Scoring systems for Oral Lichen Planus used by differently experienced raters.

BACKGROUND: Scoring systems have been widely used to evaluate the severity and activity of oral lichen planus (OLP). The aim of the present study was to compare two existing (one modified) scoring systems in the evaluation of OLP severity and correlation with pain. Three differently experienced raters were involved. MATERIALS AND METHODS: Consecutive patients with OLP were assessed for pain using the Visual Analogue Scale and examined at 10 intraoral sites before starting (T0) and three weeks after (T1) steroid therapy (Clobetasol). Three differently experienced raters evaluated photographs using two scoring systems designated White-Erosive-Atrophic (WEA) modified from an older WEA system (WEA-MOD) and Reticular-erythematous-Ulcerative (REU) systems. WEA-MOD Kendall's W and interclass correlation coefficient were calculated and correlation between REU/WEA-MOD and pain was calculated using Spearman coefficient. RESULTS: Most patients showed lesions on buccal mucosa (85-93,5%) and maxillary/mandibular gingivae (31,8-31,2%), predominantly reticular. At T0, Kendall-W coefficients of 0.89 and 0.74 were obtained for the REU and WEA respectively. At T1, Kendall-W coefficients of 0.83 and 0.58 were obtained for the REU and WEA respectively. Interclass correlation coefficient ranged from 0.87 to 0.90 for REU and from 0.58 to 0.87 for WEA. REU and WEA scores significantly decreased after therapy (p<0.000) as well as VAS (p<0.05). REU score showed correlation with VAS. CONCLUSION: All the raters achieved comparable measures using REU whereas WEA and WEA-MOD seem less reproducible. REU seems to correlate to disease activity and pain.

Maturation of the middle phalanx of the third finger and cervical vertebrae: a comparative and diagnostic agreement study.

OBJECTIVE: Diagnostic agreement on individual basis between the third middle phalanx maturation (MPM) method and the cervical vertebral maturation (CVM) method has conjecturally been based mainly on overall correlation analyses. Herein, the true agreement between methods according to stage and sex has been evaluated through a comprehensive diagnostic performance analysis. SUBJECTS AND METHODS: Four hundred and fifty-one Caucasian subjects were included in the study, 231 females and 220 males (mean age, 12.2 ± 2.5 years; range, 7.0-17.9 years). The X-rays of the middle phalanx of the third finger and the lateral cephalograms were examined for staging by blinded operators, blinded for MPM stages and subjects' age. The MPM and CVM methods based on six stages, two pre-pubertal (1 and 2), two pubertal (3 and 4), and two post-pubertal (5 and 6), were considered. Specifically, for each MPM stage, the diagnostic performance in the identification of the corresponding CVM stage was described by Bayesian statistics. RESULTS: For both sexes, overall agreement was 77.6%. Most of the disagreement was due to 1 stage apart. Slight disagreement was seen for the stages 5 and 6, where the third middle phalanx shows an earlier maturation. CONCLUSIONS: The two maturational methods show an overall satisfactorily diagnostic agreement. However, at post-pubertal stages, the middle phalanx of the third finger appears to mature earlier than the cervical vertebrae. Post-pubertal growth phase should thus be based on the presence of stage 6 in MPM.

Evaluation of nutritional status in head and neck radio-treated patients affected by oral mucositis: efficacy of class IV laser therapy.

PURPOSE: To retrospectively evaluate the role of class IV laser therapy in the amelioration of nutritional status of patients affected by oral mucositis due to radiotherapy of the head and neck region during oncological treatment. METHODS: Sixty-three oncological patients were included in this study. All patients were affected by tumors in the head and neck region and had developed oral mucositis during radiotherapy. Forty-two patients had been treated by high-power laser therapy whereas 21 patients had been managed with traditional medications. Data collection included weight measurement (kilogram) and body mass index (BMI) calculation (mass (kilogram)/(height) (square meter)) on the first and last day of radiotherapy. In addition, gender, age, pathology, and the kind of oncological treatment have been considered. RESULTS: Laser-treated patients decreased less in BMI during radiotherapy (p=0.000). Patients treated by combined oncological treatments (radiotherapy and/or chemotherapy and/or surgery) had a higher weight loss during radiotherapy (p=0.015). According to a multivariate regression analysis, the only variable which significantly influenced the reduction of BMI was laser treatment (p=0.000). CONCLUSIONS: Laser therapy is actually considered one of the recommended remedies for the healing of oral mucositis due to cancer treatments. Healing of mucositis can deeply influence the feeding capacity of patients, through reduction of pain and improvement of chewing and swallowing capacities. It also allows lowering the costs for hospitalization and supportive care. Laser therapy should become part of nutritional interventions in oncological patients affected by oral mucositis.

Epidemiology and variables involved in dental abscess: survey of dental emergency unit in Trieste.

OBJECTIVES: The objective of this epidemiologic study was to estimate the healing time of acute dental abscesses and to evaluate the main variables involved in the healing process itself. SUBJECTS AND METHODS: Among a sample of over 24 000 patients visited at the emergency dental unit, 688 subjects were diagnosed with dental abscess and enrolled in the study. Case histories of all patients were collected to investigate the clinical course and healing time of dental abscess according to anamnestic and diagnostic data and therapeutic management. A multiple logistic regression model was performed to evaluate the association of each variable with the healing time required for dental abscess. RESULTS: Variables associated with increased healing time were spring seasonality at admission, pyretic state, trismus, involvement of multiple anatomic spaces, and spontaneous drainage. Moreover, administration of some, but not all, classes of antibiotics was also associated with an increased healing time. CONCLUSIONS: The knowledge of variables involved in healing time for dental abscess is crucial in the optimization of managing such infections in terms of cost-benefit ratio. This would represent a valuable way to ensure a shortened and more effective healing.

Is gingival crevicular fluid volume sensitive to orthodontic tooth movement? A systematic review of split-mouth longitudinal studies.

To assess the scientific evidence for detectable volume changes of gingival crevicular fluid (GCF) incident to orthodontic tooth movement (OTM). A literature survey of longitudinal split-mouth studies was performed searching PubMed, SCOPUS and the Cochrane Library, with the last access in 15 April 2012. After selection, 13 articles qualified for the final analysis. One study was judged to be of medium/high quality, six were of medium quality and the rest of low quality. Across all studies, there was very little or no statistically significant change in GCF volume incident to OTM. The changes seen were generally ascribed to the clinical or subclinical inflammation consequent to placement of the fixed orthodontic appliance. A reappraisal of the data provided in these studies was performed by comparing the GCF volume from the test (moved) and control (non-moved) teeth, in terms of effects-size (ES) coefficients and variations, as percentages. Generally, the ES coefficients and the variations were below 1.0 and 20%, respectively. Therefore, when using current methods to collect and measure GCF volume, there was no meaningful diagnostic potential for the GCF volume as an index of tissue remodelling incident to OTM. The GCF volume is not a reliable index for tissue remodelling incident to OTM.

Repeatability of gingival crevicular fluid collection and quantification, as determined through its alkaline phosphatase activity: implications for diagnostic use.

BACKGROUND AND OBJECTIVE: In spite of four decades of studies on gingival crevicular fluid, no data have been reported on the repeatability of gingival crevicular fluid collection and the subsequent quantification procedures. The present study reports, for the first time, on the repeatability and method error of gingival crevicular fluid collection and quantification, as determined through its alkaline phosphatase (ALP) activity. Diagnostic considerations are then explored. MATERIAL AND METHODS: Twenty-seven healthy subjects (17 women and 10 men; mean age ± SD, 21.2 ± 4.8 years) with optimal periodontal status were enrolled according to a blind prospective design. The gingival crevicular fluid was collected at baseline, and after 1 d, 1 wk and 3 mo. At each clinical session, two consecutive rounds of gingival crevicular fluid collection were made from each of the four maxillary incisors, allowing the recovery of resting and flow gingival crevicular fluid. The total ALP activities were determined spectrophotometrically, and repeatability and method errors for the resting, flow and overall (resting + flow) gingival crevicular fluid ALP activities were calculated, relative to the corresponding baseline levels. RESULTS: No significant differences were seen over time, although the flow gingival crevicular fluid ALP activity was generally lower than that for the resting gingival crevicular fluid. The method errors ranged from 40 to 58%, with the flow and overall gingival crevicular fluid activities showing the highest and lowest errors, respectively. CONCLUSION: Reliable use of the gingival crevicular fluid ALP collection and quantification, both in research and diagnosis on an individual basis, should take into account relevant errors, and variations are to be considered as true only above relevant thresholds.

Assessment of facial asymmetry in growing subjects with a three-dimensional laser scanning system.

OBJECTIVES: To evaluate facial asymmetry in growing subjects with no malocclusion on three-dimensional laser facial scans. SETTING AND SAMPLE POPULATION: Twenty-seven healthy Caucasian children (15 boys and 12 girls, aged 5.4 ± 0.3 years) in the primary dentition without malocclusion were randomly selected from a local kindergarten in Slovenia. MATERIAL AND METHODS: Surface facial images were obtained using a three-dimensional laser scanning system at baseline and at 18, 30, 42 and 54 months of follow-up. Facial asymmetry was assessed quantitatively by measuring the average distance between facial image and mirrored image. Further, the percentage of asymmetry was calculated as the percentage of image to mirrored image not coinciding within 0.5 mm. Qualitative assessment was performed on colour deviation maps by recording the predominant side of the face for the upper, middle and lower parts of the face separately. Nonparametric tests were used for data analysis. RESULTS: No face was perfectly symmetric. The average distance between the mirrored images for the whole face ranged 0.22-0.85 mm and the percentage of asymmetry 7.8-66.9. There were no significant gender differences (p > 0.05), and no significant change was found over the observed period. The upper part of the face was the least asymmetric, while the lower and middle parts showed similar degrees of asymmetry. CONCLUSION: Facial asymmetry is already present at an early developmental stage and does not show any tendency to increase or decrease with growth in the pre-pubertal period.

Oral manifestation upon short time cocaine abuse. A case report.

Effects of cocaine abuse on the oral mucosa are still poorly defined. Herein, a case of an 18-year-old male patient with a 15-day history of persistent painful ulcers and aphthous lesions of unknown etiology and with no other remarkable manifestations, is presented. All of the laboratory tests performed showed to be within normal ranges. Only subsequently, the patient admitted a cocaine abuse, through smoking and rubbing, over the last 15 days. Finally, after 15 days of interruption of cocaine abuse the oral lesions showed complete regression.

Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for.

The aim of this investigation was to perform a review of the literature dealing with the issue of relationships between dental occlusion, body posture and temporomandibular disorders (TMD). A search of the available literature was performed to determine what the current evidence is regarding: (i) The physiology of the dental occlusion-body posture relationship, (ii) The relationship of these two topics with TMD and (iii) The validity of the available clinical and instrumental devices (surface electromyography, kinesiography and postural platforms) to measure the dental occlusion-body posture-TMD relationship. The available posturographic techniques and devices have not consistently found any association between body posture and dental occlusion. This outcome is most likely due to the many compensation mechanisms occurring within the neuromuscular system regulating body balance. Furthermore, the literature shows that TMD are not often related to specific occlusal conditions, and they also do not have any detectable relationships with head and body posture. The use of clinical and instrumental approaches for assessing body posture is not supported by the wide majority of the literature, mainly because of wide variations in the measurable variables of posture. In conclusion, there is no evidence for the existence of a predictable relationship between occlusal and postural features, and it is clear that the presence of TMD pain is not related with the existence of measurable occluso-postural abnormalities. Therefore, the use instruments and techniques aiming to measure purported occlusal, electromyographic, kinesiographic or posturographic abnormalities cannot be justified in the evidence-based TMD practice.

Surface corrosion and fracture resistance of two nickel-titanium-based archwires induced by fluoride, pH, and thermocycling. An in vitro comparative study.

The present comparative study aimed to evaluate the surface corrosion and fracture resistance of two commercially available nickel-titanium (NiTi)-based archwires, as induced by a combination of fluoride, pH, and thermocycling. One hundred and ten rectangular section NiTi-based archwires were used, 55 of each of the following: thermally activated Thermaloy® and super-elastic NeoSentalloy® 100 g. Each of these was divided into five equal subgroups. One of these five subgroups did not undergo any treatment and served as the control, while the other four were subjected to 30 days of incubation at 37°C under fluoridated artificial saliva (FS) at 1500 ppm fluoride treatment alone (two subgroups) or combined with a session of thermocycling (FS + Th) treatment at the end of incubation (two subgroups). Within each of the Thermaloy® and NeoSentalloy® groups, the FS and FS + Th treatments were performed under two different pH conditions: 5.5 and 3.5 (each with one subgroup per treatment). Analysis of the surface topography and tensile properties by means of scanning electron microscopy (a single sample per subgroup), atomic force microscopy, and a universal testing machine for ultimate tensile strength were carried out once in each of the control subgroups or immediately after the treatments in the other subgroups for 10 of the archwires. Non-parametric tests were used in the data analysis. Significant effects in terms of surface corrosion, but not fracture resistance, were seen mainly for the Thermaloy® group at the lowest pH, with no effects of Th irrespective of the group or pH condition. Different NiTi-based archwires can have different corrosion resistance, even though the effects of surface corrosion and fracture resistance appear not to be significant in clinical situations, especially considering that thermocycling had no effect on these parameters.

Diagnostic performance of dental maturity for identification of skeletal maturation phase.

The objective of this study is to analyse the diagnostic performance of the circumpubertal dental maturation phases for the identification of individual-specific skeletal maturation phases. A total of 354 healthy subjects, 208 females and 146 males (mean age, 11.1 ± 2.4 years; range, 6.8-17.1 years), were enrolled in the study. Dental maturity was assessed through the calcification stages from panoramic radiographs of the mandibular canine, the first and second premolars, and the second molar. Determination of skeletal maturity was according to the cervical vertebra maturation (CVM) method on lateral cephalograms. Diagnostic performances were evaluated according to the dental maturation stages for each tooth for the identification of the CVM stages and growth phases (as pre-pubertal, pubertal, and post-pubertal) using positive likelihood ratios (LHRs). A positive LHR threshold of 10 or more was considered for satisfactory reliability of any dental maturation stage for the identification of any of the CVM stages or growth phases. The positive LHRs were generally less than 2.0, with a few exceptions. These four teeth showed positive LHRs greater than 10 only for the identification of the pre-pubertal growth phase, with values from 10.8 for the second molar (stage E) to 39.3 for the first premolar (stage E). Dental maturation assessment is only useful for diagnosis of the pre-pubertal growth phase, and thus, precise information in relation to the timing of the onset of the growth spurt is not provided by these indices.

The monitoring of gingival crevicular fluid volume during orthodontic treatment: a longitudinal randomized split-mouth study.

UNLABELLED: This randomized split-mouth study was aimed at evaluating whether an orthodontic appliance per se or orthodontic tooth movement can induce detectable changes in gingival crevicular fluid (GCF) volume, and thus whether GCF volume is a predictable biomarker for tissue remodelling incident to orthodontic tooth movement. MATERIALS AND METHODS: Sixteen healthy orthodontic patients (7 females and 9 males; mean age, 17.7 years; range, 13-27 years) with the need for extraction of the first upper premolars were enrolled. One randomly chosen maxillary canine was subjected to a distalizing force by a 0.017 × 0.025 inch titanium-molybdenum alloy archwire and considered as the test tooth (TT). The contralateral canine, which was not subjected to any force but was included in an orthodontic appliance, was used as a control (CT). GCF sampling was performed at both mesial and distal sites of the CTs and TTs at baseline, immediately before applying the orthodontic appliance, and after 1 hour, 24 hours, and 7, 14, and 21 days. A Periotron was used to measure the GCF volume. A modest but significant increase in the GCF volume over time was seen in both the CTs (mesial sites) and the TTs (both mesial and distal sites) with no differences between the experimental teeth. Subclinical tissue inflammation consequent to the placement of the orthodontic appliance might be responsible for these GCF volume changes. The GCF volume does not appear to be a reliable biomarker for tissue remodelling during orthodontic treatment.

Gingival crevicular fluid alkaline phosphatase activity as a non-invasive biomarker of skeletal maturation.

OBJECTIVES: To evaluate the gingival crevicular fluid (GCF) alkaline phosphatase (ALP) activity in growing subjects in relation to the stages of individual skeletal maturation. SETTING AND SAMPLE POPULATION: The Department of Biomedicine, University of Trieste. Seventy-two healthy growing subjects (45 women and 27 men; range, 7.8-17.7 years). MATERIALS AND METHODS: Double-blind, prospective, cross-sectional design. Samples of GCF were collected from each subject at the mesial and distal sites of both of the central incisors, in the maxilla and mandible. Skeletal maturation phase was assessed through the cervical vertebral maturation (CVM) method. Enzymatic activity was determined spectrophotometrically. RESULTS: The relationship between GCF ALP activity and CVM stages was significant. In particular, a twofold peak in enzyme activity was seen at the CS3 and CS4 pubertal stages, compared to the pre-pubertal stages (CS1 and CS2) and post-pubertal stages (CS5 and CS6), at both the maxillary and mandibular sites. No differences were seen between the maxillary and mandibular sites, or between the sexes. CONCLUSIONS: As an adjunct to standard methods based upon radiographic parameters, the GCF ALP may be a candidate as a non-invasive clinical biomarker for the identification of the pubertal growth spurt in periodontally healthy subjects scheduled for orthodontic treatment.

Do malocclusion and Helkimo Index ≥ 5 correlate with body posture?

Whether there are correlations between the stomatognathic system and body posture remains controversial. Here, we have investigated whether malocclusal traits and having a Helkimo Index ≥ 5 show detectable correlations with body-posture alterations in children and young adults. A total of 1178 11- to 19-year-old subjects were divided into four groups: (i) controls; (ii) malocclusion; (iii) Helkimo Index ≥ 5 and (iv) malocclusion + Helkimo Index ≥ 5. Dental occlusion assessment included the following: overbite, overjet, posterior crossbite, scissorbite, mandibular crowding and dental class. Subsequently, body-posture assessments were performed through static analyses of body inclination and trunk asymmetry, and according to the dynamic Fukuda stepping test. Univariate and multivariate statistical analyses were performed. Although at the univariate level both the trunk asymmetry and Fukuda stepping test showed significant differences among the groups, the multivariate level revealed that age and gender were mostly responsible for this. The only significant correlation that was seen was for the malocclusion + Helkimo Index ≥ 5 group: these subjects had a positive (worse) trunk asymmetry and a negative (better) Fukuda stepping test performance. At the further multivariate analyses of each single malocclusal trait /Helkimo Index ≥ 5 (irrespective of the groups), only an increased overbite showed a statistically significant association with a slightly better Fukuda stepping test performance. Given the small number of significant associations seen and their limited entities, this study does not support the existence of clinically relevant correlations for malocclusal traits and Helkimo Index ≥ 5 with body posture in children and young adults.

Posturography as a diagnostic aid in dentistry: a systematic review.

The aim of this systematic review of the literature was to assess the scientific evidence for detectable correlations between the stomatognathic system and whole-body posture and to provide information on the relevance of posturography as a diagnostic aid in dentistry. A literature survey was performed using the Medline database, covering the period from January 1966 to May 2009, and using the medical subject headings. After selection, 21 articles qualified for the final analysis. Only one study was judged to be of medium/high quality, with all of the rest classified as of low quality design. Only two studies included follow-up of 28 days and 1 year. Overall, 14 of the studies reported detectable correlations between the stomatognathic system and body posture in at least one of the parameters used, although in four of these studies the authors suggested caution in the interpretation of their data. After a reappraisal of the data provided in 13 of the studies, a weak correlation that reaches biological, but not clinical, relevance is apparent. With limitations because of the poor methodological quality of the present published studies, conclusions are that a correlation between the stomatognathic system and whole-body posture can be detected, at least under experimental conditions; although posturography has little relevance in the monitoring of body posture responses to changes in the stomatognathic system (including temporomandibular disorders). While more investigations with improved levels of scientific evidence are needed, the current evidence does not support the usefulness of posturography as a diagnostic aid in dentistry.

Copper-zinc superoxide dismutase activity in healthy and inflamed human dental pulp.

AIM: To examine copper-zinc superoxide dismutase (Cu, Zn-SOD) activity in clinically healthy and symptomatic human dental pulps. METHODOLOGY: Twenty-five systemically healthy patients, 14 females and 11 males (age: 13.1-34.6 years; mean: 21.7 +/- 6.3), were the source of the pulp tissue. The condition of the pulps was assessed using clinical and radiographic evaluation. The pulp tissue was collected by longitudinally grooving and splitting the teeth (if extracted) or during endodontic treatment, and were age- and sex-matched between the healthy and the irreversible symptomatic pulpitis tissue groups. Cu, Zn-SOD activity was determined through spectrophotometric methods and a Mann-Whitney test assessed the significance of differences between the groups. RESULTS: The enzyme activities were 144.8 +/- 42.2 and 68.1 +/- 25.0 U mg(-1) in the healthy and irreversible symptomatic pulp tissue, respectively. The difference between the groups was statistically significant (P < 0.001). CONCLUSIONS: These results demonstrate a potential role for Cu, Zn-SOD during dental pulp inflammation in humans.

Risk/prevention indicators for the prevalence of dental caries in schoolchildren: results from the Italian OHSAR Survey.

The Italian Oral Health of Schoolchildren of the Abruzzo Region (OHSAR) Survey was designed to assess indicators associated with the prevalence of caries in both the primary and permanent dentitions in the same schoolchildren, and it comprised a representative sample of 5,938 7-, 9- and 11-year-old schoolchildren from three provinces within the region of Abruzzo, Italy, a low fluoride concentration area. Gender, age, geographic location, socioeconomic level, dietary and oral hygiene habits, and the use of F supplements were all considered as indicators. The subsequent multivariate analyses showed that the socioeconomic level, snack consumption frequency, consumption of sweets and the use of F supplements were mostly associated with caries prevalence in both dentitions. Other indicators, such as gender, age, geographic location, between-meal snack consumption frequency, consumption of sweet drinks, toothbrushing frequency and onset of regular toothbrushing habits also showed some significant associations with dental caries across the age groups and/or dentitions. Of interest, the consumption of commercial bottled mineral water was also seen to be a preventive indicator for dental caries of the primary dentition, particularly in the 7-year-old group. The consumption of sweet snacks, use of interdental floss and kind of toothbrush mainly used (manual or electric) did not show any relevant association with the outcomes. The strong effect of the geographic location, socioeconomical level and the preventive effects of commercial bottled mineral water are worth further investigation.

Catalase activity in human healthy and inflamed dental pulps.

AIM: To examine the catalase activity in clinically healthy and symptomatic human dental pulps to verify if an active defence system against oxidizing agents is present as a response to bacterial invasion. METHODOLOGY: Thirty-three systemically healthy patients, 18 females and 15 males (ages: 11.0-25.9 years; mean 18.8 +/- 3.6), were the source of the pulp tissue. The condition of the pulps was assessed using clinical and radiographic evaluations. The specimens were recovered by longitudinally grooving and splitting the teeth (if extracted) or during endodontic treatment, and were matched for age and sex between the healthy and inflamed specimen groups. Catalase activity was determined through spectrophotometric methods. RESULTS: Enzymatic activity was 1126 +/- 343 and 3074 +/- 698 mU mL(-1) x mg of total protein in the healthy and inflamed pulp tissue specimens, respectively. This difference was statistically significant (P<0.01). CONCLUSIONS: These results indicate a role for catalase during dental pulp inflammation in humans, and may represent an inherent biological defence system against reactive oxidants of this tissue.

Aspartate aminotransferase activity in human healthy and inflamed dental pulps.

Aspartate aminotransferase (AST) seems to be an important mediator of inflammatory processes. Its role in the progression and detection of inflammatory periodontal disease has been increasingly recognized in recent years. In the present study AST activity was analyzed in normal healthy human dental pulps, in reversible pulpitis, and in irreversible pulpitis. Enzymatic AST activity showed that the control values for the healthy pulps were 4.8 +/- 0.7 units/mg of pulp tissue. In reversible pulpitis specimens the AST activity increased to 7.98 +/- 2.1 units/mg of pulp tissue. In irreversible pulpitis specimens the values decreased to 2.28 +/- 1.7 units/mg of pulp tissue. Differences between the groups (control versus reversible pulpitis and reversible pulpitis versus irreversible pulpitis) were statistically significant (p = 0.0015). These results could point to a role of AST in the early events that lead to development of pulpal inflammation.