Diabetes mellitus and periodontal disease: The call for interprofessional education and interprofessional collaborative care - A systematic review of the literature.

Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.

Use of fractal analysis in dental images for osteoporosis detection: a systematic review and meta-analysis.

Fractal dimension (FD) calculated on oral radiographs has been proposed as a useful tool to screen for osteoporosis. This systematic review and meta-analysis firstly aimed at assessing the reliability of FD measures in distinguishing osteoporotic patients (OP) from healthy controls (HC), and secondly, to identify a standardized procedure of FD calculation in dental radiographs for the possible use as a surrogate measure of osteoporosis. A comprehensive search was conducted up to September 2020 using PubMed, Web of Science, and SCOPUS databases. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Meta-analysis was performed on FD values calculated for HC and OP. Overall, 293 articles were identified. After a three steps screening, 19 studies were included in the qualitative appraisal and 12 were considered for meta-analysis. The methodological quality of the retrieved studies was generally low. Most of the studies included used White and Rudolph and box counting to process the images and to calculate FD, respectively. Overall, 51% of the studies found a meaningful difference between HC and OP groups. Meta-analyses showed that to date, FD measures on dental radiographs are not able to distinguish the OP from HC group significantly. From the current evidence, the use of FD for the identification of OP is not reliable, and no clear conclusion can be drawn due to the heterogeneity of studies. The present review revealed the need for further studies and provided the fundamentals to design them in order to find a standardized procedure for FD calculation (regions for FD assessment; images processing technique; methods for FD measurement). More effort should be made to identify osteoporosis using dental images which are cheap and routinely taken during periodic dental examinations.

Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects.

OBJECTIVE: To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects? METHODS: Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes. RESULTS: Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm). CONCLUSIONS: In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft. KNOWLEDGE TRANSFER STATEMENT: The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.

Diabetic patients' knowledge of the bidirectional link: are dental health care professionals effectively conveying the message?

Diabetes mellitus (DM) has emerged as a global public health concern with significant upshots due to its high prevalence, severity and associated complications. The present review aims to evaluate the literature that has investigated the awareness and attitude of diabetic patients about their oral/periodontal health to identify gaps in the dissemination of this critical information. Literature addressing diabetic patient's awareness/knowledge, response to their periodontal health needs, and the source of oral health education was investigated using a computer search of electronic databases. Twenty-six papers were included in the systematic review for analysis. The studies reported data from 13 different countries involving 10 550 participants, 9843 patients with DM and 974 healthy controls. The overall analysis of the studies showed that approximately 73% of the diabetic patients were unaware of the link between their systemic condition (DM) and periodontal health. The results of the study show that a large number of diabetic patients are unaware of the link between oral/periodontal health and DM. There is a strong need to implement the recent guidelines established by the IDF/EFP concerning mutual care of diabetic patients by the medical and dental health care professionals. This will result in improved general and oral health of our diabetic patients.

Optical properties and pulse shape discrimination in siloxane-based scintillation detectors.

The possibility to detect fast neutrons as a distinct signal from that one of γ-rays background is surely of great importance for several topics, spanning from homeland security to radiation monitoring in nuclear physics research plants. Nowadays, Helium-3 based detectors are extremely expensive, while the use of large volume liquid scintillators presents serious concerns related to spillage risks and waste disposal. A very attractive alternative is the use of commercially available solid scintillators, which exploits an aromatic polymer matrix entrapping very high loadings of primary dye, thereby enabling the use of pulse shape analysis (PSA) to discriminate between fast neutrons and γ-rays. In this work, we analyse in detail the optical features of a solid scintillator composed by polymethylphenylsiloxane (PMPS) as base polymer loaded with moderate amounts of 2,5-diphenyloxazole (PPO). Furthermore, fluorescence decay kinetics have been correlated to the observed pulse shape discrimination capabilities of this radiation and thermally resistant scintillator, whose performances have been discussed in terms of conformational features and excimers formation revealed by the optical analyses.

Photoinduced electron transfer in a molecular dyad by nanosecond pump-pump-probe spectroscopy.

The design of robust and inexpensive molecular photocatalysts for the conversion of abundant stable molecules like H2O and CO2 into an energetic carrier is one of the major fundamental questions for scientists nowadays. The outstanding challenge is to couple single photoinduced charge separation events with the sequential accumulation of redox equivalents at the catalytic unit for performing multielectronic catalytic reactions. Herein, double excitation by nanosecond pump-pump-probe experiments was used to interrogate the photoinduced charge transfer and charge accumulation on a molecular dyad composed of a porphyrin chromophore and a ruthenium-based catalyst in the presence of a reversible electron acceptor. An accumulative charge transfer state is unattainable because of rapid reverse electron transfer to the photosensitizer upon the second excitation and the low driving force of the forward photodriven electron transfer reaction. Such a method allows the fundamental understanding of the relaxation mechanism after two sequential photon absorptions, deciphering the undesired electron transfer reactions that limit the charge accumulation efficiency. This study is a step toward the improvement of synthetic strategies of molecular photocatalysts for light-induced charge accumulation and more generally, for solar energy conversion.

PARAFAC analysis of IBIL spectra from silver ion exchanged glasses.

In this work we present for the first time an application of PARAllel FACtor (PARAFAC) analysis to the investigation of Ion Beam Induced Luminescence (IBIL) spectra of Ag+↔Na+ ion exchanged silicate glasses, in order to check the possibility to obtain additional information on the formation of silver aggregates under ion irradiation by a proper statistical rearrangement of experimental spectra. We decomposed the data by PARAFAC taking into account both IBIL emission features and their evolution as a function of the time. Shape and trend under irradiation of the extracted components were correlated to silver concentration and aggregates in the investigated systems. Strength and weakness of this statistical approach applied to IBIL spectra recorded as a function of time were evidenced and discussed.

Knowledge, attitudes, and behavior concerning dental trauma among parents of children attending primary school.

BACKGROUND: Traumatic dental injuries occur frequently in children and adolescents. The purpose of the present study is to examine the levels of knowledge and behaviors regarding dental trauma among parents of children attending primary schools in the Apulia region of Italy. METHODS: The study was carried out using an anonymous questionnaire with closed answers distributed to 2,775 parents who were enrolled based on the entire regional school population. Analyses were conducted using the PROC CORRESP (procedure to perform multiple correspondence analysis) and PROC FASTCLUS (procedure to perform cluster analysis). Statistical significance was set at p-value <0.05. RESULTS: A total 15.5% of the sample reported that their children had experienced dental trauma. Overall, 53.8% of respondents stated that they knew what to do in cases of dental injury. Regarding the time limit within which it is possible to usefully intervene for dental trauma, 56.8% of respondents indicated "within 30 minutes". Of the total sample, 56.5% knew how to preserve a displaced tooth. A total 62.9% of parents felt it was appropriate for their children to use dental guards during sports activities. The multivariate analysis showed that wrong knowledge are distributed among all kinds of subject. Parents with previous experience of dental trauma referred right behaviours, instead weak knowledge and wrong behaviours are associated with parents that easily worried for dental events. CONCLUSIONS: This study showed that most parents reported no experience of dental trauma in their children, and half of them did not know what to do in case of traumatic dental injury and they would intervene within 30 minutes, suggesting that dental trauma may trigger panic. However, they did not have the information needed to best assist the affected child. Motivating parents to assume a preventive approach towards dental trauma may produce positive changes that would result an increase of long-term health benefits among both parents and children.

Concerning the role of cell lysis-cryptic growth in anaerobic side-stream reactors: the single-cell analysis of viable, dead and lysed bacteria.

In the Anaerobic Side-Stream Reactor (ASSR), part of the return sludge undergoes alternating aerobic and anaerobic conditions with the aim of reducing sludge production. In this paper, viability, enzymatic activity, death and lysis of bacterial cells exposed to aerobic and anaerobic conditions for 16 d were investigated at single-cell level by flow cytometry, with the objective of contributing to the understanding of the mechanisms of sludge reduction in the ASSR systems. Results indicated that total and viable bacteria did not decrease during the anaerobic phase, indicating that anaerobiosis at ambient temperature does not produce a significant cell lysis. Bacteria decay and lysis occurred principally under aerobic conditions. The aerobic decay rate of total bacteria (bTB) was considered as the rate of generation of lysed bacteria. Values of bTB of 0.07-0.11 d(-1) were measured in anaerobic + aerobic sequence. The enzymatic activity was not particularly affected by the transition from anaerobiosis to aerobiosis. Large solubilisation of COD and NH4(+) was observed only under anaerobic conditions, as a consequence of hydrolysis of organic matter, but not due to cell lysis. The observations supported the proposal of two independent mechanisms contributing equally to sludge reduction: (1) under anaerobic conditions: sludge hydrolysis of non-bacterial material, (2) under aerobic conditions: bacterial cell lysis and oxidation of released biodegradable compounds.

Factors influencing groundwater quality: towards an integrated management approach.

The safety of groundwater resources is a serious issue, particularly when these resources are the main source of water for drinking, irrigation and industrial use in coastal areas. In Italy, 85% of the water used by the public is of underground origin. The aim of this report is to analyze the main factors that make groundwater vulnerable. Soil characteristics and filtration capacity can promote or hinder the diffusion of environmental contaminants. Global climate change influences the prevalence and degree of groundwater contamination. Anthropic pressure causes considerable exploitation of water resources, leading to reduced water availability and the progressive deterioration of water quality. Management of water quality will require a multidisciplinary, dynamic and practical approach focused on identifying the measures necessary to reduce contamination and mitigate the risks associated with the use of contaminated water resources.

Mineral water or tap water? An endless debate.

The consumption of mineral water has been increasing because of the frequent and unjustified reports of the water supply contamination. However some authors have shown that bottled waters are not always better than tap water. Mineral waters are more palatable for organoleptic characteristic because, being pure at source, they do not undergo disinfection treatments and are sometimes enriched with CO2. In fact, they are characterized by their microbial facies subject to changes during the production cycle which can contribute to their contamination. It is necessary to provide people with the tools necessary to operate a critical choice of the type of water to be consumed not exclusively for their organoleptic characteristics or marketing strategies.

What do parents know about dental trauma among school-age children? A pilot study.

BACKGROUND: The Ministry of Health published in November 2012 the "National guidelines for the prevention and clinical management of dental trauma in individuals during their developmental age". The aim of this study is to verify the knowledge among parents of children of primary schools to plan corrective actions. METHODS: The study was carried out filling in an anonymous questionnaire distributed to parents enrolled in three primary schools. RESULTS: Despite the publication of the National guidelines, the survey results confirm parents' lack of awareness, knowledge and skills in relation to dental trauma. CONCLUSIONS: This survey will allow to plan a training on interventions aimed at the protection of oral health.

Is the left forelimb preference indicative of a stressful situation in horses?

Evidence for behavioural and brain lateralisation is now widespread among the animal kingdom; lateralisation of limb use (pawedness) occurs in several mammals including both feral and domestic horses. We investigated limb preferences in 14 Quarter Horse during different motor tasks (walking, stepping on and off a step, truck loading and unloading). Population lateralisation was observed in two tasks: horses preferentially used their left forelimb during truck loading and stepping off a step. The results also revealed that horses showed higher scores for anxious behaviours during truck loading suggesting that the use of the left forelimb in this task may reflect the main role of the right hemisphere in control of behaviour during stressful situation.

Ion Beam Induced Luminescence capabilities for the analysis of coarse-grained river sediments.

In this work the Ion Beam Induced Luminescence (IBIL) capabilities for the analysis of geological mobile sediment samples from the beds of three major rivers flowing in the Veneto Region (North-Eastern Italy) is presented in the first application of this technique to characterize such samples. Diffuse Reflectance Infrared Fourier Transform Spectroscopy (DRIFTS) spectra were also measured and discussed to give indications for the identification of the main luminescence features. The evolution of the different IBIL components with the irradiation dose was studied and their correlation to matrix defects outlined. Finally, a Principal Component Analysis (PCA) of the IBIL evolving spectra was performed to verify the capability of this approach to discriminate among the different samples.

Performances of heated humidifiers in mechanical ventilation: a preliminary intra-breath analysis.

A correct humidification of gases delivered to mechanically ventilated patients is essential to avoid some complications. Heated Humidifiers (HHs) are widely used in long lasting ventilation to treat gases delivered to patients. Their performances depend on some parameters, such as environmental conditions and ventilatory settings. The aim of this work is to experimentally assess the influence of minute volume (MV), respiratory frequency (f) and the ratio between duration of inspiration and expiration (I:E) on HHs performances in terms of relative humidity (RH) at the humidification chamber outlet. The main novelty of this work is the assessment of RH oscillations during artificial ventilation. Results show marked oscillations of RH during a single breath (ripple of 20% in the worst case); oscillations decrease if f and I:E increase, on the other hand they increase with MV. Since the variation of gas temperature during a respiratory act can be neglected, the RH oscillations are related to the vapour content in the delivered gases. These results further support the hypothesis which asserts that HHs performances could be improved by using a control strategy taking into account ventilatory settings.

Effects of the environment on dog semen parameters and testosterone concentration.

Whether a mammal reproduces seasonally or continuously depends mostly on the environment and its effects on the endocrine pattern. Although the dog was the first species to have been domesticated, little information is available on the changes in reproduction that have occurred since. In this study, we evaluated whether environmental stimuli can act as modulators of male gonadal activity in the dog at the latitude of Bari (Italy). Therefore, for 1 year, serum and seminal testosterone (T) concentrations, together with seminal parameters, were recorded monthly and evaluated in relation to environmental variables such as temperature, humidity, and photoperiod. We found that, in temperate regions, the annual serum T profile is not affected by environmental conditions, whereas seminal T profile peaks in October and reaches its nadir in April. The percentage of progressive motile spermatozoa is also dependent on environmental cues. The results support the intuitive idea that recorded data require a proper analysis to be meaningful. In fact, we found that, in the dog, environmental changes appear to affect male gonadal physiology, and this is clear when recorded data are analyzed monthly; in contrast, pooling data into seasonal groups hides monthly environmental variations.

Prevention of foodborne diseases and home safety.

Injuries and infectious diseases show high levels of morbidity at home. It is known that diseases associated with the consumption of contaminated or poorly preserved food, can be significantly reduced if proper hygiene practices are observed. This article analyzes the main risks associated with household food consumption and aims to highlight some of the recommendations that are still widely disregarded. In particular, we highlight the issues concerning the management of food (especially cooking and storage) and water (mineral and tap water), as well as good manufacturing practices that the consumer have to take to avoid food contamination. For this purpose, a detailed information on prevention would provide people with a greater awareness of risk and, therefore, a improved perception to the real dangers.

Variaciones del SUV hepático con relación al índice de masa corporal en estudios PET/TC de cuerpo entero / Variations of the hepatic SUV in relation to the body mass index in whole body PET-CT studies

Objetivo. Evaluar variaciones del SUV hepático respecto al índice de masa corporal (IMC) de los pacientes estudiados con PET/TC de cuerpo entero. Material y métodos. Estudio retrospectivo. Variables estudiadas: dosis inyectada de 18F-FDG (mCi), edad (años), glucemia (mg/dl), talla (cm) y peso (kg). Se calculó el IMC y se expresó el valor medio de SUV según sexo e IMC. Se aplicó un análisis de regresión lineal para determinar las variables independientes que mejor predicen el valor de SUV. Resultados. El análisis incluyó 603 pacientes: 305 mujeres y 298 hombres, cuyas edades medias fueron 54,9±15,2 años. El SUV hepático promedio fue significativamente mayor en los varones y aumentó de manera significativa tanto en mujeres como en hombres con sobrepeso y aún más en aquellos con obesidad. Las variables independientes que mejor predijeron el valor de SUV fueron sexo, edad e IMC. En pacientes con similares características, el valor de SUV se incrementó en 0,002 por cada aumento en un año de edad y en 0,066 por cada aumento de una unidad en el valor del IMC. Conclusiones. La captación hepática de 18F-FDG aumenta a medida que lo hace el IMC del paciente. Las variables independientes que mejor predicen el valor de SUV hepático son edad y sexo de los pacientes. Nuestros hallazgos restan utilidad al empleo del valor de actividad metabólica hepática fisiológica como referencial respecto a captaciones dudosas en otros sitios del abdomen y pelvis, al menos en pacientes varones con sobrepeso y obesidad (AU)

Objective. To evaluate SUV changes in the liver in relation to body mass index (BMI) of patients who undergo whole body PET-CT scans. Material and methods. A retrospective study was performed. The variables studied were injected dose of 18FFDG (mCi), age (years), blood glucose level (mg/dL), height (cm) and weight (kg). BMI was calculated and the SUV mean value was expressed according to gender and BMI. A linear regression analysis was applied to identify the independent variables that best predict the SUV value. Results. Six hundred and three patients were studied (305 women, 298 men; mean age: 54.9±15.2 years old). Mean SUV measurement was significantly higher in males than females and increased significantly both in male and female patients who were overweight and even more in obese patients. The independent variables that best predicted the SUV value were gender, age, and BMI. In those patients having similar characteristics related to the analyzed variables, the SUV value increased by 0.002 for each increase in one year, and by 0.066 per unit increase in the BMI value. Conclusions. Hepatic uptake of 18FFDG increases according to the patient's BMI. The independent variables that best predict the hepatic SUV value are age and sex of patients. Our findings show that the practice of using the physiological hepatic metabolic activity level as a reference regarding questionable deposits elsewhere in the abdomen and pelvis is not useful, at least in male patients with overweightness and obesity (AU)

Changes in soft tissues around immediate full-arch rehabilitations: a prospective study.

INTRODUCTION: Nowadays, aesthetic appearance is receiving more and more attention from clinicians and patients. Therefore, it is of paramount importance for the surgeon to maintain or to improve the quality and the stability of the soft tissue-implant interface. The scientific literature supports the idea that the immediate placement and provisionalization of endosseus implants and abutments can indeed offer additional clinical control over the peri-implant tissue architecture. On this basis, this prospective study aims to evaluate the changes in soft tissues around immediately loaded dental implants in full-arch rehabilitations, over a period of 3 months. MATERIALS AND METHODS: Fifteen subjects were treated for immediate full-arch rehabilitations. Following implant placement, provisional rehabilitations made of bisphenol-A-glycidyldimethacrylate (BIS-GMA) and resin were placed. All records were made using a periodontal probe. The facial soft-tissue level was measured evaluating the distance between the soft-tissue margin and the incisal edge of the crown. Moreover, papilla levels were measured at the mesial and distal sites from a reference line connecting the occlusal edge of the crowns. RESULTS: The average value at the mesial site was -0.035 mm (±1, median 0 mm), while at the midfacial site, it was 0 mm (±0.76, median 0 mm) and at the distal site, -0.05 mm (±0.92, median 0 mm). The plaque score index showed a reduction during the follow-up period. DISCUSSION: Our data indicate that no differences at the midfacial point were detectable over the observation period. This is in agreement with several studies; it is plausible that these results are linked to a correct position of the implant in the alveolar socket. Moreover, comparing our results with what has been reported by other authors, it is surprising that while other studies highlight that papilla loss at the mesial and distal aspect is an expected consequence of immediate implant restorations, our data do not show any changes. The explanation of these results remains unclear. Further studies are needed to support our data and to clarify what mechanisms are involved in the maintenance of soft tissue.