Clinical Effectiveness of Restorative Materials for the Restoration of Carious Primary Teeth: An Umbrella Review.

Since untreated dental caries remain a worldwide burden, this umbrella review aimed to assess the quality of evidence on the clinical effectiveness of different restorative materials for the treatment of carious primary teeth. A literature search in electronic bibliographic databases was performed to find systematic reviews with at least two-arm comparisons between restorative materials and a follow-up period ≥12 months. Reviews retrieved were screened; those eligible were selected, and the degree of overlap was calculated using the 'corrected covered area' (CCA). Data were extracted and the risk of bias was assessed using the ROBIS tool. Fourteen systematic reviews with a moderate overlap (6% CCA) were included. All materials studied performed similarly and were equally efficient for the restoration of carious primary teeth. Amalgam and resin composite had the lowest mean failure rate at 24 months while high-viscosity and metal-reinforced glass ionomer cements had the highest. At 36 months, high-viscosity glass ionomer cements showed the highest failure rate with compomer showing the lowest. Most reviews had an unclear risk of bias. Within the limitations of the review, all materials have acceptable mean failure rates and could be recommended for the restoration of carious primary teeth

Fluorescence-Based Methods for Detecting Caries Lesions: Systematic Review, Meta-Analysis and Sources of Heterogeneity

Background Fluorescence-based methods have been proposed to aid caries lesion detection. Summarizing and analysing findings of studies about fluorescence-based methods could clarify their real benefits. Objective We aimed to perform a comprehensive systematic review and meta-analysis to evaluate the accuracy of fluorescence-based methods in detecting caries lesions. Data Source Two independent reviewers searched PubMed, Embase and Scopus through June 2012 to identify papers/articles published. Other sources were checked to identify non-published literature. Study Eligibility Criteria, Participants and Diagnostic Methods The eligibility criteria were studies that: (1) have assessed the accuracy of fluorescence-based methods of detecting caries lesions on occlusal, approximal or smooth surfaces, in both primary or permanent human teeth, in the laboratory or clinical setting; (2) have used a reference standard; and (3) have reported sufficient data relating to the sample size and the accuracy of methods. Study Appraisal and Synthesis Methods A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated. Results Seventy five studies met the inclusion criteria from the 434 articles initially identified. The search of the grey or non-published literature did not identify any further studies. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias. Conclusions Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed

Masking-efficacy and caries arrestment after resin infiltration or fluoridation of initial caries lesions in adolescents during orthodontic treatment - a randomised controlled trial.

OBJECTIVES The aim of this randomised, controlled, split-mouth trial was to assess the masking results in initial caries lesions (ICL) that were either resin infiltrated or fluoridated during treatment with fixed orthodontic appliances. METHODS Adolescent patients (age range:12-18years) with fixed orthodontic appliances who had developed ICL [ICDAS 1 or 2 (International Caries Detection and Assessment System)] during orthodontic treatment were consecutively recruited and randomly assigned to either resin infiltration with up to 3 etching procedures (Group:Inf) or to 3-monthly application of a fluoride varnish (Group:FV). Both interventions were performed according to the manufacturer's recommendations. Primary and secondary outcomes (ΔE, ICDAS, DIAGNOdent) included the evaluation of the appearance of the ICL before (T0), 1 week after (T1) treatment and at the last appointment before debonding (T2). RESULTS Fifteen patients (8females, 7males) with 57ICL were included. Mean (SD) observation time at the last appointment before debonding was 0.5 (0.3) years. At T0 FV and Inf did not differ significantly in ΔE (median ΔE0,FV(25th/75th percentiles):11.6 (8.7/20.3): ΔE0,Inf:15.1 (11.4/19.5); pT0=0.135), ICDAS (pT0=0.920) and DD (pT0=0.367). At T1 and T2 ΔE values (pT1<0.001,pT2<0.001), ICDAS scores (pT1<0.001,pT2<0.001) and DIAGNOdent values (pT1=<0.001,pT2=<0.001) for Inf were significantly reduced whereas ΔE values (pT1=0.382,pT2=0.072) and ICDAS scores (pT1=0.268,pT2<0.001) for FV remained unchanged. CONCLUSIONS Resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances both immediately after application and at the last appointment before debonding. Furthermore, the visual appearance of fluoridated lesions was not as satisfactory as that of the infiltrated ones at both T1 and T2. CLINICAL SIGNIFICANCE Resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances both immediately after application and at the last appointment before debonding. Furthermore, the visual appearance of fluoridated lesions was not as satisfactory as that of the infiltrated ones immediately after first application as well as half a year after application. TRIAL REGISTRATION German Clinical Trials Register (DRKS-ID: DRKS00011797)

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document.

PURPOSE The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth. METHODS Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified. RESULTS There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates. CONCLUSION The management of deep carious lesions in primary teeth can be challenging and must consider the patient's compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option

Fluorescence devices for the detection of dental caries

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non‐invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence‐based devices. There are three categories of fluorescence‐based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay. OBJECTIVES: Our primary objectives were to estimate the diagnostic test accuracy of fluorescence‐based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a fluorescence‐based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity‐specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90). MAIN RESULTS: We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta‐analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta‐analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non‐generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta‐regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi(2) = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results. AUTHORS' CONCLUSIONS: There is considerable variation in the performance of these fluorescence‐based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence‐based devices appeared to outperform red fluorescence‐based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta‐analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies

Late effects of antineoplastic treatment on dental structures of childhood cancer survivors.

Tο ποσοστό 5ετούς επιβίωσης στα παιδιά με νεοπλασματική νόσο, σήμερα, ξεπερνά το 80% (Effinger et al. 2014, Landier et al. 2004), με το 60-90% να εμφανίζει απώτερες επιπλοκές σαν αποτέλεσμα της αντινεοπλασματικής θεραπείας (Oeffinger et al. 2006, Blaauwbroek et al. 2007). Στα παιδιά, επειδή είναι υπό ανάπτυξη οργανισμοί παρουσιάζονται ιδιαίτερες επιπλοκές στο κρανιοπροσωπικό σύμπλεγμα, συχνότερα στους σκληρούς και μαλακούς ιστούς, που εμφανίζονται άμεσα, και επηρεάζουν την ανάπτυξη και τη λειτουργία του κρανιοπροσωπικού συμπλέγματος (Effinger et al. 2014). Οι πιο συχνές κλινικές επιπλοκές που έχουν καταγραφεί στη βιβλιογραφία είναι ανωμαλίες στη διάπλαση της μύλης και της ρίζας των δοντιών (Effinger et al. 2014),στην διάπλαση των οστών και των στηρικτικών ιστών (Denys et al. 1998, Paulino et al. 2000) καθώς και στη λειτουργία της κροταφογναθικής διάρθρωσης (Gevorgyan et al. 2007) και των σιελογόνων αδένων (Dahllof 2008, Deasy et al. 2010). Η κλινική εικόνα των ανωμαλιών στην διάπλαση της μύλης των δοντιών ποικίλλει από απλές ατέλειες της αδαμαντίνης μέχρι ανωμαλίες του αριθμού, του σχήματος και του μεγέθους των δοντιών (Kaste et al. 2009, Gawade et al. 2014). Τα δόντια αυτά μπορεί επίσης να παρουσιάσουν μειωμένο μήκος ρίζας και μειωμένη οστική στήριξη (Duggal 2003). Αγενεσίες δοντιών, ασυμμετρία προσώπου, και δυσλειτουργία της κροταφογναθικής διάρθρωσης έχουν επίσης αναφερθεί (Goho 1993). Οι μέχρι σήμερα βιβλιογραφικές αναφορές σχετικά με τις απώτερες επιπτώσεις της αντινεοπλασματικής θεραπείας είναι περιορισμένες. Οι περισσότερες αφορούν την απλή καταγραφή των επιπτώσεων καθώς και των αντίστοιχων παραγόντων κινδύνου για την ανάπτυξη τους, χωρίς ιδιαίτερες συσχετίσεις με τα επιμέρους χαρακτηριστικά της εκάστοτε θεραπείας (Kaste et al. 2009, Effinger et al. 2014, Gawade et al. 2014). Η έλλειψη δεδομένων έγκειται στην δυσκολία συλλογής του δείγματος και στην αδυναμία προσδιορισμού των συγκεκριμένων χαρακτηριστικών της θεραπείας σε κάθε εξατομικευμένη περίπτωση. Γενικός στόχος της παρούσας μελέτης είναι η καταγραφή των απώτερων επιπτώσεων της αντινεοπλασματικής θεραπείας κατά την παιδική ηλικία στην διάπλαση των δοντιών σε παιδιά και εφήβους με μέσο χρόνο από το πέρας της θεραπείας τα 5 έτη. Επιμέρους στόχοι είναι: • η καταγραφή και αξιολόγηση της οδοντικής κατάστασης (στοματική υγεία και τερηδονική προσβολή) των επιβιωσάντων • η καταγραφή και αξιολόγηση ακτινογραφικά της επίδρασης στη διάπλαση της ρίζας των δοντιών • η αξιολόγηση της επίδρασης της θεραπείας στην λειτουργία των σιελογόνων αδένων με την αξιολόγηση της ροής και της ρυθμιστικής ικανότητας του σάλιου • η συσχέτιση των παραπάνω ευρημάτων με τα επιμέρους χαρακτηριστικά της θεραπείας (είδος και σχήμα θεραπείας και ηλικία κατά την έναρξη της) • ο προσδιορισμός των παραγόντων εκείνων που μπορούν να τροποποιήσουν την εμφάνιση και τον βαθμό των επιπτώσεων αυτών. • η συσχέτιση της αντικειμενικής υποσιαλεμίας και της υποκειμενικά προσδιοριζόμενης ξηροστομίας. Η έρευνα είναι μια μελέτη κοορτών αναδρομικού τύπου (retrospective cohort) παιδιών, εφήβων και νεαρών ενηλίκων που έχουν θεραπευθεί κατά την παιδική ηλικία για κάποιας μορφής κακοήθεια. Περιλαμβάνει ερωτηματολόγιο, κλινική και ακτινογραφική εξέταση και συλλογή σάλιου μετά από ενυπόγραφη συγκατάθεση των ασθενών και των γονέων τους. Το ερευνητικό πρωτόκολλο εγκρίθηκε από την Επιτροπή Έρευνας και Δεοντολογίας της Οδοντιατρικής Σχολής του Εθνικού και Καποδιστριακού Πανεπιστημίου Αθηνών (Ν363, ημ. Εγκρ. 22/6/2018). Το δείγμα αποτέλεσαν 70 παιδιά και έφηβοι ηλικίας 4-21 ετών, που είχαν υποβληθεί σε αντινεοπλασματική θεραπεία από ηλικία 0-10 ετών και είχαν ολοκληρώσει τη θεραπεία τους τουλάχιστον 1 χρόνο πριν την ημέρα της εξέτασης. Το δείγμα αντλήθηκε από τους ασθενείς της Ογκολογικής Αιματολογικής Μονάδας της Α΄ Παιδιατρική Κλινική του Εθνικού και Καποδιστριακού Πανεπιστημίου Αθηνών. Η συλλογή δεδομένων, αρχικά, περιελάμβανε καταγραφή του ιστορικού της νεοπλασματικής νόσου και το είδος θεραπείας στην οποία είχαν υποβληθεί οι συμμετέχοντες. Ακολούθησε οδοντιατρική κλινική εξέταση, στην οποία καταγράφηκαν: η στοματική υγιεινή (OHI-s, Greene &amp; Vermillion 1964), η περιοδοντική κατάσταση (CPI, WHO 1977), η οδοντική τερηδόνα (ICDAS, WHO 1977), οι ανωμαλίες στην αδαμαντίνη (DDE, Oliveira et al. 2006), η σύγκλειση και οι ορθοδοντικές ανάγκες (IOTN, Brook &amp; Shaw 1989). Στη συνέχεια πραγματοποιήθηκε ακτινογραφική εξέταση για την αξιολόγηση της διάπλασης των δοντιών και της ανάπτυξής τους (Hölttä 2002) με πανοραμικές ακτινογραφίες. Η συλλογή δεδομένων ολοκληρώθηκε με τη λήψη δείγματος σάλιου για την μέτρηση της ροής διέγερσης και της ρυθμιστικής ικανότητας του. Η στατιστική ανάλυση των δεδομένων έγινε με την χρήση του στατιστικού πακέτου SPSS (ν 17.0) και το επίπεδο στατιστικής σημαντικότητας ορίστηκε στο ρ &lt;0.05. Το πρώτο μέρος αφορούσε περιγραφικές στατιστικές, όπου σε πίνακες συχνοτήτων παρουσιάζονται: τα δημογραφικά χαρακτηριστικά του δείγματος, η οδοντική κατάσταση των επιβιωσάντων και ο επιπολασμός των απώτερων επιπτώσεων της αντινεοπλασματικής θεραπείας (ποσοστά, μέσος όρος, διακυμάνσεις, τυπικά σφάλματα) τόσο στην μύλη όσο και στην ρίζα των δοντιών. Ακολούθησε σύγκριση με τις αντίστοιχες τιμές σε υγιή παιδία στον γενικό πληθυσμό με τους ίδιους δείκτες για τις αντίστοιχες ηλικίες και φύλο. Χρησιμοποιήθηκε το χ2 για τον έλεγχο των συσχετίσεων των επιπτώσεων με τα επιμέρους χαρακτηριστικά του δείγματος, της νόσου και της θεραπείας της και οι οποίες δόθηκαν σε πίνακες διπλής εισόδου. Αναφορικά με την επίδραση της θεραπείας στους σιελογόνους αδένες έγινε μονοπαραγοντική ανάλυση για την συσχέτιση των εξαρτημένων μεταβλητών (ροή σάλιου και ρυθμιστική ικανότητα) με τις ανεξάρτητες μεταβλητές (χαρακτηριστικά νόσου και θεραπείας). Πραγματοποιήθηκε περεταίρω διερεύνηση στατιστικά σημαντικών συσχετίσεων μέσω πολυπαραγοντικής παλινδρόμησης για τον προσδιορισμό πιθανών παραγόντων κινδύνου για την εμφάνιση σοβαρών επιπτώσεων. Τέλος, το McNemar exact test χρησιμοποιήθηκε για την αξιολόγηση της συσχέτισης της αντικειμενικής υποσιελεμίας και της υποκειμενικά προσδιοριζόμενης ξηροστομίας. Από τους 70 επιβιώσαντες που συμμετείχαν στην μελέτη 32 ήταν αγόρια και 38 κορίτσια, με μέσο όρο ηλικίας κατά την εξέταση τα 11.2 έτη. Οι περισσότεροι συμμετέχοντες είχαν διαγνωσθεί με λευχαιμία και ο μέσος όρος ηλικίας κατά την διάγνωση ήταν 4.17 έτη. Το 71% είχε υποβληθεί μόνο σε χημειοθεραπεία και ο μέσος χρόνος από την ολοκλήρωση της θεραπείας μέχρι και την ημέρα της εξέτασης ήταν 5.48 χρόνια. Οι περισσότεροι συμμετέχοντες είχαν μικτή οδοντοφυΐα, η στοματική υγιεινή τους ήταν μέτρια, και είχαν τρυγία με βάση τον αντίστοιχο περιοδοντικό δείκτη. Η μέση τιμή του δείκτη τερηδόνας ήταν 1.65 για τα μόνιμα δόντια και 1.26 για τα νεογιλά. Η ηλικιακή κατανομή του δείκτη στοματικής υγιεινής ήταν ίδια με την αντίστοιχη του γενικού πληθυσμού της χώρας, ενώ τα άτομα των μικρότερων ηλικιακών ομάδων είχαν καλύτερη περιοδοντική κατάσταση. Αναφορικά με την κατανομή της τερηδόνας τα αποτελέσματα έδειξαν ότι στις μικρότερες ηλικιακές ομάδες ο αριθμός των τερηδονισμένων δοντιών ήταν μεγαλύτερος, ενώ στις μεγαλύτερες ηλικιακές ομάδες αυξανόταν αντίστοιχα ο αριθμός των εμφραγμένων δοντιών. Από τους επιβιώσαντες 59% παρουσίασαν βλάβες στην μύλη των δοντιών τους, με την υποπλασία να είναι η επίπτωση με τον μεγαλύτερο επιπολασμό. Ακολούθησε η μικροδοντία ενώ όλες οι υπόλοιπες επιπτώσεις παρουσιάζονταν σε ποσοστά ≤10%. Στην ηλικιακή κατανομή των βλαβών που καταγράφησαν κλινικά ήταν χαρακτηριστικό ότι στις μικρότερες ηλικίες το ποσοστό των τερηδονικών βλαβών ήταν αυξημένο ενώ αντίθετα στις μεγαλύτερες ηλικιακές ομάδες αυξάνονταν ο επιπολασμός των βλαβών της μύλης. Υψηλή συχνότητα εμφάνισης βλαβών της μύλης σχετίζεται με τους παρακάτω παράγοντες: μεγαλύτερη ηλικία κατά την εξέταση, συνδυαστικά θεραπευτικά σχήματα, υψηλές δόσης ακτινοβολίας (&gt;50Gy) και υψηλές δόσεις κυκλοφωσφαμίδης. Τα ακτινογραφικά ευρήματα ήταν πιο συχνά με τις βλάβες στη ρίζα να παρουσιάζονται στο 62% των ασθενών. Η πιο κοινή βλάβη με ποσοστό 57% ήταν η ατελής διάπλαση της ρίζας και ακολουθούσαν οι ενωμένες κωνικές ρίζες (44%). Διακοπή της διάπλασης της ρίζας, μικροδοντία και στενές ρίζες καταγράφηκαν σε στο 1/3 των συμμετεχόντων. Οι αντίστοιχοι παράγοντες που αυξάνουν τον κίνδυνο εμφάνισης βλαβών στη μύλη ήταν η μεγαλύτερη ηλικία κατά την εξέταση, το μεγαλύτερο χρονικό διάστημα από το πέρας της θεραπείας, υψηλές δόσεις κυκλοφωσφαμίδης και η χρήση στεροειδών φαρμάκων. Τα αποτελέσματα επίσης κατέγραψαν μειωμένη διάνοιξη του στόματος στην συντριπτική πλειοψηφία των επιβιωσάντων συγκριτικά με το μέσο όρο μέγιστης διάνοιξης που υπάρχει στις καμπύλες ανάπτυξης για τα παιδιά (50η εκατοστιαία καμπύλη). Οι αποκλίσεις που καταγράφηκαν στα δύο φύλα και στις διαφορετικές ηλικιακές ομάδες ήταν στατιστικά σημαντικές, υπογραμμίζοντας μια τάση για μειωμένη διάνοιξη στους επιβιώσαντες. Αναφορικά με την ροή διέγερσης του σάλιου και την ρυθμιστική του ικανότητα, βρέθηκε ότι 46% των συμμετεχόντων είχαν φυσιολογική ροή και μόνο 5% πολύ χαμηλή. Αντίστοιχα, 71% είχαν υψηλή ρυθμιστική ικανότητα και μόνο 4% χαμηλή. Η πολυπαραγοντική ανάλυση έδειξε ότι ο χρόνος από το πέρας της αντινεοπλασματικής θεραπείας ήταν ο μόνος παράγοντας κινδύνου της μεταβολής των ποιοτικών και ποσοτικών χαρακτηριστικών του σάλιου. Σχεδόν οι μισοί από τους επιβιώσαντες ανέφεραν ότι δεν αισθάνονται κανένα από τα συμπτώματα του δείκτη ξηροστομίας, υπογραμμίζοντας ότι δεν υπάρχει στατιστικά σημαντική συσχέτιση μεταξύ αντικειμενικής και υποκειμενικής αντίληψης. Η μέση οδοντική ηλικία των ασθενών υπερεκτιμήθηκε σχεδόν κατά 4 μήνες συγκριτικά με την αντίστοιχη πραγματική ηλικία τους. Η κατανομή της εκτιμώμενης διαφοράς ήταν ευρεία και κυμαινόταν από μια υποεκτίμηση της οδοντικής ηλικίας κατά 4.03 χρόνια μέχρι μια υπερεκτίμηση κατά 2.54 χρόνια. Στο 62% των ασθενών καταγράφηκε τουλάχιστον μια βλάβη. Ο μέσος όρος του δείκτη βαρύτητας των βλαβών ήταν 17.46, με το 28% των επιβιωσάντων να παρουσιάζουν σοβαρές βλάβες. Η πολυπαραγοντική ανάλυση έδειξε ότι ασθενείς που έχουν διαγνωσθεί με λευχαιμία, ασθενείς που έχουν υποβληθεί σε συνδυασμό αντινεοπλασματικών πρωτοκόλλων, ασθενείς στους οποίου έχει χορηγηθεί κυκλοφωσφαμίδη και στεροειδή, και ασθενείς που έχουν ολοκληρώσει την θεραπεία περισσότερα χρόνια έχουν μεγαλύτερη πιθανότητα να εμφανίσουν σοβαρές βλάβες στα δόντια. Συμπερασματικά το ποσοστό των ασθενών που παρουσιάζει βλάβες στα δόντια ως αποτέλεσμα της νόσου και της θεραπείας της είναι μεγάλο. Είναι εμφανές ότι οι βλάβες της ρίζας συναντώνται συχνότερα και είναι και η επίδραση τους είναι σημαντική στην μακροβιότητα των δοντιών που έχουν επηρεασθεί. Είναι ξεκάθαρο ότι οι βλάβες εμφανίζονται στα δόντια τα οποία είναι υπό ανάπτυξη την περίοδο της θεραπείας με τη βαρύτητα της επίδρασης να επηρεάζεται από παράγοντες που σχετίζονται με την νόσο και την θεραπεία της. Παρόλα αυτά τα μέχρι σήμερα δεδομένα δεν επιτρέπουν την διεξαγωγή συμπερασμάτων αναφορικά με την επιμέρους δράση του κάθε αντινεοπλασματικού φαρμάκου στα υπό ανάπτυξη κύτταρα και η επίδραση της συνδυαστικής δράσης των θεραπευτικών σχημάτων υπερτερεί έναντι της μονοθεραπείας. Θα λέγαμε λοιπόν ότι ο ρόλος του οδοντιάτρου σε αυτή την ειδική ομάδα ασθενών, είναι σημαντικός τόσο για την έγκαιρη και έγκυρη διάγνωση πιθανών βλαβών όσο και για την σωστή επίλυση προβλημάτων που προκύπτουν και την ενημέρωση και καθοδήγηση των ασθενών. Θα πρέπει λοιπόν να είναι αναπόσπαστο κομμάτι της ογκολογικής ομάδας με απώτερο σκοπό την βελτιστοποίηση της καθημερινότητας των παιδιών αυτών.Early diagnosis and contemporary advanced cancer treatment modalities have increased the 5year survival rate of childhood cancer survivors. This increase is associated with a linear increase in the percentage of children (60-90%) that present with at least one late effect of the antineoplastic treatment (Oeffinger et al. 2006, Blaauwbroek et al. 2007). The effects on the teeth and the craniofacial complex are common, develop early and can interfere directly and indirectly with cranio-facial growth, and child&apos;s dental development (Effinger et al. 2014). The most common dental effects that have been reported in the literature are increased caries experience, developmental defects of the size, shape and mineralization of the crown of the teeth (hypodontia, hypoplasia, microdontia), tooth agenesis, impaired or arrested root growth, bony defects (facial asymmetry, TMJ problems) and xerostomia (Dahllof 2008, Effinger et al. 2014, Gawade et al. 2014). The development and the extend of these defects depends on factors associated with both the disease and its treatment. Associated risk factors are age at diagnosis, type and duration of treatment, absorbed dose of therapeutic agents and the developmental stage of the tooth (Scully &amp; Epstein 1996, Cheng et al. 2000). Up to date, the available data on the literature are limited and report only the dental late effects without any association between specific characteristics of the treatment and the extend of the effects (Effinger et al. 2014, Gawade et al. 2014). Very few are also the reports that offer clear guidelines for screening of these patients with appropriate indices for the long term monitoring of the progression of the defects as well as the development of the craniofacial complex. Early diagnosis in association with appropriate knowledge of the defects and their evolution is necessary for effective treatment planning and counseling of the patient and their carer in order to improve their quality of life. The study aimed to record the dental late effects of antineoplastic treatment in children treated for any type of malignancy early in life. The main objective was to record the crown and root defects in childhood cancer survivors over a 5-year post-treatment follow-up period. Further objectives were: a) to record and assess the oral health status of childhood cancer survivors b) to record and assess their caries experience c) to associate the above findings with disease and treatment specific characteristics in order to identify possible risk factors that can alter the development and the severity of the incidence of the defects. d) to assess the late nature of the effect of antineoplastic treatment on major salivary glands through estimation of salivary flow rate and buffer capacity of childhood cancer survivors. e) to associate salivary flow rate and buffer capacity with specific treatment and patient characteristics. to associate subjective xerostomia, through a patient-reported xerostomia inventory, with clinically measured hyposalivation. The present study is a retrospective cohort report of clinical and radiographic findings in children and adolescents diagnosed with any type of malignancy and treated with various protocols early in life. The sample derived from the Division of Pediatric Hematology-Oncology, First Department of Pediatrics (Medical School, National and Kapodistrian University of Athens). The research protocol was submitted and approved by the Ethics Committee of the School of Dentistry National and Kapodistrian University of Athens (N363, approved on 22/6/2018). All eligible patients who accepted to participate were thoroughly informed of the nature, potential risks and benefits of their participation and were asked (them or their legal guardians) to sign a written informed consent. The sample consisted of 70 children and adolescents, with a history of malignancy, being in remission after antineoplastic treatment. Specific inclusion criteria were children and adolescent cancer survivors, aged 4-21 years old, with a history of malignancy presenting early in life, that have been treated with various protocols between ages 0-10 years and have completed antineoplastic treatment for at least 1year at the day of the examination. Data were recorded in three different parts. In the first part, patients’ demographics and specific characteristics regarding disease and its treatment were collected by reviewing of medical records. In the second part, data regarding patients&apos; dental history, oral hygiene and dietary habits were collected. A structured questionnaire in the form of an interview was completed by the patients or their legal guardians in cases of younger patients. The third part involved thorough clinical and radiographic examination. Clinical examination evaluated oral hygiene (OHI-s), periodontal status (CPI), caries experience at the cavitation level (DMFT using ICDAS rating), crown defects, dental occlusion and orthodontic treatment needed (IOTN). Radiographic examination included evaluation of changes in crown size (microdontia, macrodontia); tooth number (agenesis); root shape (tapered roots, blunted roots, thinning of the roots, taurodontia) and root development (impaired and arrested root growth). Finally, saliva sample was collected and stimulated salivary flow rate and salivary buffer capacity were measured. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS v. 17.0) and statistical significance was set at p &lt; 0.05. Initially, patients’ demographics and data regarding disease and treatment protocols were presented using frequency tables. Data regarding clinical findings were also presented using frequency tables followed by the incidence of each crown defects. Data analysis through chi-square and Kruskal-Wallis tests was used to associate the defects with disease and treatment-specific characteristics. Salivary variables were presented using charts and frequency tables. Univariate ordinal logistic regression analysis was performed to associate the dependent variables (salivary flow rate and buffer capacity) with the continuous independent variables (disease and treatment characteristics). Comparisons were also performed, to explore significant differences in gender, age at examination, caries status, radiation dose and site, and administration of different chemotherapeutic agents. Multivariate ordinal logistic regression analysis with backward elimination of nonsignificant predictors (deletion criterion p&gt;0.05) was also performed to identify possible risk factors for the development of deviations in physiological salivary flow rate and buffer capacity of childhood cancer survivors. Regarding radiographic findings the cumulative incidence of each late dental defect was calculated. Data analysis through chi-square and Kruskal-Wallis tests was used to associate the defects with disease and treatment-specific characteristics. Univariate analysis was tested by chi-square test and Kruskal-Wallis to associate the defects with disease and treatment-specific characteristics. Statistically significant associations revealed the factors that increased the risk for the development of late dental defects. Multivariate regression analysis was used to record the association of severely abnormal disturbances and possible risk factors. Of the 70 survivors who participated in the study, 32 were boys and 38 girls, with an average age at 11.2 years. Most participants were diagnosed with leukemia and the average age at diagnosis was 4.17 years. 71% had only undergone chemotherapy and the average time from completion of treatment to the day of examination was 5.48 years. Most participants were in mixed dentition, their oral hygiene was moderate, and they had calculus based on the corresponding periodontal index. The average value of the caries index was 1.65 for permanent teeth and 1.26 for primary teeth. The age distribution of the oral hygiene index was the same as that of the general population of the country, while people in the younger age groups had a better periodontal status. With regard to caries distribution, the results showed that in the younger age groups the number of decayed tooth was higher, while in the older age groups the number of filled teeth increased accordingly. 59% of the survivors experienced crown defects, with hypoplasia being the defect most frequently seen. Microdontia followed, while all other defects presented in ≤10%. In the age distribution of clinically recorded lesions it was characteristic that at younger ages the rate of caries was increased while in the older age groups the prevalence of crown lesions increased. High incidence of crown lesions is associated with the following factors: older age at examination, combination treatment protocols, high radiation dose (&gt;50Gy) and high doses of administered cyclophosphamide. Radiographic findings were more common with root defects presented in 62% of patients. The most common lesion with 57% was the incomplete root growth followed by the fused conical roots (44%). Arrested root growth, microdontia and narrow roots were recorded in 1/3 of the participants. Corresponding factors that increase the risk of developing lesions in the root were: older age at the examination, longer post-treatment periods, high doses of cyclophosphamide and administration of steroid drugs. The results also recorded reduced mouth opening in the vast majority of survivors compared to the average maximum opening in the growth curves for children (50th percentile). The deviations recorded in both sexes and different age groups were statistically significant, underlining a trend towards reduced opening in survivors. Regard stimulated salivary flow rate and its buffer capacity, it was found that 46% of participants had normal flow rate with only 5% very low. Similarly, 71% had high buffer capacity and only 4% low. Multivariate analysis showed that time since the end of antineoplastic treatment was the only risk factor for changing the qualitative and quantitative characteristics of saliva. Almost half of the survivors reported not feeling any of the symptoms of the dry mouth index, pointing out that there is no statistically sig

Chlorhexidine Mouthwash for Gingivitis Control in Orthodontic Patients: A Systematic Review and Meta-Analysis.

PURPOSE To summarise the available data on the effects of chlorhexidine (CHX) mouthwash in treating gingivitis during treatment with fixed orthodontic appliances. MATERIALS AND METHODS Multiple electronic databases were searched up to December 7th, 2021. Only randomised controlled trials (RCTs) were eligible for inclusion. The quality of the included RCTs was assessed with the Cochrane risk of bias tool for randomised trials (RoB 2.0). After data extraction and risk of bias assessment, differences were recorded in several oral hygiene indices in time and mean percentage change in those indices using different antimicrobial solutions. RESULTS Fourteen studies were deemed eligible for inclusion, reporting on a total of 602 patients with an age range of 11-35 years. The experimental solution was a 0.06%, 0.12%, or 0.2% CHX mouthwash with the control either a placebo mouthwash or a selection from a variety of mouthwashes. Treatment duration varied from 1 day to almost 5 months and the follow-up period varied from 1 min to 5 months. Chlorhexidine mouthrinses led to reduced plaque accumulation and gingival inflammation during orthodontic treatment, while at the same time, some of the control group mouthrinses were deemed equally effective. No statistically significant difference was detected in the meta-analysis between CHX and mouthwashes with propolis/probiotics/herbs in terms of the gingival index at 3 to 4 weeks (mean difference 0.07, 95% CI: -0.18, 0.31, p = 0.59). CONCLUSION Chlorhexidine mouthwash in orthodontic patients successfully controls gingival inflammation and bleeding when compared to untreated controls, but is equally effective as other mouthrinses where various oral health indices are concerned

A systematic review on the effectiveness of organic unprocessed products in controlling gingivitis in patients undergoing orthodontic treatment with fixed appliances.

OBJECTIVES The aim of this systematic review is to summarize the available data on the effects of organic unprocessed products in treating gingivitis during treatment with fixed orthodontic appliances. MATERIALS AND METHODS Multiple electronic databases were searched up to October 1, 2020. Randomized controlled trials (RCTs), controlled clinical trials, cohort studies of prospective and retrospective design, and cross-sectional studies reporting on natural products for controlling gingivitis in orthodontic patients were eligible for inclusion. The quality of the included RCTs was assessed per the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). RESULTS Three RCTs were finally eligible for inclusion, yielding a total of 135 patients with an age range of 12-40 years. Organic products used were Aloe vera mouth rinse, ingestion of honey and chamomile mouthwash. Treatment follow-up period varied from 30 min to 15 days. The results indicated that the use of the aforementioned organic products significantly reduced plaque and gingival bleeding levels as early as treatment started. The reduction in biofilm accumulation and gingival bleeding was significant throughout the studies' follow-up. CONCLUSIONS Owing to their antimicrobial and anti-inflammatory properties, nonpharmacological formulations successfully controlled gingival inflammation and plaque indices in orthodontic patients

Απώτερες επιπλοκές της κατά την παιδική ηλικία νεοπλασματικής θεραπείας στα δόντια και στο κρανιοπροσωπικό σύμπλεγα

Early diagnosis and contemporary advanced cancer treatment modalities have increased the 5year survival rate of childhood cancer survivors. This increase is associated with a linear increase in the percentage of children (60-90%) that present with at least one late effect of the antineoplastic treatment (Oeffinger et al. 2006, Blaauwbroek et al. 2007). The effects on the teeth and the craniofacial complex are common, develop early and can interfere directly and indirectly with cranio-facial growth, and child's dental development (Effinger et al. 2014).The most common dental effects that have been reported in the literature are increased caries experience, developmental defects of the size, shape and mineralization of the crown of the teeth (hypodontia, hypoplasia, microdontia), tooth agenesis, impaired or arrested root growth, bony defects (facial asymmetry, TMJ problems) and xerostomia (Dahllof 2008, Effinger et al. 2014, Gawade et al. 2014). The development and the extend of these defects depends on factors associated with both the disease and its treatment. Associated risk factors are age at diagnosis, type and duration of treatment, absorbed dose of therapeutic agents and the developmental stage of the tooth (Scully & Epstein 1996, Cheng et al. 2000).Up to date, the available data on the literature are limited and report only the dental late effects without any association between specific characteristics of the treatment and the extend of the effects (Effinger et al. 2014, Gawade et al. 2014). Very few are also the reports that offer clear guidelines for screening of these patients with appropriate indices for the long term monitoring of the progression of the defects as well as the development of the craniofacial complex. Early diagnosis in association with appropriate knowledge of the defects and their evolution is necessary for effective treatment planning and counseling of the patient and their carer in order to improve their quality of life. The study aimed to record the dental late effects of antineoplastic treatment in children treated for any type of malignancy early in life. The main objective was to record the crown and root defects in childhood cancer survivors over a 5-year post-treatment follow-up period. Further objectives were: a) to record and assess the oral health status of childhood cancer survivors b) to record and assess their caries experience c) to associate the above findings with disease and treatment specific characteristics in order to identify possible risk factors that can alter the development and the severity of the incidence of the defects. d) to assess the late nature of the effect of antineoplastic treatment on major salivary glands through estimation of salivary flow rate and buffer capacity of childhood cancer survivors. e) to associate salivary flow rate and buffer capacity with specific treatment and patient characteristics. to associate subjective xerostomia, through a patient-reported xerostomia inventory, with clinically measured hyposalivation. The present study is a retrospective cohort report of clinical and radiographic findings in children and adolescents diagnosed with any type of malignancy and treated with various protocols early in life. The sample derived from the Division of Pediatric Hematology-Oncology, First Department of Pediatrics (Medical School, National and Kapodistrian University of Athens). The research protocol was submitted and approved by the Ethics Committee of the School of Dentistry National and Kapodistrian University of Athens (N363, approved on 22/6/2018). All eligible patients who accepted to participate were thoroughly informed of the nature, potential risks and benefits of their participation and were asked (them or their legal guardians) to sign a written informed consent. The sample consisted of 70 children and adolescents, with a history of malignancy, being in remission after antineoplastic treatment. Specific inclusion criteria were children and adolescent cancer survivors, aged 4-21 years old, with a history of malignancy presenting early in life, that have been treated with various protocols between ages 0-10 years and have completed antineoplastic treatment for at least 1year at the day of the examination. Data were recorded in three different parts. In the first part, patients’ demographics and specific characteristics regarding disease and its treatment were collected by reviewing of medical records. In the second part, data regarding patients' dental history, oral hygiene and dietary habits were collected. A structured questionnaire in the form of an interview was completed by the patients or their legal guardians in cases of younger patients. The third part involved thorough clinical and radiographic examination. Clinical examination evaluated oral hygiene (OHI-s), periodontal status (CPI), caries experience at the cavitation level (DMFT using ICDAS rating), crown defects, dental occlusion and orthodontic treatment needed (IOTN). Radiographic examination included evaluation of changes in crown size (microdontia, macrodontia); tooth number (agenesis); root shape (tapered roots, blunted roots, thinning of the roots, taurodontia) and root development (impaired and arrested root growth). Finally, saliva sample was collected and stimulated salivary flow rate and salivary buffer capacity were measured. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS v. 17.0) and statistical signicance was set at p 0.05) was also performed to identify possible risk factors for the development of deviations in physiological salivary flow rate and buffer capacity of childhood cancer survivors. Regarding radiographic findings the cumulative incidence of each late dental defect was calculated. Data analysis through chi-square and Kruskal-Wallis tests was used to associate the defects with disease and treatment-specific characteristics. Univariate analysis was tested by chi-square test and Kruskal-Wallis to associate the defects with disease and treatment-specific characteristics. Statistically significant associations revealed the factors that increased the risk for the development of late dental defects. Multivariate regression analysis was used to record the association of severely abnormal disturbances and possible risk factors. Of the 70 survivors who participated in the study, 32 were boys and 38 girls, with an average age at 11.2 years. Most participants were diagnosed with leukemia and the average age at diagnosis was 4.17 years. 71% had only undergone chemotherapy and the average time from completion of treatment to the day of examination was 5.48 years. Most participants were in mixed dentition, their oral hygiene was moderate, and they had calculus based on the corresponding periodontal index. The average value of the caries index was 1.65 for permanent teeth and 1.26 for primary teeth. The age distribution of the oral hygiene index was the same as that of the general population of the country, while people in the younger age groups had a better periodontal status. With regard to caries distribution, the results showed that in the younger age groups the number of decayed tooth was higher, while in the older age groups the number of filled teeth increased accordingly. 59% of the survivors experienced crown defects, with hypoplasia being the defect most frequently seen. Microdontia followed, while all other defects presented in ≤10%. In the age distribution of clinically recorded lesions it was characteristic that at younger ages the rate of caries was increased while in the older age groups the prevalence of crown lesions increased. High incidence of crown lesions is associated with the following factors: older age at examination, combination treatment protocols, high radiation dose (>50Gy) and high doses of administered cyclophosphamide. Radiographic findings were more common with root defects presented in 62% of patients. The most common lesion with 57% was the incomplete root growth followed by the fused conical roots (44%). Arrested root growth, microdontia and narrow roots were recorded in 1/3 of the participants. Corresponding factors that increase the risk of developing lesions in the root were: older age at the examination, longer post-treatment periods, high doses of cyclophosphamide and administration of steroid drugs. The results also recorded reduced mouth opening in the vast majority of survivors compared to the average maximum opening in the growth curves for children (50th percentile). The deviations recorded in both sexes and different age groups were statistically significant, underlining a trend towards reduced opening in survivors. Regard stimulated salivary flow rate and its buffer capacity, it was found that 46% of participants had normal flow rate with only 5% very low. Similarly, 71% had high buffer capacity and only 4% low. Multivariate analysis showed that time since the end of antineoplastic treatment was the only risk factor for changing the qualitative and quantitative characteristics of saliva. Almost half of the survivors reported not feeling any of the symptoms of the dry mouth index, pointing out that there is no statistically significant correlation between objective and subjective perception. The average dental age of patients was overestimated by almost 4 months compared to their chronological age. The distribution of the estimated difference was broad and ranged from an underestimation of 4.03 years to an overestimate of 2.54 years. At least one lesion was recorded in 62% of patients. The average severity index was 17.46, with 28% of survivors showing severe defects. Multivariate analysis showed that patients diagnosed with leukemia, patients who have undergone a combination of anineoplastic treatment protocols, patients treated with cyclophosphamide and steroids, and patients for whom more time has elapsed since the end of treatment are more likely to experience severe dental defects. In conclusion the percentage of patients who experience dental defects as a result of the disease and its treatment is large. It is evident that root defects occur more often and their effect is important in the longevity of affected teeth. It is clear that lesions occur in teeth that are under development during the treatment period with the severity of the effect being influenced by factors related to the disease and its treatment. However, the data to date do not allow conclusions to be drawn regarding the individual action of each antineoplastic drug in the cells under development as the effect of the combination action of the treatment regimens outweighs monotherapy. We could therefore say that the role of the dentist in this special group of patients is important both for the timely and valid diagnosis of possible lesions and for the proper resolution of problems that arise as well as the information and guidance of patients. It should therefore be an integral part of the oncology team with the ultimate aim of optimizing the quality of life of these children.Tο ποσοστό 5ετούς επιβίωσης στα παιδιά με νεοπλασματική νόσο, σήμερα, ξεπερνά το 80% (Effinger et al. 2014, Landier et al. 2004), με το 60-90% να εμφανίζει απώτερες επιπλοκές σαν αποτέλεσμα της αντινεοπλασματικής θεραπείας (Oeffinger et al. 2006, Blaauwbroek et al. 2007). Στα παιδιά, επειδή είναι υπό ανάπτυξη οργανισμοί παρουσιάζονται ιδιαίτερες επιπλοκές στο κρανιοπροσωπικό σύμπλεγμα, συχνότερα στους σκληρούς και μαλακούς ιστούς, που εμφανίζονται άμεσα, και επηρεάζουν την ανάπτυξη και τη λειτουργία του κρανιοπροσωπικού συμπλέγματος (Effinger et al. 2014).Οι πιο συχνές κλινικές επιπλοκές που έχουν καταγραφεί στη βιβλιογραφία είναι ανωμαλίες στη διάπλαση της μύλης και της ρίζας των δοντιών (Effinger et al. 2014),στην διάπλαση των οστών και των στηρικτικών ιστών (Denys et al. 1998, Paulino et al. 2000) καθώς και στη λειτουργία της κροταφογναθικής διάρθρωσης (Gevorgyan et al. 2007) και των σιελογόνων αδένων (Dahllof 2008, Deasy et al. 2010). Η κλινική εικόνα των ανωμαλιών στην διάπλαση της μύλης των δοντιών ποικίλλει από απλές ατέλειες της αδαμαντίνης μέχρι ανωμαλίες του αριθμού, του σχήματος και του μεγέθους των δοντιών (Kaste et al. 2009, Gawade et al. 2014). Τα δόντια αυτά μπορεί επίσης να παρουσιάσουν μειωμένο μήκος ρίζας και μειωμένη οστική στήριξη (Duggal 2003). Αγενεσίες δοντιών, ασυμμετρία προσώπου, και δυσλειτουργία της κροταφογναθικής διάρθρωσης έχουν επίσης αναφερθεί (Goho 1993). Οι μέχρι σήμερα βιβλιογραφικές αναφορές σχετικά με τις απώτερες επιπτώσεις της αντινεοπλασματικής θεραπείας είναι περιορισμένες. Οι περισσότερες αφορούν την απλή καταγραφή των επιπτώσεων καθώς και των αντίστοιχων παραγόντων κινδύνου για την ανάπτυξη τους, χωρίς ιδιαίτερες συσχετίσεις με τα επιμέρους χαρακτηριστικά της εκάστοτε θεραπείας (Kaste et al. 2009, Effinger et al. 2014, Gawade et al. 2014). Η έλλειψη δεδομένων έγκειται στην δυσκολία συλλογής του δείγματος και στην αδυναμία προσδιορισμού των συγκεκριμένων χαρακτηριστικών της θεραπείας σε κάθε εξατομικευμένη περίπτωση. Γενικός στόχος της παρούσας μελέτης είναι η καταγραφή των απώτερων επιπτώσεων της αντινεοπλασματικής θεραπείας κατά την παιδική ηλικία στην διάπλαση των δοντιών σε παιδιά και εφήβους με μέσο χρόνο από το πέρας της θεραπείας τα 5 έτη. Επιμέρους στόχοι είναι:•η καταγραφή και αξιολόγηση της οδοντικής κατάστασης (στοματική υγεία και τερηδονική προσβολή) των επιβιωσάντων•η καταγραφή και αξιολόγηση ακτινογραφικά της επίδρασης στη διάπλαση της ρίζας των δοντιών•η αξιολόγηση της επίδρασης της θεραπείας στην λειτουργία των σιελογόνων αδένων με την αξιολόγηση της ροής και της ρυθμιστικής ικανότητας του σάλιου•η συσχέτιση των παραπάνω ευρημάτων με τα επιμέρους χαρακτηριστικά της θεραπείας (είδος και σχήμα θεραπείας και ηλικία κατά την έναρξη της)•ο προσδιορισμός των παραγόντων εκείνων που μπορούν να τροποποιήσουν την εμφάνιση και τον βαθμό των επιπτώσεων αυτών. •η συσχέτιση της αντικειμενικής υποσιαλεμίας και της υποκειμενικά προσδιοριζόμενης ξηροστομίας. Η έρευνα είναι μια μελέτη κοορτών αναδρομικού τύπου (retrospective cohort) παιδιών, εφήβων και νεαρών ενηλίκων που έχουν θεραπευθεί κατά την παιδική ηλικία για κάποιας μορφής κακοήθεια. Περιλαμβάνει ερωτηματολόγιο, κλινική και ακτινογραφική εξέταση και συλλογή σάλιου μετά από ενυπόγραφη συγκατάθεση των ασθενών και των γονέων τους. Το ερευνητικό πρωτόκολλο εγκρίθηκε από την Επιτροπή Έρευνας και Δεοντολογίας της Οδοντιατρικής Σχολής του Εθνικού και Καποδιστριακού Πανεπιστημίου Αθηνών (Ν363, ημ. Εγκρ. 22/6/2018). Το δείγμα αποτέλεσαν 70 παιδιά και έφηβοι ηλικίας 4-21 ετών, που είχαν υποβληθεί σε αντινεοπλασματική θεραπεία από ηλικία 0-10 ετών και είχαν ολοκληρώσει τη θεραπεία τους τουλάχιστον 1 χρόνο πριν την ημέρα της εξέτασης. Το δείγμα αντλήθηκε από τους ασθενείς της Ογκολογικής Αιματολογικής Μονάδας της Α΄ Παιδιατρική Κλινική του Εθνικού και Καποδιστριακού Πανεπιστημίου Αθηνών.Η συλλογή δεδομένων, αρχικά, περιελάμβανε καταγραφή του ιστορικού της νεοπλασματικής νόσου και το είδος θεραπείας στην οποία είχαν υποβληθεί οι συμμετέχοντες. Ακολούθησε οδοντιατρική κλινική εξέταση, στην οποία καταγράφηκαν: η στοματική υγιεινή (OHI-s, Greene & Vermillion 1964), η περιοδοντική κατάσταση (CPI, WHO 1977), η οδοντική τερηδόνα (ICDAS, WHO 1977), οι ανωμαλίες στην αδαμαντίνη (DDE, Oliveira et al. 2006), η σύγκλειση και οι ορθοδοντικές ανάγκες (IOTN, Brook & Shaw 1989). Στη συνέχεια πραγματοποιήθηκε ακτινογραφική εξέταση για την αξιολόγηση της διάπλασης των δοντιών και της ανάπτυξής τους (Hölttä 2002) με πανοραμικές ακτινογραφίες. Η συλλογή δεδομένων ολοκληρώθηκε με τη λήψη δείγματος σάλιου για την μέτρηση της ροής διέγερσης και της ρυθμιστικής ικανότητας του. Η στατιστική ανάλυση των δεδομένων έγινε με την χρήση του στατιστικού πακέτου SPSS (ν 17.0) και το επίπεδο στατιστικής σημαντικότητας ορίστηκε στο ρ 50Gy) και υψηλές δόσεις κυκλοφωσφαμίδης. Τα ακτινογραφικά ευρήματα ήταν πιο συχνά με τις βλάβες στη ρίζα να παρουσιάζονται στο 62% των ασθενών. Η πιο κοινή βλάβη με ποσοστό 57% ήταν η ατελής διάπλαση της ρίζας και ακολουθούσαν οι ενωμένες κωνικές ρίζες (44%). Διακοπή της διάπλασης της ρίζας, μικροδοντία και στενές ρίζες καταγράφηκαν σε στο 1/3 των συμμετεχόντων. Οι αντίστοιχοι παράγοντες που αυξάνουν τον κίνδυνο εμφάνισης βλαβών στη μύλη ήταν η μεγαλύτερη ηλικία κατά την εξέταση, το μεγαλύτερο χρονικό διάστημα από το πέρας της θεραπείας, υψηλές δόσεις κυκλοφωσφαμίδης και η χρήση στεροειδών φαρμάκων. Τα αποτελέσματα επίσης κατέγραψαν μειωμένη διάνοιξη του στόματος στην συντριπτική πλειοψηφία των επιβιωσάντων συγκριτικά με το μέσο όρο μέγιστης διάνοιξης που υπάρχει στις καμπύλες ανάπτυξης για τα παιδιά (50η εκατοστιαία καμπύλη). Οι αποκλίσεις που καταγράφηκαν στα δύο φύλα και στις διαφορετικές ηλικιακές ομάδες ήταν στατιστικά σημαντικές, υπογραμμίζοντας μια τάση για μειωμένη διάνοιξη στους επιβιώσαντες. Αναφορικά με την ροή διέγερσης του σάλιου και την ρυθμιστική του ικανότητα, βρέθηκε ότι 46% των συμμετεχόντων είχαν φυσιολογική ροή και μόνο 5% πολύ χαμηλή. Αντίστοιχα, 71% είχαν υψηλή ρυθμιστική ικανότητα και μόνο 4% χαμηλή. Η πολυπαραγοντική ανάλυση έδειξε ότι ο χρόνος από το πέρας της αντινεοπλασματικής θεραπείας ήταν ο μόνος παράγοντας κινδύνου της μεταβολής των ποιοτικών και ποσοτικών χαρακτηριστικών του σάλιου. Σχεδόν οι μισοί από τους επιβιώσαντες ανέφεραν ότι δεν αισθάνονται κανένα από τα συμπτώματα του δείκτη ξηροστομίας, υπογραμμίζοντας ότι δεν υπάρχει στατιστικά σημαντική συσχέτιση μεταξύ αντικειμενικής και υποκειμενικής αντίληψης. Η μέση οδοντική ηλικία των ασθενών υπερεκτιμήθηκε σχεδόν κατά 4 μήνες συγκριτικά με την αντίστοιχη πραγματική ηλικία τους. Η κατανομή της εκτιμώμενης διαφοράς ήταν ευρεία και κυμαινόταν από μια υποεκτίμηση της οδοντικής ηλικίας

Dental management of long-term childhood cancer survivors: a systematic review.

PURPOSE Critically review and summarise existing knowledge on prevalence of oral, dental, and craniofacial side-effects of antineoplastic treatment in childhood cancer survivors (CCS). METHODS A literature search was conducted for studies reporting on children aged 4-19 years treated for any type of malignancy up to the age of 15 years and for whom, at the time of the examination, more than 8 months have elapsed since the end of treatment. Data regarding dental late effects on teeth and craniofacial complex were collected and mean prevalence of each defect was reported. RESULTS From the 800 articles identified, 17 studies fulfilled inclusion criteria and were included. A total of 983 CCS were examined, with the total number of healthy controls being 1266 children. Haematological malignancy was the most prevalent diagnosis with the age at diagnosis ranging between 0-15 years. Multiple antineoplastic protocols were implemented with the elapsed time being 8 months up to 17 years. One-third of CCS experienced at least one late effect, with corresponding value for the control group being below 25%. Among the defects identified clinically, microdontia, hypodontia and enamel developmental defects were recorded in 1/4 of CCS. Impaired root growth and agenesis were the two defects mostly recorded radiographically. The effect on dental maturity and on salivary glands was unclear. CONCLUSION CCS are at risk of developing dental late effects because of their disease and its treatment and therefore, routine periodic examinations are essential to record their development and provide comprehensive oral healthcare