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Over the past years, a novel direction in dentistry, named 'Dental Sleep Medicine,' has been increasingly developed. The objective is to find an effective remedy for the treatment of Obstructive Sleep Apnoea Syndrome (OSAS) through the use of various Oral Appliances (OAs). These appliances can be used alternatively or in conjunction with the Continuous Positive Airway Pressure (CPAP), depending on the degree of OSAS and patient compliance. The various OAs available and discussed in the medical literature differ from each other based on the patency mechanism of the airways. Furthermore, OAs determine not only an improvement of the respiratory flow, but also the improvement of cardiovascular system of patient, as well as the general improvements of the quality of life. The use of OA reduces the risk of hypertension, cardiovascular and cerebrovascular diseases, that are common with patients with OSAS. The purpose of this Chapter is to provide a review of medical literature in order to evaluate the different types of OAs, their characteristics, use and effects and to provide a guidance for an effective multidisciplinary management of OSAS treatment.

La carcinogenesi è un processo multifattoriale in cui sono coinvolti differenti fattori esogeni; tra questi, il microbiota sembra svolgere un ruolo attivo nei mec- canismi di sviluppo del carcinoma orale [1]. Nella presente trattazione saranno descritti i principali aspetti epidemiologici, clinici e patogenetici che vedono coinvolto il microbiota orale nel processo di carcinogenesi omodistrettuale. A tal proposito, per facilità di trattazione, è stata condotta una distinzione del microbiota orale in due gruppi: microbiota orale batterico e microbiota orale non batterico (i.e. Candida spp, Human Papilloma Virus). Fra i microrganismi appartenenti a quest’ultimo gruppo, verrà condotta una disamina più appro- fondita sul ruolo dello Human Papilloma Virus (HPV) nell’oncogenesi del cavo orale, al fine di fornire le più attuali e chiare evidenze.

L’osteonecrosi delle ossa mascellari (ONJ) farmaco-relata è stata de- finita nel capitolo I come “una reazione avversa farmaco-correlata, caratterizzata dalla progressiva distruzione e necrosi dell’osso man- dibolare e/o mascellare di soggetti esposti al trattamento con farmaci per cui sia accertato un aumentato rischio di malattia, in assenza di un pregresso trattamento radiante”1. Tale definizione sottolinea la consapevolezza di uno stato di allerta e di vigilanza sui fattori di ri- schio associati alla patologia, con la possibile progressiva inclusione di nuove popolazioni di soggetti potenzialmente a rischio, e in linea con la continua evoluzione delle conoscenze scientifiche in materia di eziopatogenesi di ONJ farmaco-relata2,3.

L’osteonecrosi delle ossa mascellari (ONJ) da farmaci è una severa patologia odontoiatrica, recentemente defi nita come «una reazione avversa farmacocorrelata, caratterizzata dalla progressiva distruzione e necrosi dell’osso mandibolare e/o mascellare di soggetti esposti al trattamento con farmaci per cui sia accertato un aumentato rischio di malattia, in assenza di un pregresso trattamento radiante»1-3. I pazienti osteometabolici a rischio di sviluppare l’ONJ sono quelli sottoposti a terapia con bisfosfonati (in particolare aminobisfosfonati o Nitrogen-containing BisPhosphonate/NBP) e, più recentemente, con denosumab (anticorpo monoclonale anti-RANKL)4. Tali farmaci antiriassorbitivi caratterizzati da una prevalente azione inibitoria sul metabolismo dell’osso, sono ampiamente prescritti per la cura di patologie osteometaboliche, prevalentemente osteoporosi primaria o secondaria, oltre che per la prevenzione e il trattamento di lesioni scheletriche in pazienti con patologia onco-ematologica1,5-7.

Aim. Dementia is a common disorder among the elderly. Alzheimer’s disease (AD) is the most common cause of dementia. In addition to known risk factors (e.g. age and familiarity) of AD, recently it has been suggested a possible promoting role for chronic inflammatory infective diseases. Periodontal disease (PD) is a frequent chronic multi-bacterial infection involving the tissues supporting the teeth; in addition to promoting inflammation locally, the periodontal pathogens possess mechanisms able to influence the systemic balance of inflammatory mediators. Similarly to other systemic diseases (e.g. cardiovascular disease, diabetes, renal diseases and low birth weight), a possible link has been proposed between PD and the development and progression of AD. Aim of the present study was to evaluate the oral health status and the prevalence/severity of PD in a group of patients affected by AD compared to a control group of healthy subjects. Materials and methods. A case-controlled clinical trial was designed to compare patients with AD (Test group - T; n = 16; M: 8; F: 8, range age 64-93 yrs) with healthy controls (Control group - C; n = 16; M: 8; F:8; range age 64-92 yrs). The population study was named ZAP (Zabut Aging Project) and all participants, enrolled in a Sicilian rural community (Sambuca di Sicilia, AG, Italy), were matched for age and sex. Following variables were recorded: smoking and drinking habits, number of teeth, Decayed Missed Filled Teeth scoring (DMFT), measurement of the probing depth (CPI and PSR index). The association between AD and PD, socio-demographic and behavioural-clinical variables was assessed using the χ2 test or Fisher’s exact test, as appropriate. To measure the association level, crude OR and the 95% Confidence Interval (CI) were calculated. Statistical significance of the difference in the average DMFT between cases and controls was assessed using the Student’s t-test. A p value ≤0.05 was considered statistically significant. Results. One patient of T group was a smoker versus four of C group; four T patients were drinker versus two of C group. Seven of T group (43.7%) were totally edentulous, conversely only 2 (12.5%) of controls have the same condition (p=0.04). With respect to oral status, DMFT index was 23.7 ±9.0 in T patients versus 25.2±7.8 in controls (p=0.633). There were no significant differences between T and C groups regarding periodontal index: high PSR and CPI scores (>3) were recorded in 77.8% of AD patients and 46.1% of health cases (p >0.05). A similar distribution among two groups was observed regarding the other investigated variables (e.g. smoking and drinking habits). Conclusions. In this rural Sicilian adult/elderly community, poor oral health is frequent with a DMFT score higher than general population. The obtained data do not support the hypothesis of a major prevalence and severity of PD among AD patients. However, to confirm these preliminary results the recruitment of a wider sample size and further data, regarding proteomic salivary profiles and RT PCR-based microbiological investigation on sub-gingival plaque samples, still need in order to better clarify the role of PD and periodontal pathogens in the AD natural history.

Background: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs. Methods: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered. Results: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values5) in K-OLPs and nK-OLPs, respectively. The PSQI’s validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI. Conclusions: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management.

Objectives: To investigate the quality of sleep and the psychological profiles of a large cohort of Italian patients with burning mouth syndrome (BMS) and to clarify the relationships between these variables and pain. Methods: In this case–control study, 200 patients with BMS vs an equal number of age- and sex-matched healthy controls, recruited in 10 universities, were enrolled. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), Numeric Pain Intensity Scale (NRS) and Total Pain Rating Index (T-PRI) were administered. Descriptive statistics, including the Mann–Whitney U test and hierarchical multiple linear regression analysis, were used. Results: Poor sleep quality (PSQI≥5) was present in 78.8% (160) patients with BMS. BMS patients had statistically higher scores in all items of the PSQI and ESS than the healthy controls (p&nbsp

Personalized medicine is a new paradigm in health care, and the concept of socio-cultural gender, as opposed to biological sex, emerged in several medical approaches. This exploratory study aimed to investigate the knowledge of sex and gender in clinical medicine among Sicilian physicians. Data collection was based on an online survey sent to the members of the Medical Councils of Sicily (Italy). The questionnaire included nine specific items about awareness and attitudes regarding gender medicine and its importance in clinical practice. 8023 Sicilian physicians received the solicitation e-mail and only 496 responded. Regarding the knowledge of gender medicine, 71.1% of participants stated that they know it, while 88.5% believe that gender medicine should be included in training programs. Similarly, a high percentage (77.6%) would like to keep up to date on this topic. Physicians sampled seem to understand the importance of gender medicine principles, although their experience of some gender issues (i.e., sex disparities in acute cardiovascular care and smoking cessation strategies) is low (55.44% and 21.57%, respectively). The results of this exploratory study should encourage facing the gender medicine gap in the current curricula of health professionals and should implement the transitional value of sex and gender principles in the clinical setting.

Introduction: Contrary to early beliefs, celiac disease (CD) is relatively common; however, it still remains underdiagnosed since most cases are atypical, with few or no gastrointestinal symptoms and predominance of extraintestinal manifestations. As a consequence, the diagnosis of the disorder often requires a multidisciplinary approach. Also some oral ailments have been described in celiac patients. In this study, we review the papers that have reported oral manifestations in subjects with CD. Methods: A comprehensive literature search was conducted in Medline and Embase databases using appropriate key words. Additional papers were selected by cross-referencing from the retrieved articles. Results: Dental enamel defects are the oral lesions most closely related to CD. There are conflicting data on the association between CD and recurrent aphthous stomatitis. A correlation of CD with atrophic glossitis has been reported, although robust evidence in support of it is lacking. Patients with CD have caries indexes seemingly lower than healthy individuals, but they may experience delay in tooth eruption. Occurrence of other oral mucosal lesions in CD subjects is likely occasional. Conclusions: Patients with systematic dental enamel defects should be screened for CD even in the absence of gastrointestinal symptoms. CD screening tests for patients with oral aphthae or idiopathic atrophic glossitis should be selectively considered during a medical evaluation that focuses on all aspects of the patient’s status.

Obstructive sleep apnea (OSA) is a complex disorder characterized by total or partial collapse of the upper airways (UA) during sleep, causing obstructive apneas or hypopneas, respectively. During respiratory events, respiratory efforts occur against the restricted or collapsed upper airway, hypoxia and hypercapnia develop, and sympathetic activation increases. The main symptoms of OSA are intermittent snoring and excessive daytime sleepiness. OSA is often associated with obesity, hypertension, and increased cardiovascular risk. Pathophysiological aspects include: anatomical and physiological determinants of UA closure, and immediate and long-term consequences of chronic intermittent hypoxia (CIH), which is believed to be the most relevant alteration induced by OSA. This chapter will briefly review OSA pathophysiology, with special attention to physiological phenotypes of OSA, and the role of intermittent hypoxia in the pathogenesis of cardiometabolic abnormalities.

Objectives: To analyze psychological profiles, pain and oral symptoms in patients with oral lichen planus (OLP). Materials and methods: 300 patients with keratotic OLP (K-OLP; reticular, papular, plaque-like subtypes), 300 patients with predominant non-keratotic OLP (nK-OLP; erythematosus atrophic, erosive, ulcerative, bullous subtypes) and 300 controls were recruited in 15 universities. The number of oral sites involved and oral symptoms were recorded. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered. Results: The OLP patients, especially the nK-OLP, showed higher scores in the NRS, T-PRI, HAM-D, HAM-A and PSQI compared with the controls (p-value