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This paper gathers some contributions concerning survey methodology in dental research, as discussed during the first Workshop of the SISMEC STATDENT working group on statistical methods and applications in dentistry, held in Ancona on the 28th September 2011. The first contribution deals with the European Global Oral Health Indicators Development (EGOHID) Project which proposed a comprehensive and standardized system of epidemiological tools (questionnaires and clinical forms) for national data collection on oral health in Europe. The second contribution regards the design and conduct of trials to evaluate the clinical efficacy and safety of toothbrushes and mouthrinses. Finally, a flexible and effective tool used to trace dental age reference charts tailored to Italian children is presented.

Objectives: The aim of this study was to investigate the effectiveness of an orthodontic tooth movement acceleration device (AcceleDent, OrthoAccel Technologies, Houston, Texas) when used during an aligner treatment. Materials and Methods: Adult patients who began an aligner treatment (Lineo, Micerium Lab, Avegno, Italy) were allocated to two treatment groups. The first one (Group A), with a 7-day aligner change regimen, used the AcceleDent device for 20 min per day, whereas the second one (Group B) changed the aligners every 14 days and did not use any device. The registered outcomes were the possibility of completing the treatment, the number of aligners needed and treatment duration in the two groups. Moreover, we assessed patients’ perception of pain during the first week of treatment. Results: Twenty-four patients were allocated to Group A or B depending on the acceptance of AcceleDent use. Patients which used AcceleDent (Group A) completed the treatment using each aligner for fewer days than those belonging to Group B (9.0 ± 1.0 and 15.4 ± 1.2 days, respectively) (P < 0.001). As a secondary outcome, a significant difference was found in pain perception during the first week of treatment between the two groups (P < 0.05). Conclusions: This controlled clinical trial shows that is possible to apply a 7-day change regimen together with AcceleDent use and successfully complete an aligner treatment with a significant saving of time when compared to a standard 14-days change regimen. Finally, the use of this device allowed reduction in pain perception during the orthodontic treatment

Gingival inflammation is caused by bacterial plaque (dental biofilm) that accumulates daily on the teeth. Results in redness, slight swelling, or "puffiness" of the gums and bleeding on tooth brushing. Treatment involves thorough professional tooth cleaning and effective daily removal of dental plaque by tooth brushing and cleaning between the teeth. Necrotizing gingivitis is a more serious condition that is mainly found in developing countries and is associated with people with severe malnutrition or people living with HIV with low CD4 counts.

Il carcinoma a cellule squamose, la più frequente neoplasia maligna del cavo orale, è gravato da un elevato tasso di mortalità, spesso correlato a ritardo diagnostico, e da un forte impatto sulla qualità della vita nei pazienti che ne sono affetti. Si tratta di una malattia con fattori di rischio noti, prevenibile e facilmente diagnosticabile, nei confronti della quale, tuttavia, non sono messe in atto misure preventive appropriate sia di prevenzione primaria (controllo dei fattori di rischio) che di prevenzione secondaria (diagnosi precoce). L’incidenza di tale neoplasia, infatti, è aumentata negli ultimi decenni; parimenti, non sono stati rilevati significativi miglioramenti nei tassi di sopravvivenza e i trend epidemiologici non lasciano intravedere possibili, future inversioni di tale tendenza. Nel capitolo è trattata la prevenzione primaria del carcinoma orale a cellule squamose, sia a livello individuale che comunitario; è altresì presentata e discussa l’attività che i professionisti della salute orale possono svolgere nel promuovere la cessazione del fumo presso i propri pazienti, insieme ad un approfondimento sul counselling per il paziente affetto da carcinoma orale o da disordini potenzialmente maligni.

Obstructive sleep apnoea syndrome (OSAS) is the most severe condition on the spectrum of sleep-related breathing disorders (SRBDs). The Paediatric Sleep Questionnaire (PSQ) is one of the most used and validated screening tools, but it lacks the comprehensive assessment of some determinants of OSAS, specifically anamnestic assessment and sleep quality. This study aims to assess the accuracy of some specific items added to the original PSQ, particularly related to the patient’s anamnestic history and to the quality of sleep, for the screening of OSAS in a paediatric population living in Sicily (Italy). Fifteen specific items, divided into “anamnestic” and “related to sleep quality” were added to the original PSQ. The whole questionnaire was administered via a digital form to the parents of children at 4 schools (age range: 3–13 years). For each item, sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The highest sensitivity (80.0, 95% CI: 28.4, 99.5), in combination with the highest specificity (61.1, 95% CI: 35.7, 82.7), was found for the Item 32 (“assumption of bizarre or abnormal positions during sleep”). This item was found statistically significant for predicting the occurrence of OSAS in children (p-value ≤0.003). The study demonstrates the accuracy of specific items related to sleep quality disturbance for the preliminary assessment of the disease. Although these results should be validated on a larger sample of subjects, they suggest that including the factors discriminating sleep quality could further increase the efficiency and accuracy of PSQ.

Background One of the most effective smoking cessation strategies involves care and advice from nurses due to their role in the front line of treatment. Lack of education on smoking cessation counselling may be detrimental, and adequate smoking cessation training during healthcare studies is needed. Objectives The study aimed to examine nurses’ attitudes, belief, and knowledge of smoking cessation counselling; knowledge of the health risks associated with smoking was also assessed. Design A cross-sectional survey on 77 nurses from the nursing staff of Cardiology, Cardiac Intensive Care and Surgical Oncology Units of two tertiary hospitals. Methods Cronbach’s alpha was calculated to assess the questionnaire’s internal consistency, and three composite indicators were computed to assess the three dimensions of the questionnaire (knowledge, attitude, belief). Furthermore, a stepwise linear regression model was used to predict the attitude to be engaged in smoking cessation counselling, related to demographic and behavioural variables, as well as knowledge and belief indicators. The analysis was stratified by Unit. Results Nurses from three Units had a significantly different attitude score (2.55 ± 0.93 for Cardiology, 2.49 ± 0.72 for Cardiac Intensive Care and 2.09 ± 0.59 for Surgical Oncology Unit) (P-value = 0.0493). Analogously, knowledge of smoking cessation counselling was reported to be higher for Cardiac Intensive Care Unit nurses (3.19 ± 0.70) compared to Surgical Oncology nurses (2.73 ± 0.74) (P-value = 0.021). At the multivariable analysis, attitude towards smoking cessation counselling was significantly related to the nurse’s belief about counselling, for Cardiology staff (coeff = 0.74, 95% CI [0.32–1.16], P-value = 0.002) and for Surgical Oncology staff (coeff = 0.37, 95% CI [0.01–0.72], P-value = 0.042). Conclusions Incorporation of smoking cessation interventions in nurses’ and nursing managers’ education could improve the nursing staff’s attitude, belief, and knowledge regarding smoking cessation counselling, which would lead to the inclusion of tobacco prevention and cessation as an integral part of patient care.

Gingival inflammation is caused by bacterial plaque (dental biofilm) that accumulates daily on the teeth. Results in redness, slight swelling, or "puffiness" of the gums and bleeding on tooth brushing. Treatment involves thorough professional tooth cleaning and effective daily removal of dental plaque by tooth brushing and cleaning between the teeth. Necrotizing gingivitis (NG) is a more serious condition that is mainly found in developing countries and is associated with people with severe malnutrition or people living with HIV with low CD4 counts.

Dental extraction has often been described as the main trigger event of osteonecrosis of the jaws (ONJ). This longitudinal hospital-based study aimed to evaluate the outcome at 2 years of a standardized medical-surgical protocol for dental extraction, combined with platelet rich-plasma (PRP) application, compared with conventional protocol not combined with PRP or any other autologous platelet concentrate in cancer (ONC) and osteometabolic (OST) patients, at risk of bisphosphonate (BP)-related ONJ. Twenty patients were consecutively recruited: six received BPs for cancer skeletal-related events (34.17 &plusmn, 19.97 months), while fourteen received BPs for metabolic bone disease (74.5 &plusmn, 34.73 months). These patients underwent a standardized protocol for dental extraction, combined with autologous PRP application in the post-extraction socket. A total of 63 dental extractions were performed (24 and 39 in ONC and OST groups, respectively). As controls, historical cases, derived from the literature and including 171 ONC and 734 OST patients, were considered. The outcome of the surgical treatment was successful in all patients treated with PRP: two years after extraction, no patient had clinical or radiological signs of ONJ. When this datum was compared with historical controls, no statistically significant differences were found (p &gt, 0.1). The combination of a standardized medical-surgical protocol with PRP application may contribute to limit the occurrence of BP-related ONJ, in both ONC and OST patients. Additional prospective studies with a larger patient sample are necessary to confirm this datum.

Background In periodontal patients with jawbone resorption, the autologous bone graft is considered a "gold standard" procedure for the placing of dental prosthesis; however, this procedure is a costly intervention and poses the risk of clinical complications. Thanks to the use of adult mesenchymal stem cells, smart biomaterials, and active biomolecules, regenerative medicine and bone tissue engineering represent a valid alternative to the traditional procedures. Aims In the past, mesenchymal stem cells isolated from periodontally compromised gingiva were considered a biological waste and discarded during surgical procedures. This study aims to test the osteoconductive activity of FISIOGRAFT Bone Granular® and Matriderm® collagen scaffolds on mesenchymal stem cells isolated from periodontally compromised gingiva as a low-cost and painless strategy of autologous bone tissue regeneration. Materials and methods We isolated human mesenchymal stem cells from 22 healthy and 26 periodontally compromised gingival biopsy tissues and confirmed the stem cell phenotype by doubling time assay, colony-forming unit assay, and expression of surface and nuclear mesenchymal stem cell markers, respectively by cytofluorimetry and real-time quantitative PCR. Healthy and periodontally compromised gingival mesenchymal stem cells were seeded on FISIOGRAFT Bone Granular® and Matriderm® scaffolds, and in vitro cell viability and bone differentiation were then evaluated. Results Even though preliminary, the results demonstrate that FISIOGRAFT Bone Granular® is not suitable for in vitro growth and osteogenic differentiation of healthy and periodontally compromised mesenchymal stem cells, which, instead, are able to grow, homogeneously distribute, and bone differentiate in the Matriderm® collagen scaffold. Conclusion Matriderm® represents a biocompatible scaffold able to support the in vitro cell growth and osteodifferentiation ability of gingival mesenchymal stem cells isolated from waste gingiva, and could be employed to develop low-cost and painless strategy of autologous bone tissue regeneration.

OBIETTIVI Scopo del presente lavoro è fornire agli specialisti della salute orale la descrizione delle caratteristiche del colloquio narrativo, inteso come differente dalla tradizionale anamnesi e in grado di rilevare l’universo del paziente, alla base del processo di umaniz-zazione delle cure in odontostomatologia, e illustrare un modello di umanizzazione di cure odontoiatriche. METODI Nell’articolo vengono descritti i punti chiave del processo di umanizzazione delle cure e come tale pratica sia stata integrata nella U.O. di Medicina Orale, A.O.U. P. Giaccone di Palermo per l’approccio al paziente fragile. La comunità scientifica ha già messo in discussione il tradizionale approccio medico incentrato sulla malattia e pone sempre più attenzione al coinvolgimento del paziente nel processo di diagnosi e cura; nel caso della pratica odontoiatrica, ogni volta che un paziente si siede sulla poltrona porta con sé una storia, la sua e quella del suo apparato stomatognatico. Pertanto, nell’ottica di ottimizzare le cure risulta utile ripensare il rapporto odontoiatra-paziente: non si fa buona pratica clinica senza ascoltare empaticamente la storia dei pazienti, le loro rappresentazioni e percezioni, i loro vissuti. Diventa, così, necessario organizzare setting migliori e più efficaci dove sia possibile inserire, con naturalezza routinaria, un adeguato ascolto attivo e adottare tecniche di comunicazione specifiche. Quindi, l’anamnesi tecnicamente corretta con raccolta asettica di informazioni lascia il posto al colloquio narrativo per permettere all’operatore di riflettere su cosa significa avere a che fare con la tematica illness del paziente oltre che con il problema disease. Gli autori illustrano la loro esperienza e il loro modello di team management odontoiatrico in chiave narrativa per l’umanizzazione delle cure. OBJECTIVES The purpose of this paper is to provide the oral health specialists the characteristics of the narrative interview, understood as different from the traditional anamnesis and able to detect the patient’s universe, basis of the humanization process in dentistry, and to show a clinical model of humanization of dental care. METHODS This article describes the key points of the process of humanization in dentistry and as such practice has been integrated into the Unit of Oral Medicine, at University Hospital of Palermo, in order to support to the patients’ frailty. The scientific community has questioned the traditional medical approach focused on the disease and pays increasing attention to the patient’s involvement in the diagnosis and treatment process. In the case of dental medical practice, every time a patient sits in the dental chair he brings with him a story, that of his stomatognathic system. Therefore, in order to optimize treatments, it is useful to rethink the dentist/patient relationship today: good clinical practice is not done without empathically listening to the patients’ history, their representations, perceptions, and experiences. Thus, it becomes necessary to organize better and more effective settings where it is possible to insert, routinely, adequate active listening and adopt specific communication techniques. So, the anamnesis technically correct as aseptic collection of information, is replaced by the narrative interview, in order to allow the clinicians to truly understand the meaning of patients’ illness, and not only to contemplate the disease features. The authors illustrate their experience of dental team management in a narrative key.

OBIETTIVI Obiettivo di questo lavoro è proporre una revisione critica della letteratura sulle pigmentazioni orali indotte dalla clorexidina, in particolare sul meccanismo di formazione delle pigmentazioni, sulla loro prevalenza, sui fattori che ne influenzano l’insorgenza e la gravità e sull’efficacia clinica del sistema antipigmentazione a base di sodio metabisolfito e di acido ascorbico (ADS). MATERIALI E METODI È stata effettuata una ricerca bibliografica utilizzando in combinazione le seguenti parole chiave: Chlorhexidine, Mouthwash, Staining, Anti-Discoloration System, Gingivitis, Plaque. Sono stati presi in considerazione articoli scientifici e revisioni della letteratura in inglese, in tedesco e in italiano. La valutazione della letteratura sull’efficacia dell’ADS è stata effettuata su 12 studi clinici randomizzati e controllati che valutavano l’efficacia antipigmentante e l’effetto sulla placca e sulla gengivite di collutori contenenti clorexidina e ADS disponibili in commercio sul mercato italiano. Non sono stati presi in considerazione gli studi clinici che hanno testato sistemi antipigmentazione diversi dall’ADS. RISULTATI Sono stati presentati i meccanismi coinvolti nella formazione delle pigmentazioni (reazione di imbrunimento non enzimatico di Maillard, formazione di solfuri di ferro e stagno, precipitazione di cromogeni alimentari, suscettibilità individuale) e la loro prevalenza. I fattori che influenzano insorgenza e gravità delle pigmentazioni sono rappresentati dalla concentrazione della clorexidina, dalla presenza di placca sulle superfici dentarie, dall’assunzione di cibi e bevande cromogene e dal fumo di tabacco, veicolo di sostanze cromogene. L’ADS è un sistema antipigmentazione brevettato a partire dal 2003 e presente in collutori contenenti clorexidina commercializzati in Italia. La sua azione antipigmentante si esplica mediante ini-bizione della reazione di imbrunimento non enzimatico e della for-mazione di solfuri metallici cromogeni. La maggior parte degli studi ha evidenziato che il collutorio contenente ADS è efficace nell’inibire la formazione di pigmentazioni, mantenendo sia l’attività antiplacca che quella inibente l’infiammazione gengivale. Una recente metanalisi, condotta su risultati ottenuti da studi clinici che testavano anche sistemi alternativi all’ADS, ha confermato tali risultati, con qualità delle prove da debole a moderata. CONCLUSIONI Dall’analisi dei 12 studi presi in esame emerge una rilevante variabilità metodologica, che potrebbe essere responsabile della non univocità dei risultati, con particolare riferimento all’attività antiplacca. Sono auspicabili ulteriori studi randomizzati e controllati con disegno omogeneo, soprattutto in relazione alla sospensione delle manovre di igiene orale durante l’utilizzo del collutorio, al controllo dei cromogeni alimentari, al timing della rilevazione degli indici e all’inclusione di pazienti parodontopatici o sottoposti a chirurgia parodontale. SIGNIFICATO CLINICO I risultati di una recente metanalisi indicano che i sistemi antipigmentazione contenuti nei collutori sono efficaci nel prevenire la formazione di pigmentazioni soltanto quando l’uso del collutorio non è associato alle manovre di igiene orale domiciliare (prove di qualità moderata). La metanalisi indica altresì che l’aggiunta di un sistema antipig¬mentazione non influenza negativamente l’efficacia clinica della clorexidina (prove di qualità da debole a moderata). OBJECTIVES To propose a critical review on chlorhexidine-induced oral discoloration, including the mechanisms, the prevalence and the factors influencing onset and severity. Additionally, this paper investigates the clinical efficacy of the Anti-Discoloration System based on sodium metabisulfite and ascorbic acid (ADS). MATERIALS AND METHODS A literature search was conducted using in combination the following keywords: Chlorhexidine, Mouthwash, Staining, Anti- Discoloration System, Gingivitis, Plaque. Scientific papers and literature reviews in English, German and Italian were included. The literature evaluation on the efficacy of ADS was performed including 12 randomized controlled clinical trials designed to assess the anti-plaque, anti-gingivitis and anti-discoloration effects of mouthwashes containing chlorhexidine and ADS. These mouthwash products were commercially available in Italy. Clinical studies that tested Anti- Discoloration Systems different from ADS were not considered. RESULTS The possible mechanisms involved in the development of oral discolorations (non-enzymatic browning reaction, also known as the Maillard reaction, formation of iron and tin sulfides, precipitation of food chromogens, individual susceptibility) and the prevalence of pigmentations were presented. The factors that influence the onset and severity of pigmentations include chlorhexidine concentration, plaque on tooth surfaces, dietary consumption of food and beverages containing chromo¬gens, and tobacco smoking. The ADS is an Anti-Discoloration System patented since 2003 and added to mouthwashes available on the Italian market. The ADS reduces tooth discolorations by inhibiting non-enzymatic browning reaction and formation of chromogenic metal sulphides. Most studies showed that the mouthwash containing ADS is ef¬fective in reducing tooth discolorations while maintaining the ch-lorhexidine efficacy with respect to reduction of plaque and gingivitis. These results were confirmed by a meta-analysis including clinical trials testing both ADS and systems alternative to ADS (qua-lity of the evidence: weak to moderate). CONCLUSIONS In the 12 studies included considerable methodological heterogeneity was observed and this could be responsible for the discrepancy in results, particularly with respect to anti-plaque activity. Further clinical trials, homogenous in design, are needed. The inclusion of periodontitis patients and/or undergoing periodontal surgery, diet restrictions, timing of recording plaque and gingivitis indices, and suspension of oral hygiene are potentially important with respect to design homogeneity. CLINICAL SIGNIFICANCE A recent meta-analysis confir¬med that the addiction of an Anti-Discoloration System to chlorhexidine mouthwash reduces tooth discoloration in situations in which toothbrushing is not involved (quality of the evidence: moderate). Meta-analysis also indicated that the addiction of an Anti-Discoloration System does not affect the anti-plaque and anti-gingivitis efficacy of chlorhexidine (quality of the evidence: weak to moderate).

This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma (OSCC), the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC (mean age: 62 years, M/F: 2.39∶1) were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included: sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges: dichotomous (≤1 month vs. >1 month) and polytomous (3 months) delay. Data were investigated by univariate and multivariate analyses and a P value ≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were: 'Personal experience of cancer' (dichotomous delay: P=0.05, odds ratio (OR)=0.33, 95% confidence interval (CI)=0.11-0.99; polytomous delay: P=0.006, Chi-square=10.224) and 'Unawareness' (dichotomous delay: P

Obiettivi. Il fumo di sigaretta, seconda causa di morte nel mondo, e l’abuso di alcol, una delle principali cause di mortalità e morbilità, costituiscono importanti fattori di rischio per le patologie del cavo orale. Scopo di questo lavoro è presentare gli effetti del fumo di sigaretta e dell’abuso di alcol sulla salute orale. Sono inoltre illustrate le modalità di realizzazione di interventi di cessazione dell’abitudine al fumo nell’ambito dell’attività professionale dell’odontoiatra e dell’igienista dentale. Materiali e metodi. Attraverso la banca dati Medline/Pubmed sono stati selezionati i lavori originali, le revisioni della letteratura e le linee guida in lingua inglese e in italiano pubblicati sull’argomento dal 2006 al primo trimestre del 2013. Altre fonti sono state scelte dai riferimenti bibliografici selezionati. Risultati e conclusioni. Il fumo rappresenta il più importante fattore di rischio per il carcinoma a cellule squamose della mucosa orale e per le lesioni potenzialmente maligne; l’abuso di alcol, associato al fumo, aumenta in modo sinergico il rischio di insorgenza del carcinoma orale. Il fumo, inoltre, dopo la placca batterica, è il secondo fattore di rischio per l’insorgenza e la progressione della parodontite cronica, mentre ulteriori studi sono necessari per stabilire un analogo ruolo per il consumo di alcol. L’approccio delle “5 A” rappresenta una modalità di intervento efficace che i componenti del team odontoiatrico possono attuare con tutti i pazienti fumatori. I pazienti impegnati in tentativi di cessazione del fumo dovrebbero far ricorso alla terapia sostitutiva nicotinica, o all’assunzione di bupropione a rilascio controllato o di vareniclina, per incrementare significativamente le probabilità di successo del tentativo di cessazione. Objectives. Cigarette smoking, the second cause of death worldwide, and alcohol abuse, a leading cause of mortality and morbidity, are major risk factors for oral diseases. The aim of this paper is to present the effects of cigarette smoking and alcohol abuse on oral health. Specific strategies are also proposed to develop smoking cessation interventions in the office practice of dentists and dental hygienists providing. Materials and methods. Original papers, reviews and guidelines on this subject, published in English and in Italian from 2006 to the first trimester of 2013, were located in the Medline/Pubmed database. Additional publications were obtained by searching the reference list of retrieved works. Results and conclusions. Cigarette smoking is the most important risk factor for oral squamous cell carcinoma and potentially malignant oral lesions; alcohol abuse increases oral cancer risk in a synergistic fashion. Moreover, cigarette smoking is the second risk factor for chronic periodontitis, after dental plaque, whereas further studies are needed to assess the role of alcohol consumption on onset and progression of chronic periodontitis. The “Five A’s” approach represents an effective protocol for smoking cessation that members of dental team can use with all smoker patients. The patients attempting to quit should use the nicotine replacement therapy, sustained-release bupropion or varenicline in order to significantly increase success rate of quit attempt.

The use of topically applied fluoride has been widely researched as a means to reduce the risk of dental caries in conjunction with other treatment modalities (mechanical oral hygiene, dietary control, antimicrobial intervention, pit and fissure sealants). There is overwhelming evidence that reports not only the significance and importance of the use of fluoride as a caries-preventive agent, but also how safe fluoride application is when used appropriately, particularly in higher risk individuals and populations. This paper reviews the caries-protective benefits of topical fluoride application in children and adolescents, with an emphasis on the clinical efficacy and safety of the vehicles by which fluoride is topically delivered. Fluoride toothpaste represents today the most cost-effective fluoride-delivery system in the oral cavity and its use should be the centerpiece in all caries-preventive strategies. On the other hand, mouthrinses, gels and varnishes currently represent adjuncts to toothpaste use and should be targeted towards individuals and groups at high risk of caries.

Background: The side effects of chlorhexidine (CHX) have stimulated the search for alternative antiplaque agents such as amine fluoride/stannous fluoride (ASF) and essential oils (EO). The aim of the study was to investigate the plaqueinhibiting effects of two commercially available mouthrinses containing ASF and EO, respectively. Methods: The study was an observer-masked, randomized, 5 · 5 Latin square cross-over design, balanced for carryover effects, involving 15 volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse and a saline solution served as positive and negative controls, respectively. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced rinsing with their allocated rinses. On day 5, subjects were scored for disclosed plaque. The ASF rinse was tested at two dosages: 10 and 20 ml (ASF-10 and ASF-20, respectively). Results: The ASF and EO rinses showed a significant inhibition of plaque regrowth compared to saline (P 0.05). There was no correlation between the occurrence of side effects and the use of a particular rinse product (P >0.2). Conclusions: ASF and EO mouthrinses exerted effective and similar plaque inhibition. The two dosages tested for ASF did not differ in plaque reduction. These findings, together with those from long-term trials, suggest that ASF and EO rinses may represent effective alternatives to CHX rinse as adjuncts to oral hygiene.

Summary Objectives To evaluate the antibacterial activity of four endodontic sealers: one epoxy resin sealer (AH Plus), two zinc oxide eugenol (ZOE)-based sealers (Endomethasone, Pulp Canal Sealer), and one sealer containing both ZOE and orthophenilphenol (Vcanalare). Methods A direct contact test (DCT) was performed. A 10 μl suspension of Enterococcus faecalis was placed on the test material 20 min, 24 h and 7 days after mixing. Bacteria were allowed to directly contact the sealers for 1 h at 37 °C. Bacterial growth was then spectrophotometrically measured every 30 min for 7 h, and again after 24 h as well. Results All freshly mixed sealers showed complete inhibition of bacterial growth. Similar results were obtained with the 24-h-old samples, with the exception of AH Plus. Vcanalare was the only sealer still inhibiting bacterial growth 7 days after mixing. Conclusions The antimicrobial activity of the tested sealers depends on the time interval between mixing and testing. All sealers exhibit bactericidal effect when freshly mixed, but only Vcanalare extended this effect until 7 days after setting.

Obiettivi. Scopo di questo lavoro è presentare le più recenti acquisizioni in tema di epidemiologia, diagnosi, eziopatogenesi e management clinico dell’ipersensibilità dentinale. Vengono inoltre descritti i prodotti disponibili per il suo trattamento e gli studi sperimentali e clinici condotti per valutarne l’efficacia. Materiali e metodi. Attraverso la banca dati Medline/Pubmed sono stati selezionati i lavori originali, le revisioni della letteratura e le linee guida pubblicate in lingua inglese e in italiano sull’argomento dal 2009 al 2013. Altre fonti sono state selezionate dai riferimenti bibliografici individuati. Risultati e conclusioni. Il management dell’ipersensibilità prevede il controllo dei fattori causali e l’applicazione domiciliare/professionale di prodotti contenenti agenti occludenti. Gli studi in vitro non possono riprodurre del tutto i comportamenti quotidiani dei pazienti e le variabili ecologiche del cavo orale. L’efficacia di tali prodotti pertanto deve essere valutata mediante studi clinici randomizzati e controllati. Il complesso arginina-carbonato di calcio ha dato prova di efficacia nell’indurre sollievo immediato e duraturo. Sono necessari ulteriori trial clinici, randomizzati e controllati, per confermare i risultati relativi al fosfosilicato di calcio-sodio e all’acetato di stronzio. Objectives: The aim of this paper is to present an overview on the current state of knowledge of the epidemiology, aetiology/risk factors, pain mechanisms, diagnosis and management of dentin hypersensitivity. Available products for treatment of dentin hypersensitivity are presented and the scientific and clinical research validating their efficacy is reviewed. Material and methods: Original papers, reviews and guidelines on this subject, published in English form 2009 to 2013, were retrieved from Medline/Pubmed database. Additional publications were obtained by searching the reference list of retrieved works. Results and conclusions: The management of dentin hypersensitivity is based on the control of causal factors and the application, at-home or in-office, of various products which are aimed to occlude patent tubules. In vitro methods suffer from some limitations to mimicking the “real-life” individual behaviours and the ecological variables of the oral environment, then randomized and controlled clinical trials are considered the gold standard to evaluate the efficacy of these products. The arginine-calcium carbonate complex has demonstrated to be efficacious in providing instant and long-lasting relief. Further randomized and controlled clinical studies are needed to confirm the results of amorphous sodium calcium phosphosilicate and strontium acetate.

Objectives: A series of patients affected by desquamative gingivitis (DG) was investigated in order to evaluate relation patterns among clinical parameters relevant to plaque induced periodontitis, periodontal microbiological data and the presence of DG lesions. Patients and methods: Eight oral lichen planus (OLP) and four mucous membrane pemphigoid (MMP) patients were examined. Periodontal measurements (performed at six sites per tooth on all teeth) included probing depth (PD), gingival recession (REC), clinical attachment loss (CAL) and full mouth plaque (FMPS) and bleeding (FMBS) scores; the presence and the exact location (site by site) of DG lesions were carefully recorded. Sub-gingival plaque samples were collected and examined by means of real-time PCR for the quantitative determination of the six most important marker organisms of periodontitis. Statistically significant differences and correlation of studied variables between DG-positive and DG-negative sites were investigated in MMP and OLP cases using Mann–Whitney test (p

Probiotics are living microorganisms (e.g., bacteria) that are either the same as or similar to organisms found naturally in the human body and may be beneficial to health. Current researches have shown that the balance between beneficial and pathogenic bacteria is essential in order to maintain the oral health. Therefore, oral cavity has recently been suggested as a relevant target for probiotic applications. Dental caries can be seen as a microbial imbalance where the oral microbiota shift towards community dominance which produces acidogenic and acid-tolerant gram positive bacteria. Similarly, the accumulation of bacteria within the biofilm, facilitated by poor oral hygiene, predisposes to allogenic shifts in the microbial community, leading to the onset of periodontal inflammation. Probiotic bacteria belonging to the genus of Lactobacillus, Bifidobacterium and Streptococcus have been proven effective for preventing caries by reducing the number of cariogenic bacteria in saliva after a short period of consuming the probiotic. In contrast, the effect of probiotics on improving gingivitis and periodontitis has been less investigated. The currently available studies on the effect of probiotics on periodontal pathogens and clinical periodontal parameters showed differing results depending on the strains used and the endpoints analyzed. Many of the clinical studies are pilot in nature and with low quality, therefore, properly conducted clinical trials, using probiotic strains with in vitro proven periodontal probiotic effects, are needed. The putative beneficial effects of probiotics on oral malodour have also been evaluated, but further evidence is needed to fully explore the potential of probiotics for preventing malodour.

Summary Background The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease. Material/Methods Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT−), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed. Results Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT− patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P

We thank Kucharz [1] for the valuable historical comment to our review focusing on the role of oral infection on systemic diseases [2]. The majority of scientists today write and read the English language whereas articles in Polish and German are scarcely known outside of Poland and Germany, respectively. For these reasons, the contribution of Kaczorowsky [3] is commonly forgotten in medical literature, but the letter of Kurchaz properly acknowledges this pioneer researcher in the periodontal medicine. We also thank Blum [4] for adding his results [5,6] to our review article. As the number of references citable is limited, we did not cite the articles written by Blum et al. [5,6], but we read and appreciated both them. In our review, we cited the paper of Tonetti et al. [7], published in 2007 like the papers of Blum et al., and dealing with the effects of periodontal therapy on systemic inflammation (including CRP level) as well as endothelial dysfunction.

The aim of this study was to compare the plaque removal efficacy of a new oscillating/rotating/pulsating toothbrush [Oral-B® Professional Care® 8500 (PC 8500)] with two manual toothbrushes [Oral-B® CrossAction™ Vitalizer (CAV) and Oral-B® Indicator™ (IND), respectively]. The safety of the PC 8500 was also assessed. The study was a single-use, observer-masked, randomised 3×3 Latin square crossover design balanced for carryover effects. The enrolled subjects (n=66) refrained from brushing for 23–25 h before each clinical examination. Plaque scores were recorded before and after brushing with the allocated toothbrush using the Turesky et al. modification of the Quigley and Hein plaque index. The safety was assessed evaluating the soft tissue conditions present after 30 days of the use of the PC 8500. The PC 8500 toothbrush was better in plaque removal efficacy compared with the CAV and IND brushes for full mouth and approximal surfaces (P0.05). The latter was shown to be significantly more effective than the IND at all tooth surfaces (P

Objective: The aim of this study was to investigate the smoking habits of Italian dental and dental hygiene students and to assess their knowledge on the health effects of cigarette smoking and their attitudes toward tobacco-use cessation (TUC) in dental practice. Materials and methods: Data was collected from 220 students attending the Dental and Dental Hygiene Schools (DS and DHS, respectively) at the University of Palermo (Italy). Results: The percentage of smokers amongst DS and DHS students was similar (32.78% vs. 32.5%) with 67.77% of DS students and 77.5% of DHS agreeing that the damages to health caused by smoking were covered in their didactic course work. A high percentage of DS (63.33%) and DHS (67.5%) students reported the relationship between smoking and a number of associated health conditions. Both DS and DHS students showed poor knowledge of TUC interventions. Both DS and DHS students reported to be conscious of their own role as a counsellor, with DHS students feeling more comfortable in approaching counselling in clinical practice. Although DS and DHS students reported a positive attitude toward TUC interventions, almost half of the students had some concerns about the effectiveness of smoking cessation activities. Discussion: The introduction of a comprehensive tobacco education curriculum in DS and DHS programs could further improve students’ perceptions and attitudes and provide knowledge and clinical experience which would lead to the incorporation of TUC into subsequent professional practice.

During past decades the relationship between dentistry and internal medicine and especially the concept of the so-called focal infection theory have long been a matter of debate. The pathogenesis of focal diseases has been classically attributed to dental pulp pathologies and periapical infections. Nonetheless, in recent years, their role is being dismissed while increasing interest is being devoted to the possible associations between periodontal infection and systemic diseases. In fact, periodontal pathogens and their products, as well as inflammatory mediators produced in periodontal tissues, might enter the bloodstream, causing systemic effects and/or contributing to systemic diseases. On the basis of this mechanism, chronic periodontitis has been suggested as a risk factor for cardiovascular diseases associated with atherosclerosis, bacterial endocarditis, diabetes mellitus, respiratory disease, preterm delivery, rheumatoid arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic syndrome, renal diseases and neurodegenerative diseases such as Alzheimer's disease. Various hypotheses, including common susceptibility, systemic inflammation, direct bacterial infection and cross-reactivity, or molecular mimicry, between bacterial antigens and self-antigens, have been postulated to explain these relationships. In this scenario, the association of periodontal disease with systemic diseases has set the stage for introducing the concept of periodontal medicine. This narrative review summarizes the evolution of focal infection theory up to the current pathophysiology of periodontal disease, and presents an update on the relationships between chronic periodontitis and systemic diseases.

The aim of this study was to determine the effect of immersion disinfection procedures on the dimensional stability of two elastomeric impression materials. Impressions of a stainless steel die were made with polyether (PE) and with additionpolymerized silicone rubber (PVS). The test specimens underwent disinfection treatment by immersion in two commercially available solutions containing quaternary ammonium compounds (Sterigum Powder, SP) and glutaraldehyde plus an amino derivative (MD520, MD), respectively. The impressions were measured at 4 different time points: before any disinfection treatment (T0); after the first disinfection (T1); 6 hours after the first disinfection (T2); after the second disinfection, carried out 6 hours after the first one (T3). Impressions which were not disinfected served as controls. When both impression materials were disinfected with SP, significant differences were detected among all measurements (P < 0.0001), with the exception of T2 vs T3 (P > 0.05). On the other hand, when MD was used, significant differences were found when T0 measurement was compared to T1, T2 and T3 measurements (P = 0.0043 for PE, and P = 0.0014 for PVS). The dimensional change of all material/disinfectant combinations was always ≤0.5%. Therefore, the effects of immersion disinfection on the dimension of elastomers in SP or MD are not clinically relevant

BACKGROUND: Due to the side effects of chlorhexidine digluconate (CHX) mouthrinsing, a spray has been proposed as an alternative method of CHX delivery to the oral cavity. The aim of this study was to investigate the plaque inhibitory effects of CHX, cetylpyridinium chloride (CPC), and triclosan (TRN) delivered by sprays and mouthrinses. METHODS: The study was an observer-masked, randomized cross-over design balanced for carryover effects, involving 15 healthy volunteers in a 4-day plaque regrowth model. Products being tested (0.2% CHX, 0.12% CHX, 0.05% CPC, and 0.03% TRN) were used both as sprays and mouthrinses. A saline solution served as a negative control. On day 1, subjects received professional prophylaxis, suspended oral hygiene measures, and commenced using their allocated products. On day 5, subjects were scored for disclosed plaque. RESULTS: CHX sprays (P0.05). TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control (P0.05). A similar trend of efficacy was detected for rinses. Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays (P0.2). CONCLUSIONS: These findings, together with those from clinical trials, suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas. On the contrary, the TRN and CPC sprays showed little or no plaque inhibitory effects.

The decreased mouth opening (microstomia) represents a frequent finding in patients with systemic scleroderma (SSD), but little information is available about the efficacy of nonsurgical management of this condition. The aim of this study is to assess the effects of a nonsurgical exercise program on the decreased mouth opening in a group of 10 SSD patients with severe microstomia (maximal mouth opening < or =30 mm). The subjects were instructed to perform an exercise program including both mouth-stretching and oral augmentation exercises. The effects of such exercises were assessed after an 18-week period by measuring the maximal mouth opening of each subject. All patients completed the study and no adverse effects occurred, with the exception of transient muscular fatigue. The exercise program improved the mouth opening of all subjects (mean increase: 10.7+/-2.06 mm, P0.1). At the end of the 18-week period, all patients commented that eating, speaking and oral hygiene measures were easier. The edentulous subjects also experienced less difficulty inserting their own dentures. These findings suggest that regular application of the proposed exercise program may be useful in the management of microstomia in SSD patients.

PURPOSE: To compare two systems used for conditioning the gingival sulcus and exposing the finish line before the final impression for a fixed denture: retraction cords and diode laser. METHODS: All subjects participating in the study had healthy gingival and periodontal status before intervention for fixed prosthesis. 74 abutments for complete crown restoration were randomly divided into two groups for displacing the gingival sulcus before the final impression: gingival retraction cords (RC) and diode laser (DL). The height of the clinical crowns was measured by a blinded examiner in three points of the buccal surface (mesial, midline and distal) at four different times: after tooth preparation (T0), 15 days after tooth preparation, before exposing the finish line with RC or with DL (T1), 10 minutes after exposing the finish line (T2), and 15 days after the final impression was taken (T3). The amount of gingival retraction produced (ΔT2-T1) and restoration to baseline (ΔT3-T1) were calculated. Ease of technique and patient comfort were evaluated through the Visual Analog Scale. The time required to carry out the technique and bleeding during and after the conditioning procedure were also evaluated. RESULTS: There was no difference between the two techniques with regard to the height differences: ΔT2-T1 was 0.65±0.33 for RC and 0.66±0.43 for the DL (P= 0.966), while ΔT3-T1 was 0.03±0.27 for RC and 0.02±0.46 for DL (P= 0.286). DL required less time, was easier for the operator and more comfortable than RC for the patient (all P

BACKGROUND. A fundamental requirement to obtain a correct endodontic preparation depends on the respect, during cleaning and shaping, of the original morphology of the apical foramen, (AF), so that the filling material will form a complete seal. METHODS. In our previous studies, in order to verify if this presumption was respected using rotary NiTi instruments with cutting tip, we instrumented extracted teeth characterised by a different degree of root curvatures. Using a standardized system to replace the sample, the original shape of the apical foramen of each tooth was recorded using a computerised technique and then compared to the shape after instrumentation. The data showed differences on AF shapes depending on the degree of root canal curvatures. In fact, the teeth with straight canals showed the least alterations on the original AF shape; on the contrary, the teeth with curved canals showed apical foramen enlargement or transportation. Therefore, in the current study we aimed to compare the in vitro effects of stainless steel, (Flexofile, Dentsply Maillefer, Baillaigues, Switzerland), vs NiTi safe cutting tip (Quantec SC, (Tycom Dental, Irvine CA, U.S.A.), vs NiTi non cutting tip, (Quantec LX, Tycom Dental, Irvine CA, U.S.A.), instrumentation on original apical foramen shape. We used NiTi instruments according to standard technique suggested by Tycom, and hand steel files, to instrument the apical third, according to the Crown-Down technique. Working length was fixed at -0.5 from AF. RESULTS AND CONCLUSIONS. Our results suggested that in the presence of accentuated canal curves rotary Niti, with cutting tip, cause significantly more enlargement of the AF area. At the same time, we also observed that NiTi rotary files, with both cutting and non-cutting tip, cause eccentric enlargement of AF in curved canals. Therefore, NiTi engine-driven instruments should be used carefully in the presence of accentuated canal curves to avoid enlargement or transportation of AF, probably because rotary NiTi files may slip out of operative control, leaving a mark on the foramen shape. In the presence of severe curves, we suggest modifying the operative sequences by alternating rotary NiTi with hand NiTi or stainless steel instruments, especially in the preparation of apical third.

The aim of this study was to investigate in vitro the antibacterial effect of a dentin/enamel adhesive containing MDPB (Clearfil Protect Bond) after curing and to compare it with an adhesive not containing MDPB (Clearfil SE Bond). The antibacterial effect of the cured adhesives was tested on Enterococcus faecalis by the evaluation of growth inhibition in a 48-h microplate direct contact test (DCT). The presence of antibacterial activity due to soluble components was also investigated by an agar diffusion test (ADT) performed with the adhesives cured on the surface of dentin disks. In the DCT, both the tested materials showed complete inhibition of bacterial growth until the 7-h reading, regardless of whether direct contact with the bacterial inoculum was continued or limited to 1 h. Stationary growth phase turbidity levels were observed at 24 or 48-h incubation. The ADT produced no inhibition areas around the dentin disks. Both adhesives tested in vitro under conditions simulating those encountered in the restorative treatment of dental caries were equally able to delay bacterial growth demonstrating a similar bacteriostatic effect. As suggested by both the DCT and the ADT, the antibacterial effect of the two adhesives depends on direct contact and does not seem to be related to the diffusion of soluble components.

The aim of this study was to assess the level of tobacco dependence education offered by Italian dental hygiene programs. A fifty-question survey was mailed to the thirty-one active public and private dental hygiene programs in Italy during the 2008-09 academic year. The survey assessed faculty confidence in teaching tobacco treatment, which courses contained tobacco dependence content, the number of minutes spent on specific content areas, and the level of clinical competence that dental hygiene graduates should be able to demonstrate. Surveys were returned by sixteen programs for a response rate of 52 percent. Respondents indicated tobacco dependence education was included in clinic or clinic seminar (56 percent), periodontics (44 percent), oral pathology (31 percent), and prevention (19 percent). All programs reported including the effects of tobacco on general and oral diseases in courses. However, more in-depth topics received less curriculum time; these included tobacco treatment strategies (63 percent) and discussion of cessation medications (31 percent). Interestingly, 62 percent of the respondents indicated they expected dental hygiene graduates to demonstrate a tobacco treatment competency level of a moderate intervention or higher (counseling, discussion of medications, follow-up) rather than a brief intervention in which patients are advised to quit then referred to a quitline. The results of this study indicated that Italian dental hygiene students are not currently receiving adequate instruction in tobacco treatment techniques nor are they being adequately assessed. This unique overview of Italian dental hygiene tobacco dependence education provides a basis for further discussion towards a national competency-based curriculum.

Periodontal diseases include a group of infl ammatory diseases characterized by progressive destruction of the periodontium. Dental plaque is the initiator of periodontal disease, but disease severity and response to treatment are determined predominantly by host-based risk factors. Genetic disorders can modify the host defense mechanisms or infl uence the homeostasis of the periodontium during childhood, thus increasing patients’ susceptibility to periodontal disease. The periodontal manifestations of these disorders may persist into adulthood. When dealing with periodontal problems, particularly in children and adolescents, it is advisable to establish a differential diagnosis of periodontal disease due to systemic conditions. This paper reviews the current literature concerning the effect on periodontal health of genetic disorders such as connective tissue metabolism disorders, metabolic disorders, skin disorders, leukocyte defects, and chromosome abnormalities. Treatment strategies of patients with genetic disorders affected by periodontal diseases are also suggested according to the evidence available. In patients affected by genetic disorders, the response to treatment is not always as expected, and sometimes the progression of periodontal disease is inevitable despite adequate maintenance treatment