Dental intrinsic green pigmentation from primary to mixed dentition: clinical and histological findings.

AIM: The aim of this report is to present a case of a child with green pigmentation of the primary dentition caused by bilirubin elevation due to choleostasis during neonatal life, and the 5-year follow-up. CASE REPORT: The case presented initially with bands of green pigmentation of all primary teeth in a pattern that followed the time of their calcification, with those formed earlier being more severely affected. Fading of the green pigmentation was detected during the follow-up, while erupted lower permanent incisors were normal. Histological findings of an exfoliated primary incisor showed a green line at the enamel-dentine junction with the external surface of the dentine showing a band of variable width and irregularly arranged tubules. CONCLUSION: Bilirubin green pigmentation of primary teeth follows a chronological pattern and its intensity fades with time. Overlying enamel in affected areas may appear thinner.

The presence of Helicobacter pylori in dental plaque of children and their parents: is it related to their periodontal status and oral hygiene?

AIM: To investigate the possible presence of H. pylori in subgingival dental plaque of children with upper gastrointestinal symptoms, as well as of their parents' and to detect any association between the presence of H. pylori and oral hygiene together with the periodontal status of children and their parents. MATERIALS AND METHODS: The study comprised of 35 children with upper gastrointestinal symptoms, aged 4 to 14 years and 45 family members (mothers and/or fathers). Gastric biopsies were collected from all children for CLO-test, histology and culture. Serology was used to assess the H. pylori infection status of their parents. Before endoscopy, subgingival dental plaque from children and their parents were collected from 4 healthy and 4 diseased sites, and the clinical indices (gingival index, plaque index, bleeding on probing, pocket depth, loss of clinical attachment) after plaque collection were recorded. STATISTICS: The Chi-square test was performed to investigate possible differences between children and their parents and logistic regression analysis was used to evaluate the association of parental infection status with that of children. RESULTS: 15 out of 35 children (42.86%) were found H. pylori-positive. In 6 out of the 15 infected children (40%) H. pylori was also identified in their subgingival plaque samples, as well as in one among the 20 non infected children. The presence of H. pylori in dental plaque was significantly associated with its presence in the gastric antrum (p=0.0274). H. pylori was identified in the dental plaque of 7 mothers corresponding to children with positive PCR in their dental plaque and of 4 fathers (one corresponding with his child found H. pylori positive in dental plaque). Children who had H. pylori identified in their dental plaque belonged to families with members also having H. pylori in dental plaque. No significant relationship between periodontal clinical parameters and detection of H. pylori in dental plaque in both children and their parents was found. However, the presence of H. pylori in the subgingival plaque samples was significantly correlated with the parental diseased sites (p=0.02). CONCLUSION: H. pylori was detected in subgingival dental plaque of children and their families, possibly acting as a "reservoir" contributing to the intra-familial spread. Efficient oral hygiene and healthy periodontal status could reduce this transmission.

Oral hygiene and periodontal treatment needs in children and adolescents with coeliac disease in Greece.

AIM: To evaluate the factors that influence the oral hygiene and the periodontal treatment needs of children and adolescents with coeliac disease (CD) in Greece. METHODS: The sample consisted of 35 children and adolescents, aged 4-18 years. The evaluation included consideration of the detailed medical history, the duration of CD and of gluten-free diet, the history of oral mucosal findings and a dental questionnaire that included information about oral hygiene habits, symptoms of periodontal disease and dental attendance. The clinical dental examination consisted of the simplified gingival index, the oral hygiene index and the periodontal screening and recording index. STATISTICS: The chi square and logistic regression analysis were performed in order to determine the factors or parameters that had a statistically significant (p ≤ 0.05) impact on oral hygiene and periodontal treatment needs of children and adolescents with CD. RESULTS: The periodontal treatment need of children and adolescents with CD were high and most of them needed treatment of gingivitis (60.01%) and only a few subjects had a healthy periodontium (34.29%). The periodontal treatment need index, the simplified gingival index and the hygiene index correlated statistically significantly with the presence of a coexisting disease, frequency of tooth brushing, bleeding upon brushing and oral malodor. CONCLUSION: The periodontal treatment need of children and adolescents with CD correlated with factors that related to the presence of a second medical condition and to the personal oral hygiene habits. Additionally, the oral hygiene level and periodontal status of children with CD do not have any specific characteristics but they have similarities to the oral hygiene level and periodontal status of the children of the general population.

[Ultrasound in diagnosis of superior mesenteric artery syndrome]. / Imaging con ultrasuoni nella diagnosi della sindrome dell'arteria mesenterica superiore.

OBJECTIVE: To reveal a possible reduction of the aorto-mesenteric angle and to diagnose suspected cases of superior mesenteric artery (SMA) syndrome. It was controlled, prospective study in which, in order to reveal a possible reduction of aorto-mesenteric angle, the following techniques. MATERIALS AND METHODS: In a cohort of patients referred to our department by their general practitioners for unexplained dyspepsia and/or abdominal pain an abdominal ultrasonography with power colour Doppler was performed; patients with reduced SMA angle were screened by gastroduodenoscopy, hypotonic duodenography, contrast-enhanced spiral computerized tomography. RESULTS: In a cohort of 1468 patients, 460 subjects were taken into consideration, specifi cally the patients where US and power colour Doppler had been adequately performed. US detected a signifi cant reduction of the SMA angle in 20 of those patients; in these 20 subjects, gastroscopy showed duodenal compressive pulsation in 5 of the 20 patients under examination, and X-ray revealed a compression of the third segment of the duodenum in 18 of them. The following CT examination confi rmed the presence of a reduced angle and various degrees of duodenal compression in all patients. US and CT examinations gave overlapping results (p>0.05) in diagnosing pathological aorta-mesenteric angle. CONCLUSIONS: The analysis of data led the authors to believe that the incidence of reduced aorto-mesenteric angle and SMA syndrome might be underrated. US power colour Doppler imaging that is a rapid, repeatable, and non invasive, low cost and easy to perform diagnostic procedure, is useful in epidemiological screening of reduced aorto-mesenteric angle to diagnose suspected cases of SMA syndrome in patients with inexplicable abdominal pain.

Effects of antioxidants on postprandial oxidative stress and endothelial dysfunction in subjects with impaired glucose tolerance and type 2 diabetes.

AIM: To compare changes in the oxidation-reduction balance and endothelial function before and after meal in patients with type 2 diabetes or impaired glucose tolerance and determine the effects of standard antioxidant supplementation. METHODS: Forty diabetics and 40 subjects with impaired glucose tolerance were compared with a control group. We assessed before and after a test meal (homogenized milkshake containing 80 g of saturated fat, amounting to 1,480 kcal), some reactive oxygen species, inflammation markers and flow-mediated vascular dilatation. These parameters were then reassessed after standard antioxidant treatment. RESULTS: After the meal, diabetics, subjects with impaired glucose tolerance and controls had higher levels of oxidant compounds compared to fasting levels. In subjects with diabetes and impaired glucose tolerance (IGT), Vascular Adhesion Molecule-1 and CRP were higher after the meal--diabetic subjects exhibited lower fasting flow-mediated dilatation, which deteriorated significantly after the meal. Antioxidant administration significantly improved the parameters investigated in all subjects. CONCLUSIONS: In diabetic subjects, altered glycaemia and lipaemia are closely correlated with markers of systemic oxidative stress. Our results show that the abnormal changes in oxidative-reductive balance parameters are paralleled by similar changes in markers of endothelial dysfunction and inflammation at 4 h after ingestion of a fatty meal. Supplementation with a pool of antioxidants can reduce oxidative stress and inflammation in healthy subjects and, more importantly, in IGT patients. This previous aspect suggests that the timing of antioxidant supplementation has an important role in endothelium protection in healthy and pre-diabetic subjects, and along with prompt antioxidant treatment before irreversible endothelial damage has occurred, may have an important protective role in subjects with IGT-patients who require administration of adequate dietary antioxidants.

The HFE gene heterozygosis H63D: a cofactor for liver damage in patients with steatohepatitis? Epidemiological and clinical considerations.

BACKGROUND: The altered status of iron metabolism is reported in hereditary haemochromatosis and in non-alcoholic liver fatty disease. We investigated the relation between the H63D HFE mutation gene and non-alcoholic steatohepatitis (NASH). METHODS: We studied as outpatients, 272 Italian persons with NASH and compared them with 430 healthy subjects. Genetic screening for haemochromatosis, haematochemical tests, liver ultrasound examination and liver biopsies were carried out. RESULTS: The prevalence of heterozygosity for the H63D mutation in NASH patients was not significantly greater than controls. In assessing the C282Y HFE gene mutation alone, the percentage of heterozygosis for C282Y was not different in subjects with NASH compared with controls. As regards a mutation C282Y/H63D there was no significant difference between the two groups. The mean fibrosis score was not significantly different between subjects of group A, with and without HFE mutations (1 +/- 8 and 1 +/- 9, respectively); we did not find a significant correlation between hepatic iron concentration and histological score between subjects. CONCLUSION: We have not found a significantly increased prevalence of the mutation H63D in the HFE gene in our patients with NASH. In these patients there was no more severe hepatic histological score when compared with NASH subjects without HFE mutations.

[Hyperhomocysteinemia, oxidative stress, endothelial dysfunction in postmenopausal women]. / Iperomocisteinemia, stress ossidativo, danno endoteliale e menopausa.

AIM: Menopause seems to accelerate the development of atherosclerosis and cardiovascular diseases. Several studies show a significant correlation between elevated homocysteine serum levels and increased cardiovascular risk. Oxidative stress is involved in the pathophysiology of endothelial dysfunction and atherosclerosis. Our study aim was to assess the correlations between intima-media thickness, homocysteine serum levels and oxidative stress both in fertile and postmenopausal women. MATERIALS AND METHODS: We have investigated 34 fertile women (mean age = 42 +/- 2 yrs; BMI = 21 kg/m2 and 34 postmenopausal women (48 +/- 3 yrs; BMI = 22 +/- 2 kg/m2). RESULTS: Results show increased levels of homocysteine, oxidative stress and intima-media tickness (IMT) in postmenopausal women. having a positive correlation with IMT. CONCLUSIONS: The positive correlations between serum levels of homocysteine and IMT in postmenopausal women reinforce the idea that a hyperhomocysteinemia may play a role in the progression of atherosclerosis. The lack of estrogens could be a pathophysiologic risk factor for endothelial damage via an augmented oxidative stress. Clin

Critical velocity and lactate threshold in young swimmers.

The purpose of the present study was to compare the critical swimming velocity (CV) in children, with the lactate threshold (LT) and the velocity corresponding to a blood lactate concentration of 4 mmol x l(-1) (V4). Twenty swimmers (ten females and ten males, mean +/- SD age: 12.9 +/- 1.1 years, body weight: 51.2 +/- 10.0 kg, height: 157.1 +/- 9.7 cm) performed four repetitions of 200 m swimming with increasing intensity (80, 85, 90 and 100% of their 200 m maximum velocity), interspersed with 15 minutes of passive rest. Blood lactate concentration was determined after each repetition. From the speed-lactate curve, the velocity corresponding to LT and V4 was calculated. In order to calculate CV, all swimmers were timed exerting maximum effort, on distances of 50, 100, 200 and 400 m. CV was expressed as the slope of the linear relationship of time versus distance and was calculated from combinations of four (CV4) three or two timed distances. Velocity on LT (1.079 +/- 0.114 m x s(-1)) and V4 (1.106 +/- 0.112 m x s(-1)) was comparable to CV4 (1.085 +/- 0.121 m x s(-1)). CV calculated from a combination including distances of 50, 100 or 200 m were higher compared to LT (p < 0.05). V4 was higher compared to CV of 100-200-400, CV of 200-400, CV of 100-400 (p < 0.05). The CV calculated from distances of 50 and 100 m was significantly higher than all other velocities (p < 0.05). These results confirm that the critical velocity seems to be a valid, practical and time-saving, non-invasive alternative method which can be applied in the swimming pool by a coach for the evaluation of the endurance capacity of young swimmers. For practical reasons, combinations of less than four distances can be used (i.e. 50-400 m, or 50-100-400 m).

[Heterozygosis H63D in patients with steatohepatitis and chronic hepatitis C]. / Eterozigosi H63D per emocromatosi in pazienti affetti da steatoepatite e epatite cronica da virus C.

OBJECTIVE: Classic hereditary hemochromatosis is an autosomal recessive iron-overload disorder associated with mutation of the HFE gene. The homozygous genetic defect predisposes to a chain of events that may culminate in severe damage in multiple organs. Pathologic implications of heterozygous defect are still questionable; in fact since these individuals may have slight increases in intra-cellular iron, it has been questioned whether this would enhance damage from other diseases. We investigated whether steatohepatitis and chronic hepatitis C can be worsened by heterozygosis for C282Y and H63D. PATIENTS AND METHODS: We investigated 216 subjects with Steatohepatitis and/or chronic hepatitis C diagnosed by ultrasonography and liver biopsy with histological assessment compared with 110 healthy subjects. In all subjects we performed Saturated Transferrine, Plasma Ferritin and the research of HFE mutation by a Real Time Method. A statistical analysis was performed. RESULTS: A H63D mutation was present in 32/108 patients with Steatohepatitis, in 30/108 patients with chronic hepatitis C and in 22/110 healthy subjects. A C282Y mutation was present in 2/108 patients with chronic hepatitis C, in 4/108 with steatohepatitis and in 2/108 healthy subjects. No significant difference was present about incidence of this mutation between pathological and healthy subjects. No significant differences have observed between pathological groups and normal group about the degree of histological damage. CONCLUSIONS: Our study revealed that steatohepatitis and chronic hepatitis C cannot be worsened by heterozygosis for C282Y and H63D.

Randomized clinical trial to compare the effects of methadone and buprenorphine on the immune system in drug abusers.

RATIONALE: Buprenorphine may be a useful alternative option to methadone in addicts. Opioids can produce severe changes in the immune system. OBJECTIVES: The objectives of this study are to compare the effect of sublingual buprenorphine and methadone on the immune system and to compare the two substances on the drying-out program compliance. METHODS: We studied 62 randomized outpatients for a period of 12 months. Subjects (55 males and 7 females; mean age 25+/-4 years; average history of heroin abuse being 2 years) on maintenance treatment were assigned in two groups (A and B). Methadone chloride (medium dose 100 mg/day) was administered to group A, whereas group B received sublingual buprenorphine (32.40+/-2.8 mg/day). Urine toxicological screening, plasma levels of TNF-alpha interleukin-1, interleukin-beta, lymphocyte CD14 and a self-rating depression questionnaire were measured. RESULTS: Urine screening was negative for opiates in 17.6% of group A and in 10.7% of group B (p<0.001; r = 0.62). Depression score was 62+/-2 in group A and 55+/-3 in group B (p < 0.01). Cytokine and CD14 revealed higher concentrations both in groups A and B without significant differences (p > 0.05) between the two groups. CONCLUSIONS: The effects of buprenorphine and methadone tested on the immune system were overlapping in our patients. The elevated cytokine levels observed may suggest that the two drugs stimulate immunologic hyperactivation of an immune system that was formerly inhibited by heroin. Furthermore, our data suggest that buprenorphine can be a valid alternative to methadone in maintenance treatment of chronic heroin abuse and referred a marked decline in depression.

Acute upper gastrointestinal bleeding: comparison between recent users and nonusers of nonsteroidal anti-inflammatory drugs.

BACKGROUND AND STUDY AIMS: To determine clinical, endoscopic, and outcome differences between recent users and nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs) presenting with upper gastrointestinal bleeding (UGIB). PATIENTS AND METHODS: A total of 330 consecutive patients who presented with clinical manifestations of UGIB underwent urgent endoscopy after clinical assessment within 12 h of admission. The patients were divided into two groups, depending on whether there was a positive or negative history of recent NSAID use. Urgent endoscopy followed by endoscopic hemostasis and/or biopsy, as needed, was performed by the same endoscopist, who was blinded to the patients' clinical status. RESULTS: The baseline characteristics, clinically estimated severity of UGIB, and outcome did not differ between the two groups. Recent NSAID users were found to bleed from an ulcer more frequently (P=0.009) than nonusers of NSAIDs, the latter more often having a history of peptic ulcer or UGIB (P=0.02). Bleeding ulcers were mostly duodenal in the NSAID group and gastric in the non-NSAID group (P<0.001). Helicobacter pylori infection was significantly more common among NSAID users (P<0.01). The group of NSAID users included a significantly greater proportion of alcohol abusers (P=0.01), who were found to bleed mostly from erosive gastritis. CONCLUSIONS: Recent NSAID users were found to bleed from ulcers, mostly duodenal, and to have H. pylori infection more frequently than UGI bleeders with a negative history of NSAID consumption. Alcohol abuse was also more common among NSAID users. The severity of bleeding and the outcome did not differ between the two groups.

A clinical survey of periodontal conditions in Greece.

The present study used full-mouth clinical assessments of plaque, calculus, bleeding on probing, probing pocket depth and probing attachment level to evaluate the periodontal conditions in a rural (A) and an urban (B) sample of 25-64 year old Greek adults, comprising 190 and 373 subjects, respectively. 13% of the subjects in sample (A) and 8% in sample (B) were edentulous, while mean values of teeth present in the four age cohorts ranged between 19.8-12.6 and 23.3-18.3, respectively. A poor level of oral hygiene was recorded in both samples with high plaque, calculus and bleeding scores. Deep pocketing was more pronounced in the rural than in the urban sample; between 1.7 and 8.0% of all sites probed showed a PPD of > or = 6 mm and between 20 and 51.2% of the subjects in each age cohort had at least one deep pocket. Corresponding figures for the urban sample was 0.6-4.7% and 15.1-49.2%. However, the prevalence of severe attachment loss was of comparable magnitude in both samples; between 2.8-25.7% of the sites in sample (A) and 2.8-20.6% in sample (B) displayed a PAL of > or = 6 mm, while 32.5-72.1% and 31.8-73.8% of the subjects, respectively, had at least one severely affected site. It was further found that the distribution of advanced disease in the samples was skewed; 14.4% of the subjects in sample (A) and 9.5% in sample (B) accounted for 75% of all deep pockets, while 21.8 and 19.4% of the subjects, respectively, accounted for 75% of all sites with PAL of > or = 6 mm. Multiple regression revealed that male sex and high plaque and bleeding scores had a significant, positive influence to the amount of attachment loss on a subject level.

A radiographic survey of periodontal conditions in Greece.

The present study used radiographic assessments to evaluate the pattern of destructive periodontal disease ina rural and an urban sample of 25-64 year old Greek adults. The rural sample (A) comprised 190 subjects and the urban sample (B) 400 subjects. 13% of the subjects in sample A and 8% in sample B were edentulous. Full-mouth intraoral radiographs were obtained from the 503 dentate subjects and were examined with respect to (i) number and type of teeth present, and (ii) alveolar bone level (ABL), i.e., the distance between the cementoenamel junction and the alveolar bone crest at the approximal tooth surfaces. The results revealed that alveolar bone loss was ubiquitous in both samples. Pronounced bone loss, however, (i.e., a subject mean ABL of > or = 6 mm) affected 18% (sample A) and 8% (sample B) of the individuals. Although an ABL of > or = 6 mm was scored at 7.2 sites/subject in sample A and at 4.5 sites/subject in sample B, more than 10 such sites were found in 23% (A) and 11% (B) of the examined subjects. 25% of the subjects in the rural sample (A) and 12% in the urban sample (B) accounted for 75% of the total number of tooth sites with pronounced bone loss. Multiple regression revealed that age and number of remaining teeth were the parameters most strongly correlated with the amount of bone loss on both the individual subject and the tooth site level. The present findings (i) demonstrated a high prevalence and severity of destructive periodontal disease in these 2 samples. and (ii) confirmed the skewed distribution of advanced disease in the population.

Comparative estimation of periodontal conditions by means of different index systems.

The aim of the present study was to compare epidemiological data of periodontal disease obtained from a sample of adults by means of different, commonly employed, partial and full-mouth index systems, in order to explore the amount of discrepancy attributed to the methodology per se. 169 dentate subjects, aged 25-64 years, were subjected to a clinical examination, including circumferential probing assessments of pocket depth (PPD) and attachment level (PAL) at all teeth present. The individual mean % of tooth sites with PPD of > or = 6 mm and the % of subjects exhibiting at least one such deep pocket were calculated based on (i) full-mouth data, (ii) data derived from the buccal and mesial surfaces from 1 randomly selected upper and 1 lower quadrant, (iii) probing assessments at the 6 "Ramfjord teeth", (iv) the full-mouth community periodontal index for treatment needs (CPITN), and (v) the partial CPITN based on 10 index teeth. The PAL data were analyzed by means of 3 versions of the extent and severity index, 1 generated by full-mouth assessments and 2 by partial assessments based on 28 and 10 tooth sites, respectively. In the entire sample, the individual mean % of sites with PPD of > or = 6 mm generated by the different systems ranged between 5.0 and 4.2 sites/subject. By full-mouth CPITN scorings, an average of 1.0 score-4 sextants/subject was recorded, while the partial CPITN generated a corresponding value of 0.8 score-4 sextants/subject.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of dental behaviour in adults with an advanced level of education in Athens]. / Diereunese tes odontiatrikes symperiphoras enelikon atomon ypselou ekpaideutikou epipedou sten Athena.

The purpose of this study was to evaluate the dental health behaviour in adults of advanced education. Ninety adults, aged 31-60, men and women were randomly selected from a population of advanced education. All the subjects had a thorough oral examination in order to record their dental health indices. Before the examination each participant was interviewed personally for determining, among others, their knowledge about oral health in general and more specifically about prevention of oral diseases. Their responses were correlated with the dental health indices that were determined by the dental examination. The results of the study indicate that this segment of the population demonstrates better oral health status than other population groups of the same age in Greece; the values of the restorative treatment indices were especially very high. From their responses it was found that although their theoretical knowledge on general dental health was satisfactory their information on prevention of oral disease was very limited. It is therefore concluded that although the level of education of adult population correlates well with the level of dental care received, an effective control of oral disease could be realised only if prevention procedures and dental health education is initiated early in life.

Pattern of tooth loss in a selected population in Greece.

The pattern of tooth loss with age for individual teeth was examined in a selected population. The survey covered patients attending the Dental School of Athens University. Tooth loss increased steadily with age and was higher for the periodontitis than the gingivitis group. Mortality of individual teeth was analyzed for each type of tooth within the maxillary pair and within the mandibular pair and no statistical significance was found. The statistically highly significant differences in loss rates within most groups of four teeth were clearly attributable to differences between the maxilla and mandible. For the permanent second molars differences in loss were close to the significance level while for the first molars the difference was statistically highly significant. A statistically significant difference was found between losses of the four second premolars while highly significantly differences were noticed between first premolars. Mortality for canines was low, but differences in losses were highly statistically significant. The two mandibular incisors had the lowest rates of loss in our sample, difference in loss between maxillary and mandibular incisors was statistically highly significant. Central incisors had a similar pattern of loss to that of lateral incisors but differences in loss rates were not statistically significant.

Factors influencing oral hygiene and gingival health in Greek schoolchildren.

397 children aged 12-17 years from different schools were divided into two groups. Group I comprised 192 children from private schools in Athens and Group II comprised 205 children from state schools of an industrial area in Piraeus. They were also subgrouped according to their socioeconomic class. They were interviewed with regard to their oral health habits, frequency of dental visits, etc., and subjected to clinical examination using the criteria and indices described by Silness & Löe and Löe & Silness. Stepwise regression analysis was used in the statistical evaluation of factors related to GI and Pl I. The following factors were found to be statistically significant in relation to GI: socioeconomic class, toothbrushing frequency, sex, and group examined. For Pl I statistically significant factors were found to be: age, group examined, and sex. All other variables were not significantly correlated to GI and Pl I.