Therapeutic approach to pediatric oral disorders.

The promotion of oral health in pediatrics stands as an institutional requirement in countries such as Italy where children's dental disorders still register a high incidence despite high levels of general health. Guidelines indicate the need to target a large age group and stress the relevance of parental education, whom pediatricians and dentists should address to. In this respect, teething is paradigmatic, due to the interactions between inflammation of the gingival mucosa, the possible associations with systemic symptoms as well as the psychological parental component. Teething products include: remedies used in folk medicine (chamomile and rose honey), whose clinical efficacy has not been proved; local anesthetics (lidocaine and benzocaine), easily absorbed by the oral mucosa and able to provide for a rapid, though short-lived relief; salicylates, prescribed by pediatricians in selected cases where the pain and inflammatory component is very high; systemic anti-inflammatory (paracetamol in elixir formulation), prescribed only in particularly serious cases, whereas they are sold over the counter in numerous countries; and - last but not least - film-forming devices containing hyaluronic acid, whose efficacy has been clinically tested in various children disorders of the oral cavity, including teething.

Oral hygiene compliance in orthodontic patients: a randomized controlled study on the effects of a post-treatment communication.

BACKGROUND: Several studies have recently demonstrated that a post-treatment communication to explain the importance of an oral hygiene can improve the orthodontic patients' compliance over a period of 66 days. The main goal of this study is to evaluate the effects of a structured follow-up communication after orthodontic appliance application on oral hygiene compliance after 30-40 days. METHODS: Eighty-four orthodontic participants enrolled from patients who were beginning fixed orthodontic treatment at the Orthodontic Department, Gaslini Hospital, Genova, between July and October 2014 were randomly assigned to one of three trial arms. Before the bonding, all patients underwent a session of oral hygiene aimed at obtaining an plaque index of "zero." At the following orthodontic appointment, the plaque index was calculated for each patient in order to assess oral hygiene compliance. The first group served as control and did not receive any post-procedure communication, the second group received a structured text message giving reassurance, and the third group received a structured telephone call. Participants were blinded to group assignment and were not made aware that the text message or the telephone call was part of the study. (The research protocol was approved by the Italian Comitato Etico Regionale della Liguria-sezione 3^ c/o IRCCS-Istituto G. Gaslini 845/2014, and it is not registered in the trial's register.) RESULTS: Thirty patients were randomly assigned to the control group, 28 participants to the text message group, and 26 to the telephone group. Participants who received a post-treatment communication reported higher level of oral hygiene compliance than participants in the control group. The plaque index was 0.3 (interquartile range (Iqr), 0.60) and 0.75 (Iqr, 1.30), respectively, with a significant difference (P = 0.0205). CONCLUSIONS: A follow-up procedure after orthodontic treatment may be an effective tool to increase oral hygiene compliance also over a short period.

Self-reported pain after orthodontic treatments: a randomized controlled study on the effects of two follow-up procedures.

OBJECTIVES: To assess the effects of a follow-up text message and a telephone call after bonding on participants' self-reported level of pain. MATERIALS AND METHODS: Eighty-four participants were randomly assigned to one of three trial arms. Randomization was performed by the Department of Epidemiology and Biostatistics of IRCCS G.Gaslini. Participants were enrolled from patients with a permanent dentition who were beginning fixed no extraction treatment at the Orthodontic Department, Gaslini Hospital. Participants completed baseline questionnaires to assess their levels of pain prior to treatment. After the initial appointment, participants were completed a pain questionnaire at the same time, daily, for 7 days. The first group, served as control, did not receive any post-procedure communication; the second group received a structured text message; and the third group received a structured telephone call. Participants were blinded to group assignment. LIMITATIONS: A larger sample size should have been considered in order to increase the ability to generalize this study's results. RESULTS: Participants in both the telephone call group and the text message group reported lower level of pain than participants in the control group with a larger and more consistent effect for the telephone call group. Most participants reported a higher level of pain during the first 48 hours post-bonding. The analgesic's consumption significantly correlated with the level of pain during the previous 24 hours. Female participants appeared to be more sensitive to pain than male participants. CONCLUSIONS: A telephone follow-up after orthodontic treatment may be an effective procedure to reduce participants' level of pain. PROTOCOL: The research protocol was approved by the Italian Comitato Etico Regionale della Liguria-sezione 3^ c/o IRCCS- Istituto G.Gaslini 845/2014. REGISTRATION: 182 Reg 2014, 16/09/2014 Comitato Etico Regione Liguria, Sez.3.

A modified intraoral resin mouthguard to prevent self-mutilations in lesch-nyhan patients.

Lesch-Nyhan syndrome, described in 1964 by Lesch and Nyhan, is a X-linked recessive disorder, occurring in 1 : 100000 to 1 : 380000 live births. LNS is characterized by a decrease in activity of hypoxanthine guanine phosphoribosyl transferase, an enzyme involved in purine metabolism, resulting in overproduction of uric acid. Hyperuricemia and neurological features including choreoathetoid spasticity, self-mutilation, and mental retardation clinically characterize this syndrome. In LNS patients the typical feature is loss of tissue from biting themselves with partial or complete amputation of fingers, lips, and tongue. The self-mutilation compares with the eruption of the deciduous teeth. Several drugs trials have been administered to improve self-destructive behavior and invasive treatment approaches, such as extractions of teeth and orthognathic surgery, have been suggested with variable effectiveness. Nowadays prevention is, therefore, the standard of care. The role of dentistry is essential in the management of the self-mutilating behavior, because the teeth represent the main self-injury instrument. This report presents a revision of various therapeutic approaches to manage self-destruction, highlighting the effectiveness of a preventive treatment. It describes a new technique: a resin mouthguard, realized at Gaslini Hospital, to obtain immediate healing of the oral lesions, confirmed in the follow-up period.