1,721,021 research outputs found
Protocolli terapeutici nei pazienti affetti da patologie sistemiche o sindromi. Disturbo dello Spettro Autistico: un aggiornamento sulla gestione della salute orale in età pediatrica
No full textAutism spectrum disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech and nonverbal communication, as well as in restricted repetitive behaviour. It is more common in males than in females (with a ratio of 4:1) and is usually first diagnosed in early childhood (around 2-3-year-old) with many of the most-obvious symptoms. The effects of ASD and the severity of symptoms differ from person to person. While some people with ASD can live independently, others have severe disabilities and require life-long care and support.
ASD prevalence appears to be increasing globally over the past 50 years. There are many possible explanations for this increase, including better diagnostic tools, improved reporting, greater propensity for families to accept the pathology, greater presence in the territories of support structures and associations and changes in health policies.
A report of 2018 from the World Health Organization estimates that 1 in 160 children (i.e., 62.5/10,000) worldwide have one of the various forms of ASD and that ASDs begin in childhood and tend to persist during adolescence and adulthood
As far as Italy is concerned, prevalence estimates are based on surveys performed on patients attending the National Health System (NHS). The most recent estimates indicate prevalence of 23/10,000 for the Emilia-Romagna region in subjects aged up to 18 years (year 2016) and of 29/10,000 for the Piemonte region (year 2010). These estimates rise respectively to 80/10,000 and 42/10,000 if only children in primary school age (6-10 years) are considered. Another recent prevalence estimates for the province of Pisa in 2018 is as high as 1 in 87.
Despite the differences in the reported prevalence, all these studies clearly indicate that ASD is a pathology with a strong social impact and important public health implications. In this respect, oral health problems represent a key component. Normal daily activities a such as tooth brushing as well as understanding the behavior of other individuals, constitute a constant challenge for children affected by ASD. Due to these difficulties to maintain a good oral hygiene and to be periodically examined and eventually treated, children with ASD have significantly more untreated caries and a higher prevalence of periodontitis and gingivitis as well as higher values of DMFT/dmft and caries prevalence compared to the average population. In addition, dental care, for patients with such disorders, requires special procedures and adaptations. It has been proved, that some patients with moderate or slight intellectual disorders can be successfully treated through paying particular attention to the procedures even if they adapt slowly and with difficulty to them. Autistic children, if compared to other patients with psychiatric disorders, show a greater obstacle to deal with, which is anxiety. A dental surgery is full of potential frightful stimuli, due to the peculiar environment and equipment used. In these children, it is often more difficult to interpret, beforehand, the signs of fear and anxiety and thereby to prevent the loss of cooperation, but it is possible to carry out dental care when such anxiety signs are recognized and duly considered. Evidence-based psychosocial interventions, such as behavioral treatment and parent skills training programmers, can reduce difficulties in communication and social behavior, with a positive impact on well-being and quality of life for persons with ASD and their caregivers. These type of interventions, that require special training programs for the dentists operating with children affected by ASD, represent an important economic load for families and/or national public health systems.
The worsening of periodontal health due to scarce domestic hygiene and food habits for this population, already highlighted in some of the existing literature for similar populations, stresses the need for establishing specific preventive and intervention programs for children with ASD. One important aspect of such a program should include a collaboration between therapists/neuropsychiatrists and dentists and hygienists. This collaboration could have very beneficial effects in terms of improvement of dietary and horal hygiene habits of the children and would allow an early diagnosis and treatment of their oral health problems drastically reducing the need for general anesthesia.
It is hoped that, a surveillance system will be set up to better understand the need for treatment and the outpatient management enhancing existing approach to dental care of patients with ASD taking into account the communicative and behavioural difficulties that these patients present48
Awareness of complications and maintenance mode of oral piercing in a group of adolescents and young italian adults with intraoral piercing
Full text linkBackground: 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 com- plications 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 steri- lization 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% check
Dental erosion in patients with gastro-esophageal reflux (GERD)
No full textGastroesophageal reflux disease (GERD) occurs when gastric juice acidifies the mouth on a regular basis leading to a loss
of mineralised tooth tissue. Aim: To evaluate the risk of dental erosion in people with GERD and relate erosion to reported variables collected by questionnaire. Methods: A sample, composed of a group of patients over 18 years with GERD and an asymptomatic control group, was interviewed and examined for the evaluation of the Basic Erosive Wear Examination (BEWE),a questionnaire on symptoms of GERD and an interview for the determination of caries risk through Caries ManagementBy Risk Assessment (CaMBRA). The control group was patients presenting for the first dental visit at the Outpatient Department of the Policlinico Umberto I. Permission for the collection of data was obtained of the Director of the Department of Stomatology, Departments of Endoscopy and Surgery Hospital “Alfredo Fiorini” Terracina and Hospital “San Giovanni di Dio” of Fondi. Salivary pH was measured using litmus strip in a commercial kit. Results: 214 subjects of mean age 27 were equally divided by sex and age in the two experimental groups (control, n = 107 and GERD, n =107). A statistical correlation was shownfor the GERD group, level of risk of “severe” dental erosion (60% of those with GERD, 3% in the control group) and a diet rich in acidic foods and beverages. Acidic dietary habits with an average frequency of 3 times a day was present in the GERD group with a rate of 6%. A diet low in fatty foods was prevalent in the control group (63% in control vs 48% in the GERD).
The difference in salivary pH was highly significant for all variables. The GERD group has increased prevalence and severity of dental erosion. The pH of plaque and saliva were significantly correlated to dental erosion. The medical history and
salivary factors showed a correlation with the level of caries risk.
Conclusion:GERD emerges as a risk factor for dental erosion. Moreover it was noted that the GERD group has dietary habits that could increase acidity symptoms. It is therefore necessary to establish protocols for screening and counselling for prevention and management of dental erosion in patients
with GERD
Migrant oral care needs: public health service vs. charitable organization, Rome
No full textAim:To provide an accurate profile of cultural diversity in customs and needs for dental care among immigrants in Rome, Italy. Collecting data on immigrant populations and their health needs is crucial, in order to develop effective care delivery.
Methods: A questionnaire was used between September 2006 and March 2007, for out-patients, at their first visit to two primary
oral health care clinics (national public health service - NPHS and a charitable organisation - CO) in Rome. Socio economic
status (SES), access to general and oral health care and OHRQoL were assessed. Illegal immigrants were classified where
they did not have a personal identification card. Verbal consent of respondents was recorded. Permission of the Director of the
Department of Stomatology and Dental Clinic Caritas was given for the collection of data.
Results:The sample consisted of 250 subjects (144 Italian and 106 non-Italian). 100 out-patients of the CO and 150 of NPHS. Immigrants made up 81% of the CO sample and 16% in the NPHS sample (p<0.001). Overall, women represented 57% (N=144) of respondents. Patients attending the CO were significantly younger than those at the NPHS (p<0.001). The measures of SES showed significantly lower integration and more unemployment among CO patients, who also lacked information on access to care and more precarious employment, residential (10% homeless) and legal status. Almost all migrant patients had suffered from a dental problem
in the last year. Conclusion:Illegal immigrants prefer to access dental care provided by a voluntary organisation as it offers assistance, bypassing bureaucracy. Although access to health care by those who do not comply with the rules on residing in Italy should not require the presentation of documents or be reported to the authorities. Immigrants who use the NPHS are generally more integrated, and have been living in Italy for more than 5 years. Predictably, for immigrants, oral health is a low priority, and this should be regarded as a public health issue
Disabled patients and oral health in Rome, Italy: long-term evaluation of educational initiatives.
No full textThis study is concerned with the educational intervention layout proposed as a possible answer for the disparities in healthcare services for disabled persons. The data sampling was performed on individuals in Rome, affected by psychophysical disabilities, living in residential care facilities. Participants were randomly divided into two groups: Study and Control Group, consisting of patients who did or did not participate in the Educational Phase. All the caregivers participated in an educational course. Screening period: September 2008 - March 2009. Examinations were performed using Visible Plaque Index (VPI), Gingival Bleeding Index (GBI) and Microbiological Analysis. The total number of patients utilized for the study was 36 (18 in each group). The final sample amounted to 70% (14/20) in the Study Group and to 75% (15/20) in the Control Group. In both examined groups Oral Hygiene, Gingival Health State and Microbiological Analysis show an overall improvement of the indices, compared with the initial status, mostly at a follow-up after 4 weeks. However, Study Group show a significantly better improvement. Conversely, after 6 months the overall clinical indices worsened again. The difference in the significant improvements of the groups, even if only over a short-time evaluation, endorses that the participation of the patients as well as tutors in the educational phase is an effective strategy for the short-term
Oral health status and Oral Health-Related Quality of Life in Italian deinstitutionalized psychiatric patients
Full text linkThe aim of this study is to investigate the oral health status and Oral Health-Related Quality of Life (OHRQoL, measured with OHIP- 14) in psychiatric patients assisted by the unique Italian mental health care system, in accordance to regulatory Law 180/78.
MATERIALS AND METHODS:
Demographic and medical variables were retrieved from institutional medical records. General health and oral health variables, oral health-related behavior and last dental contact were recorded. Clinical evaluation was performed on each patient. For oral health data collection, a standardized medical form was used.
RESULTS:
The study involved an overall number of 67 patients. Primary diagnosis of mental illness was at mean age of 29 years. The average number of teeth per patient was 25.45 ±6,55. The overall mean value of caries experience was 9.1 decayed, missing and/or filled teeth (DMFT Index). Among affected patients (60%, n=33) the mean value of DMFT for all age groups was 11.3 (range 2-27). The present study highlighted a direct linear relationship between caries experience and OHRQoL. As the caries level increased, pain, functional and psychological discomfort scores increased.
DISCUSSION AND CONCLUSIONS:
The overall caries experience value of 9.1 DMFT was lower than that reported in existing literature, which is usually related to traditionally institutionalized psychiatric patients, and most important of all, data on access to dental care is fairly good. These results, although derived from a pilot study on a limited sample, suggest that, where a psychosocial rehabilitative program is set out for psychiatric patients, as in the case of the Italian experience, the program can also determine an improvement in oral health status. It is important that programs for oral health promotion are developed in collaboration with mental health services and social measures are patient-centered as an integral part of the individual's rehabilitation program
Awareness of risks related to oral piercing in Italian piercers. Pilot study in Lazio Region
Full text linkSpecific 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
Validation of the Italian version of the Oral Health Impact Profile-14 (IOHIP-14)
Full text linkThe original english version of Oral Health Impact Profile (IOHIP) was translated in Italian language, and then validated among a consecutive sample of patients attending in the dental ward at the Dental Institute of the “Sapienza”
University of Rome, Italy. Research design: The original english version of IOHIP-14 was translated into the Italian Language by a professional translator and subsequently
back-translated into English by an independent person and then validated. Participants: 852 person, 342 males (40.1%) and 510 females (59.9%) participated to this survey.
Results: The Cronbach’s alpha of the scale was 0.90. No correlation was negative and the correlation coefficients extended form 0.27 (the correlation between "pain" “irritable”) to 0.69 (the correlation between “totally unable to function” and “difficult to do jobs”). The coefficients ranged from 0.42 to 0.74 with no value above the drop-out value of 0.20 recommended for included an item in a 15 points scale. A highly significant relationship between the IOHIP scores and the perceived
oral health status was observed. The subjects who perceived their oral health status to be poor had a higher IOHIP score than those thought their oral health status was good or fair. Similarly there was a significant relationship between the IOHIP scores and the perceived need for dental care. Conclusions: The translated Italian version of
IOHIP-14 demonstrates an acceptable method to assess the impact of oral health on the quality of life, with evidence of reliability and validity, making it a promising instrument for assessing IOHIP in an adult population
A multimedia oral health promoting project in primary schools in central Italy
Full text linkThe 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
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