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Key Clinical Message Melkersson–Rosenthal syndrome (MRS) remains an enigmatic pathology due to an unknown etiology. Our report, of a 69‐year‐old man with MRS misdiagnosed for about 40 years, underlines the diagnostic difficulty of this condition. A holistic view of the patient, with a correct medical history investigation, are often decisive in the diagnosis of MRS. Abstract Melkersson–Rosenthal syndrome (MRS) is a rare disorder with a still unknown etiology. It is defined by three main symptoms, which are orofacial granulomatosis (OFG), facial palsy, and fissured tongue. It generally presents in young people, during the second or third decade, and its incidence in the entire population is about 1%. We focus our attention on a 69‐year‐old man who came to us with an important swelling of the upper lip. His anamnesis revealed that he suffered from a facial palsy four times in his life and at the physical examination we attested the presence of scrotal tongue. We suspected a misdiagnosed MRS and we searched the web in order to give him a diagnosis and a therapy. We found that OFG is the most common symptom of MRS and that it can show as a non complete form, where the three main symptoms cannot occur simultaneously. We also prescribed a therapy based on the use of topic steroids and antiviral, according to literature. After the positive response to the therapy and according to data found in the most recent literature, we can assume that our patient suffers from a misdiagnosed MRS for about 40 years.

Objective: This paper deals with oral leukoplakia, a potential oral malignant disorder that often increases in malignancy due to an associated infection supported by the fungus Candida albicans. The work is aimed at describing this dual condition through a literature review and an unusual clinical case treated with Photodynamic Therapy. Materials and Methods: We used PubMed as a research engine in order to detect the most recent papers (2014-2023) written in English. Our main goal was to obtain more information about oral leukoplakia, its colonization by C. albicans and its rate of malignant transformation. We also searched the database in order to evaluate the efficacy of Photodynamic therapy against Candida infections. Case Presentation: The case presentation refers to a 37-year-old man with a diagnosis of tongue leukoplakia with a co-infection of C. albicans, treated with Photodynamic Therapy instead of conventional antifungal drugs. Results: The literature review was based on a total of 17939 articles, which were reduced to only 25 after setting the inclusion and exclusion criteria in several steps. Oral leukoplakia is an idiopathic condition that can be considered a precancerous lesion; its co-infection with C. albicans increases the chances of its malignant transformation. Photodynamic therapy is a new approach in terms of non-conventional therapies, and there is growing evidence that it can be used in the treatment of oral diseases, too. Conclusions: We eradicated the presence of C. albicans strains on our patient’s leukoplakia by using a mixture of photo-activated curcumin and H2O2, decreasing the chances of malignant transformation of our patient’s lesion, who is still undergoing a six-month control protocol.

Introduction: Despite sound evidence on the importance of sleep for human beings and its role in healing, hospitalized patients still experience sleep disruption with deleterious effects. Many factors affecting patients’ sleep can be removed or minimized. We evaluated the efficacy of a multicomponent Good Sleep Bundle (GSB) developed to improve patients’ perceived quality of sleep, through which we modified environmental factors, timing of nighttime clinical interventions, and actively involved patients in order to positively influence their experience during hospitalization. Methods: In a prospective, before and after controlled study, two different groups of 65 patients each were admitted to a cardiothoracic unit in two different periods, receiving the usual care (control group) and the GSB (GSB group), respectively. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) at the admission, discharge, and 30 days after discharge in all patients enrolled. Comparisons between the two groups evaluated changes in PSQI score from admission to discharge (primary endpoint), and from admission to 30 days after discharge (secondary endpoint). Results: The mean PSQI score difference between admission and discharge was 4.54 (SD 4.11) in the control group, and 2.05 (SD 4.25) in the GSB group. The mean difference in PSQI score change between the two groups, which was the primary endpoint, was 2.49 (SD 4.19). This difference was highly significant (p = 0.0009). Conclusion: The GSB was associated with a highly significant reduction of the negative effects that hospitalization produces on patients’ perceived quality of sleep compared with the usual care group.

Fetal alcohol spectrum disorder (FASD) is a set of conditions resulting from prenatal alcohol exposure (PAE). FASD is estimated to affect between 2% and 5% of people in the United States and Western Europe. The exact teratogenic mechanism of alcohol on fetal development is still unclear. Ethanol (EtOH) contributes to the malfunctioning of the neurological system in children exposed in utero by decreasing glutathione peroxidase action, with an increase in the production of reactive oxygen species (ROS), which causes oxidative stress. We report a case of a mother with declared alcohol abuse and cigarette smoking during pregnancy. By analyzing the ethyl glucuronide (EtG, a metabolite of alcohol) and the nicotine/cotinine in the mother’s hair and meconium, we confirmed the alcohol and smoking abuse magnitude. We also found that the mother during pregnancy was a cocaine abuser. As a result, her newborn was diagnosed with fetal alcohol syndrome (FAS). At the time of the delivery, the mother, but not the newborn, had an elevation in oxidative stress. However, the infant, a few days later, displayed marked potentiation in oxidative stress. The clinical complexity of the events involving the infant was presented and discussed, underlining also the importance that for cases of FASD, it is crucial to have more intensive hospital monitoring and controls during the initial days.

Dear Editor In recent years, within the extensive research regarding human microbiota and chronic diseases, new medical and laboratory technologies have played a crucial role in understanding more complex biological pathways between human cells and microbes. On the other hand, molecular and cellular diversity and their involvement in health responses to changing host conditions have only recently been understood, through the development of brand-new laboratory tools based on ‘omics approaches. The continuous insertion of already conceptualized, new experimental large datasets and raw data onto bibliographic platforms means that they are now accessible for subsequent elaboration by other researchers. This aspect has allowed the creation of an interactive mesh of proteins, genes, and small molecules, usually called, interactome or interactomics. Oral microbiota a “conditio sine qua non “in health and disease The Microbiota associated with the human oral cavity represent a collective-interactive group of microbial species, mainly composed of bacteria (Firmicutes, Bacillus, Proteobacteria, and Actinomycetes) but also with some protozoa, fungi, and viral species, and is one of the most complex microbial communities in the human body1,2. These microorganisms are closely associated and disposed of as biofilm in different distinct habitats of the oral cavity, such as the tongue, teeth, mucosal surfaces, so that about 6-7 different microbiotas are present in the mouth, with the tongue dorsum showing the main extensive microbial community in the oral cavity. The types of bacteria found in oral microbiota do not change significantly; in fact, healthy people from different countries with different alimentary habits have similar compositions of oral microbiota, in this condition microorganisms coexisting in normal human tissues and provide proper functional activity in the host. This process activates the control of different fundamental processes such as immunity signal transduction, gene expression patterns and metabolism. The imbalance of oral microflora, normally called dysbiosis, has been strictly correlated with the genesis of different chronic diseases such as cancer3. For example, the anaerobic oral bacteria Fusobacterium nucleatum, which regularly lives on the tongue dorsum, normally conducts a commensal-type cell life, activating various useful biological processes such as: oral-nasal innate immunity, food flavour, and others4. In these conditions, the oral interactome network is able to modulate and maintain the commensal status of F. nucleatum. The dramatic change in microbiota bacterial composition due to a dysbiosis process is related to a significative change in the interactome network and can turn the bacterium behaviour from commensal to pathogenic5. In this case the tissue target cells are continuously stimulated through their receptors by microbiota compounds or by single bacterial proteins and injured by small molecules released in the interactome signal pathway. In the same way, target oral cells produce other related molecule-signals such as those involved in response to intensive oxidative stress (Figure 1). Understanding the microbiological “Pandora’s box” involved in cancer “Cancer-related bacteria” have traditionally been studied by considering their singular biochemical aspects involved in the neoplastic process function/activation or in maintaining tissue homeostasis, but this aspect lacks completeness and provides a highly limited view of the phenomenon. For example, F. nucleatum has been intensively studied in relationship to colon-rectal cancer or in some forms of oral neoplasia6. These studies often consider the bacterium as the singular biological effector in carcinogenesis, but the same approach could be observed in the literature for Porphyromonas gingivalis and with microbial genera such as: Veillonella, Actinomyces, Haemophilus, etc.7. In actual fact, this method only reveals the bacterial effector molecules for cancer, but not the complex molecular pathway due to other microbial species belonging to the microbiota or those in the target-cells molecular signals. During the tissue neoplastic transformation process and already in the first step of tumorigenesis, microbiota as well as human target cells emit a great number of molecular signals involved in: (i) the process of turning opportunistic bacteria into pathogens, (ii) chronic inflammation, (iii) anti-apoptotic molecules, (iv) related cancerogenic substances, (v) actions for evasion of the immune system8. Some of these signals could be present years before in the oral microbiota (e.g., in the tongue biofilm) and before the tumour is clinically significant. In the same way activated cancer bacteria, through transitory bacteraemia phenomena, could move from the oral microflora to systemic tissues activating a carcinogenesis process in another body site (Figure 1). The interactome is a way to well understand the role of oral microbiota in human health Interactomics represents a pragmatic construct that depends on omics-based sciences. It is certainly a de novo entity that has arisen of late within the context of postgenomic systems biology. In oral biology, this approach starts from the initial concept of protein/protein interaction between bacteria and cells, now enlarged to small molecules including metabolites and small RNAs. These molecules are normally involved in microbe-microbe and microbe-human cells communication. Freire et al9, described a singular vision regarding oral interactome networks between health and disease. In particular, these authors discuss the acquisition of a complex (mature) microbiota and adaptive immunity, as though these cell to cell relationships have evolved as a means to maintain homeostasis and where the role of the microbiota is to modulate-educate the immune system (e.g. host cytokine control) 10. These authors basically view and suppose the interactome network to be an ecological chronometer of health and disease9. If this approach is shifted to the cancer-microbe interactome and taking into consideration the heterogeneous nature of cancer, the outstanding role of this complex biological network means that it has become a new significant aspect that can contribute to the advanced diagnosis and potential treatment of cancer, particularly as regards its solid forms. The interpretation of this complex signal mesh could extend the horizon of new personalized treatments against tumors, giving a new perspective in advanced medicine that integrates clinical knowledge, bioinformatics, and networks in systems biology. The role of Dentistry and Oral Hygiene for cancer prevention in the interactomics era As described above, a bacteria-mediated carcinogenesis process often begins a long time before its clinical evidence. One of the first signs is represented by signals of a permanent microbial flora dysbiosis that in healthy subjects could be due to a microbial biofilm resident in the tongue dorsum or in tooth plaque. The first sign of this microbial alteration is represented by evident halitosis, due to the production of volatile sulfur compounds by bacteria11, as well as some stress-related mRNAs in the oral tissues12. This suggests that the control of dysbiosis and biofilm in oral medicine represents the first step in cancer prevention. Furthermore, the oral pathologist can promptly identify the early signs of epithelial dysplasia in the oral cavity and, by using the new high-throughput laboratory technologies, can identify the interactomics markers for diagnosis and therapy, e.g. micro and circular RNAs or other small molecules. This is a crucial aspect for efficient personalized medicine in the future. In a very immediate future, with only less than 1 minute, dentists through a simple tongue brush will can have important information for prevention and treatment of misdiagnosed cancer. Acknowledgments One of the authors, CC performed his/her activity in the framework of the International PhD in Innovation Sciences and Technologies at the University of Cagliari, Italy. Conflict of Interest The Authors declare that there is no conflict of interest. References Zhang Y, Wang X, Li H, Ni C, Du Z, Yan F. Human oral microbiota and its modulation for oral health. Biomed Pharmacother 2018; 99: 883-893. Verma D, Garg PK, Dubey AK. Insights into the human oral microbiome. Arch Microbiol 2018; 200: 525-540. Tuominen H, Rautava J. Oral microbiota and cancer development. Pathobiology 2021; 88: 116-126. Starkenmann C, Le Calvé B, Niclass Y, Cayeux I, Beccucci S, Troccaz M. Olfactory perception of cysteine-S-conjugates from fruits and vegetables. J Agric Food Chem 2008; 22: 575-80. Han YW. Fusobacterium nucleatum: a commensal-turned pathogen. Curr Opin Microbiol 2015; 23: 141-147. Dessì A, Bosco A, Pintus R, Orrù G, Fanos V. Fusobacterium nucleatum and alteration of the oral microbiome: from pregnancy to SARS-COV-2 infection. Eur Rev Med Pharmacol Sci 2021; 25: 4579-4596. Chattopadhyay I, Verma M, Panda M. Role of oral microbiome signatures in diagnosis and prognosis of oral cancer. Technol Cancer Res Treat 2019; 18: 1533033819867354. Gholizadeh P, Eslami H, Yousefi M, Asgharzadeh M, Aghazadeh M, Kafil HS. Role of oral microbiome on oral cancers, a review. Biomed Pharmacother 2016; 84: 552-558. Freire M, Nelson KE, Edlund A. The oral host-microbial interactome: an ecological chronometer of health? Trends Microbiol 2021; 29: 551-561. Belkaid Y, Harrison OJ. Homeostatic immunity and the microbiota. Immunity 2017; 46: 562-576. Mogilnicka I, Bogucki P, Ufnal M. Microbiota and malodor-etiology and management. Int J Mol Sci 2020; 21: 2886. Orrù G, Muggironi F, Mameli A, Demontis C, Arcadu B, Scano A, Denotti G, Piras V, Girometta C, Zeza B, Pilloni A. BAX gene overexpression in the tongue could warn of infection risk due to periodontal pathogens. Open Dent J 2018: 12: 1070-1078. Figure 1. From dysbiosis to cancer, a schematic representation of the main interactomic signals involved in bacteria -mediated carcinogenesis in the oral cavity, for example, tongue tissue.

The aim of this study was to investigate ocular surface changes associated with face mask (FMs) use of healthcare personnel during the COVID-19 pandemic. We prospectively evaluated 200 eyes of 100 individuals during working hours and 40 eyes of 20 individuals during their rest days as a control group. Dry eye symptoms were assessed with the Ocular Surface Disease Index (OSDI) and McMonnies questionnaire. The clinical investigation included the best corrected visual acuity (BCVA), corneal fluorescein staining (FS), break-up time (BUT), and Schirmer test I before and after a 7-h work shift with a continuative use of surgical or N95 masks. The control group was evaluated similarly twice a day, at 8:00 a.m. and at 3:00 p.m.. In the study group, BCVA, FS, BUT, and Schirmer test were investigated and there was a significant negative variation at the end of the shift. On the contrary, the control group did not show significant variations of any clinical feature. Furthermore, no significant changes in clinical parameters were observed during the use of surgical or N95 masks. In conclusion, FMs continuative use resulted in daily ocular surface modifications specifically in healthcare personnel.

Gum hypertrophy is a very frequent condition linked to orthodontic treatment, especially in teenagers, and the same time, about 80% of young adults are affected by acne vulgaris, a chronic inflammatory skin disease, typically treated with antibacterial therapy. The use of probiotics has gained popularity in the medical field, and many studies have demonstrated its effectiveness, such as the positive effects of some bacterial strains belonging to Lactobacillus species. The aim of this study is to document the effect of Lactobacillus reuteri (L. reuteri) on facial skin that was randomly observed in two orthodontic patients. We present two case reports of a 14-year-old female patient and a 15-year-old male patient suffering from acne vulgaris who, during fixed orthodontic treatment, showed clinical signs of gingivitis with high values of Full Mouth Plaque Score (FMPS) and Bleeding on Probing (BOP). The patients were treated first with professional oral hygiene sessions and Scaling and Root Planing (SRP) procedures, and then with the administration of a formulate containing L. reuteri as a probiotic. The follow-up was made at four weeks. During the follow-up analysis, both patients showed a significant clinical remission for gum hypertrophy and skin acne vulgaris.

The aim of this study is the evaluation of the safety and the efficacy of long-term combination therapy deferasirox plus desferrioxamine and deferasirox plus deferiprone in a large group of transfusion-dependent thalassemia patients with high values of serum ferritin and/or magnetic resonance, indicative of severe liver and cardiac iron accumulation. Sixteen adults with transfusion-dependent thalassemia were treated simultaneously with deferasirox plus desferrioxamine, while another 42 patients (seven children) were treated with deferasirox plus deferiprone. The hepatic and cardiac iron overload was assessed prior to treatment and then annually with magnetic resonance imaging, and the serum ferritin was measured monthly. Adverse events were checked at each transfusion visit. The safety of both the combinations was consistent with established monotherapies. Both treatments were able to decrease the serum ferritin and liver iron concentration over time, depending on the level of compliance with therapy. Cardiac iron measured as R2* did not significantly change in patients treated with deferasirox plus desferrioxamine. Most patients with MRI indicative of myocardial siderosis at the beginning of treatment reached normal values of cardiac iron at the last determination if treated with deferasirox plus desferrioxamine. The greatest limitation of these therapies was low patient adherence to the two drugs, which is not surprising considering that the need for an intensive chelation is generally linked to previous issues of compliance.

This study is primarily aimed at assessing serum changes on a large panel of proteins in patients with chronic back pain following spa therapy, as well as evaluating different spa therapy regimens as a preliminary exploratory clinical study. Sixty-six patients with chronic back pain secondary to osteoarthritis were randomly enrolled and treated with daily mud packs and bicarbonate-alkaline mineral water baths, or a thermal hydrotherapy rehabilitation scheme, the combination of the two regimens or usual medication only (control group), for two weeks. Clinical variables were evaluated at baseline, after 2 and 12 weeks. One thousand serum proteins were tested before and after a two-week mud bath therapy. All spa treatment groups showed clinical benefit as determined by improvements in VAS pain, Roland Morris disability questionnaire and neck disability index at both time points. The following serum proteins were found greatly increased (≥2.5 fold) after spa treatment: inhibin beta A subunit (INHBA), activin A receptor type 2B (ACVR2B), angiopoietin-1 (ANGPT1), beta-2-microglobulin (B2M), growth differentiation factor 10 (GDF10), C-X-C motif chemokine ligand 5 (CXCL5), fibroblast growth factor 2 (FGF2), fibroblast growth factor 12 (FGF12), oxidized low density lipoprotein receptor 1 (OLR1), matrix metallopeptidase 13 (MMP13). Three proteins were found greatly decreased (≤0.65 fold): apolipoprotein C-III (Apoc3), interleukin 23 alpha subunit p19 (IL23A) and syndecan-1 (SDC1). Spa therapy was confirmed as beneficial for chronic back pain and proved to induce changes in proteins involved in functions such as gene expression modulation, differentiation, angiogenesis, tissue repair, acute and chronic inflammatory response.

Introduction: The microrganisms of the human oral cavity include more than 700 species or phenotypes of bacteria. Some “diseases of civilization” are strictly correlated to changes in the microbiome following the food revolution that occurred after WWII. For that reason, a precise recognition of the microbiome profile before and after this period should be useful to determine the health-compatible model of microbiome. The aim of this study was to compare the microbiome profiles (number of total cells, and pathogen types) of dental samples obtained from two distinct groups of children, a 200-year-old retrieved one and a present one. Methods: Two different groups of samples have been studied. The first group was a set of 50 recent subgingival plaque samples obtained from children of age 2-8 years, 14 males and 36 females. They were enrolled by the Department of Dental Disease Prevention (University of Cagliari, in Sardinia, Italy) during standard dental care procedures. None reported periodontal disease and none had been under antibiotic therapy during the previous 6 months. The second group was an old retrieved group that included 24 teeth from 6 different 6- to 8-year-old crania fragments; they were obtained from a 200-year-old charnel-house located in Villaputzu, a city close to Cagliari. Representative periodontal bacteria have been identified by a previously published real-time PCR procedure (Sokransky et al., 1998) in which P. gingivalis and T. forsythia (red complex), A. actinomycetemcomitans (green complex) and F. nucleatum (orange complex) were detected. In addition, the title of each pathogen was expressed as a percentage of the total bacteria (biofilm) in the sample. Results and discussion: The profile of periodontal microbiomes, between recent/ancient samples showed a significant difference relative to Sokransky’s red complex bacteria (p < 0.05). In all analyzed periodontal strains, the pathogenic bacteria P. gingivalis and T. forsythia showed the highest title in the recent group. Conclusions: Our hypothesis is that the transfer of “commensal-pathogen” as an absolute number on the oral biofilm might be linked to the distinct alimentary habits of the two populations. Some diet rich in reducing agents, such as processed meat-based foods, might be able to increase the average number of pathogen anaerobic bacteria in the oral microbiota. The outcome would be an increase of the oral systemic diseases reported with these pathogens. Our data suggest that the ancient Sardinian population was able to control the pathogen oral anaerobic biofilm by some diet rich in antioxidant compounds. Further investigations are required to focus on the genetic profile and the health status of this ancient population but it appears that molecular microbiology might be considered as the “time machine” in oral biology.

The objective of this study was to assess bone mineral density (BMD) in women on long-term mud-bath therapy (MBT) for osteoarthritis in a Salus per Aquam (SPA) environment. Two hundred and fifty female patients were randomly enrolled in this study in the SPA center of Sardara (Cagliari, Italy) where they were treated with a combination of daily full body mudpacks and bicarbonate-alkaline mineral water baths at cycles of 2 weeks/year. BMD was evaluated by means of calcaneus ultrasonometry (Sahara Hologic Inc., Bedford, MA, USA) and results analyzed according to duration of treatment and clinical variables. In the group of patients undergoing MBT for more than 10 years (group A) and for 3 to 10 years (group B) a reduced frequency of osteopenia and osteoporosis was detected (35.8% and 7.6% group A; 38.4% and 8.5% group B, respectively) compared to controls (group C) (48.9% and 23.4%, P

Objectives: Fibromyalgia (FM) is a syndrome characterized by chronic, diffuse musculoskeletal pain and by a low pain threshold at specific anatomical points (tender points). Numerous other conditions (Irritable bowel syndrome, tension-type headache, migraine headaches, etc.) may overlap with FM. Aim of this study was to evaluate the quality of life and associated clinical distress in patients with FM. Methods: 53 females affected by primary fibromyalgia and 40 healthy females were examined were examined by an experienced rheumatologist and interviewed using the Fibromyalgia Impact Questionnaire (FIQ). Clinical monitoring included Visual Analogue Scale for pain and pain pressure threshold measurements. Results: Mean FIQ scores were 66.39±14.94 in FM patients and 13.15±5.37 in control subjects and the difference was statistically significant. Among associated clinical distress higher frequencies have been found for paraesthesia (87%), sleep disturbance (72%), tension type headache (70%), oto-vestibule syndrome (72%) and irritable colon (60%). An R.O.C. bend was developed in the presence of paraesthesias and oto-vestibule syndromes at the same time. This allowed us to identify a FIQ cut off value of 66.85 so FM patients were divided into 2 groups according to their FIQ scores: severe degree and mild or slight degree. Conclusions: Based on our data, it would appear possible to use a FIQ value equal to or higher than 66.85 for the clinical picture of FM to be classified as severe.

The aim of this review is to create a complete analysis about tongue-tie (or short lingual frenum or ankyloglossia) according to the most important works published in literature. The analysis allowed us to do a complete evaluation of this problem, from embriology to the therapeutic approach we could use today, focusing our attention on laser-assisted therapy. This review is based on the research on the PubMed Database (www.ncbi.nlm.nih.gov) of studies about lingual frenum written in English between January 1980 and May 2014. The keywords inserted were “lingual frenum”, “frenectomy”, “laser therapy”. We have analyzed: case series, case reports, clinical studies, and also literature reviews in which embryology, physiology, diagnosis and treatment of ankyloglossia were described. We excluded laboratory studies, studies based on animal tests and studies about patients with particular syndromes in which we can also find tongue-tie. The selection criteria allowed us to select 42 articles. The treatment options for the releasing of the frenum are surgically represented by frenotomy (i.e. simple horizontal cut of this training) and frenectomy (i.e. removal). In both cases, the intervention on the short lingual frenum is simple, short-lasting, and without particular complications. Furthermore, this kind of treatment can be carried out with different devices: with the typical cold blade scalpel or by the use of laser, a new method that shows more advantages over the prior art. Laser-assisted therapy permits to intervene on newborns (from 0 to 20 days, when there are breastfeeding problems) without total anesthesia and suture. The Er:YAG, CO2 laser (according to literature data) and Diode laser (according to our experience) are advantageous, safe and effective in tongue-tie treatment.

Lesch-Nyhan syndrome, described in 1964 by Lesch and Nyhan, is a X-linked recessive disorder, occurring in 1 : 100000 to 1 : 380000 live births. LNS is characterized by a decrease in activity of hypoxanthine guanine phosphoribosyl transferase, an enzyme involved in purine metabolism, resulting in overproduction of uric acid. Hyperuricemia and neurological features including choreoathetoid spasticity, self-mutilation, and mental retardation clinically characterize this syndrome. In LNS patients the typical feature is loss of tissue from biting themselves with partial or complete amputation of fingers, lips, and tongue. The self-mutilation compares with the eruption of the deciduous teeth. Several drugs trials have been administered to improve self-destructive behavior and invasive treatment approaches, such as extractions of teeth and orthognathic surgery, have been suggested with variable effectiveness. Nowadays prevention is, therefore, the standard of care. The role of dentistry is essential in the management of the self-mutilating behavior, because the teeth represent the main self-injury instrument. This report presents a revision of various therapeutic approaches to manage self-destruction, highlighting the effectiveness of a preventive treatment. It describes a new technique: a resin mouthguard, realized at Gaslini Hospital, to obtain immediate healing of the oral lesions, confirmed in the follow-up period.

Oral breathing is a respiratory dysfunction that affects approximately 10-15% of child population. It is responsable of local effects and systemic effects, both immediate and long-term. They affect the growth of the subject and his physical health in many ways: pediatric, psycho-behavioral and cognitive. The etiology is multifactorial. It’s important the establishment of a vicious circle involving more areas and it is essential to stop it as soon as possible. In order to correct this anomaly, the pediatric dentist must be able to make a correct diagnosis to treat early the disfunction and to avoid the onset of cascade mechanisms. Who plays a central role is the pediatrician who first and frequently come into contact with little patients. He can identify the anomalies, and therefore collaborate with other specialists, including the dentist. The key aspect that guides us in the diagnosis, and allows us to identify the oral respirator, is the “adenoid facies”. The purpose of the study is to highlight the importance and benefits of an early and multidisciplinary intervention (pediatric, orthopedic-orthodontic-functional). A sample of 20 patients was selected with the following inclusion criteria: mouth breathing, transverse discrepancy > 4 mm, early mixed dentition, central and lateral permenent incisors, overjet increased, lip and nasal incompetence, snoring and/or sleep apnea episodes. The protocol of intervention includes the use of the following devices and procedures: a maxillary rapid expander (to correct the transverse discrepancy, to increase the amplitude of the upper respiratory airway and to reduce nasal resistances tract) in association with myo-functional devices (nasal stimulator and oral obturator). They allow the reconstruction of a physiological balance between the perioral musculature and tongue, the acquisition of nasal and lips competence and the reduction of overjet. This protocol speeds up and stabilizes the results. The control of the muscles during the growth phase is important: muscular forces influence the direction of facial growth.