COMPARISON BETWEEN THERAPY WITH ACUPUNCTURE AND PHARMACOTHERAPY WITH CLONAZEPAM IN PATIENTS WITH BURNING MOUTH SYDNROME

Sindrom pekućih usta (SPU) je kronični oralni symptom karakteriziran osjećajem pečenja u osoba koje imaju klinički zdrav izgled oralne sluznice. Čini se da je u podlozi neuropatološki poremećaj. Nadalje, postoji manjak randomiziranih kontroliranih istraživanja s obzirom na postojeće liječenje ovog sindroma. U ispitivanje je bilo uključeno 60 bolesnika (6 muškaraca i 54 žene) sa sindromom primarnog sindroma pekućih usta kao i 20 kontrolnih ispitanika koje su liječeni na Klinici za neurologiju zbog tegoba od strane slabinske kralježnice. Ispitanici su nakon postavljanja dijagnoze sindroma pekućih usta, podijeljeni u tri skupine po dvadeset ispitanika kod kojih će se primijeniti terapija klonazepamom, terapija akupunkturom i grupa ispitanika bez terapije (kontrolna skupina). Ispitanici su prije dobivanja bilo koje od terapija (klonazepam, akupunktura, kontrolna skupina) ispunili upitnike VAS, Lanssova skala, MoCa, SF-36, Hamiltonova skala, Beckova skala. Iste upitnike su ispunili i nakon završetka bilo koje od terapija. Svrha istraživanja je bila: ustanoviti učinkovitost akupunkture i klonazepama u oboljelih od sindroma pekućih usta a na temelju rezultata skala (LANSS, VAS, MoCa, SF-36, Beck i Hamilton), te neurološke poremećaje u oboljelih od sindroma pekućih usta. Rezultati ovog istraživanja pokazuju kako je liječenje akupunkturom i kloazepamom dovelo do značajne regresije boli, kao i do regresije anksiodepresivnih tegoba i poboljšanja kvalitete života, dok kod kognitivnih funkcija nije došlo do značajnijih promjena. U rezultatima vidnih evociranih potencijala nije nađeno značajnijih odstupanja od normale, analizom tremora također nije nađeno značajnijih odstupanja od normalnih vrijednosti. Zabilježena je statistički značajna pojavnost disfunkcije u EMNG-u refleksu treptaja uz promjenu habituacije R2 komponente i pozitivnu R3 komponentu, također je u vrijednostima V-R latence u BAERU zabilježeno produljenje latence što ukazuje na disfunkciju u inervacijskom području n trigeminusa. Iz istraživanja se dade zaključiti kako su akupuntkura i klonazepam učinkoviti u liječenju sindroma pekućih usta.Background and objectives: Burning mouth syndrome (BMS) is a chronic oral symptom with burning sensation and clinically healthy appearance of the oral mucosa. Recently, neuropathological basis has been provided to support this concept. Furthermore, there is a lack of randomized controlled studies regarding applied therapies. Therefore, the aim of this study was to compare the effectiveness of acupuncture and clonazepam in patients with burning mouth syndrome measured by the following scales (LANSS, VAS, MoCa, SF-36, Beck i Hamilton), to determine a correlation between temporomandibular disturbances and BMS as well as to establish a correlation between neurological disturbances and BMS. Methods: This study included 60 patients with BMS (6 men and 54 women) and 20 controls with low back painful disturbances. BMS patients were randomly divided into three groups: 20 patients who took clonazepam, 20 patients who underwent acupuncture treatment and 20 subjects without any therapies. Prior to and after any therapies the subjects were asked to rate pain severity on the following scales: VAS, LANSS, MoCa, SF-36, Hamilton, and Beck. The analysis of temporomandibular disturbances was made by clinical examination and x-ray. Neurological tests included brain evoked auditory and eye potentials (BAEP), electromyoneurography of the blink reflex. Statistical analysis was performed by use of Student t test and logistic regression analysis. P values lower than 0.05 were considered significant. Results: The results of this study showed that both acupuncture and clonazepam led to a significant elimination of pain as well as anxio-depressive symptoms and, also, to improvement in quality of life in BMS patients. However, there was no improvement in cognitive function. There was no significant assignation in evoked eye potentials as well as in tremor analysis. There was a significant dysfunction seen electromyographically of the blink reflex with changed habituation of R2 component and positive R3 component as well as an increased V-R latency in BAEP, which implies a dysfunction of the innervation area of the trigeminal nerve. Conclusion: Acupuncture and clonazepam are similarly effective for patients with burning mouth syndrome

Dijagnostičke i terapijske nedoumice u liječenju intrakranijskih aneurizma

Intracranial aneurysms have a prevalence of about 2% of the population. They are a common incidental finding of noninvasive neuroimaging methods, raising the question of the necessity of treatment of patients with an asymptomatic intracranial aneurysm. For long, the only treatment option was surgical clipping of aneurysm neck. In the last 25 years, endovascular techniques have been developed as an alternative solution for patients who are not eligible for neurosurgical procedures. Research has shown better results of embolization procedures with lower rates of complications, but a higher rate of recanalization is still a major drawback of endovascular coiling. There are no strict protocols and the treatment of choice for intracranial aneurysms should be agreed upon by both the physician and the patient. This review aims to provide an insight into the management of intracerebral aneurysms with emphasis on the decision making problems faced by clinicians.Intrakranijske aneurizme prisutne su u oko 2% populacije. Uobičajen su slučajni nalaz neinvazivnih neuroslikovnih metoda otvarajući pitanje nužnosti liječenja bolesnika s asimptomatskom intrakranijskom aneurizmom. Dugo je jedina mogućnost liječenja bila kirurško podvezivanje vrata aneurizme, no u posljednjih 25 godina usavršen je endovaskularni pristup pružajući alternativu bolesnicima koji ne ispunjavaju uvjete za neurokirurške zahvate. Istraživanja su pokazala bolje rezultate embolizacijskih postupaka s nižim stopama komplikacija, ipak, veća stopa rekanalizacija i dalje je glavni nedostatak endovaskularnog pristupa. Ne postoje strogi protokoli tretiranja intrakranijskih aneurizma te konačna odluka leži u dijalogu između liječnika i bolesnika. Cilj ovoga preglednog rada jest pružiti uvid u pristup intracerebralnim aneurizmama s naglaskom na probleme donošenja odluka s kojima se suočavaju kliničari

Program for Dental Health Advancement in Children „Dental Passport“

Cilj: Potreba za poboljšanjem oralnog zdravlja u Republici Hrvatskoj temeljila se na zdravstvenim po-kazateljima i lošem stanju oralnog zdravlja te je rezultirala provedbom mjera za poboljšanje korištenja dentalne zdravstvene zaštite školske djece na temelju nacionalnog programa Zubna putovnica s kojim se počelo u školskoj godini 2017./2018. Svrha ovog rada bila je predstaviti sadržaj i rezultate provedbe programa te ih analizirati s naglaskom na održivost i obuhvatnost programa te provedbu preventivnih aktivnosti, odnosno postupaka. Materijal i metode: Podatci su prikupljeni iz ispunjenih obrazaca Zubna putovnica od rujna 2017. Do kolovoza 2018. godine. Pregledi i dijagnostičko-terapijski postupci (DTP) bilježili su se u sklopu Centralnoga zdravstvenog informacijskog ustava Republike Hrvatske. Rezultati: U školskoj godini 2017./2018. Doktora dentalne medicine posjetilo je 24.729 učenika 6. razreda, s odazivom od 68 % za Republiku Hrvatsku. Prema podatcima CEZIH-a u razdoblju od 1. Rujna do 31. Prosinca 2017. Godine kod djece u dobi od 12 godina zabilježeno je povećanje broja prvih pregleda i dijagnostičko-terapijskih postupaka u odnosu prema istom razdoblju 2015. Najrjeđe zabilježeni preventivni postupci kod predškolske djece i učenika 6. Razreda bili su pečaćenje fisura po zubu i pečatni ispuni, a demonstracija čišćenja usta i motiviranje djece na higijenu usta bili su najčešći. Zaključak: Dobra organizacija rada u djelatnosti školske medicine daje osnovu za provedbu dentalnih programa u koje se uključuje školsku djecu, ali su također veća motiviranost pružatelja dentalne zdravstvene zaštite u provedbi preventivnih postupaka te motiviranost roditelja i pacijena-ta za aktivnije uključivanje u program Zubna putovnica, važne odrednice u daljnjoj provedbi i poboljšanju dentalnog zdravlja djece.Objective: The need for improving oral health in the Republic of Croatia was based on health indicators andpoor oral health status and resulted in the implementation of measures to improve the use of dental health care for schoolchildren through the national program called “Dental Passport”, which began in the 2017/2018 school year. Purpose: The aim of this study was to present the content and results of its implementation and to analyse them with emphasis on the sustainability and inclusion of the program and its implementation in preventive activities and procedures. Material and Methods: The data were collected from the completed “Dental Passport” forms from September 2017 to August 2018. The dental examinations and diagnostic-therapeutic procedures were recorded in The Central Health Information System of Croatia. Results: In the school year 2017/2018, 24,729 6th grade elementary school tudents visited a dentist. The response rate in the Republic of Croatia was 68%. According to the CEZIH data, in the period from September 1 to December 31 2017, an increase in the number of first examinations and diagnostic-therapeutic procedures was observed in children aged 12 years, compared to the same peri-od in 2015. The least reported preventive procedures in preschool children and 6th grade students were fissure sealing and sealing restorations, while motivating and instructing children on oral hygiene were the most common reported procedures. Conclusion: Good organization of work in school medicine pro-vides the basis for the implementation of dental programs involving schoolchildren. However, greater motivation of the dental health care provider in the implementation of preventive procedures and motivation of parents and patients for a more active involvement in the “Dental Passport” program are important determinants in further implementation and improvement of oral health in children

Possible Risk Factors for Dental Fear and Anxiety in Children Who Suffered Traumatic Dental Injury

Background: Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children. Methods: The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents’ knowledge and attitudes, while the DFA level was determined using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status. Results: The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R2 = 0.545, F (4.215) = 64.28 p < 0.001. Conclusions: These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs