Antimicrobial Treatment of Periodontal Diseases

U ovom se članku ocjenjuje vrijednost sustavne protumikrobne terapije bolesti parodonta. Poznavati tip parodontne infekcije može biti važno u izboru protumikrobne terapije. Protumikrobno liječenje treba prilagoditi razlikama u osjetljivosti na antibiotike pojedinih parodontnih patogena. U literaturi je opisano mnogo različitih vrsta antibiotske terapije što otežava odluku o izboru antibiotika u kliničkoj praksi. Vrijednost sustavne upotrebe antibiotika u zaustavljanju progresije parodontnih bolesti ispitana je u mnogobrojnim studijama. Glavni kandidati za antibiotsku terapiju jesu pacijenti kojima konvencionalnom mehaničkom terapijom nije zaustavljeno napredovanje bolesti. Opravdana je upotreba i u bolesnika s lokaliziranim agresivnim parodontitisom ili drugim rano razvijenim oblicima bolesti, te u pacijenata sa sustavskim bolestima koje utječu na parodontitis. Dokazano je da kao dodatak uobičajenoj terapiji može poboljšati ishod liječenja. Ozbiljne nuspojave koje sa sobom donosi sustavna uporaba antibiotika, kao što su razvoj rezistencije, te porast oportunističkih mikroorganizama, ne opravdavaju rutinsku uporabu antibiotika u liječenju kroničnih, sporoprogredirajućih oblika parodontnih bolesti.This paper presents a critical evaluation of the use of systemic antimicrobial treatment in periodontal disease. Recognizing specific types of periodontal infections can significantly influence the choice of antimicrobial treatment. Therapy should be tailored to differences in antibiotic susceptibility between various periodontal pathogens. Many different antibiotic regimens have been described in the literature, making the choice in clinical practice difficult. Numerous studies have examined the impact of systemic antibiotic treatment in stopping the progression of periodontal diseases. Major candidates for antibiotic therapy are patients whose disease continues to progress despite conventional mechanical treatment. Antibiotics can also be used in patients with localized aggressive or other early developed forms of periodontitis, as well as in patients with systemic diseases affecting the course of periodontitis. They have proven to be beneficial as an adjunct to standard therapy. Serious side-effects of systemic antibiotic treatment, such as development of resistance and increase in opportunistic microorganisms, do not justify their use in the treatment of chronic, slowly-progressive forms of periodontal diseases

Comparison of Periodontal Health in Two Different Rural Population Types in Croatia

Planinsko selo ima manji stupanj parodontne bolesti i gubitka pričvrstka od primorskoga sela. Usporedba parodontnog zdravlja i potreba tretmana između primorske i planinske seoske sredine učinjena je na uzorku od 441 osobe (40% populacije) dobi iznad 15 godina uporabom Parodontnog indeksa zajednice (CPI) i indeksa Gubitka pričvrstka (LA). Prevalencija parodontne bolesti u u objema sredinama vrlo je visoka. Gingivitis i parodontitis javljaju se vrlo rano. Prevalencija zdravog parodonta nije zabilježena iznad 30. godine ni u primorskoj ni u planinskoj sredini. Plitiki parodontni džepovi postoje već u adolescenata u primorju 11,76% (p < 0,05), a u planini od 20. godine - 14, 26%. Iznad 30. godine u objema sredinama više od 50% populacije ima plitki ili duboki džep, a iznad 55. godine oko 40% obiju populacija ima registriran barem jedan duboki džep. Isključenih sekstanata u svim dobnim skupinama ima planinsko selo i to u rasponu od 2 do 11 puta više (p < 0,05). U objema populacijama više od 4 sekstanta je iznad 65. godine isključeno. Zbog manjega broja preostalih zubi planinsko selo ima i manji stupanj parodontne bolesti. Više od 50% populacija iznad 35. godine ima gubitak pričvrstka > 6mm (prosječno u 1 sekstantu). Iznad 45. godine gotovo da i nema sekstanata s gubitkom pričvrstka < 3mm. Više od 90% ispitanika obaju područja treba neku vrstu parodontnog tretmana.The rural population in mountain region has less periodonal disease and attachment loss degree. A comparison of periodontal health and necessary treatment between the littoral and rural populations in mountain region was conducted on a sample of 441 individuals (40% of the population) in the 15+ age group, by applying the Community Periodontal Index (CPI) and the Loss of Attachment Index (LA). The prevalence of periodontal disease in both areas appears to be very high. The occurrence of gingivitis and parodontitis is evident at an early age. Neither in the littoral nor in the mountains region was the prevalence of healthy periodont in the 30+ age group recorded. In the littoral area shallow periodontal pockets are already present with adolescents - 11.76% (p<0.05), and in the mountain region from the age of 20 - 14.26%. More than 50% of the 30+ population of both regions has either deep or shallow pockets, while approximately 40% of the 55+ population in both groups has at least one deep pocket. The mountain village has excluded sextants in all age groups, ranging from 2 to 11 times more then the littoral village (p<0.05). In the 65+ group of both populations more than 4 sextants are excluded. Because of the smaller number of remaining teeth, the mountain village records less periodontal disease. More than 50% of the 35+ age group has loss of attachment >6mm (approximately in one sextant). In the 45+ age group there is almost no sextant with loss of attachment <3mm. More than 90% of the examinees in both regions need some kind of periodontal treatment

Therapy of Advanced Periimplantitis - Case Presentation Clinical and Microbial Results after 10 Months

Sve više bude postavljenih usadaka neizbježno je da će biti više komplikacija u vezi s takvim terapijskim postupkom. Jedna od komplikacija koju je najteže izliječiti i koja posljedično može dovesti do gubitka usatka jest bakterijski uzrokovan periimplantitis. U ovome prikazu slučaja opisat će se uspješna terapija uznapredovala periimplantitisa. Pacijent u dobi od 58 godina poslan je parodontologu zbog smetnji u usnoj šupljini u obliku neugodna zadaha te gnojenja oko zuba i usadaka. Prigodom parodontološkoga pregleda opaženo je da su oba usatka na mjestima 22 i 25 zahvaćena periimplantatnim mukozitisom te da postoji krvarenje i gnojenje pri sondiranju. Kod usatka u području 25 postojao je i problem potpunoga nedostatka keratinizirane gingive. Na temelju kliničkog i rtg nalaza te pozitivnog mikrobiološog nalaza na parodontopatogene dijagnosticiran je periimplatitis oko oba usatka. Inicijalna parodontološka terapija završena je u četiri posjeta. Pacijent je dobio upute kako da održava oralnu higijenu te je uključena antiseptička terapija, ispiranje klorheksidinom i uporaba klorheksidinskoga gela izravno u džepove oko usadaka. Kako i nakon takve terapije gnojenje nije prestalo, uključena je i antibiotska terapija te ispiranje džepova jodom. Nakon što je infektivni proces uspješno stavljen pod nadzor, u daljnjem terapijskom postupku proveden je parodontološki kirurški zahvat kako bi se oko usatka 25 pokušao ispraviti nedostatak keratinizirane gingive i dobiti nov pričvrstak. Pošto je režanj odignut, površina usatka očišćena je sterilnom vatom natopljenom u klorheksidin, a s nepca je uzet vezivni presadak te je postavljen na kosti i na izložene navoje usatka. Preko presatka postavljen je Gengigel (hijaluronska kiselina) radi boljeg cijeljenja rane. Pet mjeseci nakon operacije ponovljena je mikrobiološka raščlamba te više nije bilo parodontnih patogena, a klinička mjerenja su pokazala da je smanjena dubina sondiranja, da ne postoji krvarenje ili gnojenje i da je nastala zona keratinizirane gingive od 2 mm oko usatka 25.With the ever increasing number of placed implants it is inevitable that the number of complications connected with such therapeutic procedure will also increase. One of the complications which is hardest to treat and which consequently can lead to loss of the implant, is bacterial caused periimplantitis. This case presentation describes the successful therapy of advanced periimplantitis. The male patient, aged 58 years, was referred to the periodontist because of problems in the oral cavity in the form of unpleasant breath and suppuration around the tooth and implant. During the periodontal examination it was observed that both implants on places 22 and 25 were affected by periimplantic mucositis and bleeding and suppuration occurred during probing. With regard to the implant in area 25 the problem of complete loss of keratinised gingiva was also present. On the basis of the clinical and X-ray findings, and positive microbial test for periodontopathogens, periimplantitis was diagnosed around both implants. Initial periodontological therapy was carried out in four visits. The patient received instructions on the maintenance of oral hygiene and antiseptic therapy was included, rinsing with chlorhexidine and application of chlorhexidine gel directly into the pockets around the implants. As after this therapy the suppuration did not stop antibiotic therapy was included, with rinsing of the pockets with iodine. After successful control of the infective process, further therapy involved a periodontological surgical operation in order to correct the loss of keratinised gingiva around implant 25 and to obtain new attachment. After lifting the flap the surface of the implant was cleaned with sterile cotton wool soaked in chlorhexidine, and from the palate a connective transplant was taken and placed on the bone and the exposed thread of the implant. Gengigel (hyaluronic acid) was placed over the transplant for better healing of the wound. Five months after the operation microbial analysis was repeated. Periodontal pathogens were no longer present and clinical measurements showed reduced probing depth, absence of bleeding and suppuration, and the occurrence of zones of keratinised gingiva of 2 mm around implant 25

Oralna higijena kao važan čimbenik u sprječavanju pneumonije povezane s mehaničkom ventilacijom

Inadequate oral hygiene in intensive care units (ICUs) has been recognized as a critical issue, for it is an important risk factor for ventilator associated pneumonia (VAP). VAP is an aspiration pneumonia that occurs in mechanically ventilated patients, mostly caused by bacteria colonizing the oral cavity and dental plaque. It is the second most common nosocomial infection and the leading cause of complications and death in mechanically ventilated patients. It has been suggested that improvement of oral hygiene in ICU patients could lead to a reduced incidence of VAP. Although diverse oral care measures for ICU patients have been proposed in the literature, there is no evidence that could identify the most efficient ones. Although there are several evidence-based protocols, oral care measures are still performed inconsistently and differ greatly between individual ICUs. This paper lists the oral care measures most commonly performed in ICUs, indicating their advantages and disadvantages. Brushing with regular toothbrush and rinsing with chlorhexidine are considered optimal measures of oral hygiene in critically ill patients. To date, there is no definitive agreement about the most effective oral care protocol, but evidence demonstrates that consistent performance of oral care may lower the incidence of VAP in critically ill patients.Nezadovoljavajuća oralna higijena na jedinicama intenzivnog liječenja (JIL ) prepoznata je kao ključno pitanje, jer predstavlja značajan čimbenik rizika za razvoj pneumonije povezane s mehaničkom ventilacijom. Pneumonija povezana s mehaničkom ventilacijom je aspiracijska pneumonija koja se javlja kod mehanički ventiliranih bolesnika i većinom je uzrokovana bakterijama koje koloniziraju usnu šupljinu i zubni plak. Druga je po redu najčešća nozokomijalna infekcija i vodeći je uzrok komplikacija i smrti u mehanički ventiliranih bolesnika. Smatra se kako bi poboljšanje oralne higijene u JIL moglo rezultirati smanjenom incidencijom pneumonije povezane s mehaničkom ventilacijom. Iako su u literaturi predložene razne mjere oralne higijene za bolesnike u JIL , ne postoje dokazi koji bi pokazali koje su od njih najučinkovitije. Iako postoji nekoliko protokola temeljenih na dokazima, mjere oralne higijene se još uvijek provode nedosljedno i razlikuju se među pojedinim JIL . Ovaj rad navodi mjere oralne higijene koje se najčešće provode u JIL i ukazuje na njihove prednosti i nedostatke. Optimalnim mjerama oralne higijene smatraju se četkanje običnom zubnom četkicom i ispiranje klorheksidinom. Iako do danas ne postoji suglasje o najučinkovitijem protokolu oralne skrbi, pokazalo se kako dosljedno provođenje oralne higijene može smanjiti incidenciju pneumonije povezane s mehaničkom ventilacijom u kritično bolesnih pacijenata

Quantitative Analysis of Candidiasis and Pyrosis in Oral Lichen Ruber

Retrospektivnim istraživanjem elaborirani su svi slučajevi OLR-a u pacijenata koji su došli na liječenje u Zavod za oralnu medicinu Stomatološkog fakulteta Sveučilišta u Zagrebu u razdoblju od 1. siječnja 1995 do 31. prosinca 1998 godine. Svrha rada bila je utvrditi čestoću infekcije Candidom albicans i postojanje piroze u pacijenata s OLR-om. Prosječna starost žena je 55 godina, muškaraca 53. U žena je OLR bio u dvostruko većoj frekvenciji nego u muškaraca (66,6 : 33,3 %). Najčešće se OLR javljao između 40 i 60. godina života. Najčešća je forma OLR planus (69%). U 75 pacijenata ili 43,1% od ukupno 174 OLR nađena je kandidijaza, a simptom piroze postojao je u 62 pacijenta ili 35,6%. Pacijenata samo s kandidijazom bez piroze bilo je 39 ili 22,4%, samo s pirozom bez kandidijaze 26 ili 14,9%, a s kandidijazom i pirozom 36 ili 20,7%. Zbog tako visoke čestoće infekcije Candidom albicans i postojanja simptoma piroze, kada su dijagnosticirani, u terapijskim postupcima OLR-a treba liječiti i kandidijazu i pirozu.All oral lichen ruber (OLR) cases seen at the Department of Oral Medicine, School of Dental Medicine University of Zagreb, from January 1, 1995 to December 31, 1998, were included in this retrospective study. The aim of the study was to assess the prevalence of Candida (C. albicans) infection and burning mouth syndrome (BMS) in OLR patients. The mean age of the examined men and women was 53 and 55 years, respectively. In women, the prevalence of OLR was twice as high as in men (66.6% : 33.3%). OLR most commonly occured between the age of 40 and 60 years. The most frequent type of OLR was lichen planus (69%). C. albicans was detected in 75 of 174 (43.1%) patients, while BMS was present in 62 (35.6%) patients. There were 39 (22.4%) patients with candidiasis (without BMS), 26 (14.9%) with BMS (without candidiasis), and 36 (20.7%) with both candidiasis and BMS. The high prevalence of C. albicans infection and BMS concurrence indicates to the need for simultaneous treatment of both entities

Radiographic and Prosthetic Assessment Prior to Implantoprosthetic Therapy

Jedan od osnovnih uvjeta uspješnosti terapije oseointegrirajućim usadcima jest dobro predkirurško planiranje. Svrha je ovoga rada prikazati na slučaju djelomične bezubosti u distalnom dijelu mandibule mogućnosti radiološke i protetske ocjene prije kirurškoga tretmana. Na modelu čeljusti učinjeno je dijagnostičko navoštavanje. Nakon toga izrađena je šablona iz vakuum termoplastične folije. Metalne kuglice poznatoga promjera stavljene su u pozicije navoštanih zuba kako bi se radiološkom tehnikom ocijenila mogućnost implantacije u predviđenim pozicijama. Učinjen je klasični ortopantomogram te na temelju njega i slojeviti tomogram s točnim presjecima mandibule na položajima budućih usadaka. Na temelju rendgenskih nalaza određen je položaj i duljina usadaka. Prikazan je klasičan dvofazni kirurški protokol te operacijska tehnika s intraoralnim pretprotetskim šablonama. Uporabljeni su usadci Astratech microthread koničnoga profila kako bi se promjerom usatka što više približili promjeru budućega zuba. Dužina usatka određena je u skladu s navedenom radiološkom raščlambom tako da je usadak na poziciji 35 kraći od usadaka 34 i 37 zbog anatomske pozicije foramena mentale. Pri kirurškome pozicioniranju usatka osim pozicije koja je određena šablonom usadci su u okomitome smjeru pozicionirani u skladu s biološkom širinom sluznice i u konačnici parodontološko estetskim zahtjevima. Rezultati prikazuju uspješnost terapije nakon dobra planiranja i pripreme. Prikazana je prednost slojevite tomografije u planiranju i određivanju anatomsko-morfoloških karakteristika donje čeljusti koja nam daje sigurnost u izboru dužine, a osobito širine usatka. Predkirurško planiranje je postupak kojime možemo predvidjeti položaj usatka i estetiku budućega protetskog rada te tako olakšati kirurški zahvat.One of the fundamental pre-conditions for successful therapy by osseo-integrating implants is good pre-surgical planning. The aim of this work is to present the possibilities of radiographic and prosthetic evaluation prior to surgical treatment in the case of partial edentulousness.in the distal part of the mandibula. Diagnostic wax-up is done on a model of the jaw. After which a pattern is made of vacuum thermoplastic foil. Metal pellets of known diameter are placed in the positions of the waxed-up teeth to enable radiographic evaluation of the possibility of implantation in the planned positions. Classical orthopantomography is performed on the basis of which a multi-layer tomogram is done with exact cross-sections of the mandibula in the positions of future implants. On the basis of radiographic findings the position and length of the implants are determined. The classical two-phase surgical protocol is described and surgical technique with intraoral pre-prosthetic patterns. Astratech microthread implants of conical profile are used to ensure that the implant diameter is as close as possible to the diameter of the future tooth. The length of an implant is determined in accordance with the cited radiographic analysis, so that the implant in position 35 is shorter in relation to implants 34 and 37, due to the anatomic position of the foramen mentale. During surgical positioning of implants, apart from the position which is defined by the pattern, in the vertical direction the implants are positioned in accordance with the biological width of the mucous membrane and finally with periodontal aesthetic requirements. The results show the success of the therapy following good planning and preparation. The advantage is shown of multi-layer tomography in planning and determining the anatomical-morphological characteristics of the lower jaw, which provides assurance in the choice of length and particularly the width of the implant. Pre-surgical planning is a procedure by which it is possible to foresee the position of an implant and aesthetics of future prosthetic work, and thus to facilitate the surgical intervention

The Distribution of Periodontal Disease and Loss of Attachment in Jaw Sextants in Different Age Groups – Cross–Sectional Study

The distribution of periodontal disease stages is not the same in both human jaws, parts of the same jaw or in different ages of life. In the sample of 2,730 sextants, 455 persons 15+ years of age, analysis of distribution of both periodontal disease and loss of attachment in jaw sextants in different age groups was made, using the Community Periodontal Index (CPI) and Loss of Attachment (LA). Statistical significance testing was checked using the Pearson Chi-Square-test with probability of 95%. Healthy periodontium is mostly found in upper anterior sextant (36%, p < 0.001), and bleeding on probing in lower right sextant (25.45%, p < 0.001). There is most calculus in lower anterior sextant (48.19%, p < 0.001), followed by upper posterior (15–17%). Deep pockets are more often in lower anterior sextant (31.87%, p < 0.001), and upper and lower posterior sextants are without teeth in 18–20.5% of cases, but lower anterior sextant in only 7.73% (p < 0.001). Cumulative minimal loss of attachment (0–3 mm) significantly is more often present in upper anterior sextant (21.2%, p < 0.001), while values 5–11 mm are more often in lower anterior sextant (25–43%, p < 0.001). Loss of attachment 12mm appears in only 1.4% present sextants and it is rear on left jaw side. Significant differences in distribution of both periodontal disease and loss of attachment appear in age 30+

Parodontne bolesti kao čimbenik rizika

There is an increasing body of evidence in periodontology that speaks in favor of the association between human chronic inflammatory diseases and opportunistic infections. Considering their frequency and microbiological etiology, periodontal diseases, especially severe periodontitis, have become subjects of many studies. Periodontitis is a major infectious threat to the whole organism, since it can affect distant organs and tissues by releasing microbes, their products and mediators of inflammation into the bloodstream. This fact has reduced the boundaries between medicine and dentistry, but the change in thinking has developed an entirely new field of periodontology, also known as “periodontal medicine”. Over the past decade a growing body of scientific evidence shows a strong connection between periodontal disease and systemic conditions and diseases such as atherosclerosis, cardiovascular and cerebrovascular diseases, premature birth, diabetes and respiratory diseases. Most of the research has been focused on the relationship between periodontal disease and atherosclerosis since they have many common, potential pathophysiological mechanisms, including complex etiology, and share many risk factors, especially smoking history. There is data linking periodontitis with an increased risk for atherosclerosis and thromboembolic events. Periodontitis in pregnant women may increase the risk for preterm birth and low birth-weight. The role of diabetes as a risk factor for periodontal disease has been investigated earlier, but a number of studies suggest that there may be a two-way relationship, in accordance with the concept that infection may weaken metabolic control of diabetes. The results of numerous studies and the development of periodontal medicine have led to productive cooperation with colleagues in medicine, and discovered many new evidences that suggest that the oral cavity is an integral part of the human body, and that systemic health must include oral and periodontal health.Sve je više dokaza koje govore u prilog povezanosti kroničnih upalnih bolesti čovjeka s oportunističkim infekcijama u parodontologiji. Parodontne bolesti, posebice uznapredovali parodontitis, postale su predmet mnogobrojnih istraživanja s obzirom na učestalost i mikrobiološku etiologiju. Parodontitis predstavlja veliku infektivnu opasnost za cijeli organizam jer otpuštajući mikroorganizme, njihove produkte te medijatore upale u krvotok može djelovati na udaljene organe i tkiva. Navedena činjenica smanjila je granice između medicine i stomatologije te je promjenom razmišljanja došlo do razvoja potpuno novog područja u parodontologiji koje je nazvano „parodontna medicina“. Tijekom prošlog desetljeća sve veći broj znanstvenih činjenica upućuje na snažnu povezanost parodontnih bolesti i sistemnih stanja i bolesti kao što su: ateroskleroza, kardiovaskularne i cerebrovaskularne bolesti, prijevremeni porođaj, dijabetes i plućne bolesti. Najviše istraživanja bilo je usmjereno na povezanost između parodontitisa i ateroskleroze s obzirom da imaju mnogo zajedničkih, potencijalnih patofizioloških mehanizama, kompleksne su etiologije te dijele brojne rizične faktore, među kojima je najznačajniji status pušača. Pronađeni su dokazi koji povezuju parodontitis s povećanim rizikom za aterosklerozu i tromboemboličkim zbivanjima. Parodontitis trudnica može povećati rizik za prijevremeno rođenje i smanjenu porođajnu težinu djeteta. Uloga dijabetesa kao faktora rizika za parodontitis istražena je ranije, ali određen broj studija ukazuje da možda postoji i dvosmjerni odnos, u skladu s koncepcijom da infekcija može doprinijeti oslabljenoj metaboličkoj kontroli dijabetesa. Rezultati mnogobrojnih studija i razvoj parodontne medicine doveli su do plodonosne suradnje s kolegama u medicini i otkrili mnoga nova saznanja koja potvrđuju da je usna šupljina integralni dio ljudskog tijela te da sistemsko zdravlje mora uključivati oralno i parodontno zdravlje

Unrealistic Optimism and Demographic Influence on Oral Health-Related Behaviour and Perception in Adolescents in Croatia

Znanje i motivacija smatraju se osnovnim odrednicama zdravstveno-higijenskih navika. U ovom radu željeli smo proučiti utjecaj demografskih karakteristika, percepcije, motivacije i educiranosti adolescenata na oralno zdravlje i njihove oralnohigijenske navike. Ispitivanje je provedeno anonimno, anketnim upitnikom godine 2006. na uzorku od 302 srednjoškolca u dobi od 17 do 19 godina, u tri grada u različitim regijama korištene su neparametrijske statističke metode za analizu podataka. Percepcija adolescenata o oralnom zdravlju na visokoj je razini, za razliku od niske percepcije oralnih bolesti. Iako različiti demografski, socijalni i spolni čimbenici utječu na oralnohigijenske navike, na njih manje utječe znanje adolescenata. Pa čak i oni s većim znanjem o oralnim bolestima i prevenciji, nisu češće primjenjivali osnovne higijenske navike, niti su se češće koristili pomoćnim sredstvima, mijenjali četkicu, posjećivali stomatologa ili izbjegavali šećer. Očito je da adolescenti ne izvlače smisao iz informacija o riziku za vlastito zdravlje, niti mogu jednostavno prepoznati vezu vlastita ponašanja i rizika kojem se izlažu. To je povezano s nerealnim optimizmom i tendencijom da se negativni događaji uočavaju rjeđe, a pozitivni češće na sebi nego na drugima.Knowledge and motivation are considered to be essential determinants of health-related behaviour. The aim of this study was to evaluate the influence of demographic characteristics, perception, knowledge and motivation regarding oral health of adolescents on their habits in oral hygiene. The study was conducted in 2006 in the sample of 302 secondary school students, aged 17 to 19, from three cities in different Croatian regions using a questionnaire. Data were analysed by nonparametric statistics. Adolescents have relatively high perception regarding oral health, but their perception of oral diseases is quite low. Although different demographic, social and gender-related factors affect oral health behaviours, they are less affected by adolescents’ knowledge. And in fact those who were better educated about oral diseases and prevention didn’t practice basic hygiene significantly more often, nor used additional products, changed their toothbrush, visited dentist or avoided sugar. It is obvious that young people do not draw personal implications from health risk information, or can not easily recognise the link between their own behaviour and the risk they are putting themselves into. It has been related to unrealistic optimism, the tendency to perceive negative events as less likely and positive events as more likely to oneself than to others