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This chapter provides an illuminating insight into the processes of the humanization of care in order to increase specialist knowledge regarding the nature of the doctor-patient relationship. It will deal with the notion of care and its various aspects, including the existential dimension of the process of caregiving by means of a narrative (storytelling) interview. After a brief analysis of the changes which have affected medical science in past centuries, the focus of the paper will be directed to the remarkable transformation which clinical practice has undergone, by virtue of which the concept of the taking care of the patient has gained increasing attention. Thus, care can be provided by means of the narrative interview, not only as medical history but also as action: it recognises the patient’s world, in turn opening up the processes of the humanization of care in the field of dental medicine. The scientific community has long questioned the traditional medical approach, which is centred on disease, and it now pays ever more attention to the involvement of the patient in the process of diagnosis and treatment. Every time a patient sits down in front of a specialist, they bring with them stories, their own and ours, describing their stomatognathic system. A technically accurate medical history with information untouched by the doctor makes space for the narrative interview and ‘caring presence’ of the operator, to reflect on what it means to ‘care for the patient’. From the point of view of optimising care, it is therefore useful to rethink the relationship between dentist and patient: effective clinical practice is not possible without listening empathically to the patient’s story, their perceptions, and their experiences. It is necessary to reformulate settings to improve and render them more effective and, where possible, to include appropriate active listening strategies and adopt specific communication techniques. In this paper the authors will describe their vision of the humanisation of care in the form of a narrative.

To date, there are very few epidemiologic studies on caries disease in 6–7 year old children living in Sicily (Southern Italy). The first permanent molar (FPM) is the most commonly affected tooth in this target population, and a one-unit increase in the number of decayed FPMs is predictive of caries in other teeth and in adulthood. The primary aim of this research is to estimate the prevalence of caries in 6–7 year old schoolchildren living in Palermo and, as a secondary aim, to estimate the prevalence of affected FPMs. It was designed as a cluster cross-sectional survey on 995 children from 16 schools, selected based on their geographical location, in one of the eight city districts. Caries data were recorded using the International Caries Detection and Assessment System for each tooth surface. The relation between socio-economic status, behavioural determinants, and clinical information and the number of teeth with initial caries (IC), moderate caries (MC), or extensive caries (SC) was analysed through the ordinal logistic regression. Among the 995 schoolchildren, 662 (66.5%) had at least one lesion and 742 (74.6%) had FPMs. Of the latter, 238 (32.0%) were affected by IC, 86 (11.6%) were affected by MC, and only 3 (0.4%) were affected by SC. During multivariable analysis, there was evidence of an increased risk of MC and SC related to the deprivation of the district in which the children lived and went to school, as well as to the protective role of parental education and employment. The same significant determinants were found for IC and MC FPMs. The study showed the important role of socio-economic determinants, unhealthy behaviours, and social deprivation related to the increased risk of moderate and extensive caries in 6–7 year old schoolchildren. Investigating this target population is very important, as early development of caries in FPMs may have serious consequences in the prognostics of oral health in an adult.

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.

Caries and periodontal diseases are highly neglected disease affecting millions of Italian children; both diseases are preventable and the combination of high prevalence, high morbidity and a relative lack of attention of the Italian National Health Service make caries and periodontal disease a significant public health problem. To date none studies reported epidemiological data of 6–7-year-old-italian-children-population. The aim of this survey was to describe the dental and periodontal health status in 6- and 7-year-old schoolchildren from Palermo and to evaluate the association between socioeconomic determinants and behavioural habits. A sample of 2701 children aged 6 and 7 from the selected public schools in all the eight districts of the town received a clinical intraoral examination carried out by trained dentists. Parents were asked to fill in a questionnaire investigating children’s eating habits, oral health related behaviours and socioeconomic determinants of the household. The percentage of 6- and 7-year-old schoolchildren with at least one carious lesion was found to be 66.5%. A higher mother’s and father’s educational level were a protective factor for carious lesions; conversely, a paternal unemployment was found to be a risk factor. Living in II and VII districts was a risk factor for all stages of carious lesions. KEY WORDS: Dental caries; Schoolchildren; Oral health-related determinants; Caries risk factors; ICDAS II; Caries epidemiology; Deprivation index; Oral health promotion; Dental sealants; Di.Chir.On.S 2021

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.

(1) Aim: To assess the attitude toward Lifestyle Medicine and healthy behaviours among students in the healthcare area and to demonstrate its association to psychological well-being, (2) Methods: A cross-sectional study is conducted among 508 undergraduates of the University of Palermo (140 (27.6%) in the healthcare area and 368 (72.4%) in the non-healthcare area), during the academic year 2018&ndash, 2019. Psychological well-being is measured through two dimensions of eudaimonia and hedonia, using the 10-item Hedonic and Eudaimonic Motives for Activities-Revised (HEMA-R) scale, with answers coded on a 7-point scale. The association between demographic and modifiable behavioural risk factors for chronic diseases is assessed through crude and adjusted Odds ratios with 95% confidence intervals, (3) Results: Orientation to both hedonia and eudaimonia is significantly associated to the Mediterranean diet (ORAdj = 2.28, 95% CI = (1.42&ndash, 3.70)) and drinking spirits less than once a week (ORAdj = 1.89, 95% CI = (1.10&ndash, 3.27)) and once a week or more (ORAdj = 6.02, 95% CI = (1.05&ndash, 34.52)), while these conditions occur together less frequently for current smokers (ORAdj = 0.38, 95% CI = (0.18&ndash, 0.81)). Students inclined to well-being consider healthcare professionals as models for their patients and all people in general (OR = 1.96, 95% CI = (1.28&ndash, 3.00)), (4) Conclusions: The positive relation found between a virtuous lifestyle and psychological well-being suggests the construction, development and cultivation of individual skills are a means to succeed in counteracting at risk behaviours for health.

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.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

The present study aimed to evaluate the characteristics and quality of statistical methodology used in clinical studies on dentin hypersensitivity management. An electronic search was performed for data published from 2009 to 2014 by using PubMed, Ovid/MEDLINE, and Cochrane Library databases. The primary search terms were used in combination. Eligibility criteria included randomized clinical trials that evaluated the efficacy of desensitizing agents in terms of reducing dentin hypersensitivity. A total of 40 studies were considered eligible for assessment of quality statistical methodology. The four main concerns identified were i) use of nonparametric tests in the presence of large samples, coupled with lack of information about normality and equality of variances of the response; ii) lack of P-value adjustment for multiple comparisons; iii) failure to account for interactions between treatment and follow-up time; and iv) no information about the number of teeth examined per patient and the consequent lack of cluster-specific approach in data analysis. Owing to these concerns, statistical methodology was judged as inappropriate in 77.1% of the 35 studies that used parametric methods. Additional studies with appropriate statistical analysis are required to obtain appropriate assessment of the efficacy of desensitizing agents.

Objectives: Our group recorded the characteristic of oro-dental health among a group of drug addicts in recovery treatment with methadone, and it evaluated the changes related to the withdrawal therapy. Methodology: A sample of 50 drug addicts in treatment with methadone was included in this study. At the beginning of the withdrawal therapy, the authors recorded the parameters involved in the most common oral diseases. Moreover, it was evaluated how, during the rehabilitation protocol, the behavioral parameters and the xerostomia that influence the oral health changed. A medical history especially referring to drug addiction features was made. An intraoral objective exam was done for each patient, at the beginning of the therapy and after 3 and 6 months. Results: 82% of the subjects showed a DMFT > 0. No patient showed any presences of previous restorative therapies. Lowenthal's caries, mostly localized in the cervical upper maxillary incisor, were found in 12% of the subjects. The Löe and Silness index showed marginal gingivitis in 95% of subjects, whereas 44% showed improper occlusion and/or parafunctional habits. 52% of the subjects had a normal diet, but a qualitative evaluation showed a high percentage (48%) of immoderate refined sugars use. Xerostomia, that was present in 72% of patients during the drug dependence period, showed a marked reduction in the withdrawal period. Conclusion: The group analyzed made a combined use with other drugs. They showed a high rate of caries and marginal periodontitis. The statistical analysis of the data proves how the methadone rehabilitation program is effective even on the oral health. It will show its effects over two different time related phases: after a first phase of decreased attention to oral health (0-3 months), all index will increase in the long term (3-6 months). The rehabilitation program contributes to an improved oral health of drug addicts.

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).

The aim of this narrative review is to investigate the implication of mesenchymal stem cells harvested from human dental pulp in in vivo bone tissue regeneration. We focused on studies related to roles of human dental pulp stem cells in in vivo bone regeneration. A total of 1021 studies were identified; after the assessment of eligibility, only 39 studies were included in the review. The evaluated information of the studies regards the experimental strategies (e.g., the isolation method, the scaffold, the in vivo animal models). The overall main evidences highlighted from the analysis are that dental pulp stem cells and human-exfoliated deciduous teeth stem cells supported by a suitable scaffold should be considered a valuable source for bone tissue regeneration.

Background Chronic periodontal disease is an infectious disease consisting of prolonged inflammation of the supporting tooth tissue and resulting in bone loss. Guided bone regeneration procedures have become common and safe treatments in dentistry, and in this context dental stem cells would represent the ideal solution as autologous cells. In this study, we verified the ability of dental pulp mesenchymal stem cells (DPSCs) and gingival mesenchymal stem cells (GMSCs) harvested from periodontally affected teeth to produce new mineralized bone tissue in vitro, and compared this to cells from healthy teeth. Methods To characterize DPSCs and GMSCs, we assessed colony-forming assay, immunophenotyping, mesenchymal/stem cell phenotyping, stem gene profiling by means of flow cytometry, and quantitative polymerase chain reaction (qPCR). The effects of proinflammatory cytokines on mesenchymal stem cell (MSC) proliferation and differentiation potential were investigated. We also observed participation of several heat shock proteins (HSPs) and actin-depolymerizing factors (ADFs) during osteogenic differentiation. Results DPSCs and GMSCs were successfully isolated both from periodontally affected dental tissue and controls. Periodontally affected dental MSCs proliferated faster, and the inflamed environment did not affect MSC marker expressions. The calcium deposition was higher in periodontally affected MSCs than in the control group. Proinflammatory cytokines activate a cytoskeleton remodeling, interacting with HSPs including HSP90 and HSPA9, thioredoxin-1, and ADFs such as as profilin-1, cofilin-1, and vinculin that probably mediate the increased acquisition in the inflamed environment. Conclusions Our findings provide evidence that periodontally affected dental tissue (both pulp and gingiva) can be used as a source of MSCs with intact stem cell properties. Moreover, we demonstrated that the osteogenic capability of DPSCs and GMSCs in the test group was not only preserved but increased by the overexpression of several proinflammatory cytokine-dependent chaperones and stress response proteins. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0633-z) contains supplementary material, which is available to authorized users.

The aim of this study was to evaluate if antibiotic prophylaxis reduces the bacterial contamination of bone particles collected directly from the burs used for implant site preparation. Thirty-four patients underwent the surgical procedures for a total of 34 implant sites. One 1 gr. tablet of amoxicillin + clavulanic acid was given to the test group 12 hours and 1 hour before the surgery. The control group did not take antibiotic prophylaxis. Bone particles were collected and centrifuged. The suspensions were subjected to serial dilutions and each dilution was examined twice using a spatulation technique in Trypticase Soy Agar (TSA), in Sabouraud Dextrose Agar, and in Mitis Salivarius Agar (MSA). The number of colonies was calculated and the identification of various microorganisms was made. The most represented species, in both groups of patients, belonged to the “oral Streptococci.” For TSA, the test and control groups differed significantly (p = 0.018). Conversely, there was no significant difference for MSA (p = 0.201) and for the number of bacterial species isolated in the samples of the two groups of patients (p = 0.898). The antibiotic prophylaxis reduced, but did not cancel, the risk of infection of the autogenous particulate bone graft. This trial is registered with IRCT2017102537002N1.

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.

Oral Diseases (2012) 18, 396–401 Objective: The aim of this study is to assess the main oral mucosal lesions (OMLs) within a hospital base and to provide an anamnestic, diagnostic model based on homogeneity analysis of some variables. Methods: The demographic and behavioural data (i.e. gender, age, smoking status, alcohol consumption and therapeutic drug usage) of 1753 patients with at least one OML were considered. Multiple correspondence analysis (MCA) and multivariate tests of the simultaneous marginal homogeneity hypothesis (SMH) were used to analyse the evidence of any differences between the demographic and behavioural profiles relating to OMLs diagnoses. Statistical significance of P

Objective: Desquamative gingivitis (DG) represents the gingival manifestation associated with several mucocutaneous disorders and systemic conditions. Little is known of whether or not DG could influence the onset or progression of plaque-related periodontitis. In this study, the potential impact of DG on plaque-related attachment loss and pocket formation has been evaluated. Methods: A cross-sectional evaluation of 12 patients with DG [eight oral lichen planus (OLP), four mucous membrane pemphigoid (MMP)], never treated for DG lesions or plaque-related periodontitis, was carried out. Probing depth (PD), clinical attachment loss (CAL), full-mouth plaque (FMPS), and bleeding (FMBS) scores were evaluated at six sites per tooth. Clinical parameters of sites with DG lesions were compared with that of DG unaffected sites. Results: Median PD and CAL, as well as FMPS and FMBS, were not significantly different (P > 0.05 Mann–Whitney test) for both OLP and MMP patients. However, a negative association between DG lesions and PD 6 mm (only for OLP: OR = 3.83) were found to be significant. Conclusions: The potential interference between DG lesions and periodontitis needs further prospective investigation; nonetheless, a higher level of attention might be prudent.

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.

Background: The main therapeutic approach for periodontal diseases is mechanical treatment of root surfaces via scaling and root planing (SRP). Multicenter clinical trials have demonstrated that the adjunctive use of a chlorhexidine (CHX) chip is effective in improving clinical results compared to SRP alone. However, some recent studies failed to confirm these clinical results, and conflicting results were reported regarding the effects of the CHX chip on subgingival microflora. The aim of this study was to provide further data on the clinical and microbiologic effects of CHX chips when used as an adjunct to SRP. Methods: A total of 116 systemically healthy individuals with moderate to advanced periodontitis, aged 33 to 65 years, were recruited from the Departments of Periodontology of four Italian universities. For each subject, two experimental sites were chosen that had probing depths (PD) >= 5 mm and bleeding on probing (BOP) and were located in two symmetric quadrants. These two sites were randomized at the split-mouth level, with one receiving SRP treatment alone and the other receiving treatment with SRP plus one CHX chip (SRP + CHX). PD, relative attachment level (RAL), and BOP were evaluated at baseline, prior to any treatment, and after 3 and 6 months. Supragingival plaque and the modified gingival index were evaluated at baseline and after 15 days and 1, 3, and 6 months. Subgingival microbiologic samples were harvested at baseline and after 15 days and 1, 3, and 6 months, cultured for total bacterial counts (TBCs), and investigated by polymerase chain reaction analysis for the identification of eight putative periodontopathogens. Results: When all of the pockets were considered, the PD and RAL were significantly less at 3 and 6 months compared to the baseline scores (P= 7 mm were considered. The percentage of sites positive for BOP was similar between the treatments at each time point. At 15 days and I month, the TBC for the SRP + CHX treatment group was significantly lower than for the SRP treatment group (P

Background: Chronic desquamative gingivitis (DG) is a condition characterized by erythema, ulceration, and desquamation of the free and attached gingiva, usually expression of a district-systemic disease, such as oral lichen planus (OLP). Methods: A combined protocol of oral hygiene and topic corticosteroid therapy was applied in 30 patients with DG associated with OLP. Plaque index (PI) and bleeding on probing (BoP) were evaluated at baseline and after 3 months. Results: PI scoring was significantly lower after treatment in anterior, posterior, and all sites (P

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.

Candida pararugosa was first isolated from human feces, but after the initial description no further recovery from humans has been reported. During a study on oral Candida colonization in denture wearers living in Palermo (Italy), we isolated C. pararugosa from a 61-year-old woman without signs of oral candidosis. This constitutes, to the authors' knowledge, the first isolation of C. pararugosa from the oral cavity. After six months, colonization by C. pararugosa persisted, suggesting that this species could be a component of the normal oral microbiota. The identification procedure we used could be useful in elucidating the epidemiology of C. pararugosa and for establishing its clinical significance.

Candida dubliniensis, an emerging oral pathogen, phenotypically resembles Candida albicans so closely that it is easily misidentified as such. The aim of the present study was to evaluate the usefulness of two phenotypic methods, growth at 45 degrees C and 2,3,5-triphenyltetrazolium chloride (TTC) reduction, for confirming presumptive identification of C. dubliniensis and C. albicans by colony color on CHROMagar Candida (CAC) medium. A combination of these methods was used to establish the prevalence of oral C. dubliniensis in an Italian population of 45 human immunodeficiency virus (HIV)-infected subjects. Twenty-two samples (48.9%) were positive for yeasts on CAC medium producing a total of 37 fungal isolates. The colony color and 45 degrees C growth ability test correctly identified all C. dubliniensis and C. albicans isolates (5/37, 13.5%, and 16/37, 43.2%, respectively), while assessment of TTC reduction misidentified one C. albicans isolate. The isolation rate of C. dubliniensis was 11.1% (5/45 patients). All of the C. dubliniensis isolates were highly susceptible to fluconazole (MIC = 0.5 microg/ml). The combination of CAC medium screening with growth at 45 degrees C and TTC reduction tests may represent a simple, reliable and inexpensive identification protocol for C. dubliniensis.

Objectives. We sought to assess asymptomatic oral carriage of Candida species and relative density in human immunodeficiency virus-infected (HIV+) subjects, as well as to determine whether yeast carriage is associated with CD4+cell count, HIV-1 RNA quantity, gender, route of HIV transmission, antiretroviral therapy, or smoking. Study Design. A cross-sectional analysis of oral rinses from HIV+ and healthy subjects was undertaken. Oral candidal carriage and relative species were investigated in 42 HIV+ and 41 healthy individuals, all of whom were seen at the Palermo University Department of Oral Sciences, Italy. Data were managed and analyzed by means of the computer software package StatView 5.0.1. Results. Carriage rate was 61.9% and 29.3% (P =.003) among HIV+ and healthy subjects, respectively. Similarly, density carriage in the HIV+ group was found to be significantly higher than in the control group (P =.0002). Among HIV+ subjects, Candida carriage was significantly associated with smoking, whereas density was not. Oral candidal carriage and relative density were not significantly associated with the other 4 parameters evaluated. Candida albicans was the most frequently recovered species. Conclusions. Asymptomatic candidal carriage and relative density were found to be significantly higher in the oral cavity of HIV+ subjects—but not associated with CD4+counts or HIV-1 RNA quantities. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:281-6)

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.

Osteonecrosis of the jaws (ONJ) is an adverse side event of bisphosphonates and denosumab, antiresorptive agents that effectively reduce the incidence of skeletal-related events in patients with metastatic bone cancer and multiple myeloma. Available data suggest that 0-27.5% of individuals exposed to antiresorptive agents can develop ONJ. There is increasing evidence that avoidance of surgical trauma and infection to the jawbones can minimize the risk of ONJ, but there are still a significant number of individuals who develop ONJ in the absence of these risk factors. Bone necrosis is almost irreversible and there is no definitive cure for ONJ with the exclusion, in certain cases, of surgical resection. However, most ONJ individuals are affected by advanced incurable cancer and are often managed with minimally invasive nonsurgical interventions in order to control jawbone infections and painful symptoms. This article summarizes current knowledge of ONJ epidemiology, manifestations, risk-reduction and therapeutic strategies. Further research is needed in order to determine individual predisposition to ONJ and clarify the effectiveness of available treatments.

Objective: The purpose of this study was to investigate the relationship between oral lesions and gender, age, CD4+ cell count, human immunodeficiency virus-1 (HIV-1) viral load, antiretroviral therapy, and route of transmission in a group of HIV-infected (HIV+) persons from the Mediterranean region. Study Design: The participants in this study were HIV+ adults who sought dental care between January 1999 and June 1999 in the Department of Oral Medicine (University of Palermo, Italy). Results: One hundred thirty-six HIV+ adults came in for an initial oral examination. Their mean age was 35.2 years (SD ± 7.97), and 33% were women. Their mean CD4+ cell count was 325.3 × 106 /L (SD ± 225.8), and their HIV-1 viral load was 39,168.3 copies/mL (SD ± 144,256.1). Oral lesions were found in 47% of the study group, as well as in 56.5% of women (n = 46) versus 45.5% of men (n = 90; P = .05). Oral candidiasis was the most common disease; it is significantly associated with women (P = .004), CD4+ cell count (P = .005), and HIV-1 viral load (P = .0003). No significant relationships were found between any types of oral lesions and age, antiretroviral therapy, or route of transmission (P > .2). Conclusion: The prevalence of HIV-related oral lesions was significantly higher in women than in men, especially for oral candidiasis, the most common lesion observed related to immune status and HIV-1 viral load.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:546-51)

Objective. Antimicrobial mouthrinses may represent a valid alternative to topical antifungal agents. However, the action of antimicrobials could be affected by the different ingredients incorporated into mouthrinse products. The purpose of the present study was to investigate the in vitro antifungal and fungicidal activities of antimicrobials alone. Study Design. A broth macrodilution method was used to determine the minimum inhibitory concentration of 4 antimicrobial agents against Candida species. Minimum fungicidal concentration was also determined. Results. All antimicrobials showed antifungal activity against all tested organisms, but cetylpyridinium chloride received significantly lower minimum inhibitory concentrations (P < .005). Cetylpyridinium chloride also showed a greater fungicidal activity than chlorhexidine digluconate and hexetidine (P < .005), whereas sanguinarine chloride appeared to be less fungicidal against most of the isolates tested. Conclusions. These findings suggest that cetylpyridinium chloride may be used as a topical antifungal agent. Clinical trials are now required to assess its value in the management of oral candidosis.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:44-9)

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