Publications by authors named "Stefano Petti"

59 Publications

The impact of the COVID-19 pandemic on hospitalizations for oral and oropharyngeal cancer in Brazil.

Community Dent Oral Epidemiol 2021 Mar 1. Epub 2021 Mar 1.

Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Timely diagnosis and treatment of oral and oropharyngeal cancers are central for the patient's survival. Our objective was to document the impact of the COVID-19 pandemic on the rate of hospitalizations due to these cancers in Brazil's National Health System (SUS). The number of hospitalizations by these cancers during the first periods of the pandemic-and between the same period of 2016 to 2019-was retrieved from the SUS Hospital Information System. We compared hospitalization rates between pre- and pandemic periods, by State. The hospitalization rate for oral and oropharyngeal cancer during the pandemic was lower than that of the same period of previous years. The decline between 2019 and 2020 was of 49.3%, reaching 60% in the North. The reduction in hospitalization during an extended period suggests that oral and oropharyngeal cancer care will be postponed, with potentially detrimental impact on survival.
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http://dx.doi.org/10.1111/cdoe.12632DOI Listing
March 2021

Occupational COVID-19 risk to dental staff working in a public dental unit in the outbreak epicenter.

Oral Dis 2020 Sep 3. Epub 2020 Sep 3.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Objective: The management of the COVID-19 outbreak occurred in Lombardy (Italy) implied that non-COVID-19 health care was remodeled, limiting adequate resources in non-hospital public dental healthcare settings. This situation offered the opportunity to investigate the occupational COVID-19 risk to dental staff in public non-hospital dental units.

Methods: An infection control protocol was designed for dental health care in the Territorial Health and Social Services Authority (ASST) "Melegnano and Martesana" (Milan). Since specific guidance from central authorities was lacking, information was gathered from international public health organizations. The probability to visit asymptomatic COVID-19-infected patients was estimated, and the occupational risk to dental staff was calculated.

Results: The probability to visit asymptomatic patients passed from 1.2% (95% confidence interval -95 CI, 0.6%-2.5%) in the first period (20 February-15 March 2020) to 11.1% (95 CI, 5.8%-23.6%) in the second period (16 March-30 April). Dentists and dental assistants did not develop COVID-19, while one nurse did, the nature of her occupational risk was unclear, as nurses provided prevalently non-dental health care. The probabilities of developing COVID-19 per worked hour per person excluding and including this uncertain situation were 0.0% (95 CI, 0.0%-3.2%) and 0.9% (95 CI, 0.1%-4.7%).

Conclusion: Relatively simple infection control procedures were enough to control occupational COVID-19 risk during the outbreak.
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http://dx.doi.org/10.1111/odi.13632DOI Listing
September 2020

Stability and Viability of SARS-CoV-2.

Authors:
Stefano Petti

N Engl J Med 2020 05 13;382(20):1964-1965. Epub 2020 Apr 13.

Sapienza University of Rome, Rome, Italy

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http://dx.doi.org/10.1056/NEJMc2007942DOI Listing
May 2020

The controversial natural history of oral herpes simplex virus type 1 infection.

Oral Dis 2019 Nov 27;25(8):1850-1865. Epub 2019 Nov 27.

Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy.

The natural history of oral herpes simplex virus type 1 (HSV-1) infection in the immunocompetent host is complex and rich in controversial phenomena, namely the role of unapparent transmission in primary infection acquisition, the high frequency of asymptomatic primary and recurrent infections, the lack of immunogenicity of HSV-1 internalized in the soma (cell body) of the sensory neurons of the trigeminal ganglion, the lytic activity of HSV-1 in the soma of neurons that is inhibited in the sensory neurons of the trigeminal ganglion and often uncontrolled in the other neurons, the role of keratin in promoting the development of recurrence episodes in immunocompetent hosts, the virus-host Nash equilibrium, the paradoxical HSV-1-seronegative individuals who shed HSV-1 through saliva, the limited efficacy of anti-HSV vaccines, and why the oral route of infection is the least likely to produce severe complications. The natural history of oral HSV-1 infection is also a history of symbiosis between humans and virus that may switch from mutualism to parasitism and vice versa. This balance is typical of microorganisms that are highly coevolved with humans, and its knowledge is essential to oral healthcare providers to perform adequate diagnosis and provide proper individual-based HSV-1 infection therapy.
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http://dx.doi.org/10.1111/odi.13234DOI Listing
November 2019

Rethinking dentistry and dental teaching.

Oral Dis 2020 01 7;26(1):6-11. Epub 2019 Nov 7.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.1111/odi.13215DOI Listing
January 2020

The fifth most prevalent disease is being neglected by public health organisations.

Lancet Glob Health 2018 10;6(10):e1070-e1071

Faculty of Odontology, Malmö University, Malmö, Sweden.

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http://dx.doi.org/10.1016/S2214-109X(18)30380-2DOI Listing
October 2018

World traumatic dental injury prevalence and incidence, a meta-analysis-One billion living people have had traumatic dental injuries.

Dent Traumatol 2018 Apr;34(2):71-86

Department of Surgical Sciences, Faculty of Dentistry, Health Sciences Center, Kuwait University, Kuwait City, Kuwait.

Traumatic dental injuries (TDIs) account for a considerable proportion of bodily injuries. Nevertheless, global TDI frequency is unknown, probably because TDI diagnosis is not standardized. This study estimated world TDI frequency. A literature search (publication years 1996-2016) was aimed at covering as many countries, communities, ethnic groups as possible, thus achieving high generalizability. In particular, non-specific keywords, no language restrictions, and large databanks were used. Observational studies reporting proportions of individuals with at least one TDI (prevalence) and who developed TDI (incidence rate) were considered. Prevalence rates to permanent dentition, primary dentition and in 12-year-olds, incidence rate to any tooth for any age, male-to-female prevalence ratio (PR) in 12-year-olds, with 95% confidence intervals (95 CIs), were extracted/calculated. Study quality, Z-score distribution, funnel plot symmetry analysis, between-study heterogeneity, sensitivity, and subgroup analyses were performed. Selected primary studies were 102 (permanent dentition; 268 755 individuals; median age, 13.8 years), 46 (primary dentition; 59 436 individuals; median age, 3.4 years), 42 (12-year-olds; 33 829 individuals), 11 (incidence rate; 233 480 person-years; median age, 7.8 years), and 31 (PR; 16 003 males, 16 006 females). World TDI frequency resulted as follows: permanent dentition prevalence 15.2% (95 CI, 13.0%-17.4%); primary dentition prevalence 22.7% (95 CI, 17.3%-28.7%); 12-year-olds prevalence 18.1% (95 CI, 15.3%-21.0%); incidence rate, 2.82 (95 CI, 2.28%-3.42%) per 100 person-years; PR, 1.43 (95 CI, 1.34%-1.52%). Differences between WHO Regions were found. This study shows that more than one billion living people have had TDI. TDI is a neglected condition which could rank fifth if it was included in the list of the world's most frequent acute/chronic diseases and injuries.
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http://dx.doi.org/10.1111/edt.12389DOI Listing
April 2018

Evaluation of microbiota associated with Herpesviruses in active sites of generalized aggressive periodontitis.

Ann Stomatol (Roma) 2017 Apr-Jun;8(2):59-70. Epub 2017 Nov 8.

Department of Public Health and Infectious Diseases, " Sapienza" University of Rome, Rome, Italy.

Aims: The present study aimed to investigate microbial patterns associated with disease progression and coinfection by different Herpesviruses in generalized aggressive periodontitis (GAP).

Methods: Microbiological samples were obtained from active (AS) and non-active (n-AS) sites in 165 subjects affected by GAP and were analyzed for 40 bacterial species by the Checkerboard DNA-DNA Hybridization technique and for Herpes simplex 1 (HSV-1), Human Cytomegalovirus (CMV), and Epstein Bar virus (EBV) by PCR.Common Factor Analysis and Multiple Regression Analysis were applied to disclose specific microbial patterns associated with the three viruses.

Results: Herpesviruses were detected in 37.6% of subjects. Detection of each of the searched viruses was associated with specific patterns of subgingival biofilm in AS. Logistic regression analyses evidenced several virus/bacteria associations: i) EBV with ; ii) CMV with , and subsp; iii) HSV-1 with , , and .

Conclusions: Microbiological data suggest that Herpesviruses are probably not mere spectators of disease progression and that specific patterns of subgingival plaque are correlated with the presence of different Herpesviruses.
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http://dx.doi.org/10.11138/ads/2017.8.2.071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749375PMC
November 2017

Occupational risk for infection among dental healthcare workers: meta-analysis in occupational epidemiology.

BMJ Open 2017 Jul 13;7(7):e015374. Epub 2017 Jul 13.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

Objective: The occupational risk for infection among dental healthcare workers (DHCWs) is conjectured because of the risk of routine inhalation of potentially contaminated aerosols produced by the dental instruments. Nevertheless, occupational epidemiology studies are contrasting. This meta-analysis assessed the level of scientific evidence regarding the relative occupational risk for infection among DHCWs.

Methods: Literature search was performed without time and language restrictions, using broad data banks (PubMed, Scopus, Web of Science, GOOGLE Scholar) and generic keywords ('legionella' AND 'dent*'). Analytical cross-sectional studies comparing prevalence of high serum antibody levels in DHCWs and occupationally unexposed individuals were considered. The relative occupational risk was assessed through prevalence ratio (PR) with 95% CI. Between-study heterogeneity was assessed (Cochran's Q test) and was used to choose the meta-analytic method. Study quality (modified Newcastle-Ottawa Scale) and publication bias (Begg and Mazumdar's test, Egger and colleagues' test, trim and fill R method) were assessed formally and considered for the sensitivity analysis. Sensitivity analysis to study inclusion, subgroup analyses (dental staff categories; publication year, before vs after 1998, ie, 5 years after the release by the Centers for Disease Control and Prevention of the infection control guidelines in dental healthcare setting) were performed.

Results: Seven studies were included (2232 DHCWs, 1172 occupationally unexposed individuals). No evidence of publication bias was detected. The pooled PR estimate was statistically non-significant at 95% level (1.7; 95% CI 0.8 to 3.2), study-quality adjustment did not change the PR considerably (PR, 1.5; 95% CI 0.5 to 4.1). PR was statistically significant before 1998 and no longer significant after 1998. Subgroup analysis according to DHCW categories was inconclusive.

Conclusions: There is no scientific evidence that DHCWs are at high occupational risk. The differences between former and recent studies could be due to different characteristics of municipal water systems and the infection control guideline dissemination.
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http://dx.doi.org/10.1136/bmjopen-2016-015374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734417PMC
July 2017

Ebola Virus Infection among Western Healthcare Workers Unable to Recall the Transmission Route.

Biomed Res Int 2016 27;2016:8054709. Epub 2016 Nov 27.

University College London, London, UK.

During the 2014-2016 West-African Ebola virus disease (EVD) outbreak, some HCWs from Western countries became infected despite proper equipment and training on EVD infection prevention and control (IPC) standards. Despite their high awareness toward EVD, some of them could not recall the transmission routes. We explored these incidents by recalling the stories of infected Western HCWs who had no known directly exposures to blood/bodily fluids from EVD patients. We carried out conventional and unconventional literature searches through the web using the keyword "Ebola" looking for interviews and reports released by the infected HCWs and/or the healthcare organizations. We identified fourteen HCWs, some infected outside West Africa and some even classified at low EVD risk. None of them recalled accidents, unintentional exposures, or any IPC violation. Infection transmission was thus inexplicable through the acknowledged transmission routes. We formulated two hypotheses: inapparent exposures to blood/bodily fluids or transmission due to asymptomatic/mildly symptomatic carriers. This study is in no way intended to be critical with the healthcare organizations which, thanks to their interventions, put an end to a large EVD outbreak that threatened the regional and world populations.
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http://dx.doi.org/10.1155/2016/8054709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149594PMC
January 2017

NASAL MRSA Carriage Rates.

Authors:
Stefano Petti

J Am Dent Assoc 2016 10;147(10):774-5

Full Professor, Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

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http://dx.doi.org/10.1016/j.adaj.2016.08.011DOI Listing
October 2016

The Chicken-Egg Dilemma: Legionnaires' Disease and Retrograde Contamination of Dental Unit Waterlines.

Authors:
Stefano Petti

Infect Control Hosp Epidemiol 2016 10 17;37(10):1258-60. Epub 2016 Aug 17.

Department of Public Health and Infectious Diseases of the Sapienza University of Rome,Italy.

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http://dx.doi.org/10.1017/ice.2016.184DOI Listing
October 2016

Healthcare Outbreaks Associated With Dental Unit Water Systems: Strong Scientific Evidence of Minimal Risk.

Authors:
Stefano Petti

Clin Infect Dis 2016 11 7;63(9):1270. Epub 2016 Aug 7.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

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http://dx.doi.org/10.1093/cid/ciw534DOI Listing
November 2016

Tuberculosis: Occupational risk among dental healthcare workers and risk for infection among dental patients. A meta-narrative review.

Authors:
Stefano Petti

J Dent 2016 06 19;49:1-8. Epub 2016 Apr 19.

Department of Public Health and Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy. Electronic address:

Objectives: Tuberculosis transmission among healthcare workers (HCWs) and patients is due to the level of Mycobacterium tuberculosis (MT) circulation in the community and in the healthcare settings where HCWs are active. In contrast, most papers about dentistry report that dental HCWs (DHCWs) and patients are at relatively high risk, mainly based on tuberculosis case series that occurred in the 80's-90's. This meta-narrative review was designed to evaluate the tuberculosis risk in dentistry accounting for the historical-geographical contexts.

Data: All available studies reporting data on MT infection (active/latent tuberculosis, tuberculin skin test) among patients and DHCWs.

Sources: PubMed, Scopus, GOOGLE Scholar.

Keywords: MT/tuberculosis and dentistry/dentist/dental/dent*.

Results: 238 of the 351 titles were excluded because did not concern dental healthcare providing, 94 papers were excluded because they did not provide original data. Thirteen studies on occupational risk, nine on transmission to patients remained. Some, often non-confirmed, cases of MT infection among patients were reported in specific historical-geographical contexts where MT was endemic. The risk of active pulmonary tuberculosis transmission from infected DHCWs to patients is minimal today, provided that the basic infection control guidelines are applied. The development of active tuberculosis among DHCWs is occasional and is associable to MT circulation rather than dental healthcare providing.

Clinical Significance: Tuberculosis transmission in dental healthcare settings was due to the lack of basic infection control measures, while the risk is acceptable (i.e., similar to the general population) nowadays. Therefore, tuberculosis transmission can be safely prevented wearing gloves and surgical mask and providing regular air changes in the operative and non-operative dental healthcare settings. Precautionary Principle-based measures are implementable when patients with active pulmonary tuberculosis are routinely treated.
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http://dx.doi.org/10.1016/j.jdent.2016.04.003DOI Listing
June 2016

Viewing humans as molecules to improve accuracy of clinical predictions.

Authors:
Stefano Petti

Oral Dis 2016 09 26;22(6):457-9. Epub 2016 Apr 26.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.1111/odi.12478DOI Listing
September 2016

The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks.

BMC Infect Dis 2015 Dec 11;15:564. Epub 2015 Dec 11.

University College London, Gower Street WC1E 6BT, London, UK.

Background: The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks.

Methods: Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed.

Results: Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results.

Conclusions: During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible.
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http://dx.doi.org/10.1186/s12879-015-1302-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676861PMC
December 2015

Ocular Manifestations of Ebola Virus Disease: An Ophthalmologist's Guide to Prevent Infection and Panic.

Biomed Res Int 2015 18;2015:487073. Epub 2015 Oct 18.

Dental Section, Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00161 Rome, Italy.

Ebola virus disease (EVD--formerly known as Ebola hemorrhagic fever) is a severe hemorrhagic fever caused by lipid-enveloped, nonsegmented, negative-stranded RNA viruses belonging to the genus Ebolavirus. Case fatality rates may reach up to 76% of infected individuals, making this infection a deadly health problem in the sub-Saharan population. At the moment, there are still no indications on ophthalmological clinical signs and security suggestions for healthcare professionals (doctors and nurses or cooperative persons). This paper provides a short but complete guide to reduce infection risks.
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http://dx.doi.org/10.1155/2015/487073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628748PMC
August 2016

Low methicillin-resistant Staphylococcus aureus carriage rate among Italian dental students.

Am J Infect Control 2015 Dec 16;43(12):e89-91. Epub 2015 Sep 16.

Department of Preventive Dentistry of the Academic Centre for Dentistry Amsterdam, VU University Amsterdam and University of Amsterdam, Amsterdam, The Netherlands.

We assessed methicillin-resistant Staphylococcus aureus (MRSA) carriage rate among dental students from an Italian university. A total of 157 subjects participated (67 preclinical students and 90 clinical students); samples were collected from the nose, mouth, and skin. Five preclinical students and 0 clinical students were MRSA-positive. Carriage rates were 3.2% (95% confidence interval [CI], 0.4%-6.0%) overall, 7.5% (95% CI, 1.2%-13.8%) in preclinical students and 0% in clinical students. There were 2 MRSA clusters among the preclinical students: 3 second-year and 2 first-year students, who sat close to one another in the classroom the day of the sample. MRSA carriage was not associated with dental health care. The pooled carriage rate among dental students was assessed to obtain a reliable figure of carriage rate unaffected by local conditions. The 4 published surveys were pooled, and the fixed-effects method was used. Among the 484 dental students, the pooled carriage rate was 4.1% (95% CI, 2.4%-5.8%).
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http://dx.doi.org/10.1016/j.ajic.2015.08.008DOI Listing
December 2015

Within-Family Discussion on Harmful Effects of Smoking and Intention to Initiate Smoking Among European Adolescents.

J Addict Med 2015 Jul-Aug;9(4):261-5

From the Centre of Population Oral Health & Clinical Prevention Studies (MM, BAS, NY) and Centre of Studies for Oral Pathology (YM, LTY), Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia; Division of Population & Patient Health (MM), Dental Institute, King's College London, UK; Department of Global Public Health (DR, MM), Jeffery Cheah School of Dental Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia; and Department of Public Health and Infectious Diseases (SP), Sapienza University, Rome, Italy.

Objective: The main objective of this study was to determine the impact of discussion within family about the harmful effects of smoking on intention to initiate smoking in the long term among nonsmoking adolescents.

Methods: Data from Global Youth Tobacco Survey for 25 European countries were used. The outcomes of interest were, therefore, the intention to initiate smoking 1 and 5 years after the survey. Discussion within family about harmful effect of smoking was the main predictor with age, sex, and smoking status of parents, friends, and classmates as covariates. The association between predictors and outcomes was assessed through multiple regression analysis.

Results: A total of 118,703 nonsmoking adolescents were included. Within-family discussion significantly reduced the odds of intention to initiate smoking 1 and 5 years later. Intention to initiate smoking also was significantly associated with the smoking status of friends, classmates, and parents, except for father's smoking status, which was not associated with intention to initiate 1 year later.

Conclusions: This study demonstrated that within-family discussion about the harmful effects of smoking may contribute to reduce the intention to start smoking among adolescents in the long term. Such a discussion was associated with reduced intention to smoke even when adjusting for parent/friend and classmate smoking.
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http://dx.doi.org/10.1097/ADM.0000000000000127DOI Listing
May 2016

Are overweight/obese children at risk of traumatic dental injuries? A meta-analysis of observational studies.

Dent Traumatol 2015 Aug 10;31(4):274-82. Epub 2015 Apr 10.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Background/aim: Observational studies which investigated the association between overweight/obesity and traumatic dental injuries (TDI) reported contrasting results. Thus, this meta-analysis was designed to investigate such an association with the highest possible levels of internal and external validities.

Material And Methods: A comprehensive literature search was performed through PubMed, ISI Web of Science, Cochrane Library, Scopus, Google scholar to ensure generalizability. Eligible studies reported clear case and control definitions, exposure assessment. Where possible, odds ratio (OR) adjusted for covariates was extracted. Study quality was assessed through Newcastle-Ottawa Scale (NOS). Only fair-to-good quality studies with NOS scores ≥4 were selected. The method to assess the pooled OR was based on the level of between-study heterogeneity, estimated through the Cochran's Q. Reliability of the pooled OR was improved by controlling for publication bias, sensitivity analysis to study inclusion, and subgroup analyses according to tooth type (permanent vs primary teeth) and country where the study was performed (Brazilian studies vs studies from other countries).

Results: Seventeen studies were selected from America, Asia, and Europe, their NOS scores ranged between 4 and 8. Overall, there were almost 28,000 patients, 7400 of them with TDI. The level of publication bias was minimal, and no adjustment was necessary. Between-study heterogeneity was high, and the random-effects method was used to assess the pooled OR, which resulted 1.30 (95% confidence interval, 1.11-1.53; P < 0.05). Sensitivity and subgroup analyses corroborated this estimate.

Conclusion: The choice to increase internal and external validity levels decreased the precision of the pooled OR (i.e., confidence intervals were relatively wide). The statistically significant overweight/obesity-TDI association, together with the so-called counterfactual condition (i.e., TDI prevalence was higher among overweight/obese children than among lean children), suggests that causal association between these two conditions is plausible.
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http://dx.doi.org/10.1111/edt.12172DOI Listing
August 2015

Over two hundred million injuries to anterior teeth attributable to large overjet: a meta-analysis.

Authors:
Stefano Petti

Dent Traumatol 2015 Feb 27;31(1):1-8. Epub 2014 Sep 27.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Background/aim: The association between large overjet and traumatic dental injuries (TDIs) to anterior teeth is documented. However, observational studies are discrepant and generalizability (i.e. external validity) of meta-analyses is limited. Therefore, this meta-analysis sought to reconcile such discrepancies seeking to provide reliable risk estimates which could be generalizable at global level.

Material And Methods: Literature search (years 1990-2014) was performed (Scopus, GOOGLE Scholar, Medline). Selected primary studies were divided into subsets: 'primary teeth, overjet threshold 3-4 mm' (Primary3); 'permanent teeth, overjet threshold 3-4 mm' (Permanent3); 'permanent teeth, overjet threshold 6 ± 1 mm' (Permanent6). The adjusted odds ratios (ORs) were extracted. To obtain the highest level of reliability (i.e. internal validity), the pooled OR estimates were assessed accounting for between-study heterogeneity, publication bias and confounding. Result robustness was investigated with sensitivity and subgroup analyses.

Results: Fifty-four primary studies from Africa, America, Asia and Europe were included. The sampled individuals were children, adolescents and adults. Overall, there were >10 000 patients with TDI. The pooled OR estimates resulted 2.31 (95% confidence interval - 95CI, 1.01-5.27), 2.01 (95CI, 1.39-2.91) and 2.24 (95CI, 1.56-3.21) for Primary3, Permanent3 and Permant6, respectively. Sensitivity and subgroup analyses corroborated these estimates.

Conclusions: Reliability and generalizability of pooled ORs were high enough and made it possible to assess that the fraction of global TDIs attributable to large overjet is 21.8% (95CI, 9.7-34.5%) and that large overjet is co-responsible for 235 008 000 global TDI cases (95CI, 104,760,000-372,168,000). This high global burden of TDI suggests that preventive measures must be implemented in patients with large overjet.
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http://dx.doi.org/10.1111/edt.12126DOI Listing
February 2015

Biomarkers of oxidative stress to nucleic acids: background levels and effects of body mass index and life-style factors in an urban paediatric population.

Sci Total Environ 2014 Dec 15;500-501:44-51. Epub 2014 Sep 15.

Department of Public Health and Infectious Diseases, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy. Electronic address:

The aims of the present study were to establish the background levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo), 8-oxo-7,8-dihydroguanosine (8-oxoGuo), 8-oxo-7,8-dihydroguanine (8-oxoGua) among a group of healthy Italian children, and to evaluate the contribution of some potential interfering/confounding factors to the urinary (u) levels of these biomarkers of oxidised guanine derivatives. The levels of 8-oxodGuo, 8-oxoGuo, 8-oxoGua, and u-cotinine in urine samples from 159 healthy children (5-11years) recruited in a cross-sectional study were measured via liquid chromatography-tandem mass spectrometry. Data regarding the anthropometric and life-style characteristics of the participants were obtained from questionnaires. The 5th-95th percentiles of the levels of 8-oxodGuo, 8-oxoGuo, and 8-oxoGua for all children were 2.4-13.9, 3.8-19.9 and 5.4-79.5μg/L and 2.9-12.6, 4.8-15.2, and 5.1-93.4μg/g creatinine, respectively. Significant correlations were found between the level of 8-oxoGuo and that of 8-oxoGua and 8-oxodGuo but not between the level of 8-oxoGua and that of 8-oxodGuo in all children and in both the male and female subgroups. Multiple linear regression analyses revealed the independent effect of the investigated variables on 8-oxodGuo, 8-oxoGuo, and 8-oxoGua. u-Creatinine was the most significant predictor of the urinary excretion of both 8-oxoGuo and 8-oxodGuo, age displayed a significant positive independent effect on the level of 8-oxoGuo, whereas the weight status according to the BMI was negatively associated with the level of 8-oxodGuo. None of the chosen independent variables influenced the levels of 8-oxoGua.
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http://dx.doi.org/10.1016/j.scitotenv.2014.08.095DOI Listing
December 2014

Intensity and duration of in-vitro antibacterial activity of different adhesives used in orthodontics.

Eur J Oral Sci 2014 Apr;122(2):154-60

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.

This work investigated the antibacterial activity of 14 bonding agents to predict their ability to inhibit white-spot development during orthodontic treatment. Standardized, sterilized disks of each material were continuously rinsed (for up to 180 d) in a flow of sterile saline. At predetermined time points, the residual ability of each material to inhibit bacterial growth (determined by measuring the size of inhibition halos around disks placed onto appropriate culture media seeded with Streptococcus gordonii DSM6777, Streptococcus sanguinis DSM20567, Streptococcus mutans DSM20523, or Lactobacillus acidophilus DSM20079) and biofilm formation (determined by measuring the numbers of bacteria adherent to disks following incubation in appropriate broths) was tested in triplicate and compared with the baseline activities of freshly prepared materials. Overall antibacterial and anti-biofilm activities, adjusted for exposure time and strain of bacteria, were assessed. The decrease of antibacterial activity was faster (30-60 d) and complete for fluoride-enriched materials, but slower (90 d) and partial for antimicrobial-containing materials (benzalkonium chloride, zinc oxide, chlorexidine, or MDPB). Materials enriched with benzalkonium chloride, chlorexidine, or MDPB showed the highest antibacterial activities. Anti-biofilm assays yielded similar results. These data could be helpful for clinicians in the choice of the best performing bonding agent also in light of duration of the clinical application.
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http://dx.doi.org/10.1111/eos.12120DOI Listing
April 2014

High salivary Staphylococcus aureus carriage rate among healthy paedodontic patients.

New Microbiol 2014 Jan 15;37(1):91-6. Epub 2014 Jan 15.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Staphylococcus aureus can be responsible for oral and dental healthcare-associated infections. Patients with high salivary S. aureus levels are potential sources of infection, because saliva is spread in the environment during dental therapy. This study assessed the salivary S. aureus carriage rate in 97 children (6-12 years) in good general health, attending a paedodontic department. Samples of unstimulated saliva were collected, S. aureus was presumptively identified. The salivary carriage rate was 43% (95% confidence interval, 33%-53%). 6.2% children harboured levels >103 colony forming units/mL. These data suggest that the risk for environmental contamination and infection in dental healthcare settings could be high.
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January 2014

The magnitude of tobacco smoking-betel quid chewing-alcohol drinking interaction effect on oral cancer in South-East Asia. A meta-analysis of observational studies.

PLoS One 2013 18;8(11):e78999. Epub 2013 Nov 18.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Tobacco smoking, betel quid chewing and alcohol drinking are oral cancer risk factors. Observational studies unanimously report that oral cancer risk in smoking-drinking-chewing exposed subjects is exceptionally high. However, none of them assessed the fractions of this risk attributable to the three individual risk factors and to the smoking-drinking-chewing interaction. The present study sought to assess the magnitude of the smoking-drinking-chewing interaction effect on oral cancer. A meta-analysis of observational South-East Asian studies which reported oral cancer odds ratios (ORs) stratified for smoking-drinking-chewing exposures was performed. The pooled ORs were estimated and controlled for quality, heterogeneity, publication bias and inclusion criteria. The smoking-drinking-chewing interaction effect was estimated through the pooled Relative Excess Risk due to Interaction (RERI, excess risk in smoking-drinking-chewing exposed individuals with respect to the risk expected from the addition of the three individual risks of smoking, drinking and chewing). Fourteen studies were included with low between-study heterogeneity. The pooled ORs for smoking, drinking, chewing, smoking-drinking-chewing, respectively were 3.6 (95% confidence interval -95% CI, 1.9-7.0), 2.2 (95% CI, 1.6-3.0), 7.9 (95% CI, 6.7-9.3), 40.1 (95% CI, 35.1-45.8). The pooled RERI was 28.4 (95% CI, 22.9-33.7). Among smoking-drinking-chewing subjects, the individual effects accounted for 6.7% (smoking), 3.1% (drinking), 17.7% (chewing) of the risk, while the interaction effect accounted for the remaining 72.6%. These data suggest that 44,200 oral cancer cases in South-East Asia annually occur among smoking-drinking-chewing exposed subjects and 40,400 of these are exclusively associated with the interaction effect. Effective oral cancer control policies must consider concurrent tobacco smoking, alcohol drinking, betel quid chewing usages as a unique unhealthy lifestyle.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078999PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832519PMC
July 2014

Joint and independent effects of alcohol drinking and tobacco smoking on oral cancer: a large case-control study.

PLoS One 2013 10;8(7):e68132. Epub 2013 Jul 10.

School of Public Health, University of São Paulo, São Paulo, SP, Brazil.

Alcohol drinking and tobacco smoking are assumed to have significant independent and joint effects on oral cancer (OC) development. This assumption is based on consistent reports from observational studies, which, however, overestimated the independent effects of smoking and drinking, because they did not account for the interaction effect in multivariable analyses. This case-control study sought to investigate the independent and the joint effects of smoking and drinking on OC in a homogeneous sample of adults. Case patients (N = 1,144) were affected by invasive oral/oropharyngeal squamous cell carcinoma confirmed histologically, diagnosed between 1998 and 2008 in four hospitals of São Paulo (Brazil). Control patients (N = 1,661) were not affected by drinking-, smoking-associated diseases, cancers, upper aero-digestive tract diseases. Cumulative tobacco and alcohol consumptions were assessed anamnestically. Patients were categorized into never/ever users and never/level-1/level-2 users, according to the median consumption level in controls. The effects of smoking and drinking on OC adjusted for age, gender, schooling level were assessed using logistic regression analysis; Model-1 did not account for the smoking-drinking interaction; Model-2 accounted for this interaction and included the resultant interaction terms. The models were compared using the likelihood ratio test. According to Model-1, the adjusted odds ratios (ORs) for smoking, drinking, smoking-drinking were 3.50 (95% confidence interval -95CI, 2.76-4.44), 3.60 (95CI, 2.86-4.53), 12.60 (95CI, 7.89-20.13), respectively. According to Model-2 these figures were 1.41 (95CI, 1.02-1.96), 0.78 (95CI, 0.48-1.27), 8.16 (95CI, 2.09-31.78). Analogous results were obtained using three levels of exposure to smoking and drinking. Model-2 showed statistically significant better goodness-of-fit statistics than Model-1. Drinking was not independently associated with OC, while the independent effect of smoking was lower than expected, suggesting that observational studies should be revised adequately accounting for the smoking-drinking interaction. OC control policies should focus on addictive behaviours rather than on single lifestyle risk factors.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068132PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707956PMC
March 2014

Detection of oral streptococci in dental unit water lines after therapy with air turbine handpiece: biological fluid retraction more frequent than expected.

Future Microbiol 2013 Mar;8(3):413-21

Department of Public Health & Infectious Diseases, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy.

Aim: Oral streptococci detected in water from dental unit water lines (DUWLs) are a surrogate marker of patients' biological fluid retraction during therapy. We investigated oral streptococci detection rate in DUWLs in a representative sample of private offices in real-life conditions.

Materials & Methods: Samples of nondisinfected water (100 ml) were collected from the DUWL designated for the air turbine handpiece in 81 dental units, immediately after dental treatment of patients with extensive air turbine handpiece use. Water was filtered and plated on a selective medium for oral streptococci and, morphologically, typical colonies of oral streptococci were counted. The lowest detection limit was 0.01 CFU/ml.

Results: The oral streptococci detection rate was 72% (95% CI: 62-81%), with a mean level of 0.7 CFU/ml. Oral streptococci detection was not affected by handpiece age or dental treatment type, but was associated with dental unit age.

Conclusion: Biological fluid retraction into DUWLs during patient treatment and, possibly, the risk for patient-to-patient blood- or air-borne pathogen transmission are more frequent than expected.
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http://dx.doi.org/10.2217/fmb.12.151DOI Listing
March 2013

Effect of disposable barriers, disinfection, and cleaning on controlling methicillin-resistant Staphylococcus aureus environmental contamination.

Am J Infect Control 2013 Sep 1;41(9):836-40. Epub 2013 Feb 1.

Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.

Background: Environmental contamination and transmission of methicillin-resistant Staphylococcus aureus (MRSA) have been reported in dental health care settings. National professional dental associations recommend controlling surface contamination using disposable barriers or disinfection. Because these procedures may be costly, impractical, and/or toxic, we compared their effect against traditional detergent-based cleaning for decontaminating a dental chair sprayed with MRSA.

Methods: Five MRSA strain suspensions were aerosolized to give a density of approximately 10 colony-forming units/cm(2) MRSA on the dental chair 5 minutes after dispersal. Three different decontamination protocols were applied: protocol 1: disposable barriers positioned before aerosol production and removed after 5 minutes; protocol 2: disinfection (wipe-rinse method) with 1:10 dilution of 5.25% to 6.15% sodium hypochlorite solution; protocol 3: cleaning (wipe-rinse method) with a sodium-lauryl-sulphate-based detergent. Contact plates containing Mannitol Salt Agar were used to assess the level of MRSA contamination.

Results: All 3 protocols decreased MRSA surface load by >99%. Residual densities on the dental chair were 0.030 ± 0.010 (protocol 1), 0.029 ± 0.09 (protocol 2), and 0.030 ± 0.011 (protocol 3) colony-forming units/cm(2).

Conclusion: Cleaning (wipe-rinse method) using a sodium-lauryl-sulphate-based detergent demonstrated equivalence with disposable barrier placement or disinfection-based protocol for reducing MRSA contamination on dental chairs. This has practical and cost implications for controlling MRSA transmission in dental health care settings.
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http://dx.doi.org/10.1016/j.ajic.2012.09.021DOI Listing
September 2013