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Purpose Pain is considered a stressful experience, related to real or possible tissue damage with emotional, sensory, social and cognitive components. The aim of the study was to evaluate and compare, using a digital algometer, the pressure pain threshold of temporal and masseter muscles of children and adolescents with and without intellectual disability. Methods A cross-sectional study was conducted. Data regarding gender and age were collected from the caregiver of children and adolescents with and without intellectual disability. The evaluations followed this sequence: pressure pain threshold of the masseter and temporal muscles, evaluation of pain on touch using the visual analog scale and signs and symptoms of Temporomandibular disorder. The χ 2 test, the Kolgomorov–Smirnov test, Student t test and Mann–Whitney test were performed. The significance level was set at 5%. Results Two homogeneous groups by gender ( P  = 0.258) and age ( P  = 0.727) were evaluated, of which 25 children and adolescents presented intellectual disability and another 25 did not have intellectual disability. No significant difference was observed between groups on the pressure pain threshold of the masseter and temporal muscles, nor pressure average or exam time ( P  > 0.05). Regarding Temporomandibular dysfunction, no difference in signs or symptoms frequency was found ( P  > 0.05). However, the range of maximum mouth opening was smaller in the intellectual disability group ( P  = 0.006). Conclusion Children and adolescents with intellectual disability and preserved basic functionalities do not present alterations in pain perception when evaluated with computerized pressure algometer and visual analog scale. They present similar threshold of pain to pressure as those reported by normative children and adolescents. These results emphasize the importance to treat these children and adolescents with intellectual disability with respect to their pain threshold.

Objective In Italy, around 137,000 people live with multiple sclerosis, facing organizational complexities due to the current model’s limited focus on proximity care. This project aims to define a proximity model, in accordance with recent developments in the Italian healthcare landscape, engaging over 150 healthcare stakeholders and potentially impacting approximately 14,000 patients. Methods An analysis was pursued to map the multiple sclerosis pathway, followed by interviews to capture the actual implementation in Italian Multiple Sclerosis Centers. Through the experts’ insights, an optimal proximity care pathway and a Maturity Model framework were defined. This model was piloted in 14 centers, and a preliminary pre-post analysis was performed to evaluate initial improvements. Finally, a two-round Delphi method validated the Maturity Model dimensions and a set of key performance indicators. A scientific board including neurologists, patient associations and scientific associations, supervised project progresses and methodologies. Results The Pilot study results show an overall increase in the centers’ positioning within the Maturity Model levels after adopting center-specific action plans. To generalize the model, the Delphi panel validated a subset of process, volume, outcome and patient experience indicators (9 of 26 proposed) along with qualitative dimensions defining the Maturity Model (13 of 20 proposed), therefore, outlining a comprehensive monitoring framework for the multiple sclerosis patient pathway. Conclusion This study shows, for the first time in Italy, the efficacy of a bottom-up approach in addressing organizational challenges within the current multiple sclerosis scenario. This integrated model offers future opportunity for replication across various care pathways and settings.

Malignant neoplasms of any anatomical site, along with their treatments, can significantly affect the oral health of paediatric and adolescent populations, potentially influencing their oral health-related quality of life (OHRQoL). This systematic review sought to evaluate how cancer, regardless of tumour location, impacts the OHRQoL of children and adolescents. Electronic searches were conducted in PubMed, Scopus, EMBASE, Web of Science and LILACS, as well as grey literature, up to October 2023. Clinical studies reporting on OHRQoL in patients aged 0-19 years with cancer were included. Two reviewers independently performed study selection, data extraction and risk of bias assessment using the Joanna Briggs Institute tools. Certainty of evidence was evaluated using the GRADE approach. Of 27,684 records, four studies (three cross-sectional and one randomised clinical trial) met the inclusion criteria, encompassing 253 paediatric patients. OHRQoL was assessed using OHIP-14 and ECOHIS instruments. Most studies reported a weak impact of oral health on quality of life. However, methodological limitations and very low certainty of evidence were identified. Although a weak impact of oral health on quality of life was observed among children and adolescents with malignant neoplasms, the limited number and quality of available studies prevent firm conclusions. High-quality research with robust methodology is needed to better understand this relationship and draw robust conclusions and guide clinical decision-making.

Several reports have proposed that the viral load of torque teno virus (TTV) in plasma is a biomarker of immune function in solid organ transplantation (SOT) and in allogeneic hematopoietic stem cell transplantation. Additionally, for the latter one, TTV-DNA quantification in saliva has also been suggested. to investigate the correlation between the TTV viral load and immune function in paired saliva and plasma samples in patients on kidney transplantation. TTV-DNA viral load was quantified in paired samples of saliva and plasma from 71 patients before and a short-time after renal-transplantation by real-time PCR. The data obtained from 213 paired samples showed a slight consistency in the comparison between saliva and plasma, with prevalence of TTV-DNA being 58%, 52% and 60% in saliva samples and 60%, 73% and 90% in plasma samples before and at 15-20 and 45-60 days after transplantation, respectively. Additionally, a high TTV viral load was observed in plasma at 15-20 and 45-60 days after transplantation compared to that observed in saliva at the same time. Overall, monitoring TTV-DNA in saliva samples could be an additional fast non-invasive option to assess the immune functionality in SOT populations.

Down syndrome (DS) has characteristics that include mental retardation, a characteristic phenotype, congenital heart defects, immune disorders, and increased risk of periodontal disease (PD). Antimicrobial photodynamic therapy (aPDT) is the combined use of photosensitizers associated with low-level laser (LLL) and oxygen, leading to singlet oxygen formation, which contributes to the antibacterial activity of the phagocytes, killing bacteria. The objective of this study was to evaluate the efficacy of aPDT as an adjuvant to conventional periodontal treatment of PD in DS patients. A double-blinded, controlled, randomized, split-mouth study was conducted. A total of 13 DS subjects who were 18 years or older and who presented at least one tooth in each quadrant of the mouth with probing pocket depth (PPD) equal to or greater than 5 mm were included. The patients were evaluated at three different times: at the baseline, PPD were obtained. After 1 week, conventional scaling and root planing (SRP) was performed, and two randomly selected quadrants also received aPDT. One month after SRP, all the patients were reevaluated. Periodontal conditions were improved among all the participants. The PDT-with-SRP group presented a nonsignificant reduction in PPD (mean = 1.27 mm, median = 1.17 mm) relative to that of the SRP group (mean = 1.00 mm, median = 0.95 mm). Changes over time were compared using the Wilcoxon test. A significant reduction in median PPD was observed in both groups ( p  = 0.001). Both types of periodontal treatment, with and without PDT, were similarly effective and were associated with good clinical response.

Tetralogy of Fallot (TOF) is the prevalent cyanotic congenital cardiac anomaly, accounting for 80% of all cases. Despite the incidence rate, the etiopathogenesis of TOF remains unknown. Amelogenesis imperfecta (AI) is a hereditary condition that impacts enamel development, resulting in morphological and functional tooth modifications. This report aims to present the case of a young patient with TOF and AI who received direct restorative treatment, emphasizing the medical and dental factors involved in enhancing oral health and dental esthetics. The patient has a history of cardiac procedures, including the implantation of a metallic pulmonary valve, along with moderate intellectual disability and a prior seizure episode. The intraoral examination indicated extensive gingivitis, inadequate oral hygiene, hypomineralized enamel with structural deterioration, and numerous plaque retention niches, resulting in pain during mastication and oral hygiene practices. Due to the high risk of infective endocarditis, infected foci were eliminated, and antibiotic prophylaxis was administered according to the American Heart Association guidelines. Restorative therapy was conducted utilizing direct composite resin veneers to restore dental aesthetics and functionality. Post-treatment, the patient had enhanced self-esteem, maintained dental hygiene, and achieved remission of gingivitis. This case demonstrates the significance of comprehensive dental care for patients with complex congenital heart conditions and enamel developmental disorders, stressing the necessity for preventive measures, effective periodontal management, and advanced restorative techniques to reduce the risks of systemic infections.

This study was undertaken to investigate for the first time the distribution and prevalence of apical periodontitis and its determinants in an Italian population. A total of 312 participants (191 women, 121 men) received free clinical examination and full-mouth digital X-ray. Data regarding the oral health status of the patients were collected such as the reason for the visit and the incidence of lesions. We examined 8101 teeth, 6.59% of which had been submitted to endodontic treatment and 15.02% of which were lower molars. Lower molars were reported missing more frequently, in detail 16.24%. Moreover 3.89% of the lower molars had developed an apical lesion, whereas only 0.08% of the lower incisors. Periapical lesions were present in 0.29% of not endodontically treated teeth, while in endodontically treated teeth lesions were present in 17.04%. Additionally, 15.65% of the endodontically treated teeth showed incongruous (long or short) seals. A prevalence of women (61.21%) over men (38.78%) was reported indicating that women attend to their oral health more. Endodontic treatment success and failure in over- or under-filled teeth was evaluated with success being verified in 97% of appropriately treated teeth; the success rate decreases in inappropriately treated teeth (by 72.73% in over-filled and 77.71% under-filled teeth). The prevalence of teeth with periapical lesions amounted to 1.35%. Finally, endodontically treated teeth with periapical lesions amounted to 17.04%. Successful treatment can be achieved when disease is intercepted at an early stage while prevention still remains better than cure.

Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus. Seventy-one patients, divided into experimental ( n  = 41) and control ( n  = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm 2 or 4.5 J/cm 2 on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions ( P  = 0.013) and inflammatory edema ( P  = 0.031). The reduction in pain level ( P  = 0.051) and monthly recurrences ( P  = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.

Human herpesvirus 8 (HHV-8) is a gamma-herpesvirus and etiological agent of all forms of Kaposi sarcoma (KS). Saliva may play an important role in HHV-8 transmission in specific populations. Little is known about HHV-8 oral shedding pattern and the possible correlation with the HHV-8 serological profile and viremia. A prospective study was conducted of HHV-8 salivary excretion among human immunodeficiency virus HIV-seronegative (n = 47) and -seropositive (n = 44) homosexual men and HIV-seropositive women (n = 32) over a 6-month period with monthly HHV-8 serologies (immunofluorescence assays to identify antibodies to latent and lytic HHV-8 viral proteins, and a whole-virus HHV-8 enzyme-linked immunosorbent assay [ELISA]), monthly HHV-8 DNA serum/plasma detection, and daily self-collected oral rinses for HHV-8-DNA detection using real-time polymerase chain reaction. HHV-8 seropositivity was 51.1%, 63.6%, and 37.5%, in the three studied groups. There was no case of HHV-8 DNA detection in serum/plasma. Intermittent detection of oral HHV-8 DNA was observed during 5.1% (110/2,160) of visits among 28% (18/64) of HHV-8-seropositive individuals, all of whom were males and HHV-8 ELISA seropositive. In immunologically controlled populations of Brazil, HHV-8 oral shedding was limited to HHV-8-seropositive men, occurred infrequently and intermittently, and was not linked to HHV-8 viremia, suggesting a limited potential for oral or blood transmission.