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Aims: To evaluate osteoradionecrosis (ORN) incidence in a cohort of patients undergoing tooth extraction (TE) before radiotherapy (RT) for head and neck cancers. Methods: The study protocol was approved by the Ethics Committee of Università Cattolica del Sacro Cuore (ID‐2132) and registered at clinicaltrials.gov (ID: NCT04009161). TE was performed in case of signs of pericoronitis, periapical lesions, restorative impossibility, severe periodontitis. ORN was defined as exposed bone at an unhealed post‐extraction socket in the absence of oncological recurrence. The RT plans were reviewed, and each post‐extractive socket was contoured to calculate the received radiation dose. Results: In total, 156 patients with 610 TE were enrolled. The mean follow‐up was 567 days. ORN was diagnosed in four patients (2.6% of patients and 0.7% of TE). Need for osteotomy and radiation dose at the extraction site were associated with ORN (OR for osteotomy: 21.9, 95% CI: 2.17–222.2, p = 0.009; OR for RT dose: 1.1, 95% CI: 1–1.15, p = 0.05). Conclusions: TE appears to be a significant risk factor for ORN, particularly when osteotomy is required, and post‐extraction sockets receive a high RT dosage. This study proposes a decision‐making algorithm for TE and outlines a straightforward surgical protocol. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the quality of sleep and the psychological profiles of a large cohort of Italian patients with burning mouth syndrome (BMS) and to clarify the relationships between these variables and pain. Methods: In this case–control study, 200 patients with BMS vs an equal number of age‐ and sex‐matched healthy controls, recruited in 10 universities, were enrolled. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Rating Scale for Depression (HAM‐D), Hamilton Rating Scale for Anxiety (HAM‐A), Numeric Pain Intensity Scale (NRS) and Total Pain Rating Index (T‐PRI) were administered. Descriptive statistics, including the Mann–Whitney U test and hierarchical multiple linear regression analysis, were used. Results: Poor sleep quality (PSQI ≥ 5) was present in 78.8% (160) patients with BMS. BMS patients had statistically higher scores in all items of the PSQI and ESS than the healthy controls (p < .001). A depressed mood and anxiety correlated positively with sleep disturbance. The Pearson correlations were 0.570 for the PSQI vs HAM‐D (p < .001) and 0.549 for the PSQI vs HAM‐A (p < .001). Pain intensity (NRS) poorly correlated to sleep quality; the Pearson correlation was 0.162 for the PSQI vs NRS (p = .021). Conclusions: The BMS patients showed a poor sleep quality, anxiety and depression, as compared with the controls, highlighting the relationships between oral burning, sleep and mood. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To compare the effectiveness and safety of three activated irrigation techniques when removing pulp tissue from the isthmus of a transparent tooth model. The three techniques assessed were: the EndoVac (EV), passive ultrasonic irrigation (PUI) and ultrasonic wave aspiration (TUWA). Conventional syringe irrigation (CSI) was used as a control. Methodology: A transparent tooth model was created using the mesial root of an extracted mandibular first molar that had an isthmus and two independent mesial canals. An artificial 0.3‐mL cylindrical chamber was created below the apical foramen. The tooth was then cleared. After preparation, the root canals were filled with fuchsine‐stained bovine pulp tissue. The irrigation protocols were compared in respect of their effectiveness at removing pulp tissue from the isthmus and their safety with regard to irrigant extrusion. For all four groups, 5.25% sodium hypochlorite solution was used as the irrigant. Photographs were taken and analysed using an imaging software. A Kruskal–Wallis test was used to detect the differences between groups (statistical significance was set at P < 0.05). Results: No group was associated with extrusion of irrigant beyond the apex. Significant differences were observed between the groups: TUWA was the most effective technique at removing pulp tissue from the isthmus (3.39 mm2; standard deviation (SD) = 0.67; range = 1.25–3.69), followed by PUI (2.16 mm2; SD = 0.38; range = 1.37–2.96), EV (0.73 mm2; SD = 0.14; range = 0.49–0.98) and CSI (0.27 mm2; SD = 0.01; range = 0.26–0.28). Conclusion: Ultrasonic wave aspiration was the most effective technique at removing artificial pulp tissue from the isthmus of a transparent tooth model. None of the techniques extruded irrigant. [ABSTRACT FROM AUTHOR]

Background and objective A prevailing dental problem in the periodontal patient is root caries. Specifically, periodontal involvement often results in root surfaces becoming exposed and at risk for this condition. Periodontal therapy often leads to increased gingival recession as well, and the associated increased root caries risk may compromise the long-term success and survival of periodontally treated teeth.This narrative review will address the topic of root caries in the periodontal patient, focusing on unmet research needs. Material and Methods The Medline database was searched to identify items dealing with root caries, in terms of clinical features, diagnosis, pathogenic mechanisms and histopathology, as well as epidemiology, focusing then on the relationship between root caries and periodontal disorders. Results Although there is extensive literature on root caries, consensus is lacking regarding certain aspects, such as diagnostic criteria, prevalence within populations and indisputable risk factors. Advancing age could be an aggravating factor in susceptibility to root caries for the periodontal patient; however, definitive evidence in this regard is still missing. Similarly, full awareness of the increased risk of root caries in patients with periodontal disease or long-term periodontal treatment appears to be still lacking. Conclusion Research regarding root caries in age-specific (elderly) periodontal patients is needed. Improved oral hygiene practices, locally applied preventive measures, good dietary habits and regular dental check-ups are crucial approaches to prevent both periodontal disease progression and root caries. Periodontal patients with root exposure should follow a strict root caries prevention protocol, as an integral component of their periodontal maintenance therapy. [ABSTRACT FROM AUTHOR]

Somma F, Castagnola R, Lajolo C, Paternò Holtzman L, Marigo L. In vivo accuracy of three electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II. International Endodontic Journal, 45, 552-556, 2012. Abstract Aim To compare in vivo three different electronic root canal length measurement devices: Dentaport ZX, Raypex 5 and ProPex II. Methodology Thirty single-rooted permanent teeth scheduled for extraction because of periodontal disease were selected from 10 adult patients (ranging from 45 to 67 years) and divided into three groups of 10 teeth. Before the extraction, an access cavity was prepared and the crown was adjusted to establish a stable reference point for all measurements. The working length in Group 1 was determined using the Dentaport ZX apex locator. A K-file with the largest diameter that could reach the last green bar on the screen was stabilized in the canal using a dual-curable flow resin composite. The same procedure was used for the Raypex 5 (the file reached the last yellow bar) and Propex II (0.0 orange bar) apex locators. The teeth were then extracted and cleared. The distance between the tip of the file and the major foramen was then calculated for each tooth using digital photography according to Axiovision AC software (Carl Zeiss). Positive values were assigned when the file tip passed beyond the major foramen, negative values when the tip was short of the foramen and zero value when the file tip and the foramen coincided. Statistical analysis was performed using the chi-squared test or Fisher's exact test ( P ≤ 0.05). Results Dentaport ZX, Raypex 5 and ProPex ΙΙ produced, respectively, 6, 2 and 4 out of 10 correct measurements, 0, 6 and 5 long measurements and 4, 2, and 1 short measurements. The differences between the three electronic root canal length measurement devices were not significant ( P = 0.507). Conclusions Under the in vivo conditions of this study, the three electronic root canal length measurement devices were not significantly different in terms of locating the major foramen. [ABSTRACT FROM AUTHOR]

Objectives: Literature reports highlighted the presence of discriminatory episodes towards individuals infected with human immunodeficiency virus (HIV) on behalf of dental care workers. The purpose of this study was to assess hygienists' attitude when treating HIV-infected individuals in the era of highly active antiretroviral therapy (HAART). Methods: A national observational study was carried out on all the members of an Italian hygienist association. An anonymous questionnaire was mailed to 1247 hygienists: the questionnaire investigated demographic data, the relationship between the hygienists and HIV-infected persons, to identify the presence of discriminatory behaviour, the hygienists' scientific knowledge of HIVrelated problems and the precautions normally used in the office to prevent cross-infections. Results: Of the 1247 questionnaires that were delivered to hygienists, 287 (23%) were completed and returned within a 6-month period. A total of 287 hygienists answered the question 'Did you ever deny treatment to an HIV-infected persons?' and 17 hygienists (5.9%) replied 'Yes'. Protective eyewear [odds ratio (OR), 0.036; 95% confidence interval (CI), 0.002-0.818; P = 0.037] and public practice [OR, 2.93; 95% CI, 0.97-8.87; P = 0.057] were associated with refusing to treat HIV-infected persons. Conclusion: Our findings highlight the existence of episodes of discrimination by some hygienists towards HIV-infected individuals. From clinical point of view, this discriminatory behaviour may expose the dental health care workers and their patients to a greater risk of cross-infection. [ABSTRACT FROM AUTHOR]

In the last years, the use of tests with predictive value for scholastic progress has become widespread. While there is an aptitude test already in use for admission to our Dental School, we have also been conducting, without consequence to their admission, an investigation into the manual dexterity of candidate students. The aim of this test is to investigate basic manual dexterity, not ability following exercise. As previous, no such specific test had been formulated; the choice of test criteria we made was new. The tests investigated over five consecutive Academic years the ability to discern characteristics of a surface, to distinguish between different types of consistency, hand–eye co-ordination, the graphic activities, laterality and muscular strength. A re-test for some years was conducted afterwards. The results provided an overall evaluation: insufficient; sufficient; good; very good; excellent. Students who came from non-technical high schools showed a good comprehension of questions put to them, use of strategy, description of procedures; and final checking but a certain clumsiness in the hand–eye co-ordination test and a tendency to use one hand only. Students coming from technical high schools showed a less immediate grasp of questions put to them, sometimes requiring their repetition, disorganised behaviour in blind-fold tests, insufficient use of strategies and little checking but notable ability in hand–eye co-ordination tests and dextrous simultaneous use of both hands. These results were then correlated with the result of the aptitude test. In conclusion, a notable correspondence between student selection based on the aptitude test and the experimental manual dexterity test was verified. This correspondence outlines that manual dexterity is not only a ‘manual’ but a ‘mental’ ability . [ABSTRACT FROM AUTHOR]

Background: The wellbeing of oral lichen planus patients (OLPs) may be strongly influenced by a poor quality of sleep (QoS) and psychological impairment. The aims were to analyze the prevalence of sleep disturbance, anxiety, and depression in OLPs and to validate the Pittsburgh Sleep Quality Index (PSQI) in OLPs., Methods: Three hundred keratotic OLPs (K-OLPs), 300 with predominant non-keratotic OLP (nK-OLPs), and 300 controls were recruited in 15 Italian universities. The PSQI, Epworth Sleepiness Scale (ESS), Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A), Numeric Rating Scale (NRS), and Total Pain Rating Index (T-PRI) were administered., Results: Oral lichen planus patients had statistically higher scores than the controls in the majority of the PSQI sub-items (p-values < 0.001**). Moreover, OLPs had higher scores in the HAM-D, HAM-A, NRS, and T-PRI (p-values < 0.001**). No differences in the PSQI sub-items' scores were found between the K-OLPs and nK-OLPs, although nK-OLPs suffered from higher levels of anxiety, depression, and pain (p-values: HAM-A, 0.007**, HAM-D, 0.009**, NRS, <0.001**, T-PRI, <0.001**). The female gender, anxiety, depression (p-value: 0.007**, 0.001**, 0.020*) and the intensity of pain, anxiety, and depression (p-value: 0.006**, <0.001**, 0.014*) were independent predictors of poor sleep (PSQI > 5) in K-OLPs and nK-OLPs, respectively. The PSQI's validation demonstrated good internal consistency and reliability of both the total and subscale of the PSQI., Conclusions: The OLPs reported an overall impaired QoS, which seemed to be an independent parameter according to the regression analysis. Hence, clinicians should assess QoS in OLPs and treat sleep disturbances in order to improve OLPs management., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The introduction of photodynamic therapy (PDT) in various branches of the dental field such as endodontics, implantology, periodontology, and restorative dentistry and oral medicine has become useful in recent decades. This systematic review presents an overview of the literature to evaluate the usefulness of topical PDT for the treatment of benign oral soft tissue lesions and to identify limitations in prior studies to improve PDT applications., Methods: We performed a review of the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library) employing MeSH terms such as "Photodynamic therapy" and "PDT" in conjunction with other terms. We utilized the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) method to define our study eligibility criteria., Results: Initial results were 1513. Finally, there were only 21 studies that met our selection criteria. We divided the 21 selected items into two groups: inflammatory diseases and infective diseases., Conclusions: Although topical PDT is an easy to perform and well-tolerated treatment and appears to be a valid method with promising results in the treatment of benign lesions of the oral cavity's soft tissues, further studies are needed to complete the current knowledge of this technique., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: During recent years, a new population of HIV and HCV co-infected subjects has emerged presenting particular oral problems. The aim of our study was to determine the prevalence of oral lesions in HIV+ subjects and HIV and HCV co-infected subjects, to assess whether co-infection is a risk factor for the presence of oral lesions., Methods: 200 HIV+ subjects were consecutively enrolled, divided into two groups: Group 1 (130 HIV+ subjects) and Group 2 (70 HIV-HCV co-infected subjects) and visited by two oral medicine specialists. Epidemiological, laboratory and clinical parameters were gathered to determine the possible risk factors for oral lesions., Results: 52 on 200 subjects (26%) presented oral lesions: in Group 1, 25 on 130 subjects (19.23%) presented oral lesions, whereas in Group 2, 27 on 70 subjects (38.57%) presented oral lesions. Multivariate analysis showed that the following variables are statistically associated with the presence of oral lesions: HIV-HCV co-infection (OR = 2.32; 95% CI = 1.01-5.33: P < 0.05) and the use of drugs for the treatment of systemic diseases not associated with HIV (OR = 4.34; 95% CI = 1.78-5.33: P = 0.005)., Conclusions: It is possible to assess, on the basis of our results, that co-infected patients are more prone than HIV mono-infected patients to develop oral lesions and thus should undergo strict oral medicine monitoring.

Hydroxyurea is one of the most successfully used therapies for sickle cell disease. Results of many clinical trials point to hydroxyurea administration for patients with frequent painful crises and acute chest syndrome. Priapism is one of the complications that could be prevented by hydroxyurea, but there are few reports demonstrating the results. Since November 1993, hydroxyurea has been used in our clinic for preventing priapism in patients with stuttering or major attacks who are still capable of achieving intercourse on demand. Five patients were enrolled in the study, and 4 cases benefited by this treatment. After the initial treatment for the acute attack, all five patients developed stuttering priapism. Hydroxyurea was then introduced at the initial dose of 10 mg/kg, and as the hydroxyurea dosage increased, the number or length of priapism episodes decreased. One to two months after the maximal dose (20-35 mg/kg) was introduced, the episodes disappeared. In two patients, we were forced to administer over 30 mg hydroxyurea/kg to abort the episodes, and, in another patient, 25 mg/kg was necessary. All patients present normal sexual activity. Hydroxyurea was discontinued in two patients, but stuttering priapism reappeared. Hydroxyurea was then re-introduced, and priapism disappeared. One patient, using 20 mg hydroxyurea/kg, had a 6-year remission of priapism after hydroxyurea administration; however, he experienced stuttering priapism, 1 month before a major attack, that progressed to impotence. During that month, he did not seek medical attention. In conclusion, the data here presented suggests that hydroxyurea may prevent priapism attacks in sickle cell disease, probably at higher doses than usually prescribed for painful crisis prevention., (Copyright 2004 Wiley-Liss, Inc.)