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Introduction: Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by partial or total airway obstruction during sleep. Studies have shown variability in the level of knowledge and awareness about OSAS among pediatricians. The management of childhood obstructive sleep apnea syndrome (OSAS) depends on the severity of the disease, the presence of comorbidities, and the child's age. The American Pediatric Academy recommends a multidisciplinary approach involving a pediatrician, a sleep specialist, and an otolaryngologist to provide comprehensive care for children with OSAS. The aim of this cross-sectional study is to evaluate the level of knowledge among pediatricians in Italy regarding the diagnosis of pediatric OSAS., Material and Methods: An anonymized survey was conducted among Italian pediatricians. The survey was administered electronically using Google Forms, and a total of 350 pediatricians were invited to participate. Out of the 350 invitations, 299 pediatricians responded to the survey. The statistical analysis performed consisted of descriptive analysis. The study included 297 pediatricians., Results: Pediatricians demonstrated proficiency in identifying common nocturnal and day symptoms of OSAS. A majority (68.9%) considered the oral and otorhinolaryngologist areas during checkups. Approximately 70.6% took patient weight into account, and 62.8% were aware of the regional diagnostic-therapeutic-assistance pathway., Conclusions: According to the results of this manuscript, there is evidence of a good level of knowledge about OSAS, but disseminating more information about OSAS and all the health issues associated with this syndrome is suggested. This study also has limitations caused by the complexity of the pathology.

Aim: The aim of this retrospective study is to explore the introduction of edible spread cream and small candies as tools to improve motivation and compliance in young children undergoing myofunctional therapy, with the purpose of optimizing oral functions, including swallowing., Methods: Six patients, one female and five males, between the ages of 7 and 14 years, presenting with atypical swallowing, were evaluated and treated at the clinic of the University of L'Aquila. The patients included in the study were randomly divided into two groups and were treated with two different treatment protocols: Group A: traditional myofunctional therapy and traditional tools; Group B: same exercises as group A, but with edible tools (spreadable cream and small candies)., Results: As expected, the two patients who used edible tools demonstrated increased motivation and collaboration during myofunctional therapy., Conclusions: Patient compliance, especially in very young patients, limits the effectiveness of myofunctional therapy; therefore, creative solutions are needed to achieve greater cooperation, and edible tools can play a significant part in retraining correct swallowing. Although the sample of this pilot study is small, the results suggest that using actual edible tools in myofunctional therapy could increase compliance and provide better results in myofunctional therapy.

Background: Intraoral orthodontic elastics (IOE), typically referred to as rubber bands, are important tools for correcting malocclusion, and they are classified into latex and synthetic (elastomeric-based) elastics. They have different strengths and sizes, depending on their intended use, that provide clinicians with the ability to correct both anteroposterior and vertical discrepancies. Clinical use, together with saliva, alters the physical characteristics of both latex and synthetic elastics, causing declines in strength over time., Aim: The aim of the study was to assess, through a systematic review of in vitro studies, the properties of intraoral elastics. The primary goal was to evaluate how IOEs behave in terms of tension strength and duration. The secondary goal was to investigate the force loss during the first hours of wear. The tertiary goal was to assess how these forces decayed., Materials and Methods: The following electronic databases were searched from December 2020 to April 2021: Medline Full Text, PubMed, Cochrane Clinical Trials Register, Science Direct, and Literature Review. Out of 8505 initial articles, 10 were selected for the systematic review., Results: The force-degradation property was found in all types of IOEs. The loss of strength was directly proportional to time, with the highest value during the first 3 h after extension, regardless of the elastic band size and manufacturer. The forces generated by the latex bands were higher than in those of the elastomeric-based elastics, but they did not consistently correspond to the loads specified by the manufacturers. The retention forces in the latex IOEs were significantly higher than those in the nonlatex bands, suggesting that elastomeric-based bands need to be changed more frequently and at regular intervals throughout a 24 h period., Conclusion: This systematic review indicates that intraoral orthodontic elastics have the greatest loss of force during the first 3 h, that latex rubber bands have the highest strength during the first hour, that the forces generated are not always consistent with the manufacturer's specifications, and that nonlatex (elastomeric-based) IOEs need to be changed frequently and regularly during a 24-h cycle.

Introduction: Scoliosis is a complex three-dimensional malformation of the spine. Although its etiology is still being investigated, it is clear that a number of factors can influence this syndrome. The spinal deformity of idiopathic scoliosis can be viewed from an etiopathogenetic perspective as a symptom of a complicated condition with a multifactorial etiology. Numerous studies have established its relationship with malocclusion, but it is still unclear how these factors interact. Malocclusion is a change in the physiological alignment of the upper and lower teeth that can be either dental or skeletal in origin. This study's objective is to assess the relationship between scoliosis and malocclusion., Material and Methods: A total of 646 patients were enrolled (554 females and 92 males), 447 with scoliosis and 199 without, from private dental and orthopedic practices, to answer an anonymous questionnaire. They were selected in private dental and orthopedic practices where they had dental and orthopedic examinations. Twenty-two patients were excluded because of a lack of answers. Participants were given a bilingual survey, in English and Italian, composed of 13 questions formulated specifically for this study, using Google Forms (Google LLC, Mountain View, CA, USA)., Results: Univariate analysis of the question "Do you have scoliosis?" shows a significant correlation with the following questions: "Was scoliosis a family issue?" ( p < 0.05 OR 7.30 IC: 3.05-17.46) "Do you have malocclusion?" ( p < 0.05, OR: 1.19 IC:1.0-1.34) and "Was mal-occlusion a family issue?" ( p < 0.01, OR: 1.39 IC 1.10-1.77). Performing a multivariate analysis for the same variables, the best predictors of scoliosis were "Was scoliosis a family issue?" ( p < 0.001) and "Was malocclusion a family issue?" ( p < 0.05), while the question "Do you have malocclusion" lost significance., Conclusion: This study adds further confirmation that there might be an important connection between malocclusion and scoliosis; it suggests that dentists and orthopedists have to check, as early as possible, for the probable presence of both pathologies to avoid a severe progression which, in most cases, may require significant therapy and even surgery., Competing Interests: The authors declare no conflict of interest.

Introduction: Mandibular setback surgery (MSS) is one of the treatment options to resolve mandibular prognathism in patients suffering from skeletal class III malocclusion, which cannot be treated with simple orthodontic treatment. The mandibular setback surgical operation can involve changes in the pharyngeal morphology, resulting in a narrowing of the posterior airway space (PAS). This aspect is associated with an increase in airflow resistance, which increases the risk of developing snoring or obstructive sleep apnea syndrome (OSAS). The aim of this study is to evaluate the medium- and long-term effects of mandibular setback surgery on the upper airways and its possible association with OSAS in patients suffering from class III skeletal malocclusion., Material and Methods: A total of 12 patients (5 males and 7 females) were enrolled in this study. The statistical tests highlighted a significant change in the PAS and BMI values in relation to T0, before surgery (PAS: 12.7 SD: 1.2; BMI: 21.7 SD: 1.2), and T1, after surgery (PAS: 10.3 SD: 0.6, p < 0.01; BMI: 23.8 SD: 1.2, p < 0.05). Sample size was calculated to detect an effect size of 0.9, with statistical power set at 0.8 and the significance level set at 0.05., Results: No statistically significant correlation was found between the extent of mandibular setback, PAS and BMI change., Conclusion: This study confirms the effects of mandibular setback surgery on the upper airways, reporting a statistically significant PAS reduction in the medium- and long-term follow-up. On the other hand, no direct correlation was identified with OSAS risk, at least for the small mandibular setback (<8 mm), despite the statistically significant increase in BMI.

Temporomandibular disorders (TMDs) are a condition which has multifactorial etiology. The most acknowledged method to classify TMDs is the diagnostic criteria (DC) introduced firstly by Dworkin. This protocol considers different aspects that are not only biological, but even psychosocial. Diagnosis is often based on anamnesis, physical examination and instrumental diagnosis. TMDs are classified as intra-articular and/or extra-articular disorders. Common signs and symptoms include jaw pain and dysfunction, earache, headache, facial pain, limitation to opening the mouth, ear pain and temporomandibular joint (TMJ) noises. This study regards two kind of clinicians that started in the last years to be more involved in the treatment of TMDs: osteopaths (OOs) and physiotherapists (PTs). The purpose is to analyze their attitude and clinical approach on patients affected by TMDs. Four hundred therapists answered an anonymous questionnaire regarding TMJ and TMDs. OOs showed greater knowledges on TMDs and TMJ and, the therapists with both qualifications seemed to be most confident in treating patients with TMDs. In conclusion this study highlights OOs and all the clinicians with this qualification, have a higher confidence in treating patients with TMD than the others. Dentists and orthodontists, according to this study, should co-work with OOs and PTs, because they are the specialists more requested by them than other kinds of specialists.

Background: Over the past 20 years, there have been many innovations in orthodontic diagnosis and therapy. Among the innovations, there is the taking of dental impressions (DIs). Dental impressions are the negative imprint of hard and soft tissues of one or both arches, and they allow a plaster model to be formed, i.e., a positive reproduction. Traditional dental impressions can be made of different materials, such as alginate, while digital impression is captured by an intra-oral scanner. Digital impression, despite the evident advantages, has not yet replaced the conventional impression. The aim of this study is to evaluate which dental impressions are the most used by dentists. For this purpose, we considered 120 questionnaires sent electronically to patients of different dental private practices from different countries, where the dentists can use both techniques. The results highlighted that the kind of impression adopted is very much influenced by the type of therapy and orthodontic devices used in the treatment. We can conclude that, despite the advent of digital technology, conventional impressions are still used for fixed devices, while digital impressions are more adopted for orthodontic customized devices and therapies with clear aligners, that are very widespread among adult patients.

Background. Coronavirus disease has subjected the whole of humanity to two years of social isolation and a series of restrictions. These circumstances have led to the use of information technology in an increasingly widespread manner. Even in the dental field, telematic means have been used to respond to emergencies. The aim of this systematic review of the literature is to evaluate the types of orthodontic emergency that occurred most often and how they were managed by teleorthodontics during the COVID-19 pandemic. The secondary aim is that clinicians will use teleorthodontics not only during pandemics but as an additional tool to manage orthodontics. Materials and Methods. Out of 1695 articles available on PubMed, Science Direct, Cochrane and SciELO, eight articles were selected for this systematic literature review. Google Scholar was used as a secondary source to confirm that there were no additional articles. The screened papers comprised editorials, clinical studies, cross-sectional studies and retrospective studies in Italian, English or Spanish language. Results. The articles showed that the means by which patients most often communicated with their orthodontists were voice calls and smartphone applications such as WhatsApp ® Messenger. Through these media, patients communicated their orthodontic emergencies. These mainly involved fixed multibracket appliances and the most common issues were discomfort and pain, fracture or loss of the appliance, protruding distal ends of archwires, brackets, tubes and bands or retainer detachment. Through teleorthodontics, patients could solve these issues by using orthodontic relief wax, cutting the protruding distal ends of the archwire with a nail clipper or a stronger cutter and removing or replacing detached bands, brackets, tubes or metallic ligature with a clean tweezer. Conclusions. In situations where personal contact is limited, teleorthodontics represents a valuable aid for professionals and patients facing orthodontic emergencies. The hope is that it may continue to represent a valuable aid for patients with difficulties in planning an in-office visit.

Coronavirus disease 2019 represents the pandemic of the 21st century that has negatively affected the lives of the whole of humanity. For many months, the only weapons to fight against this infection were protective masks and social isolation. During recent months, fear of the virus has led people to avoid crowded environments and events, and to reduce medical checks, limiting them only to emergencies. Outpatient clinics, doctors' offices, and all closed-in environments were required to limit the patients' access. Nowadays, the presence of specific protocols around the world, and the extended vaccination campaign, have allowed a reduction of many restrictions. Unfortunately, the virus is still widespread, and dental practice and dental treatments suffer the consequences. Dental therapies in general, and in particular orthodontics, are not considered lifesaving. Due to this, orthodontists, in this historical time, must find solutions for motivating patients to start or continue therapies, while providing a safe way for them to do so. There are orthodontists who have developed, during this period, different ways to help them in treating and communicating with patients. Aim: The aim of this study is to assess the influence of the pandemic on the choice to start orthodontic treatment, oral health care, and the importance placed on the appearance of dental occlusions. Materials and Methods: This study is a survey analysis of 159 people, which was posted in Facebook groups of adult orthodontic patients. The timestamps and answers of responses were analyzed to avoid duplicated or interrupted questionnaires. Conclusions: This study found that the current health emergency has not reduced the demand for orthodontic care, while some patients' behaviors are changing in relation to oral hygiene and the importance that they attribute to dental health. It seems that dentists' availability plays a key role in this period of sanitary emergency.

Background: Eagle syndrome occurs when elongated styloid process or ossification of the stylohyoid ligament interfere with the surrounding anatomical structures giving rise to various symptoms. Watt W. Eagle identified two types: stylo-hyoid classic syndrome and stylo-carotid artery syndrome. The aim of this systematic review of the literature is to evaluate correlations between Eagle syndrome and traumatic events or teeth extractions., Methods: out of 294 articles, the final study allowed the identification of 13 studies focusing on traumatic events. Out of 342 articles, the final study allowed the analysis of two studies regarding extractive dental events., Results: 13 articles showed correlations between the onset of symptoms in Eagle syndrome and traumatic events and highlighted two possibilities: traumatic event could fracture the already elongated styloid process or calcified stylohyoid ligament; trauma itself triggers the pathophysiological mechanisms that lead to lengthening of styloid process or calcification of stylohyoid ligament and therefore the typical symptoms. The only two case reports concerning Eagle syndrome symptoms after extractive dental events describe the onset of classic type., Conclusions: The analyzed articles confirm correlation between traumatic event and onset of typical symptoms of Eagle syndrome. There is not enough literature linking extractive dental events to Eagle syndrome., Trial Registration: CRD42020185176.

The present observational prospective study analyzes the eating habits in association with the medico-oral health of catering workers, since they seem the category at higher risk of developing dental problems., Objective: To evaluate oral and medical health through a questionnaire in a total sample of 603 participants. Additionally, this article aims to provide information regarding the medico-oral implications of an unbalanced diet linked to this particular profession., Material and Methods: A questionnaire created through Google Forms platform was sent to all members of the Italian Federation of Chefs (FIC). The mean age was 46.9 ± 32.6 ranging from 17 to 66 years old., Results: Catering workers' years of service showed a significant impact on the presence of teeth pain ( p < 0.05), missing teeth (excluding the third molars) ( p < 0.01), treatment with prothesis ( p < 0.01), dental fillings ( p < 0.01), dental extractions ( p < 0.01), diabetes ( p < 0.05), high blood pressure ( p < 0.01), joint pain ( p < 0.01), back pain ( p < 0.01), neck pain ( p < 0.01), and gastroesophageal reflux ( p < 0.05)., Conclusions: A conspicuous part of the study sample was overweight, with a high BMI. Moreover, the years of service in this field showed significant impact on dental problems. Therefore, a very important role is that of preventing dental problems and giving information on the causes and effects unknown to many workers in the sector.

Atypical swallowing needs treatment in order to eliminate harmful interferences of the tongue, which prevent the harmonious growth of the stomatognathic system. The purpose of this study was to assess the effects of a functional appliance on the presence of atypical swallowing, analyzing the lip strength and the altered facial mimics. The effects of a myofunctional appliance (the Froggy Mouth) were evaluated on 40 children (6 males; 24 females; mean age 9.6 ± 2.17) with atypical swallowing-with tongue thrust diagnosed by an expert orthodontist-before and during a 6 month treatment. Data were analyzed over time with a paired samples t-test for normally distributed data. After 6 months of treatment, 33 children out of 40 achieved clinical correction of atypical swallowing due to their good compliance, even at an early stage. Seven children showed low compliance and did not obtain any result. Lip strength in compliant subjects went from 190.30 ± 86.04 cN to 489.39 ± 123.36 cN (t = p < 0.001). Facial mimics improved in 28 out of 33 compliant subjects, and four children with the initial diagnosis of labial incompetence achieved correction. This observational study demonstrates the short-term efficacy of this myofunctional appliance in the treatment of atypical swallowing, achieving correction of the facial mimics and labial incompetence with a significant improvement of the lip strength.