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In the healthcare environment, more and more people experience work-related stress. The Faculty of Medicine and Dentistry of Sapienza University of Rome, having observed the need to take care of healthcare professionals, has set itself the objective of providing useful tools such as additional and necessary personal protective equipment for healthcare professionals. Objective: To promote health through better management, skills, and the use of strategies and solutions to identify, decompress, and neutralize those responsible for work-related stress mechanisms in order to take care of those who care (CURARE CURANTES). Materials and Methods: A randomized controlled clinical trial was conducted. The participants were enrolled by three departments of the Department of Dental and Maxillofacial Sciences of Rome; in consideration of emotional involvement of health professionals who work there. A motivational program was offered. Results: There were 17 and 16 healthcare professionals in the intervention and control groups, respectively. Levels of the mental composite score (MCS) varied both in the pre–post phase of the intervention group (p = 0.002), and between the intervention group and control group in the post phase (p = 0.006). No significant differences were observed for the physical composite score (PCS). Similarly, there were no significant differences regarding the positivity scale (PS) and the two dimensions of work-related stress (job demand and decision latitude). Conclusion: This study demonstrates the efficacy of yoga training practiced directly in the workplace and wearing work clothes, entering the work context, not weighing further on the healthcare workload, and being a way to carry out physical activity even in those cases in which professionals do not have the time to do it in their free time.

(1) The evolution of techniques and materials used in dentistry has led to the introduction of a technique known as micro-infiltration, using ICON infiltrating resin. The purpose of this study was to evaluate whether the resin infiltrant can remain stable in the enamel color of human teeth over time or if it causes discoloration and review current knowledge on color stability based on the literature selected solely on studies performed on human teeth and to provide a perspective on the methods proposed by clinicians in the infiltration procedure; (2) Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement; (3) Results: Twelve studies were selected for this review. The study results suggest that the device content is sufficiently comprehensive. The reviewers expressed strong support for the device’s content for assessing the quality of reviews. The paper summarizes current reports regarding the color stability assessment of enamel treated by in- filtration resin confirmed in in vitro and in vivo studies; (4) Conclusions: Based on these considerations, the resin infiltration method can be recommended to improve the appearance of enamel lesions. The infiltrated lesions remained chromatically stable, showing no significant color changes in the long term.

Stress is a physiological response of the body to stressful life events but may not be when the individual is persistently exposed to the stress trigger, and it negatively affects certain physiological functions, thus triggering psychosomatic diseases. In literature, chronic stress and inadequate coping strategies are found to mediate the risk and development of periodontitis; mechanisms have therefore been proposed to explain the effects of stress on the periodontium. Since stress is a prevalent problem in modern life and given the importance of maintaining oral health, the present literature review aimed to estimate the association between stress and periodontal disease. The research question adopted is the following: “Are psychological stress and periodontal disease related?” The search was conducted in August 2022 and limited to articles in electronic databases from 2017 to 2022 in English, excluding reviews and literature reviews. From the electronic databases, a total of 532 articles were identified and became 306 after reviews and duplicates were removed. An additional bibliographic search was conducted through the same electronic databases, controlled terms and keywords including only systematic reviews, which were previously excluded. Through the bibliography cited in the systematic reviews, an additional 18 articles were identified, with a new total of 324. As a result of reading the title and abstract of these 324 articles, an additional 295 were excluded. Reading the full text of the remaining 29 studies, 2 articles were excluded due to non-adherence to the eligibility criteria. The remaining 27 results were included in our literature review. It has been suggested in the literature that adverse socioeconomic conditions elicit a stress response, which can trigger periodontal inflammation. Most of the 27 articles included in the study confirm and demonstrate a positive association between psychological stress and periodontal disease. Numerous studies have shown the mechanisms through which chronic stress negatively affects periodontal tissues. Therefore, in the light of the results obtained from this review, it is important that oral health professionals, also for general health purposes, consider stress factors among the risk factors of periodontal disease, its severity and decreased efficacy of treatments. It is therefore advisable to act preventively through the interception of chronic stress.

(1) Background: Traumatic dental injuries are frequent in children and young adults. The facial structures involved in dental trauma may include soft tissues of the face and mouth, bone and dental structures. Dental trauma often results in augmented dental anxiety. Phototherapy can improve stress and pain control thereby improving compliance in young patients with the necessary dental treatments, after dental trauma has occurred. (2) Methods: Phototherapy was performed to enable soft tissue healing. The Tailored Brushing Method (TBM), a personalized approach for at-home oral hygiene procedures, was also utilized, with the aim of improving biofilm control in traumatized patients. (3) Results: The approach hereafter presented made it possible to obtain subjective control of anxiety and pain documented on a visual analog scale (VAS) due to the innovative use of photo-biomodulation. In addition, for the first time, the TBM was adapted to the needs of a patient with facial trauma and illustrated. (4) Conclusions: Phototherapy and TBM were found to be effective in the combined treatment of soft tissue wounds and in the oral care of the traumatized patient.

The COVID-19 pandemic has had a deep impact on university education, necessitating an abrupt shift from face-to-face learning to distance learning (DL). This has created new challenges, especially for those courses in which practical activities and internships are integral parts of the education program. The aim of this study was to assess the impact of DL on the study progress of a population of pregraduate students of medicine, dentistry, and healthcare professions. The survey was administered through an anonymous questionnaire by sharing a Google Forms link. Demographic data and educational background information were collected to obtain a profile of the participants. Different aspects of DL were investigated, including availability of digital devices, quality of connection, and environmental conditions; other questions focused on the effects of DL on students’ progress and professional maturation. Measures of association were also calculated using the chi-squared test, Cramer V, and Somers D. Among the 372 who participated, the results showed that students had a positive attitude toward online classroom and that DL did not substantially affect their progress. Most of the associations were statistically significant, also highlighting the effect of the degree course on the responses. Some critical issues clearly emerged, however, including the lack of adequate devices and environmental conditions due to economic disparity, poor relationships, suspension of internship programs, and clinical training. The results suggest that DL cannot be considered as a substitute for classroom-based medical education outside an emergency context.

Objectives To compare 3 mouthwashes: 0.20% chlorhexidine (CHX) with Anti-Discoloration System (ADS), 0.20% CHX and 0.12% CHX with 0.05% cetylpyridinium chloride (CPC), in terms of reduction of plaque and gingival bleeding and side effects. Methods Mild gingivitis patients were randomly divided into three Groups: they underwent professional oral hygiene and received instructions: oral rinse with 10 mL for 1', twice a day, 30' after tooth brushing, for 14 days. Primary outcomes were plaque and gingival bleeding, assessed with Plaque Control Record and Gingival Bleeding Index. Feedback questionnaire and spectrophotometer evaluated secondary outcomes: adverse events. Timing of the study was T0 (baseline), T1 (professional oral hygiene) and T2 (14th day after mouthwash use). Results Sixty-six patients were recruited, two patients dropped out, and 64 patients completed the study. PCR T1-T2 mean variation was 30.67 (SD = 15.22; 95% CI 23.55 to 37.80; P = 0.000), 19.93 (SD = 11.03; 95% CI 14.90 to 24.95; P = 0.000) and 16.24 (SD = 15.35; 95% CI 9.60 to 22.88; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. GBI mean variation (T0-T2) was -9.82 (SD = 9.27; 95% CI -5.48 to 14.16; P = 0.000), -19.31 (SD = 11.33; 95% CI -14.15 to -24.47; P = 0.000) and -21.13 (SD = 12.56; 95% CI -15.70 to -26.56; P = 0.000) respectively in Groups 0.2% CHX + ADS, 0.2% CHX and 0.12% CHX + CPC. Statistical significance was found in lower efficacy of 0.2% CHX + ADS Group. Patients tolerated 0.12% CHX + CPC mouthwash better in bleeding perception (95.5%; P = 0.046), burning sensation (13.6%; P = 0.006), and mouthwash taste (100%; P = 0.000). Results on staining were no statistically significant (P = 0.106). Conclusions Addition of CPC allows reduction of CHX percentage in mouthwash formulation while keeping equal efficacy and less side effects. ADS addition decreases CHX efficacy in reducing plaque and bleeding, while resulting more tolerated than CHX.

Background Data from epidemiological studies investigating the prevalence and severity of malocclusions in children are of great relevance to public health programs aimed at orthodontic prevention. Previous epidemiological studies focused mainly on the adolescence age group and reported a prevalence of malocclusion with a high variability, going from 32% to 93%. Aim of our study was to assess the need for orthodontic treatment in a paediatric sample from Southern Italy in order to improve awareness among paediatricians about oral health preventive strategies in pediatric dentistry. Material and methods The study used the IOTN-DHC index to evaluate the need for orthodontic treatment for several malocclusions (overjet, reverse overjet, overbite, openbite, crossbite) in a sample of 579 children in the 2-9 years age range. Results The most frequently altered occlusal parameter was the overbite (prevalence: 24.5%), while the occlusal anomaly that most frequently presented a need for orthodontic treatment was the crossbite (8.8%). The overall prevalence of need for orthodontic treatment was of 19.3%, while 49% of the sample showed one or more altered occlusal parameters. No statistically significant difference was found between males and females. Conclusions Results from this study support the idea that the establishment of a malocclusion is a gradual process starting at an early age. Effective orthodontic prevention programs should therefore include preschool children being aware paediatricians of the importance of early first dental visit. Key words:Orthodontic treatment, malocclusion, oral health, pediatric dentistry.

Children with autism spectrum disorder (ASD) have significantly higher prevalence and caries severity compared to the average population. Knowledge about the oral health indices of children with this mental disorder is key to designing efficient plans of intervention. This paper reports the results of a study on the oral health status of children with ASD in central Italy. This is the first study of this type in Italy. The sample consists of 229 autistic children aged between 5 and 14 years, attending the Unit of Special Needs Policlinico Umberto I in Rome. Each patient received an intraoral examination to investigate decayed, missing, and filled teeth as well as periodontal status. Information on demographic attributes, dietary habits, medical history, and child&rsquo, s cooperativeness at the first visit was also recorded. Of the participants, 79.26% presented signs of gingivitis and about 90% of them had plaque. Caries prevalence was 66.38%. The average of the total number of decayed, missing, and filled teeth in the permanent and primary dentition was 2.91. Among the factors considered, only dietary habits and the periodontal indices showed statistically significant association with caries prevalence and caries severity. Despite the selection bias, that prevents us to interpret the results presented as epidemiological evidence, our study suggests that children with ASD in central Italy represent a population at risk.

The aim of the present study is to verify the knowledge of risks and complications of oral piercings, and to observe the main complications associated with piercings, using a sample from central Italy of patients wearing intraoral piercings. Through piercing and tattoo studios selected randomly in Rome, Latina and Campobasso, and a tattoo and piercing convention in Latina, a group of 387 individuals with oral piercings were selected and asked to complete an anonymous questionnaire. After filling in questionnaires, 70 individuals of the 387 selected agreed to be visited to allow the observation of the integrity of their teeth and gums (especially close to the oral piercing), oral hygiene conditions, piercing cleaning, bad habits and gingival recession. Among the respondents, 46.8% said they had not been informed about these risks, 48.5% claimed not to clean the piercing, 70.6% stated that they had not been made aware of gingival problems that can arise, 60.4% subjects stated that they were not informed about the complications of piercings concerning teeth, 52.8% had insufficient oral hygiene conditions, 42% showed signs of generalised gingivitis, 20% had 3&ndash, 4 mm recessions and 22% had tooth fracture(s) due to piercing. From this study, it emerged that oral piercings can represent a risk to oral health and that there is a widespread lack of awareness of the complications and correct methods of maintaining oral piercings. Periodic checks by both dentists and dental hygienists, for patients with oral piercings, could play a decisive role in preventing, intercepting and treating the complications that they can cause.

Background: Early diagnosis of occlusal caries is of paramount importance for a minimally invasive approach in dentistry. The aim of the present in vivo clinical prospective study was to compare the diagnostic outcomes of visual subjective evaluation between the International Caries Detection and Assessment System (ICDAS-II) and an intraoral fluorescence-based camera (VistaCam iX Proof, D&uuml, rr Dental, Bietigheim-Bissingen, Germany) for the detection of pits and fissures in early caries lesions of posterior teeth. Methods: The study included 1011 posterior teeth in 255 patients aged 13&ndash, 20 years (mean age 16 &plusmn, 2.2 years). Two blinded operators evaluated all the occlusal surfaces and the first assigned an ICDAS-II code, while the second assessed the VistaCam score: sound enamel (score 0&ndash, 1.2), initial enamel decay (score 1.2&ndash, 1.5), dentine caries (score 1.5&ndash, 3). Results: Some 283 (28%) of the assessed teeth were ICDAS-II code 0, 334 (33%) code 1, 189 (18.7%) code 2, 176 (17.4%) code 3, and 29 (2.9%) code 4. The level of agreement between the two procedures was expressed by using Cohen&rsquo, s and Fleiss&rsquo, kappa statistics and performing McNemar&rsquo, s test. VistaCam assessed in 513 (50.7%) sound enamel, in 292 (28.9%) initial enamel decay, and in 206 (20.4%) dentine caries. Conclusions: This comparative study showed a poor agreement between the two diagnostic methods, especially between ICDAS-II 0, 1 and 2 codes and fluorescence assessments.

Probabilistic caries risk assessment models (P-CRA), such as the Cariogram, are promising tools to planning treatments in order to control and prevent caries. The usefulness of these models for informing patients and medical decision-making depends on 2 properties known as discrimination and calibration. Current common assessment of P-CRA models, however, ignores calibration, and this can be misleading. The aim of this paper was to provide tools for a proper assessment of calibration of the P-CRA models and improve calibration when lacking. A combination of standard calibration tools (calibration plot, calibration in-the-large, and calibration slope) and 3 novel measures of calibration (the Calibration Index and 2 related metrics, E50 and E90) are proposed to evaluate if a P-CRA model is well calibrated. Moreover, an approach was proposed and validated using data from a previous follow-up study performed on children evaluated by means of a reduced Cariogram model; Platt scaling and isotonic regression were applied showing a lack of calibration. The use of the Cariogram overestimates the actual risk of new caries for forecast probabilities 0.6. Both Platt scaling and isotonic regression were able to significantly improve the calibration of the reduced Cariogram model, preserving its discrimination properties. The average specificity and sensitivity for both Platt scaling and isotonic regression using the cut-off point p= 0.5 were >83 and their sum well exceeded 160. The benefits of the proposed calibration methods are promising, but further research in this field is required.

Introduction: Severe Enamel Fluorosis is frequently found in young adolescents with aesthetic concerns. Colourimetric alterations could vary from diffuse opacities to demarcated brown and white areas. Material and methods: One young patient with a severe fluorosis was treated by a combined use of at-home bleaching and at-office resin infiltration. Results: In all the affected teeth, existing aesthetic enamel alterations, were successfully treated by the combined use of bleaching and Icon® resin application. Given the minimal substance loss due to the erosion infiltration procedure, the patient was extremely satisfied with the results. Conclusions: Our case report show the capability of treating severe fluorosis with bleaching and subsequent Icon® resin infiltration. Longer observation periods in studies with larger patients population are needed to validate the clinical significance found in this case report.

INTRODUCTION The association between the oral microbiome and periodontal diseases is still unclear. We performed a systematic review and meta-analysis to quantify the association between the specific pathogens and periodontitis. EVIDENCE ACQUISITION A computerized medical search was performed using MEDLINE and SCOPUS database between 1950 and May 2017 to identify all case-control studies that evaluated the association between specific pathogens and periodontitis. The pooled Odds Ratio with relative 95% confidence interval (95% CI) was calculated and plotted in the forest plot. EVIDENCE SYNTHESIS Eleven RCTs involving 2111 patients were included. The retrieved case-control studies evaluated the presence or absence of different targeted pathogens. Among the microrganisms evaluated Porphyromonas gengivalis (OR [95% CI] 2.93 [0.98,8.87]; P

Objectives An evaluation method is proposed to qualitatively and quantitatively evaluate the clinical outcome of the enamel hypomineralization treatment with infiltrative resin in young adolescents. The aesthetic outcome is assessed before and after treatment by visual evaluation using FDI-colour match criteria and by spectrophotometric analysis using the CIEDE2000 colour difference formula. The visual (subjective) results are compared with the spectrophotometric (objective) approach. Materials and methods 76 teeth of patients of Sapienza University (Rome, Italy) presenting early caries lesions and/or developmental defect of enamel on the labial surface of clinical crown were subjected to resin infiltration. Three observers evaluated the aesthetic appearance of the teeth before and after treatment using FDI-colour match criteria. The spectrophotometric colour difference between the affected and sound enamel in each tooth was calculated before and after resin infiltration. A correlation between FDI criteria and the calculated CIEDE2000 colour difference (ΔE00) was performed. Results Mean FDI scores and ΔE00, evaluated before and after treatment, were large in all sample. A clear correlation was detected between visual inspections and spectrophotometric colour difference of clinical outcomes. Conclusions On the basis of the present study results, the aesthetic outcome of resin infiltration proved to be highly effective, both with visual qualitative and spectrophotometric quantitative assessment. Clinical relevance statement Hypomineralized enamel colour abnormalities affect patients’ quality of life, therefore tissue preservative cosmetic treatments are requested. An evaluation method of resin infiltration clinical outcome by visual evaluation and spectrophotometry is proposed.

As regards to the most common oral disease in pediatric patients, intellectual disability is not a risk factor for caries disease itself, but it rather reduces the individual capability to self-care and therefore to his own oral care. Children suffering of systemic pathologies and/or with different stages of disability are to be considered at high risk for dental caries development. According to recent guidelines for oral health prevention in childhood, individual additional strategies for a preventive care should be applied for these patients. All the health providers, family and caregivers should be involved with the aim of being aware, motivated and informed on oral health issues, and a better access system to the dental care structure, both logistic, professional and economical should be assured.

Specific regulations about education and training for body piercing licensure courses have to be considered due to the great increase in oral piercing practices. The aim of the present survey was to assess the local and systemic risk awareness in the practice of oral piercing and their prevention in a sample of Italian piercers. An anonymous 20-item questionnaire was administered to 30 body licensed piercers in a small town of central Italy. Licenses certificates were issued by Lazio Region after the completion of an approved training program for standard body piercing including 90 hours of course and a final examination as provided by regional law. The questionnaire surveyed on oral cavity anatomy, local and systemic risks as result of oral piercing, piercing maintenance and need of a dental visit. Response rate was 66.6%. Only 20% of respondents was aware about oral cavity anatomy and none had knowledge about tongue and gums anatomy. Only 10% enlightened the need of a dental visit and 30% was aware about piercing-related temporary paralysis. The piercing maintenance was habitually proposed only by 40% of respondents. The study participants showed a low level of awareness regarding the potential health risks of oral piercing. Poor knowledge of anatomy and local and systemic risks and poor awareness of the importance of piercing maintenance explanation.

Background: The aim of the study was to focus the awareness of complications of oral piercing among a group of adolescents and young Italian adults with intraoral piercings. Material and Methods: A total of 225 teenagers were asked to complete a questionnaire on the awareness of complications of oral piercing. An additional questionnaire was administered in case of oral piercing worn, based on site piercing, knowledge about piercer license, oral and systemic risks due to oral piercing, disinfection and sterilization of the material pierced, information by the piercer about piercing hygiene maintenance and post-piercing dentist check-up. After questionnaire all partecipants received a brochure with some information about risks and maintenance mode of piercing. Results: Data revealed that more than 50% of teens surveyed was found to wear a piercing. Only 25.3% was aware of the risk of HCV cross-infection and only 17.3% reported of knowledge about risk of endocarditis. Only 17% checked the piercer license and only 18% sterilization and disinfection of the materials used. 53.7% did not received explanations about the risks associated with piercing. With regard to the maintenance mode of the piercing, it has been suggested to brush the piercing bar in 17% of cases. The post piercing specialist visits have been suggested only in 7% of cases. Conclusions: The general lack of awareness of complications and maintenance mode related to oral piercing needs to be addressed by some education programs performed at school and by dentists.

The problem of identifying potential determinants and predictors of dental caries is of key importance in caries research and it has received considerable attention in the scientific literature. From the methodological side, a broad range of statistical models is currently available to analyze dental caries indices (DMFT, dmfs, etc.). These models have been applied in several studies to investigate the impact of different risk factors on the cumulative severity of dental caries experience. However, in most of the cases (i) these studies focus on a very specific subset of risk factors; and (ii) in the statistical modeling only few candidate models are considered and model selection is at best only marginally addressed. As a result, our understanding of the robustness of the statistical inferences with respect to the choice of the model is very limited; the richness of the set of statistical models available for analysis in only marginally exploited; and inferences could be biased due the omission of potentially important confounding variables in the model's specification. In this paper we argue that these limitations can be overcome considering a general class of candidate models and carefully exploring the model space using standard model selection criteria and measures of global fit and predictive performance of the candidate models. Strengths and limitations of the proposed approach are illustrated with a real data set. In our illustration the model space contains more than 2.6 million models, which require inferences to be adjusted for ‘optimism'.

The purpose of the study Project was to test the effectiveness of a multimedia game designed in order to attract the attention of primary school children to oral health basic concepts and use the instrument to assess students’ knowledge. An originally designed multimedia game on oral health was administered in the computer class rooms, before (T0) and after (T1) an educational stage, to third (8-9 years) and fifth graders (10-11 years) of primary schools in urban and rural areas of two provinces of medium-small cities in Center Italy (Terni and Latina). Considered variables were: age, gender, school time schedule (only antemeridian, extended schedule). The statistical test used was the non-parametric Wilcox on signed-rank test. Response rate was 90.6% (due to absence on the due date). 1,300 students were involved. Overall, the average of the correct answers was 40.7% before oral health lessons and 59.2% after. An improving trend of correct answers was recorded from T0 to T1, significantly (p < 0.05) among: fifth graders (+ 17.5%), extended school time schedulers (+18.1%) and females (+18.9%). The results, however, show poor global oral health knowledge, being total percentage of correct answers below 60%. The results stress the importance of the school environment as access to health promotion for all socio-economic classes. The multimedia educational approach has proved a valuable and updated tool to attract the attention of digital native children.