol group and 1.80 ± 2.33 in the polyol group (p = 0.01). Subjects treated with xylitol chewing gums had a reduction of risk rate at tooth level of 23% with respect to those treated with polyols with a number needed to treat of 55 teeth. The area under the curve at pH 5.7 was statistically significantly lower (p = 0.02) during the experimental period in the xylitol group. A decrease of the concentration of salivary MS was noted in the xylitol group (p < 0.01)., Conclusions: Subjects using the low-dose xylitol chewing gum showed a significantly lower increment of initial and extensive caries lesions and overall a lower increment of caries experience., Clinical Relevance: One-year use of chewing gums provides an effective means for the prevention of caries disease., Trial Registration Number: NCT02310308.

Background: The pH strip method has been proposed for use in a clinical setting for the evaluation of dental plaque pH. The aim of this in-vivo study was to compare the reliability of the pH-indicator strip method to the microelectrode technique in plaque pH measurement., Methods: 136 subjects (7-9 years) were enrolled and, for each subject, measurements of plaque pH were made at two interproximal sites; a total of 272 sites were analyzed. Plaque pH was assessed in triplicate using pH-indicator strips (pH range: 4.0-7.0) and an iridium microelectrode with a diameter of 0.1 mm. The caries status of 544 proximal surfaces between two primary molars, in proximity at the plaque pH sites, was assessed. All measurements were performed before and 2, 5, 10, 15, 20, and 30 minutes after a mouth rinse with water solution of sucrose (10%). One-way ANOVA was performed to analyze statistically significant differences between the two techniques. Instrument reliability was measured by assessing the intraclass correlation coefficient., Results: Comparable, not statistically significant pH values (P values range from 0.98 to 1.00) were obtained by the two methods for AUC5.7, AUC6.2, maximum pH fall and minimum pH. High intraclass coefficients were recorded (Pearson's r=0.96, Yule's Q=0.99), implying an almost perfect association when the measurements were grouped as a carious lesion being present or not on the surface near the site of measurement., Conclusions: The use of the pH strip method has high validity and may replace the traditional microtouch electrode technique for clinical use.

Aim: To evaluate the caries prevalence and related variables in Type 1 diabetic and non-diabetic children and among the diabetic children according to their metabolic status., Methods: Sixty-eight diabetic and 136 non-diabetic children, matching by gender and age (4-14 years) were enrolled. The diabetic children were divided: a) 20 children in good metabolic control (Hb1ac≤7.5) and b) 48 children in bad metabolic control (Hb1ac>7.5). Dietary and oral hygiene habits were investigated. Caries status was registered using the International Caries Detection and Assessment System. Oral microflora was analysed using the checkerboard DNA-DNA hybridisation method. Plaque acidogenicity was recorded after a sucrose rinse., Results: Sugared beverage and snack intake was higher in diabetic group compared to non-diabetic group (p = 0.03 and p = 0.04, respectively) and in subjects in bad metabolic control (p = 0.03 and p<0.01, respectively). Oral hygiene habits were similar, except for the use of fluoridated adjuvants, higher in non-diabetic children (p = 0.04). No statistically significant differences were observed regarding caries figures, but a higher number of caries free subjects was found in diabetic subjects in good metabolic control (p<0.01). Significant difference for the main cariogenic bacteria was found between diabetic and non-diabetic subjects (p<0.05). The pH values showed statistically significant differences between diabetic and non-diabetic subjects and between diabetic subjects in good and bad metabolic control (p<0.01)., Conclusions: Diabetic children in good metabolic control might even be considered at low caries risk, while those in bad metabolic control showed an oral environment prone to a high caries risk.

Aim of the study is to assess the development of a structured sentinel system for oral health data collection at national level. Furthermore, this pilot study aims to investigate the prevalence data on dentinal sensitivity pain collected through a nationwide network of epidemiological sentinels (dental hygienists). Each sentinel was given a specific number of examinees and periodicity of data collection. Overall, 116 adults were recruited from 19 Regions, 42,24% male and 57,76% female, with a mean age of 26. DH result was consistent with literature data, being 45%. All sentinel completed the standard forms and assured a good compliance. The overall good customer satisfaction assures adhesion of the sentinels to the procedure, and the regular data collection. The pilot study proved the effectiveness of a structured nationwide network of epidemiological sentinels (dental hygienists) for oral health data collection at national level. This methodology can be an essential starting point for periodic comparative studies.

Background: Laparoscopic approach in colorectal surgery has demonstrated to give advantages in terms of postoperative outcomes, particularly in high-risk patients. The aim was to assess the impact of patients' age on the short-term outcomes after laparoscopic right colectomy for cancer., Methods: From January 2004 to September 2014, all patients who underwent laparoscopic right colectomy for cancer in a single institution were divided into four groups (A: <64 years; B: 65-74 years; C: 75-84 years; D ≥85 years). Risk factors for postoperative complications were determined on multivariable analysis., Results: Laparoscopic right colectomy was performed in 507 patients, including 171 (33.7%) in A, 168 (33.1%) in B, 131 (25.8) in C and 37 (7.4%) in D. Patients in Group C and Group D had higher ASA score (p<0.0001) and presented more frequently with anaemia (20.6% and 29.7%, p=0.001). Stages III and IV were more frequently encountered in groups C and D. Overall morbidity was 27.5% without any difference in the four groups (24.5%, 29.1%, 7.5% and 18.4% respectively, p=0.58). The rate of minor complications (such as wound infection or postoperative ileus) was higher in Group D compared to other groups (p=0.05). The only independent variable correlated with postoperative morbidity was intraoperative blood transfusion (OR 2.82; CI 95% 1.05-4.59, p<0.0001)., Conclusions: The present series suggests that patient's age did not significantly jeopardize the postoperative outcomes after laparoscopic right colectomy for cancer., (Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Objective To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study. Methods Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance). Results Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ 2 (9)  = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ 2 (9)  = 25.68 p < 0.01, Z = -4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking ( p < 0.01). Conclusions The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.

Objectives: To examine cancer trend using age-period-cohort analysis with a cohort of patients in Sardinia, Italy, where epidemiological transition occurred between 1950 and 1960., Methods: Poisson log-linear regression models were used to analyze time trend in patients undergoing upper endoscopy between 1995 and 2013., Results: A total of 10,546 clinical records (62.2% women) were retrieved. In 541 patients (5.1%), a diagnosis of cancer was reported, more often in men (5.5%) than in women (4.9%). Age and birth cohort were significantly associated with cancer rate according to age-period-cohort analysis (p < 0.0001), whereas the effect of time period was negligible (p = 0.875). An upward trend for all cancers was observed in the younger generations (7.15% before 1950, 8.85% between 1950 and 1960, and 10.7% after 1960)., Conclusions: Population aging and increased exposure to cancer risk factors after epidemiological transition were the major determinants associated with cancer in this Sardinian cohort, whereas time period had no effect, ruling out any variation in diagnostic accuracy. These results may facilitate the provision of preventive measures by the health care system, and improve population-tailored cancer screening strategies.

Objectives: This article aimed to evaluate: (a) the agreement between a near-infrared light transillumination device and clinical and radiographic examinations in caries lesion detection and (b) the reliability of images captured by the transillumination device., Methods: Two calibrated examiners evaluated the caries status in premolars and molars on 52 randomly selected subjects by comparing the transillumination device with a clinical examination for the occlusal surfaces and by comparing the transillumination device with a radiographic examination (bitewing radiographs) for the approximal surfaces. Forty-eight trained dental hygienists evaluated and reevaluated 30 randomly selected images 1-month later., Results: A high concordance between transillumination method and clinical examination (kappa = 0.99) was detected for occlusal caries lesions, while for approximal surfaces, the transillumination device identified a higher number of lesions with respect to bitewing (kappa = 0.91). At the dentinal level, the two methods identified the same number of caries lesions (kappa = 1), whereas more approximal lesions were recorded using the transillumination device in the enamel (kappa = 0.24). The intraexaminer reliability was substantial/almost perfect in 59.4% of the participants., Conclusions: The transillumination method showed a high concordance compared with traditional methods (clinical examination and bitewing radiographs). Caries detection reliability using the transillumination device images showed a high intraexaminer agreement. Transillumination showed to be a reliable method and as effective as traditional methods in caries detection.

Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management., Aim: To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases., Methods: One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report., Results & Conclusions: There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc-γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Actual caries figures emphasize the need to identify the risk indicators involved in the disease's development. The hypothesis that certain risk indicators might affect the dynamic evolution of the caries process was assessed; to clarify this premise, a cross-sectional survey was performed in school children., Methods: A total of 390 subjects aged 6-8 years old were randomly selected. Caries was assessed, and the subjects were stratified as follows: i) highest caries score; ii) most prevalent caries score; and iii) number of affected teeth. Parents/guardians completed a questionnaire regarding vital statistics, socio-economic indicators, dietary habits, oral hygiene habits and oral health behaviours., Results: Caries was detected in 42.31% of the subjects. Maternal nationality, parental education level, use of a sweetened pacifier at night, intake of lactose-free milk and toothbrushing frequency were statistically significant associated (p < 0.05) with subjects stratified according to the highest caries score. Parental educational level, maternal occupational status and use of a sweetened pacifier at night were associated (p < 0.05) with affected children stratified according to the most prevalent caries score. Maternal educational level and intake of lactose-free milk were associated with subjects with moderate caries stages compared to being caries-free (p = 0.01 and p = 0.02, respectively). Maternal nationality (p < 0.01) and toothbrushing frequency (p = 0.01) were associated with subjects affected by extensive lesions compared to caries-free children. In subjects affected by initial lesions as the most prevalent figure, gender (male) and paternal occupation status (unemployed) were statistically significant associated (p = 0.03 and p = 0.04, respectively) compared to those affected by highest prevalence of extensive caries lesions. In children with the highest prevalence of moderate caries lesions, maternal education level (p < 0.01), paternal occupational status (p = 0.03) and use of a sweetened pacifier at night (p < 0.01) were statistically significantly associated., Conclusions: Maternal nationality, maternal low level of education, intake of lactose-free milk and low toothbrushing frequency were involved in the change from caries-free status to different caries stages. Gender, paternal unemployment, maternal low educational level and use of a sweetened pacifier were correlated with caries progression, showing how distinctive risk indicators were associated with different caries stages.

In the last few years gold(III) complexes have attracted growing attention in the medicinal chemistry community as candidate anticancer agents. In particular some organogold(III) compounds manifested quite attractive pharmacological behaviors in preclinical studies. Here we compare the chemical and biological properties of the novel organogold(III) complex [Au(bipy(dmb)-H)(NH(CO)CH3)][PF6] (Aubipy(aa)) with those of its parent compounds [Au(bipy(dmb)-H)(OH)][PF6] (Aubipy(c)) and [Au2(bipy(dmb)-H)2)(μ-O)][PF6]2 (Au2bipy(c)), previously synthesized and characterized. The three study compounds were comparatively assessed for their antiproliferative actions against HCT-116 cancer cells, revealing moderate cytotoxic effects. Proapoptotic and cell cycle effects were also monitored. Afterward, to gain additional mechanistic insight, the three gold compounds were challenged against the model proteins HEWL, RNase A and cytochrome c and reactions investigated through UV-Vis and ESI-MS analysis. A peculiar and roughly invariant protein metalation profile emerges in the three cases consisting of protein binding of {Au(bipy(dmb)-H)} moieties. The implications of these results are discussed in the frame of current knowledge on anticancer gold compounds.

Introduction: Transanal endoscopic microsurgery (TEM) is a consolidated technique for the excision of rectal tumors. However, many aspects relating to its morbidity, risk of functional alterations, and therapeutic outcomes are still unclear. The aim of this study was to assess the rate of morbidity and fecal incontinence after TEM, and to identify associated risk factors., Methods: We prospectively recorded the clinical data of 157 patients who underwent TEM from 1996 to 2013. Among these, 89 patients answered a questionnaire for the assessment of fecal continence at a median follow-up time of 40 months., Results: Intraoperative and postoperative TEM complication rates were 3.8 and 20.4%. The mortality rate was 0.6%. A distance from the anal verge of more than 6 cm correlated with a higher risk of perforation, while patients with cancer were more likely to have postoperative bleeding. Incontinence was reported by 32 (36%) patients, of which 7 (8%) experienced transitory symptoms only, while 25 (28%) reported persistent symptoms. We found a correlation between patients receiving preoperative radiotherapy (RT) and the development of fecal incontinence. The recurrence rate was 3% (1/32) in pT1, 80% (4/5) in pT2, and 100% (1/1) in pT3. After radiotherapy, 7% (1/9) showed a good response (pT0-1), and 18% (2/7) showed no response (pT2-3)., Conclusions: TEM is associated with low morbidity but the risk of developing functional alterations is not negligible and should be discussed with the patient before the operation. Good oncological outcomes are possible for early invasive cancers and for selected advanced cancers following a good response to preoperative RT.

Context: Tracheo-bronchial aspiration is the most invalidating condition which can happen to patients affected by dysphagia, especially when caused by central neurologic disorders; the associated pneumonia episodes represent the most frequent cause of death in these patients. Oro-pharyngo-esophageal scintigraphy (OPES) allows both functional imaging and semiquantitative evaluation of the subsequent phases of swallowing., Case Report: We evaluated by means of OPES a woman who had previously undergone high-dose external beam radiation therapy for a nasopharyngeal carcinoma, which determined tissue fibrosis and progressive dysphagia., Conclusion: In this patient with dysphagia, OPES was a simple, inexpensive, noninvasive, and reliable technique that allowed to show the presence of bolus aspiration and quantified tracheobronchial aspirate.

A series of novel (C^N) cyclometallated Au(III) complexes of general formula [Au(py(b)-H)L(1)L(2)](n+) (py(b)-H = C^N cyclometallated 2-benzylpyridine, L(1) and L(2) being chlorido, phosphane or glucosethiolato ligands, n = 0 or 1) have been synthesized and fully characterized using different techniques, including NMR, IR and far-IR, mass spectrometry, as well as elemental analysis. The crystal structure of one compound has been solved using X-ray diffraction methods. All compounds were tested in vitro in five human cancer cell lines including the lung, breast, colon and ovarian cancer cells. For comparison purposes, all compounds were also tested in a model of healthy human cells from the embryonic kidney. Notably, all new compounds were more toxic than their cyclometallated precursor bearing two chlorido ligands, and the derivative bearing one phosphane ligand presented the most promising toxicity profile in our in vitro screening, displaying a p53 dependent activity in colorectal cancer HCT116 cells. Finally, for the first time C^N cyclometallated gold(III) complexes were shown to be potent inhibitors of the zinc finger protein PARP-1, involved in the mechanism of cisplatin resistance.

The aim of this study was to examine the correlation among socio-behavioral factors, caries status and caries risk, calculated through Cariogram, in an adult population. Four hundred eighty subjects (mean age 40.73, SE ± 0.33) randomly selected from the municipal electoral registry consented to participate in the survey. Subjects were examined, and the International Caries Detection Assessment System (ICDAS) index was registered. A highly structured questionnaire was submitted to investigate (1) personal data (i.e., age, gender, educational level, job categorization), (2) life-style behavior (i.e., smoking and dietary habits), and (3) oral health behavior (i.e., tooth brushing, use of fluoride and dental check-up frequency). An evaluation of the mutans streptococci concentration in saliva was also performed. Information on caries-related factors was entered into the Cariogram in order to generate an individual caries risk profile for each subject. Multinomial logistic regression was performed using Cariogram levels as the dependent variable. The possible correlated variables were analyzed using the principal component analysis (PCA). Considering ICDAS scores, 5.62% of the sample had at least an initial decay (ICDAS = 1-2), whereas 40.83% of the sample presented at least one moderate decay (ICDAS = 3-4) and 17.08% a severe decay (ICDAS = 5-6). Decay at ICDAS levels 5-6 and more than 5 missing teeth were statistically associated with Cariogram scores (OR = 2.36, 95%CI = 1.83-3.03 and OR = 1.43, 95%CI = 1.13-1.82, respectively). The results suggest that the Cariogram model was able to identify caries-related factors in an adult population. A direct association among the risk categories from Cariogram, the caries status and some socio-behavioral variables was verified.

Objective: The purpose of this systematic review and meta-analysis was to evaluate the reliability of the Carisolv system with respect to drilling regarding the full removal of decayed hard tissues in primary dentition. A systematic review of the literature was conducted to identify controlled trails, randomized controlled trials and clinical trials that compared the Carisolv system to the traditional mechanical caries removal in the primary dentition., Materials and Methods: The main relevant databases were searched: MEDLINE via PUBMED, Web of Science and SCOPUS. Complete caries removal, length of working time and need of local anesthesia were the outcomes evaluated., Results: A total of 195 studies were identified and complete analysis of 28 studies was performed; finally, 10 papers were included. The trials included involved a total of 348 patients for 532 treated teeth. There was no significant difference in terms of clinical efficacy between the Carisolv and the rotary instrument (z = 0.68, p = 0.50), whereas the treatment with Carisolv was significantly longer in terms of time with respect to the rotary instruments (z = 10.49, p < 0.01). The chemo mechanical technique reduces the need for local anesthesia, with a difference between two types of treatment near to statistical significance (z = 1.91 p = 0.06)., Conclusions: This systematic review indicates that the clinical efficacy of chemo-mechanical removal with Carisolv seems as reliable as the rotary instruments. However, the results should be interpreted cautiously due to the heterogeneity among study designs and to the shortage of available data. Further large-scale, well-designed randomized controlled trials are needed.

Objective: The aim of this randomized, single-blind, splitmouth design, clinical trial was to evaluate the effectiveness in plaque removal of two brushing methods, the vertical and the horizontal, in a sample of healthy young adults., Method and Materials: Forty-nine subjects were enrolled and 43 completed the study. All subjects abstained from oral hygiene practices for 48 hours. Plaque and gingival abrasions were recorded according to the Rustogi Modified Navy Plaque Index (RMNPI) and the van der Weijden method by one calibrated examiner before and immediately after the brushing session. A dental hygienist performed the two brushing methods using a randomized split-mouth design. The average plaque scores from the whole mouth, interproximal surfaces, and gingival margin were obtained before and after brushing, and the differences were evaluated using one-way analysis of variance., Results: The differences in mean plaque scores between pre- and postbrushing were statistically significant for both methods. Considering the interbrushing differences, the vertical method produced lower plaque scores compared to the horizontal for the whole mouth (P=.02). In the interproximal surfaces, the vertical method removed more plaque compared to the horizontal one (P<.01). In the gingival margin no statistically significant differences in plaque scores were recorded. Only 10 gingival abrasions were registered, mainly produced by the horizontal method., Conclusion: RESULTS suggest that both toothbrushing methods are effective in plaque removal; nevertheless, the vertical brushing method has demonstrated to remove more plaque from the interproximal surfaces than the horizontal method.

Purpose: To evaluate if the intake of a fluoridated food supplement in breastfeeding mothers increases the fluoride concentration in breast milk., Methods: A double-blind randomized placebo-controlled study was designed. Two groups of women were formed: a fluoride group (n = 112), using a non-sucrose food supplement containing fluoride (1,500 μg/l for each dose) and a control group (n = 116), using a non-sucrose food supplement without fluoride content. The women were followed for 6 weeks. Samples of breast milk were collected and analyzed using an ion-specific electrode., Results: 85 women in the fluoride group and 83 in the control group concluded the trial. Fluoride concentrations in the two groups were statistically significantly different (515 μg/l in the fluoride and 476 μg/l in the control group P= 0.04) at the end of the experimental period. In the fluoride group, a statistically significant increment in fluoride concentration during the experimental period was also observed (from 468 ± 104 μg/l to 515 ± 105 μg/l). The use of a non-sucrose food supplement containing fluoride resulted in a significant increment in fluoride concentration in breast milk.

A double-blind randomized clinical trial was performed in 6- to 7-yr-old schoolchildren to evaluate, in a 30-mo period, whether the caries increment on the distal surface of the second primary molars adjacent to permanent first molars sealed with fluoride release compounds would be lower with respect to those adjacent to permanent first molars sealed with a nonfluoridated sealant. In sum, 2,776 subjects were enrolled and randomly divided into 3 groups receiving sealants on sound first molars: high-viscosity glass ionomer cement (GIC group); resin-based sealant with fluoride (fluoride-RB group); and a resin-based sealant without fluoride (RB group). Caries (D1 - D3 level) was recorded on the distal surface of the second primary molar, considered the unit of analysis including only sound surfaces at the baseline. At baseline, no differences in caries prevalence were recorded in the 3 groups regarding the considered surfaces. At follow-up, the prevalence of an affected unit of analysis was statistically lower (p = .03) in the GIC and fluoride-RB groups (p = .04). In the GIC group, fewer new caries were observed in the unit of analysis respect to the other 2 groups. Incidence rate ratios (IRRs) were 0.70 (95% confidence interval: 0.50, 0.86; p < .01) for GIC vs. RB and 0.79 (95% confidence interval: 0.67, 0.89; p = .005) for fluoride-RB vs. RB [Corrected]. Caries incidence was significantly associated with low socioeconomic status (IRR = 1.18; 95% confidence interval: 1.10, 1.42; p = .05). Dental sealant high-viscosity GIC and fluoride-RB demonstrated protection against dental caries, and there was evidence that these materials afforded additional protection for the tooth nearest to the sealed tooth (clinical trial registration NCT01588210)., (© International & American Associations for Dental Research.)

Aim. To describe 7 years of activity of "CROMa" (Coordination of Research on Osteonecrosis of the Jaws) project of "Sapienza" University of Rome. Materials and Methods. A preventive and therapeutic care pathway was created for patients with bisphosphonates (BPs) exposure. Demographic, social, behavioural, pharmacological, and clinical variables were registered in a dedicated database. Results. In the project, 502 patients, 403 females and 99 males, were observed. Bone pathologies were 79% osteometabolic diseases (OMD) and 21% metastatic cancer (CA). Females were 90% in OMD group and 41% in CA. BP administration was 54% oral, 31% IV, and 11% IM; 89% of BPs were amino-BP and 11% non-amino-BP. Consistently with bone pathology (OMD/CA), alendronate appears to be prevalent for OMD (40% relative), while zoledronate was indicated in 92% of CA patients. Out of 502 cases collected, 28 BRONJ were detected: 17 of them were related to IV BP treatment. Preventive oral assessment was required for 50% of CA patients and by 4% of OMD patients. Conclusions. The proposed care pathway protocols for BP exposed patients appeared to be useful to meet treatment and preventive needs, in both oncological and osteometabolic diseases patients. Patients' and physicians' prevention awareness can be the starting point of a multilevel prevention system.

Objectives: A double-blind, randomised, placebo-controlled clinical trial was performed to validate the hypothesis that the use of lozenges containing Lactobacillus brevis CD2 (Inersan®, CD Investments srl) may reduce plaque pH, salivary mutans streptococci (ms) and bleeding on probing, during a 6-week period, in a sample of high caries risk schoolchildren., Methods: A total of 191 children (aged 6-8 years), presenting two to three carious lesions and a salivary ms concentration of ≥10(5) CFU/ml, were enrolled and divided into two groups, an L. brevis CD2 lozenge group and a no L. brevis lozenge group, and examined at baseline (t0), after 3 weeks (t1), after 6 weeks of lozenge use (t2) and 2 weeks after the cessation of lozenge use (t3). Plaque pH was assessed using the microtouch technique following a sucrose challenge. The area under the curve (AUC5.7 and AUC6.2) was recorded. Salivary ms were counted, and bleeding on probing was assessed., Results: At t0, the plaque-pH and ms concentration values were similar in both groups. Mean areas (AUC5.7 and AUC6.2) were significantly greater in the control group at t1, t2 and t3. L. brevis CD2 lozenges significantly reduced salivary ms concentrations and bleeding. The subjects from the test group showed a statistically significant decrease (p = 0.01) in salivary ms concentration. At t2, a statistically significantly lower bleeding value was recorded in the test group compared with the control group (p = 0.02)., Conclusions: Six weeks' use of lozenges containing L. brevis CD2 had a beneficial effect on some important variables related to oral health, including a reduction in plaque acidogenicity, salivary ms and bleeding on probing. (Trial Registration Number NCT01601145 08/21/2012).

This paper aims to provide a systematic review of the caries-prevention effect of probiotics in human. The hypothesis was that the administration of probiotic strains might play a role in caries lesion prevention and in the control of caries-related risk factors. The main relevant databases (Medline, Embase) were searched. Quality of the Randomized Clinical Trials (RCTs) was classified using the "Consolidated Standards of Reporting Trials" (CONSORT) checklist and the Impact Factor (IF) value of each journal was recorded. Sixty-six papers were identified, and 23 fulfilled the inclusion criteria. Only three studies had caries lesion development as outcome, all the others reported caries risk factors as interim evaluation. Using the CONSORT Score, the papers were coded as 4 excellent, 9 good and 10 poor. The mean IF value recorded was 1.438. Probiotics may play a role as antagonistic agent on mutans streptococci (MS), acidogenic/aciduric bacteria that contributes to the caries process. In two-thirds of the selected papers, probiotics have demonstrated the capacity to reduce MS counts in saliva and/or plaque in short-term. The effect of probiotics on the development of caries lesion seems encouraging, but to date, RCTs on this topic are insufficient to provide scientific clinical evidence.

A randomized clinical trial was performed in schoolchildren (6-7 yrs) to evaluate fluoride concentration in interproximal fluid after the placement of 3 different sealants. The sample consisted of 2,776 children randomly divided: 926 in the high-viscosity Glass-ionomer Cement group (GIC group), 923 in the fluoride Resin-based group (fluoride-RB group), and 927 in the no-fluoride Resin-based group (RB group). In total, 2,640 children completed the trial. Sealants were applied following manufacturer's instructions. Interproximal fluid samples were collected at baseline and 2, 7, and 21 days after application of sealants, by insertion of a standardized paperpoint into the interproximal mesial space of the sealed tooth for 15 seconds. Fluoride concentration was evaluated by means of a fluoride ion-selective electrode. At 2 days after sealant application, fluoride concentration was significantly higher in GIC and fluoride-RB groups compared with that in the RB group (p < .01). Mean fluoride concentrations after 7 days were 2.54 (SE 0.68) ppm, 0.85 (SE 0.26) ppm, and 0.53 (SE 0.11) ppm for the three groups, respectively. After 21 days, fluoride concentration in the GIC group remained higher than that in the other two groups. High-viscosity GIC sealants increased the fluoride concentrations in interproximal fluid more than did a Resin-based sealant containing fluoride.

Purpose: To evaluate the fluoride concentration in enamel after the use of different fluoride products and 48 hours after the cessation of fluoride use., Methods: 16 enamel slabs were divided and treated for 15 days as following: Group A, with an amine fluoride toothpaste and mouthrinse (1400 and 250 mg/L(-1), respectively); Group B, with an amine fluoride toothpaste (1400 mg/L(-1)) and mouthrinse without fluoride; Group C, with a sodium fluoride toothpaste (1400 mg/L(-1)) and mouthrinse (250 mg/L(-1)). Chemical biopsy and multiple means were used to determine fluoride concentration. The data were statistically analyzed using the two-way ANOVA and Tukey HSD tests (P<0.05)., Results: After 15 days of fluoride product use, Group A samples had the highest fluoride uptake (0.19 microg mm(-2)) (P<0.05). 48 hours after the interruption of fluoride product usage, a higher fluoride concentration was found in Group A samples. Although all fluoride products led to an enamel uptake, amine fluoride products promoted the most effective long-term uptake.

Two dinuclear oxo-bridged organogold(III) compounds, namely [(N,N,C)(2)Au(2)(μ-O)][PF(6)](2) (with N,N,CH = 6-(1-methylbenzyl)-2,2'-bipyridine, Au(2)O1; or 6-(1,1-dimethylbenzyl)-2,2'-bipyridine, Au(2)O2), were previously prepared and characterised. Their solution chemistry under physiological-like conditions has been investigated here as well as their in vitro antiproliferative properties. Notably, these compounds reveal a marked redox stability even in the presence of effective biological reductants such as ascorbic acid and glutathione. The two dinuclear gold(iii) compounds were evaluated for cytotoxic actions against a representative panel of 12 human tumor cell lines, in comparison to respective mononuclear parent compounds [(N,N,C)AuOH][PF(6)], and appreciable biological activity could be highlighted. The reactions of Au(2)O1 and Au(2)O2 with a few model proteins were studied and the ability to form metallodrug-protein adducts monitored through ESI MS methods. Typical adducts were identified where the protein is associated to monometallic gold fragments; in these adducts gold remains in the oxidation state +3 and conserves its organic ligand. A direct comparison of the biological profiles of these binuclear organogold(III) compounds with those previously reported for a series of dinuclear oxo-bridged complexes [(N,N)(2)Au(2)(μ-O)(2)][PF(6)](2) (N,N = 6(6')-substituted 2,2'-bipyridines) named Auoxo's was carried out. It emerges that the greater cytotoxicity of the latter is mainly due to the greater oxidising power of their gold(III) centres and to propensity to generate gold(i) species; in contrast, the here described bimetallic organogold(III) complexes manifest a far higher redox stability in the biological milieu coupled to lower, but still significant, antiproliferative properties. Different molecular mechanisms are thus hypothesised for these two classes of dinuclear gold(III) agents.

Background: In schoolchildren the most commonly decayed primary teeth are molars affecting proximal adjacent surfaces especially., Aim: To determine whether a more acidic plaque in response to sucrose challenge is detected in children with more carious lesions., Design: Plaque pH measurements, using the microtouch technique, were carried out in interproximal spaces between primary molars, in 157 high caries risk children (314 sites and caries status of the 628 proximal surfaces recorded). The area under the curve (AUC(5.7) and AUC(6.2) ) was analyzed., Results: The AUC(5.7) and the AUC(6.2) showed a statistically significant difference between plaque adjacent to proximal surfaces with or without caries. Differences for AUC(5.7) and AUC(6.2) were recorded between one decayed surface compared to two decayed surfaces (P<0.01) whereas a statistical significant difference was only observed for AUC(5.7) , when the areas under the curve were obtained near one decayed surface compared to two sound surfaces (P=0.04)., Conclusions: The higher acidogenicity of the dental plaque found in presence of a proximal carious lesion in primary maxillary molars represents an additional risk factor for the adjacent surface. This finding may help clinicians in treatment decisions., (© 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.)

The effect of magnolia bark extract (MBE) on different variables related to caries and gingivitis administered daily through a sugar-free chewing gum was evaluated. The study was performed with healthy adult volunteers at high risk for caries as a randomized double-blind interventional study. 120 subjects with a salivary mutans streptococci (MS) concentration ≥10(5) CFU/ml and presence of bleeding on probing >25% were enrolled and divided into three groups: magnolia, xylitol and control. The study design included examinations at baseline, after 7 days, after 30 days of gum use and 7 days after the end of gum use. Plaque pH was assessed using the strip method following a sucrose challenge. Area under the curve (AUC(5.7) and AUC(6.2)) was recorded. Whole saliva was collected and the number of salivary MS (CFU/ml) was counted. Bleeding on probing was recorded as a proxy of dental plaque. Data were analyzed using ANOVA repeated measures. Magnolia gum significantly reduced plaque acidogenicity, MS salivary concentration and gingival bleeding compared to xylitol and control gums. Subjects from the magnolia and xylitol groups showed both MS concentration (p = 0.01 and 0.06, respectively) and AUC(5.7) (p = 0.01 and 0.04, respectively) to be significantly lower compared to baseline. Thirty-day use of a chewing gum containing MBE showed beneficial effects on oral health, including reduction of salivary MS, plaque acidogenicity and bleeding on probing., (Copyright © 2011 S. Karger AG, Basel.)

The main aim of this work was to know how spread is laccase activity in spores of Bacillus species isolated from a soil where Italian law allows olive mill wastewater (OMW) spreading, and to investigate the potential role of such autochthonous soil microorganisms in degradation of OMW phenols, and prevention of groundwater pollution. Laccase activity was detected for the first time in spores of wild-type Bacillus pumilus, B. cereus sensu lato, and B. amyloliquefaciens strains. Because B. pumilus, B. cereus sensu lato, and B. amyloliquefaciens, together with B. subtilis account for a total of 93% of Bacillus isolates at the study site, the nearly totality of Bacillus spores reveals laccase activity. Thus, taking also into consideration that Bacillus spores are more abundant (about 100-fold) than white-rot fungi (that possess a well known extracellular, radical-based ligninolytic enzyme system capable of degrading OMW phenols) in the studied soil, these spores may contribute to in-situ degradation of OMW phenols. This role is further emphasized by dilution of crude OMW during infiltration of rainwater through soil that allows to minimize the antibacterial activity of phenols. The widespread presence of Bacillus spores in soils indicates a potential detoxifying role of these spores in a broader context.

Dinuclear gold(III) clusters with a rhombic Au(2)O(2) core and 2,2'-bipyridyl ligands substituted in the 6-position (bipy(R)) are examined by tandem mass spectrometry. Electrospray ionization of the hexafluorophosphate salts affords the complexes [(bipy(R))Au(mu-O)(2)Au(bipy(R))](2+) as free dications in the gas phase. The fragmentation behavior of the mass-selected dications is probed by means of collision-induced dissociation experiments which reveal an exceptionally pronounced effect of substitution. Thus, for the parent compound with R = H, i.e., [(bipy)Au(mu-O)(2)Au(bipy)](2+), fragmentation at the dicationic stage prevails to result in a loss of neutral H(2)O concomitant with an assumed rollover cyclometalation of the bipyridine ligands. In marked contrast, all complexes with alkyl substituents in the 6-position of the ligands (bipy(R) with R = CH(3), CH(CH(3))(2), CH(2)C(CH(3))(3), and 2,6-C(6)H(3)(CH(3))(2)) as well as the corresponding complex with 6,6'-dimethyl-2,2'-dipyridyl as a ligand exclusively undergo Coulomb explosion to produce two monocationic fragments. It is proposed that the additional steric strain introduced to the central Au(2)O(2) core by the substituents on the bipyridine ligand, in conjunction with the presence of oxidizable C-H bonds in the substituents, crucially affects the subtle balance between dication dissociation under maintenance of the 2-fold charge and Coulomb explosion into two singly charged fragments.