Immunoglobulin A deficiency is the most common primary immunodeficiency defined as decreased serum level of IgA (less than 7 mg/dl) in the presence of normal levels of other immunoglobulin isotypes. ...Most individuals with IgA deficiency are asymptomatic and identified coincidentally. However, some patients may present with recurrent infections, allergic disorders and autoimmune manifestations, such as diabetes mellitus, Graves disease and celiac disease. The international literature has not produced any kind of review yet about intra-oral manifestations of selective IgA-deficiency. L.S., a 7-year-old Caucasian girl, was examined at our hospital. After she had undergone a professional dental cleaning, a symmetric, bilateral ulcerative gingivitis developed nearby the upper second primary molars. The gingival ulcers were persistent and did not disappear in the following 3 weeks. In the meantime, the young patient reported the presence of gastrointestinal symptoms. IgA serum level was 4.5 mg/dl, while the other isotypes levels were in the common range. The diagnosis of selective IgA-deficiency was formulated and the girl underwent further examination for the specific IgG autoantibodies in celiac disease, which were not present. Consequently, a full prevention program was planned. This case report emphasizes the role of the paediatric dentist in the early detection of systemic disorder, such as the immunological diseases. The oral cavity often reveals to be the first site of manifestation of important systemic diseases. Immunoglobulin A (IgA) deficiency is the most common primary immunodeficiency and is defined as a decrease in serum IgA levels in the presence of normal levels of other immunoglobulin isotypes (1). Serum IgA deficiency was first described in children with ataxia-telangiectasia (2) and has since been identified in other patients, including normal patients. The prevalence of IgA deficiency ranges from 1:223 to 1:1000 in community studies and from 1:400 to 1:3000 in healthy blood donors (3).
Currently and with increasing frequency, treatments with Invisalign orthodontic devices are aimed also to adolescent patients: this evolution involves the management of some atypical characteristics, ...and among them also thumb- sucking.
A 13-year-old adolescent girl with protracted thumb sucking and dentoalveolar open bite is presented. Infantile neuropsychiatric assessment was required before and after treatment. Small areas of the aligners were occlusally flipped like a bite ramp, in particular on the palatal surface of the upper incisors, in order to discourage thumb sucking. The selection of an invisible orthodontic device was shown to be interesting because it does not impact on the fragile and complex neuropsychiatric situations. Moreover, the active daily application of the device further motivates young patients. The vertical attachments were fundamental in repositioning the front teeth and to close the dentoalveolar open bite. Treatment was ended in eight months with no behavioural or neuropsychiatric consequences in the short period. Invisalign was shown to be a useful device for orthodontic correction even in the complex management of adolescent thumb sucking.
The aim of this work is to study fears and anxieties of school age Italian children regarding dental experience. In particular, to assess the prevalence of this phenomenon and understand its possible ...correlation with five different variables: sex, age, social context, previous dental experiences, and self-consciousness of fear.
725 Italian children were divided according to five variables, and their anxiety studied through the self-filling of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS).
The obtained results are descriptive and they are expressed as percentage values. For the study of the five variables considered, we have carried out a statistical regression analysis, by using the S-PLUS 6.0 Professional software.
26% of the total sample are anxious about the dental experience (total score CFSS-DS >39). The objects of greater anxiety are: fear of being admitted to hospital, injections, and the use of drilling instruments. Every variable considered in the selection of the sample was significant (p <0.05) in explaining and influencing the phenomenon "anxiety". In particular, the subjects aged 8, attending the third class of primary school were more anxious (they were also the most conscious of their emotional difficulties), and so little girls and subjects living in areas of low level of urbanisation and those who had never lived previous dental experiences.
The percentage of children who may exhibit more or less serious behaviours to dental treatments, including the borderline subjects, is above 50%. So it is easy to realise how this problem still exists in clinical dental reality, and it is fundamental for the dentist to understand and identify these frequent difficulties.
Nitric Oxide (NO) has been linked to several cardiovascular, neurological and immunological physiological and pathological functions. Several studies have shown that the eNOS, nNOS and iNOS effects ...on cancer cell growth and proliferation are related to the upregulation of the Wnt pathway and have a central role during metastasis development. Recent studies suggest that cancer cells undergo metabolic reprogramming, which drives cancer cell growth and progression. The aim of this study was to observe the NOS activity in the pathogenesis of oral precancerous and cancerous lesions. The results showed changes in eNOS activity levels, which increased from healthy oral mucosa to oral squamous cell carcinoma SCC, through different dysplasia levels. The iNOS activity levels increased in precancerous lesions compared to healthy mucosa, where iNOS was absent, while it decreased in SCC lesions. Moreover, a gradual increase of nNOS activity together with the progression of the lesions was also found. These results may suggest how NO could play a critical role during pathogenesis, growth and development of precancerous lesions to cancer degeneration.
Our research aimed to find out whether it was possible to establish a correlation between instrumental polysomnographic variables in children with Sleep Disordered Breathing (SDB) and their clinical ...dentofacial records.
197 children, 116 (59%) male and 81 (41%) female, age range 0 to 12 years, with a clinical history highly suggestive for SDB were enrolled. All patients underwent full-night Poly-Mesam examination and a specific clinical orthodontic evaluation. A comparison between polysomnographic variables and clinical orthodontic variables was made.
OSAS can not be diagnosed by the paediatric dentist only by performing a single clinical orthodontic examination of oral cavity, but a polysomnography is essential and, if this should point out any pathology referring to SDB, a cranial lateral cephalometry will then be required.
Paediatric Oral Squamous Cell Carcinoma (OSCC) is rare, but its incidence is increasing, bringing forward the issue of the common pathogenic factors. The aim of this study is to verify the actual ...incidence of oral carcinoma reported in paediatric patients up to the age of 15 by thoroughly reviewing the available literature. Setting this cut-off age has allowed us to emphasise possible risk factors other than those always associated with the onset of this neoplasia, which are not present in this age bracket yet.
In the first stage of the research, generic key words concerning OSCC in childhood were entered into two search engines. In the second stage, terms related to predisposing diseases connected to childhood oral carcinoma and those initially found were searched.
The literature review consisted of 55 documented cases from 1894 to 2011, of which 15 were part of complete published case reports.
Paediatric OSCC, though uncommon, is not rare. The review has strongly highlighted the need to carry out an objective, thorough and standardised examination of the child's oral cavity, especially when systemic predisposing diseases, such as Epidermolysis bullosa, Xeroderma pigmentosum, Juvenile papillomatosis and Fanconi's anaemia, are present.
This study was performed to evaluate the effect of a glucose rinse and of plaque accumulation on pH of tooth surface in healthy adolescents with a device used in gastroenterology and never tested in ...the oral cavity.
Values of pH were monitored in 12 adolescents using a portable device (pH-day 2® Menfis, bioMedica S.r.l., Bologna, Italy) with a disposable antimonium electrode kept in contact with the interproximal surface of the upper molars for 40 minutes respectively before and after a one-minute rinse with 10 ml of a 10% glucose solution. The same procedure was repeated in the same subjects after 72 hours of plaque accumulation.
The device tested resulted difficult to use on the tooth surface because of the size of the active part of the probe. The glucose rinse caused a statistically significant decrease of the mean pH, restrained in basal conditions (d = -0.16, p <0.05), clinically relevant after plaque accumulation (d = -1.24, p <0.05). Time in minutes of pH < 6 grew considerably only in case of combination of plaque accumulation and glucose rinse (d = 20.90, p <0.05). A Stephan's curve of drop and recover of the pH values was not recorded.
The continuous recording of pH of natural plaque present on the tooth could represent an alternative to other techniques found in literature. More studies are necessary to verify the suitability of this new device for the monitoring of pH in the oral cavity.
The roles of nitric oxide (NO) synthase (NOS) enzyme in pathological mechanisms of the oral cavity are still incompletely understood. The aim of this study was to investigate the expression of the ...endothelial, neuronal and inducible isoforms of NOS (eNOS, nNOS and iNOS) in oral lichen planus (OLP) development in humans. OLP and healthy oral mucosa biopsies were taken for mRNA and protein analysis of NOS isoenzymes by RT-PCR, western blot and immunohistochemistry. The mRNA and protein levels of eNOS and nNOS were present in all samples, with a significant increase only for eNOS in OLP. The normal oral mucosa exhibited only small amounts of iNOS mRNA and protein, while it showed a significant rise in OLP samples. These results were confirmed by immunohistochemical analysis. Our findings suggest that NO produced by increased eNOS and iNOS expression may have circulatory and immune functions in the development of OLP.
Salivary substitutes, tongue protectors, acupuncture, psychotherapy, topical benzodiazepines, omeophatic medicine, antidepressants, anticonvulsants, antipsychotics, ormonal substitutes, complementary ...vitamin diet, even electrocon- vulsive therapy have been proposed as effective therapeutic protocols, but none of them has proved to offer a satis- factory solution to such a problem.
Helicobacter pylori is one of the most common infective agents in man. The bacterium primarily resides in the human stomach, where it causes inflammation of the gastric mucosa, which can lead to ...gastritis, duodenal or gastric ulcer and even gastric carcinoma or MALT lymphoma. Dental plaque and saliva have been considered as a reservoir for Helicobacter pylori but this hypothesis is still questionable at the moment. The aim of this study is to estimate the presence of Helicobacter pylori in saliva and periodontal pockets of the patients recruited from the Gastroenterology Department of Ospedale di Circolo Fondazione Macchi in Varese by means of C-Urea Breath Test and PCR (Polimerase Chain Reaction) method and, consequentially, to evaluate the relationship of the oral infection with HP, with the gastric infection or re-infection after antibiotics therapy and with the oral health, particularly with periodontal disease. Sixty patients, with or without an history of infection with HP and/or gastrointestinal problems, were subjected to C-Urea Breath Test and microbial analysis with PCR of saliva and subgingival plaque in periodontal pockets. 50% of the patients tested were positive to C-Urea Breath Test and 50% were negative; but only 58% had an history of past infection by HP. 42% of patients were positive to bacteria, detected in periodontal sockets and/or in saliva, while 43% of the patients resulted negative, with particular relationship of these data with the positivity or not to Breath Test. Even though there was no statistically significant difference between the two groups (A vs B) with regard to the total amount of HP in saliva or in periodontal tissues, this study demonstrates that the oral cavity is an extra-gastric reservoir of HP when it is affected by periodontal disease (defined by depth of the pockets higher or equal to 4 mm), and that periodontal disease is correlated to gastric HP infection. A statistically significant correlation between periodontal disease and Helicobacter pylori load in oral cavity was found, so dental plaque may represent a risk factor for gastrointestinal reinfection after systemic antimicrobial therapy. New treatment protocols, which combine periodontal therapy with systemic antimicrobial therapy, may be adopted in order to completely eradicate this microorganism and prevent long terms recurrences. This study will continue to be tested to further confirm the role of the oral cavity as a reservoir of Helicobacter pylori in gastrointestinal primary infections or re-infections in patients after the failure of the systemic eradication antibiotic therapy.
