Abstract-Chronic periodontitis has been associated with an increased risk for cardiovascular disease. Left ventricular mass is an established independent predictor of cardiovascular disease. In the present cross-sectional study, we tested the association between periodontitis and left ventricular mass in subjects with essential hypertension. One hundred four untreated subjects with essential hypertension underwent clinical examinations, including echocardiographic study, laboratory tests, and assessment of periodontal status according to the community periodontal index of treatment needs (CPITN eriodontium is a complex and highly specialized pressure-sensing system consisting of 4 tissues (cementum, periodontal ligament, alveolar bone, and junctional and sulcular epithelia) supporting the teeth. Of these structures, periodontal ligament is a dynamic tissue with a high rate of remodeling and turnover, which connects the teeth to the alveolar bone. 1 Prevalence of periodontal disease approaches 14% over a wide age span, including younger and elderly people. 1 Periodontitis begins with a loss of alveolar bone and subsequent formation of a pocked around the tooth, the final stage being tooth mobility and loss. 2 Periodontal pocket can be detected with a periodontal probe and estimated through measurement of distance from gingival margin to the base of the periodontal pocket. 3 In a healthy periodontium, there is no loss of epithelial attachment or pocket formation, and the gingival crevice is Ͻ2 mm deep. 3 Established risk factors for periodontal disease are dental plaque, calculus, age, genetics, smoking, and diabetes. 4 At least 9 cohort studies 5-13 examined the association between periodontal disease and coronary heart disease (CHD), with conflicting results. An overview of these studies 14 showed a 15% excess risk of CHD in association with periodontal disease, with 95% confidence intervals ranging from 8% to 122%. To define the underlying mechanisms of such association, several studies, reviewed in depth by Armitage, 15 examined the potential link between periodontal disease and cardiovascular risk factors, including diabetes, smoking, hyperlipidemia, and hypertension. Surprisingly, despite the high prevalence of hypertension in the general population and its leading prognostic importance, few data are available on the relation between elevated blood pressure (BP), hypertensive organ damage, and periodontal disease. Castelli et al 16 found a proliferation of the intima and elastic layers with lumen reduction of vessels feeding the periodontal membrane in hypertensive subjects. 16 In another study, tooth position and movements were affected by the force of BP transmitted through periodontal vessels. 17 Interestingly, periodontal pulsation reflected changes in pulse pressure rather than in mean BP. 17 Left ventricular (LV) mass is abnormally increased in about one third of people with hypertension, 18 and LV hypertrophy is associated with an excess risk of cardiovascular complications independently of BP and oth...

Pending the availability of vaccines to contain the SARS-CoV-2 pandemic, the current solution is “social distancing” with a reduction of dental treatments to those assessed as urgent and emergency cases. These treatments also involve Early Childhood Caries (ECC) due to the fact that this disease affects preschool children (a vulnerable population) and, in addition, shows a propensity to evolve into more serious complications (dental pain, infections). A narrative review was carried out to support a protocol for treating ECC with efficacious and safe (in terms of SARS-CoV-2 transmission) procedures. Protocol involves criteria for patients’ selection remotely (telemedicine), and well-detailed criteria/equipment and hygiene procedures to combat against SARS-CoV-2 transmission. Moreover, the protocol proposes innovative caries treatments, named Minimally Invasive Treatments (MITs), well known in pedodontics for their high level of children’s acceptance during dental care. MITs allow for caries removal (particularly in primary teeth) without any high-speed rotating instrument cooled with nebulized air-water spray (with high risk of virus environmental diffusion), usually adopted during traditional treatments. For evaluating MITs effectiveness in caries management, only Systematic Review and Randomized Controlled Trials (RCTs) were included in our study, without any risk of bias assessment. The indications proposed in this protocol could support clinicians for the temporary management of ECC until the SARS-CoV-2 pandemic ends.

ObjectivesTo evaluate the effectiveness and degree of acceptance by children and adolescents of the use of oscillating tips compared with rotating drills.DesignSystematic review.Data sourcesPubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library and Web of Science (October 2017).Eligibility criteriaControlled randomised or non-randomised trials that evaluated sonic and ultrasonic oscillating devices versus rotating drill.Data extractionEligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed using the Cochrane Method.ResultsTwo controlled clinical trials comprising 123 children aged 2–12 years old were identified. Both trials were at high risk of selection bias and unclear risk of detection bias. In one trial, pain due to the use of oscillating drill resulted lower than employing rotating drill (Verbal Hochman Scale: RR 0.64 (95% CI 0.41 to 1.00); Visual Facial Expression Scale: RR 0.64 (95% CI 0.44 to 0.94)). In another study, compared with traditional drill ultrasonic tip was associated with a lower level of patient’s discomfort (RR 0.40 (95% CI 0.20 to 0.79)) but not with dental anxiety (RR 1.29 (95% CI 0.97 to 1.71)). The effectiveness of the removal of caries as well as fillings durability were only considered in one study, but no statistically significant differences were found between the two interventions.ConclusionsThe evidence based on two low-quality studies was insufficient to conclude that the use of oscillating tips for the management of pain and dental fear in children or adolescents compared with rotating drills was more effective.

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BackgroundHydrogen sulphide (H2S) is a gaseous neuro-mediator that exerts analgesic effects in rodent models of visceral pain by activating KATP channels. A body of evidence support the notion that KATP channels interact with endogenous opioids. Whether H2S-induced analgesia involves opioid receptors is unknown.MethodsThe perception of painful sensation induced by colorectal distension (CRD) in conscious rats was measured by assessing the abdominal withdrawal reflex. The contribution of opioid receptors to H2S-induced analgesia was investigated by administering rats with selective μ, κ and δ opioid receptor antagonists and antisenses. To investigate whether H2S causes μ opioid receptor (MOR) transactivation, the neuronal like cells SKNMCs were challenged with H2S in the presence of MOR agonist (DAMGO) or antagonist (CTAP). MOR activation and phosphorylation, its association to β arrestin and internalization were measured.ResultsH2S exerted a potent analgesic effects on CRD-induced pain. H2S-induced analgesia required the activation of the opioid system. By pharmacological and molecular analyses, a robust inhibition of H2S-induced analgesia was observed in response to central administration of CTAP and MOR antisense, while κ and δ receptors were less involved. H2S caused MOR transactivation and internalization in SKNMCs by a mechanism that required AKT phosphorylation. MOR transactivation was inhibited by LY294002, a PI3K inhibitor, and glibenclamide, a KATP channels blocker.ConclusionsThis study provides pharmacological and molecular evidence that antinociception exerted by H2S in a rodent model of visceral pain is modulated by the transactivation of MOR. This observation provides support for development of new pharmacological approaches to visceral pain.