Aesthetic perception of patient in developmental age in interceptive orthodontic treatment.

AIM: Patients at development age show considerable attention to the shape of the face from both an aesthetic and relational point of view, to arouse interest from researchers. There are few studies related to profile analysis in patients of developmental age. Therefore, the objective of the present study was to analyse the importance of the aesthetic perception of the patient in development age in relation to the profile, before and after interceptive orthodontic treatment. MATERIALS: A sample of 25 patients who came to our observation for dentoskeletal malocclusions was considered. A questionnaire was proposed to each patient, before and after the interceptive orthodontic treatment (T0 and T1), to evaluate the aesthetic perception before and after the orthodontic treatment and its psychosocial impact. Profile analysis was performed using photographic documentation (at T0 and T1). The variables considered were the Ricketts line, the facial convexity angle, the nasolabial angle, and the labiomental angle. CONCLUSION: Interceptive orthodontic treatment has proven to be of valid clinical and psychological help. This result is confirmed by the complete aesthetic satisfaction of the patient in the frontal and latero-lateral planes.

Humanisation and health needs in children: present or future?

AIM: For a few years, teledentistry has been an emerging innovative strategy with potential in the field of paediatric dentistry. There are still few studies in this regard, so further research is needed to verify and ensure that teledentistry is not only an accessible mode of communication, but above all effective and evidence-based. This study aimed to use a preliminary telematic approach to promote the compliance of patients in the developmental age during the first dental visit. MATERIALS: Two hundred patients were selected according to the eligibility criteria, and distributed in two groups: a study group with the preliminary telematic approach (ATP) before the first visit and a control group with traditional first visit without ATP. Through an ordinal semi-proportional regression model, the degrees of collaboration between the study and control groups were compared, correcting the estimate for age groups, the presence of systemic pathologies, disorders of cognition, attention and learning, degree of anxiety and previous medical-dental experiences. CONCLUSION: The preliminary telematic approach could be useful as a support to the traditional paediatric dental visit, to promote better management and fidelity of the patient, reducing anxiety and increasing collaboration during the first visit.

Chemotherapy-induced oral mucositis in children and adolescents: a systematic review.

PURPOSE: The present systematic review aims to describe the incidence and severity of chemotherapy-related oral mucositis in children and adolescents affected by hematologic and solid tumors. METHODS: An electronic search was performed on PubMed, Scopus, Web of Science, Cochrane Library, and EBSCO up to the 8th November 2020. The PRISMA protocol was followed for the article selection and inclusion. The risk of bias in individual studies was evaluated through the Newcastle-Ottawa Scale. Data were summarized using mean and standard deviation for continuous variables, while categorical ones were described with frequency and percentage. RESULTS: A number of 9940 records were obtained after the electronic search. Seventeen of them were included in the qualitative analysis after the two stages of screening, while none of these articles was considered eligible for the quantitative analysis. The mean incidence of oral mucositis was 53.6% and it ranged from 16.7 to 91.5%, while severe oral mucositis accounted for the 15.8% (0.0-35.2%) among selected studies. Most of the articles included both patients with solid and hematologic tumors, while only five of them described oral mucositis in children with acute lymphoblastic leukemia. Even the kinds of chemotherapy administered were extremely variable. CONCLUSION: In conclusion, about half of the patients submitted to cancer chemotherapy developed oral mucositis with an incidence and severity that varies depending on the primary disease and the kind of drugs administered.

Oral manifestations of eating disorders in adolescent patients. A review.

AIM: Eating disorders (ED) are a group of psychopathological disorders that affect the patient's relationship with food and his own body and that are manifested mainly in adolescence and in young-adult age. ED include anorexia nervosa (AN), bulimia nervosa (BN) and other eating disorders as classified in the DMS-V. ED can result in several oral and dental manifestations that often occur in the early stages of ED and may allow early detection. The aim of the study is to describe the different oral and dental manifestations in patients with ED in order to offer a classification for their identification during an extra/intra-oral examination. METHODS: A search on PubMed, Medline and Cochrane Library data bases has been performed. RESULTS: Oral manifestations in ED patients include a variety of signs and symptoms, which involve the oral mucosa and perioral tissues (exfoliative cheilitis, labial erythema, atrophic glossitis, glossodynia, yellow-orange colouration of the soft palate, cheek/lip biting, candidiasis), the teeth (dental erosion, tooth hypersensitivity, dental caries), periodontal diseases, and salivary manifestations (sialoadenosis, alterations in salivary flow). The oral signs are caused by a number of factors, including nutritional deficiencies and consequent metabolic changes, poor personal hygiene, altered eating habits and pharmacological therapies. There is a very specific link between oral manifestations and ED in the presence of self-induced vomiting. CONCLUSION: The paediatric dentist may be the first professional to detect the clinical signs thus improving the interception, early diagnosis, characterisation and prognosis of ED. In addition, the oral manifestations of ED can cause alterations of the oral function, discomfort, oral pain, and worsen aesthetics of the face and the quality of life.

Impact of lockdown on children's lifestyle and their collaboration during dental sessions.

AIM: To analyse lifestyle of Italian families during lockdown, evaluating its possible impact on the collaboration of children with the paediatric dentist and associated predictive factors. MATERIALS AND METHODS: Only patients aged between 3 and 16 years, who had started treatment before the lockdown and had spent this periodwith both parents were included in the study. The interviews were carried out using an anonymous questionnaire that assessed school and play activities, the type of diet, the time dedicated to home oral hygiene and the activities carried out with parents. Parents' work situation during lockdown was included to correlate it with time spent at home. The Frankl Behavior Rating Scale was used to determine the degree of cooperation during dental sessions pre- and post-lockdown. Chi-square test and Fisher's Exact tests were used to identify statistical associations of improvement with each categorical variable. Student's t-test was used to highlight the differences in mean values of continuous variables between subjects considered more cooperative and unimproved subjects. Hosmer-Lemeshow test was used to assess the goodness-of-fit of the model. Assumption of linearity of independent variables and log-odds were assessed by Box-Tidwell transformation. Final selection was carried out using the Akaike criterion and all statistical analyses were carried out using the STATA statistical software package. RESULTS: The sample consisted of 212 patients (103F; 109M). The age ranged between 3 and 16 years with an average age of 9.03 years; 82.08% (95% CI 76.24-86.99) of the subjects showed an improvement in collaboration compared to pre-lockdown. Logistic analysis reveals a statistically significant increase of the odds of improvement in patients with a lower pre-lockdown collaboration (OR: 6.05, p = 0.001), in children with a parental presence at home (jobless, OR : 30.55, p <0.001; in "smart working", OR: 23.06, p <0.001) when compared to children whose parents work away from home. From a further exploratory analysis, time dedicated to home oral hygiene was increased if associated with an increased presence of the parents at home (p = 0.015). CONCLUSION: Changes in family routines and increased parental presence at home, during the COVID-19 pandemic lockdown, are associated with improved collaboration of children during dental sessions. A statistical association between the increase in time spent on oral hygiene and the increased presence of parents at home was found.

Dental agenesis and evaluation of body composition through bioelectrical impedance analysis. Observational study on a sample of paediatric subjects.

AIM: The aim of the present study was to evaluate the anthropometric parameters and the body composition through bioelectrical impedance analysis on paediatric subjects with dental agenesis. MATERIALS AND METHODS: The study was conducted on 144 subjects (58.3% females and 41.7% males), aged 7-14 years (average age 10.22±2.53 years). Each patient underwent a dental check-up at the Paediatric Dentistry Unit, University of Rome Tor Vergata (Italy) and a nutritional evaluation, aimed at analysing the anthropometric characteristics and evaluating the indices of body composition through bioelectrical impedance analysis (BIA) at the Human Nutrition Unit, University of Rome Tor Vergata. The sample was divided into three groups: a group with single agenesis (Group 1), a group with multiple agenesis (Group 2) and a control group (Group A). Using the predictive equations, the following values were evaluated: resistance (R), reactance (Xc), phase angle (PHA), body cell mass index (BCMI), body cell mass (BCM), total body water (TBW), intracellular water (ICW), extracellular water (ECW), fat mass (FM), fat free mass (FFM). STATISTICS: The Excel environment and the SAS System, version 9.3, were used for statistical analysis, providing a descriptive and parametric analysis of the sample. The values of the anthropometric parameters were expressed as mean ± standard deviation. For the statistical analysis of anthropometric parameters and body composition, analysis of variance (1-way ANOVA) was used, which allowed us to find differences and the Student's t-test to compare Groups 1, 2, and A. RESULTS: There is a significant difference in the resistance R value between the case group with single agenesis (Group 1) and the control group (Group A) (R, 710.28±72.46 vs 667.4±104.16, p=0.028), and the phase angle PHA between the case group with multiple agenesis (Group 2) and the control group (Group A) (PHA, 5.18±0.48 vs 5.85±1.05, p=0.028). The BCM% value shows a significant difference between both Group 1 and Group A (BCM%, 50.53 ± 3.29 vs 52.68 ± 4.74, p=0.016) and between Group 2 and Group A (BCM%, 49.25± 2.86 vs 52.68 ± 4.74, p=0.035). The TBW, ICW, ECW, FM, FFM values showed no significant differences between the various groups analysed. CONCLUSION: Body composition in subjects with dental agenesis presents a higher R, a consequently lower PHA and a lower BCM% compared to the control group. For the first time, the results highlighted the possible relationship between dental agenesis and body composition, measured through BIA.

Evaluation of DMFT in paediatric patients with social vulnerability conditions.

AIM: The aim of this study was to analyse the dmft/DMFT index in paediatric patients belonging to families with low income, in conditions of social vulnerability and absolute poverty and to compare it with a control group with a good socioeconomic status. MATERIALSN AND METHODS: The study analysed a total sample of 160 patients with average age of 8.6±2.5. The sample was divided into two groups based on the Equivalent Economic Situation Indicator (ISEE). Group 1 consists of 80 patients with an ISEE value less than €6.000 and was examined at the "Solidarietà Vincenziana" Dental Centre - Rome (Italy), which is a centre dedicated to people with minimum income, destitute, elderly without resources, immigrant children; Group 2 consists of 80 patients with an ISEE value of more than €20.000 and was examined at the Pediatric Dentistry Unit, University of Rome Tor Vergata. STATISTICS: Statistical analysis was performed using SPSS for Windows version 21 (IBM SPSS Inc., Chicago, IL, USA). The statistical analysis included a descriptive evaluation of the results in a bivariate analysis. The association between the presence of caries and the background variables was evaluated with the chi-squared association or Fisher test. The minimum level of significance was fixed at P-value?0.05. RESULTS: Analysing the number of caries-free subjects and subjects with caries in reference to the age group between 5 and 12 years and the ISEE value, without distinction of sex, there is a statistically significant difference between Group 1 and Group 2, both in relation to the dmft (p=0.038, Chi-squared Test=4.28) and to the DMFT (p=0.001, Chi-squared Test=19.23). Subjects aged between 5 and 12 years had an average DMFT of 1.88 ± 0.83 (Group 1) and 0.95 ±0.54 (Group 2). CONCLUSIONS: The study highlights a positive relationship between ISEE value, of poor socio-economic situations (condition of absolute poverty, low economic income) and increase in the DMFT index. The oral health status is an indicator of poverty. For this reason it would be advisable to plan early preventive interventions, providing the possibility of appropriate and effective access for children in economic and social needs, whose quality of life can be further negatively affected by oral diseases.

The correlation between different techniques for the evaluation of oral malodour in children with and without orthodontic treatment.

AIM: The aim of this work was to evaluate the correlation between different methods (organoleptic evaluation, gas chromatography, salivary ?-galactosidases activity) for the evaluation of halitosis in children. The secondary purpose was to investigate the influence of orthodontic treatment on halitosis. MATERIALS AND METHODS: Study Design: Oral malodour was detected with different methods in 50 children in the Paediatric Dentistry Unit, University of Rome Tor Vergata, Rome, Italy. During the dental visit, level of oral hygiene, tongue coating scores and presence of an orthodontic device, fixed or mobile, were recorded. Two trained and calibrated operators performed the organoleptic evaluation; the Oral ChromaTM device was used for the volatile sulfur compounds (VSCs) quantification and salivary ?-galactosidases (S?-g) activity was evaluated through the spectrophotometric method. STATISTICS: The Cohen's Kappa score was used to evaluate the level of agreement between the operators. The Pearson's correlation coefficient was used to evaluate the linear relationship between continuous variables (e.g. S?-g vs. VSCs values) and the Spearman's correlation coefficient was calculated for ordinal variables (e.g. organoleptic scores) vs. other parameters. The LSD test was used to compare the parameters analysed in the study. RESULTS: A positive and significant correlation between the organoleptic evaluation, the S?-g, the levels of hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) was found. The Spearman's correlation has shown that organoleptic scores were significantly correlated with S?-g (0.664, p<0.001) and the Oral ChromaTM measurements of H2S (0.538, p<0.001) and Ch3SH (0.316, p=0.026). The Pearson's correlation showed that S?-g was statistically significantly correlated with the Oral ChromaTM measurements of H2S (0.379 p=0.007) and Ch3SH (0.299, p=0.0035). Stratifying results for orthodontic treatment, it was possible to show that children under orthodontic treatment, both fixed or removable, were characterised by higher level of S?-g. The organoleptic evaluation and Oral ChromaTM measurements showed that children wearing fixed orthodontic were characterised by higher scores. CONCLUSIONS: There was a significant correlation between the three different techniques for the evaluation of oral malodour in children. Like in the adult population, the increase of S?-g activity was associated with oral malodour. The presence of fixed orthodontic appliances was correlated to increased scores of all methods for the evaluation of halitosis.

The civil liability of paediatric dentists in Italy. Trains of thought on novelties introduced by law n. 24/2017 ("Gelli-bianco" law).

AIM: This study offers an overview regarding news and main themes which have been introduced by Law n. 24/2017 (the so called "Gelli-Bianco" law) in Italy. The normative content deals with the features of civil liability for healthcare professionals. More specifically, this article is referred to the contractual and extra-contractual liability of paediatric dentists. Dentists often provide services combining healthcare and dental procedures as well as aesthetic activities. Thanks to the case law and doctrine tradition, the distinction between contracts of employment and contracts of work is clearly stated. This examination is focused on highlighting methods employed by paediatric dentists to prevent possible actions of suing for compensation.

Correlation between halitosis, oral health status and salivary ß-galactosidases and time spent in physical activities in children.

AIM: The aim of this work was to evaluate the oral health status in children and to correlate it with time spent in physical activity per week. MATERIALS AND METHODS: Fifty children (mean age 9±2 years) attending the first visit at the Paediatric Dental Unit of the University of Rome "Tor Vergata" have been included in the study. The parents of all patients were interviewed about the medical history of the children and specific data, in particular, the time spent in physical activity per week. A trained dentist examined the oral cavity of the patients and the following clinical parameters were recorded: number of deciduous and permanent teeth, caries (on deciduous and permanent teeth), presence of gingivitis (0=no; 1=yes), tongue coating score (from 0=none to 3= > 2/3 tongue dorsum surface covered)", oral infections (0=no; 1=yes), oral hygiene index (0=insufficient, 1=sufficient, 2=good), presence of at least one incongruous restoration (0=no, 1=yes), oral breathing (0=no; 1=yes), fissured tongue (0=no, 1=yes), presence of aftous ulcers, herpetic lesions or candidiasis (0=no, 1=yes), food stagnation (0=no; 1=yes). The level of salivary ?-galactosidases activity was measured spectrophotometrically. The subjects were classified into "Group 0": children who did not practice any sports beside physical education class; "Group 2": 2 hours per week; "Group 3": 3 hours; and "Group 4": 4 hours. STATISTICS: Statistical analysis was performed using SPSS for Windows version 21 (IBM SPSS Inc., Chicago, IL, USA). The Pearson's correlation coefficient (P) was used to evaluate the linear relationship between continuous variables, and the Spearman's correlation coefficient (S) was calculated for ordinal variables. Analysis of variance (ANOVA) and the Fischer's Least Significant Difference (LSD) test were used to compare the parameters analysed in the study. Data were analysed using linear regression and descriptive statistics. The significance threshold was set at 0.05. RESULTS: A more physically active lifestyle was significantly associated with a better oral hygiene and a reduced level of salivary ?-galactosidases, halitosis, gingivitis and tongue coating. Results of the organoleptic evaluation of halitosis performed by the parents and sport hours/week practiced have shown that Group 0 and 2 were characterised by statistically significant higher scores with respect to the other groups (Group 0 vs. Group 3, p=0.014; Group 2 vs. Group 3, p=0.030; Group 0 vs. Group 4, p=0.001; Group 2 vs. Group 4, p=0.002) (P= -0.458). The spectrophotometric quantification of salivary ?-galactosidases has shown that increasing the hours of sports, the enzyme activity significantly decreases (S= -0,330); similar levels were found with 0 and 2 hours of sports, but an important decrease has been recorded with both 3 (Group 0 vs. Group 3, p=0,011; Group 2 vs. Group 3, p=0,006) and 4 hours of sports practiced (Group 0 vs. Group 4, p=0,014; Group 2 vs. Group 4, p=0,008). The level of significance between children who did not practice sport and those who did for 3 and 4 hours a week was 0.005 (Group 0 vs. Group 3) and 0.0018 (Group 2 vs. Group 4) with respect to tongue coating scores (P= -0,511) and 0.012 for both groups with respect to gingivitis (Group 0 vs. Group 3; Group 0 vs. Group 4) (P=-0,427). CONCLUSION: Children who practiced sport showed a better oral hygiene level and lower halitosis, with respect to those who did not.

Effects of new probiotic mouthwash in patients with diabetes mellitus and cardiovascular diseases.

OBJECTIVE: To evaluate the impact of a new formulation of probiotic mouthwash (PM), using Biocult strong® dissolved in neutral mouthwash. PATIENTS AND METHODS: Forty-two patients with cardiovascular disease (CVD) or type 1 and type 2 diabetes were enrolled. Plaque Control Record (PCR) and Bleeding on Probing (BOP) were assessed at baseline and after two weeks of PM or positive control treatment in intervention group (IG) and control group (CG). Food intake was estimated by 3-day diet record. RESULTS: BOP was significantly reduced in all treatments and samples, except for IG in CVD sample (p=0.15). PCR decreased significantly in all treatments and samples (p<0.01). No significance was obtained for BOP and IP in the time x group interaction. Food intake was not significantly different between IG and CG in all samples. Nutrients such as fats and simple carbohydrates were correlated with BOP in patients who received positive control, rather than PM, indicating a lack of food influence on BOP and PCR in IG. CONCLUSIONS: PM treatment was effective in relation to the reduction of PCR and BOP. Probiotics represent a good, but additional, tool for prophylaxis, because they cannot completely substitute the classic oral hygiene methods. Moreover, one week of treatment was not sufficient to draw firm conclusions about the efficacy of the treatment itself.

Default mode network changes in multiple sclerosis: a link between depression and cognitive impairment?

BACKGROUND AND PURPOSE: In multiple sclerosis (MS), depression is a common disorder whose pathophysiology is still debated. To gain insights into the pathophysiology of depression in MS, resting-state (RS) functional connectivity (FC) changes of the default mode network (DMN), salience network (SN) and executive control network (ECN) were assessed in a group of depressed MS (D-MS) patients and in appropriately matched control groups. METHODS: Sixteen D-MS patients, 17 non-depressed MS (ND-MS) patients, 17 non-depressed healthy controls and 15 depressed subjects (D-S), age, sex and education matched, cognitively preserved and non-fatigued, were enrolled. All participants underwent a neuropsychological evaluation and RS functional magnetic resonance imaging study. RESULTS: Comparing D-MS patients with D-S, within the DMN, a significant RS-FC suppression was found in the posterior cingulate cortex (PCC); comparing D-MS with ND-MS, FC was significantly increased in the anterior cingulate cortex and significantly reduced in the PCC. Within the SN increased FC in the right supramarginal gyrus and right middle frontal gyrus was found in D-MS patients compared to D-S and to ND-MS; within the ECN increased FC in the right inferior parietal cortex was found in D-MS patients compared to ND-MS patients. CONCLUSIONS: In cognitively preserved D-MS patients, FC derangement occurs in the SN, ECN and DMN. In the latter, changes occurring both in the anterior cingulate cortex and PCC suggest that depression in MS may be linked to MS itself and, in particular, to a peculiar pattern of network abnormalities favored by MS pathology through disconnection mechanisms. Reduced FC in the PCC, similar to MS patients with cognitive impairment, suggests a functional link between depression and cognitive impairment in MS.

Anxiety in Multiple Sclerosis: psychometric properties of the State-Trait Anxiety Inventory.

OBJECTIVE: The aims of the present study were to examine psychometric properties of the Spielberger State-Trait Anxiety Inventory (STAI-Y-1 and STAI-Y-2, respectively) in a Multiple Sclerosis (MS) population and to identify a cut-off score to detect those MS patients with high level of state and/or trait anxiety who could be more vulnerable to development of depression and/or cognitive defects. MATERIAL AND METHODS: The STAI-Y-1 and STAI-Y-2 was completed by a group of patients (n = 175) affected by MS and a group of healthy subjects (n = 150) matched for age, educational level, and gender. In MS patients internal consistency, divergent and discriminant validities were evaluated. Construct validity was examined by exploratory factor analysis for each scale. RESULTS: There was no missing data, no floor or ceiling effects for both scales. The two scales showed high internal consistency, good divergent, and Known-groups validities. To identify high levels of state and trait anxiety in a patient with MS, we proposed three gender specific screening cut-off values (1, 1.5, 2 SD) for the STAI-Y-1 and the STAI-Y-2. CONCLUSIONS: The findings showed that the STAI-Y-1 and the STAI-Y-2 are a valid tool for clinical use in MS patients and can be useful to measure the severity of anxiety and to identify those patients with high anxiety to introduce them in specific non-pharmacological intervention.

The process of mineralisation in the development of human tooth.

AIM: Tooth development and mineralisation are processes that derive from different tissues interactions, in particular ectodermal and mesenchymal layers. These interactions are responsible for the formation of unique structures with a particular chemical composition. Despite differences, mineralised tissues are similar and they derive by highly concerted extracellular processes that involve matrix proteins, proteases, and mineral ion fluxes that collectively regulate the nucleation, growth and organisation of forming mineral crystals. This review aims at explaining mineralisation, its stages and when damage occurs and alters the hard tissues structure.

Gingival fibromatosis: a case report.

AIM: Gingival Fibromatosis is characterised by a large increase in the gingival dimension which extends above the dental crowns, covering them partially or completely. The causes of the disease may have a genetic origin, in which case gingival hyperplasia may occur in isolation or be part of a syndrome, or acquired origin, which comes from specific drugs administered systemically. A form of gingival fibromatosis of idiopathic origin has been described. The therapy involves mainly the surgical removal of the hyperplastic gingival tissue, although in these cases recurrences are frequent. CASE REPORT: A 9 years old male patient came to observation at the Clinic of Pediatric Dentistry of the Tor Vergata Polyclinic of Rome. After Primary Gingival Fibromatosis was diagnosed, the therapeutic choice was to wait and postpone gingivectomy at the end of the development phase.

Cognitive impairment and memory disorders in relapsing-remitting multiple sclerosis: the role of white matter, gray matter and hippocampus.

Cognitive disorders occur in up to 65 % of multiple sclerosis (MS) patients; they have been correlated with different MRI measures of brain tissue damage, whole and regional brain atrophy. The hippocampal involvement has been poorly investigated in cognitively impaired (CI) MS patients. The objective of this study is to analyze and compare brain tissue abnormalities, including hippocampal atrophy, in relapsing-remitting MS (RRMS) patients with and without cognitive deficits, and to investigate their role in determining cognitive impairment in MS. Forty-six RRMS patients [20 CI and 26 cognitively preserved (CP)] and 25 age, sex and education-matched healthy controls (HCs) underwent neuropsychological evaluation and 3-Tesla anatomical MRI. T2 lesion load (T2-LL) was computed with a semiautomatic method, gray matter volume and white matter volume were estimated using SIENAX. Hippocampal volume (HV) was obtained by manual segmentation. Brain tissues volumes were compared among groups and correlated with cognitive performances. Compared to HCs, RRMS patients had significant atrophy of WM, GM, left and right Hippocampus (p < 0.001). Compared to CP, CI RRMS patients showed higher T2-LL (p = 0.02) and WM atrophy (p = 0.01). In the whole RRMS group, several cognitive tests correlated with brain tissue abnormalities (T2-LL, WM and GM atrophy); only verbal memory performances correlated with left hippocampal atrophy. Our results emphasize the role of T2-LL and WM atrophy in determining clinically evident cognitive impairment in MS patients and provide evidence that GM and hippocampal atrophy occur in MS patients regardless of cognitive status.

Correlation between aerosol therapy in early childhood and Molar Incisor Hypomineralisation.

AIM: To evaluate the correlation between the use of aerosol therapy in early childhood and the presence of Molar Incisor Hypomineralisation (MIH). STUDY DESIGN: a retrospective case-control study in which a group (cases) consisted of children from 6 to 13 years with MIH visited at the unit of Pediatric Dentistry of the Policlinico Tor Vergata (Rome, Italy), and a group (controls) consisted of an equal number of children of the same age without MIH. Data about the aerosol therapy and the presence of MIH were obtained respectively by medical history and intraoral clinical examination. Collected data underwent statistical analysis using mainly non-parametric tests (p < 0.05). RESULTS: In the study were included 182 patients, of which 91 (46 males, 51%) were children with MIH (cases), and 91 (46 males, 51%) were children without MIH (controls). In the group of patients with MIH, in the early childhood, 12 (13.1%) never had aerosol therapy, 6 (6.6%) underwent aerosol therapy less than 7 days per year, 22 (24.2%) from 8 to 15 days per year, 22 (24.2%) from 16 to 45 days a year, and 29 (31.9%) more than 45 days per year. In the control group, in the early childhood, 9 (9.9%) never had aerosol therapy, 29 (31.9%) underwent aerosol therapy less than 7 days per year, 26 (28.6%) from 8 to 15 days per year, 20 (22.0%) from 16 to 45 days a year and 7 (7.6%) more than 45 days per year. STATISTICS: the risk of developing MIH in children undergoing intensive use of aerosol therapy with respect to those receiving a less intensive use resulted in an odds ratio of 3.19 (p <0.001) in the general population, 4.83 (p < 0.001) in males and was not statistically significant in females (p = 0.132). The Spearman correlation between aerosol therapy and MIH was 0.278 (p < 0.001) in the general population, 0.372 (p < 0.001) in male, and it was not statistically significant (p = 0.08) in female subjects. CONCLUSION: Aerosol therapy carried out in early childhood appears to be a risk factor for the development of MIH, particularly in male subjects.

Oral and dental signs of child abuse and neglect.

AIM: The aim of this report is to identify the main oral and dental aspects of physical and sexual abuse and dental neglect in childhood, contributing to the precocious identification and diagnosis in a dental practice. METHODS: The oral and dental manifestations were divided and classified according to the type of child abuse: physical abuse, sexual abuse, neglect. PHYSICAL ABUSE: Several studies in the literature have shown that oral or facial trauma occurs in about 50% of physically abused children; the oral cavity may be a central focus for physical abuse. Oro-facial manifestations of physical abuse include bruising, abrasions or lacerations of tongue, lips, oral mucosa, hard and soft palate, gingiva, alveolar mucosa, frenum; dental fractures, dental dislocations, dental avulsions; maxilla and mandible fractures. SEXUAL ABUSE: Although the oral cavity is a frequent site of sexual abuse in children, visible oral injuries or infections are rare. Some oral signs may represent significant indications of sexual abuse, as erythema, ulcer, vescicle with purulent drainage or pseudomembranus and condylomatous lesions of lips, tongue, palate and nose-pharynx. Furthermore, if present erythema and petechiae, of unknown etiology, found on soft and hard palates junction or on the floor of the mouth, can be certainly evident proofs of forced oral sex. DENTAL NEGLECT: Oral signs of neglect are easily identifiable and are: poor oral hygiene, halitosis, Early Childhood Caries (ECC), odontogenous infections (recurrent and previous abscesses), periodontal disease, aptha lesions as a consequence of a nutritional deficiency status. Moreover, it is analyzed the assessment of bite marks because often associated with child abuse, the identification and collection of clinical evidence of this type of injury. CONCLUSION: A precocious diagnosis of child abuse, in a dental practice, could considerably contribute in the identification of violence cases and in an early intervention.

Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study.

To better understand the effects of short-term computer-based cognitive rehabilitation (cCR) on cognitive performances and default mode network (DMN) intrinsic functional connectivity (FC) in cognitively impaired relapsing remitting (RR) multiple sclerosis (MS) patients. Eighteen cognitively impaired RRMS patients underwent neuropsychological evaluation by the Rao's brief repeatable battery and resting-state functional magnetic resonance imaging to evaluate FC of the DMN before and after a short-term (8 weeks, twice a week) cCR. A control group of 14 cognitively impaired RRMS patients was assigned to an aspecific cognitive training (aCT), and underwent the same study protocol. Correlations between DMN and cognitive performances were also tested. After cCR, there was a significant improvement of the following tests: SDMT (p < 0.01), PASAT 3" (p < 0.00), PASAT 2" (p < 0.03), SRT-D (p < 0.02), and 10/36 SPART-D (p < 0.04); as well as a significant increase of the FC of the DMN in the posterior cingulate cortex (PCC) and bilateral inferior parietal cortex (IPC). After cCR, a significant negative correlation between Stroop Color-Word Interference Test and FC in the PCC emerged. After aCT, the control group did not show any significant effect either on FC or neuropsychological tests. No significant differences were found in brain volumes and lesion load in both groups when comparing data acquired at baseline and after cCR or aCT. In cognitively impaired RRMS patients, cCR improves cognitive performances (i.e., processing speed and visual and verbal sustained memory), and increases FC in the PCC and IPC of the DMN. This exploratory study suggests that cCR may induce adaptive cortical reorganization favoring better cognitive performances, thus strengthening the value of cognitive exercise in the general perspective of building either cognitive or brain reserve.