Prevencija nekarijesnih lezija u djece

prevention; noncarious lesions; dental erosion; childrenprevencija; nekarijesne lezije; dentalna erozija; djec

A Case Report of Bulimia Induced Dental Erosion in a Female Adolescent

Vrlo teški oblici dentalne erozije rijetki su u adolescentskoj populaciji. Ovaj rad opisuje 17-godišnju pacijenticu koja se žalila na pojačanu osjetljivost zuba na hladan podražaj i dodir. Stomatološkim kliničkim pregledom ustanovljene su teške promjene - dentalna erozija svih zuba, što je tipično za intrinzične čimbenike dentalne erozije. Pacijentica je također ispunila upitnik kako bi se povezali erozija i mogući etiološki čimbenici. Odgovori iz upitnika, heteroanamnestički podaci i dentalni status, potvrdili su preliminarnu dijagnozu bulimije nervoze koja je rezultirala, za tu dob, rijetkom dentalnom destrukcijom i to u razdoblju od samo tri godine.Very severe forms of dental erosion are uncommon finding in adolescent population. This paper describes a 17-year old female who complained of increased teeth sensitivity to cold temperature and to touch. Dental examination revealed extensive and severe pattern of dental erosion of all teeth typical for intrinsic causes of dental erosion. She also completed a questionnaire investigating any association between the presence of erosion and possible etiological factors. Questionnaire responses, heteroanamnestic data and dental status confirmed our preliminary diagnosis of bulimia nervosa that resulted in a rarely significant dental destruction for that age in only three years period

The Role of Dentists in Recognition of Child Abuse

Rano prepoznavanje zlostavljanog djeteta jedan od vrlo aktualnih zadataka, a istodobno je i moralna te zakonska obveza svih medicinskih stručnjaka koji se bave djecom. Zlostavljanje podrazumijeva nekoliko kategorija: zanemarivanje te emocionalno, fizičko i seksualno zlostavljanje. Zanemarivanje je najčešći oblik zlostavljanja djece. U dentalnomedicinskoj literaturi poznat je i pojam dentalnog zanemarivanja, kao podvrste medicinskog zanemarivanja. Kao najčešći pokazatelji navode se neliječen rani dječji karijes („early childhood caries“) koji ima dugoročne posljedice na opće zdravlje i nerijetko je samo izdvojen simptom opće zanemarenog djeteta, zatim neliječena bol, upala, krvarenje ili trauma u sklopu orofacijalnog područja te odgođeno traženje dentalnomedicinske pomoći. Adekvatno znanje svih članova dentalnomedicinskog tima o simptomima različitih oblika zlostavljanja nužan je preduvjet za otkrivanje zlostavljanja i pružanje pomoći zlostavljanom djetetu u dentalnomedicinskoj praksi.Early recognition of abused children is an important task with legal obligation for all medical professionals that deal with children. Abuse encompasses a number of categories: neglect, emotional, physical and sexual abuse. The most frequent type of abuse is neglect. The dental literature includes the term dental neglect, a subgroup of medical neglect. It is often manifested by early childhood caries (which has long-term effects on general health and is frequently an outstanding symptom of a generally neglected child), untreated pain, inflammation, bleeding or trauma of the orofacial area, as well as delayed seeking of professional dental help. Adequate knowledge is required from all members of the dental team regarding different types of abuse; it is a necessary prerequisite for the discovery of abuse and delivering aid to the abused child in the dental practice

DJELOTVORNOST RAZLIČITIH PREVENTIVNIH POSTUPAKA U KONTROLI KARIOGENIH RIZIČNIH ČIMBENIKA U DJECE

Caries risk assessment is a valuable clinical procedure that in many ways facilitates implementation of preventive procedures in children with high risk of caries. The aim of this study was to investigate the effectiveness of five different caries preventive procedures in vivo. One hundred children, aged 4-5 and 10-12 years, were divided into five groups (20 per group) and treated with different preventive procedures (amine fluoride solution, professional prophylactic paste, chewing gum containing xylitol and fluoride, chlorhexidine solution, or chlorhexidine-fluoride gel). During a period of two months, five measurements were performed and the following variables evaluated: Streptococcus (S.) mutans and lactobacilli count (LB), oral hygiene index (OHI), and amount of stimulated saliva. Results showed the highest reduction in the number of bacteria to be achieved by the application of professional prophylactic tooth paste and daily use of chewing gum containing xylitol and fluoride (p<0.001). In these children, S. mutans count was reduced by class 1 and LB to <104 CFU/mL after two months. In conclusion, professional tooth cleaning and use of chewing gum with xylitol and fluorides on a daily basis could be very effective protocol in controlling caries risk factors in children.Procjena rizika za razvoj karijesa vrijedan je klinički postupak koji u mnogočemu olakšava uvođenje preventivnih postupaka u visokorizične djece za karijes. Cilj ovog istraživanja bio je ispitati djelotvornost pet različitih karijes preventivnih postupaka in vivo. Stotinu djece, razdijeljene u pet skupina, od kojih je u svakoj bilo 20-ero (u dobi od 4-5 i od 10-13 godina) tretirano je različitim preventivnim postupcima (amin fluoridnom otopinom, profesionalnom profilaktičkom pastom, žvakaćom gumom koja sadrži ksilitol i fluorid, otopinom klorheksidina, gelom koji sadrži klorheksidin i fluor). Tijekom dvomjesečnog razdoblja obavljeno je pet mjerenja i evaluirane su sljedeće varijable: broj Streptococcus mutans (SM) i Lactobacilli (LB), indeks oralne higijene (OHI) i količina stimulirane sline. Rezultati su pokazali da je najveće smanjenje broja bakterija postignuto primjenom profesionalne profilaktičke paste i svakodnevnim žvakanjem žvakaće gume koja sadrži ksilitol i fluorid (p<0.001). Kod te djece nakon dva mjeseca broj SM-a smanjen je na klasu 1 i LB-a na <104 CFU/ml. Zaključno, profesionalno čišćenje zuba i upotreba žvakaće gume s ksilitolom i fluoridima na dnevnoj bazi mogla bi biti vrlo djelotvorni način za kontrolu rizičnih čimbenika za nastanak karijesa u djece

Child Abuse and Neglect: Croatian Dental Practitioners’ Experience and Knowledge

The aim of this study was to assess the experience and knowledge regarding child abuse and neglect (CAN) amongst the Croatian dental practitioners. Self-administered, structured questionnaire was posted to 500 Croatian dental practitioners, 82 (16.4%) of which had returned the questionnaire and were included in the final sample. The results indicate that dental practitioners have low CAN encounter rates in their practice: 52 (63.41%) never, 25 (30.48%) rarely and 5 (6.09%) sometimes. Amongst those who do, the average encounter rate of suspected CAN is M = 2.08 (SD = 1.97, min = 1, max = 8) and M = 1.33 (SD = 0.42, min = 1, max = 10) for the cases where they were sure of it. Although they find themselves confident of their professional role and the role of the other professionals in the case of CAN they seem to fail to fulfil it, with only one of the participants ever reporting a CAN suspicion. In general, participants seem aware of the need and are willing to engage in further education, especially in the field of CAN prevention and recognition of it

Noise Levels in a Pedodontic Dental Practice

Svrha rada bila je odrediti razinu buke u pedodontskoj stomatološkoj ordinaciji koja prije toga nije bila akustički obrađena te anketirati stomatologe kako bi se procijenila izvrgnutost neželjenim zvukovima stomatoloških uređaja tijekom redovitoga dnevnog radnog vremena. Mjerenje buke obavljeno je u Zavodu za pedodonciju Stomatološkog fakulteta Sveučilišta u Zagrebu u ordinaciji sa šest radnih mjesta, a koristili su se najčešće potrebni stomatološki nastavci (turbina s vodom, mikromotor s vodom i bez vode, puster i SONICfl ex). Odabrana su dva načina ispitivanja - tradicionalna, normirana metoda jednokanalnoga zvukomjera s modulom za spektralnu analizu te nova dvokanalna metoda pomoću umjetne glave. Ekvivalentna razina osnovne buke izmjerena s korekcijskim fi ltrom A (LAeq) iznosila je LAeq = 54,4 dB (decibela). Razina buke u lijevom uhu umjetne glave bila je 53 dB, a u desnom 55 dB. Buka koja se stvara tijekom rada turbine s vodom iznosila je LAeq = 81 dB, mikromotora s vodom LAeq = 75 dB, mikromotora bez vode LAeq = 72,5 dB, pustera LAeq = 81,5 dB i SONICfl ex LAeq = 76 dB. Ekvivalentna razina buke kojoj je izložen stomatolog bila je LAeq = 72,1 dB, što uz korekciju zbog tonalne buke iznosi LAeq = 77,1 dB. Na temelju dobivenih rezultata može se zaključiti da je buka – iako ekvivalentna razina buke ne premašuje LAeq = 90 dB, što bi bio razlog za urgentno djelovanje - ipak veća od LAeq = 70 dB, a to je gornja granica dopuštena prema odredbama Pravilnika o zaštiti na radu. Kako buci u ordinaciji nije izvrgnut samo terapeutski tim nego i pedodontski pacijent, trebalo bi akustički obraditi prostoriju u kojoj se obavlja djelatnost, kako bi se smanjile neželjene posljedice poput straha, stresa i uznemirenosti pacijenata.The aim of this paper was to measure the level of noise in the pedodontic practice, which hasn’t been acoustically treated, and to interview the dentists in order to determine their exposure to undesired noise of dental equipment during daily work. The measurement of noise was conducted at the Department of Pedodontics, School of Dental Medicine, Zagreb, using the most frequently used handpieces (turbine, micromotor with and without water, air syringe and SONICfl ex). A standardised method of noise measurement was applied, by means of a single-channel sound level meter; and a new dual-channel method, by means of an artifi cial head. The equivalent level of background noise with a correction fi lter A (LAeq) was LAeq = 54.4 dB (decibel). The noise level in the left ear of the artifi cial head was 53 dB and in the right ear 55 dB. The noise made by a turbine was LAeq = 81 dB, by the micromotor with water LAeq = 75 dB, by the micromotor without water LAeq = 72.5 dB, by the air syringe LAeq = 81.5 dB and by SONICfl ex LAeq = 76 dB. The level of noise the dentist was exposed to was LAeq = 72.1 dB. It can be concluded that the equivalent level was above LAeq = 70 dB, which is the limit prescribed by the Safety at Work Regulations. Since it is not only the therapist that is exposed to noise, but also the pedodontic patient, it would be advisable to treat the room acoustically in order to reduce undesired consequences of the noise, such as the patient’s fear, stress and anxiety

Noise Levels in a Pedodontic Dental Practice

Svrha rada bila je odrediti razinu buke u pedodontskoj stomatološkoj ordinaciji koja prije toga nije bila akustički obrađena te anketirati stomatologe kako bi se procijenila izvrgnutost neželjenim zvukovima stomatoloških uređaja tijekom redovitoga dnevnog radnog vremena. Mjerenje buke obavljeno je u Zavodu za pedodonciju Stomatološkog fakulteta Sveučilišta u Zagrebu u ordinaciji sa šest radnih mjesta, a koristili su se najčešće potrebni stomatološki nastavci (turbina s vodom, mikromotor s vodom i bez vode, puster i SONICfl ex). Odabrana su dva načina ispitivanja - tradicionalna, normirana metoda jednokanalnoga zvukomjera s modulom za spektralnu analizu te nova dvokanalna metoda pomoću umjetne glave. Ekvivalentna razina osnovne buke izmjerena s korekcijskim fi ltrom A (LAeq) iznosila je LAeq = 54,4 dB (decibela). Razina buke u lijevom uhu umjetne glave bila je 53 dB, a u desnom 55 dB. Buka koja se stvara tijekom rada turbine s vodom iznosila je LAeq = 81 dB, mikromotora s vodom LAeq = 75 dB, mikromotora bez vode LAeq = 72,5 dB, pustera LAeq = 81,5 dB i SONICfl ex LAeq = 76 dB. Ekvivalentna razina buke kojoj je izložen stomatolog bila je LAeq = 72,1 dB, što uz korekciju zbog tonalne buke iznosi LAeq = 77,1 dB. Na temelju dobivenih rezultata može se zaključiti da je buka – iako ekvivalentna razina buke ne premašuje LAeq = 90 dB, što bi bio razlog za urgentno djelovanje - ipak veća od LAeq = 70 dB, a to je gornja granica dopuštena prema odredbama Pravilnika o zaštiti na radu. Kako buci u ordinaciji nije izvrgnut samo terapeutski tim nego i pedodontski pacijent, trebalo bi akustički obraditi prostoriju u kojoj se obavlja djelatnost, kako bi se smanjile neželjene posljedice poput straha, stresa i uznemirenosti pacijenata.The aim of this paper was to measure the level of noise in the pedodontic practice, which hasn’t been acoustically treated, and to interview the dentists in order to determine their exposure to undesired noise of dental equipment during daily work. The measurement of noise was conducted at the Department of Pedodontics, School of Dental Medicine, Zagreb, using the most frequently used handpieces (turbine, micromotor with and without water, air syringe and SONICfl ex). A standardised method of noise measurement was applied, by means of a single-channel sound level meter; and a new dual-channel method, by means of an artifi cial head. The equivalent level of background noise with a correction fi lter A (LAeq) was LAeq = 54.4 dB (decibel). The noise level in the left ear of the artifi cial head was 53 dB and in the right ear 55 dB. The noise made by a turbine was LAeq = 81 dB, by the micromotor with water LAeq = 75 dB, by the micromotor without water LAeq = 72.5 dB, by the air syringe LAeq = 81.5 dB and by SONICfl ex LAeq = 76 dB. The level of noise the dentist was exposed to was LAeq = 72.1 dB. It can be concluded that the equivalent level was above LAeq = 70 dB, which is the limit prescribed by the Safety at Work Regulations. Since it is not only the therapist that is exposed to noise, but also the pedodontic patient, it would be advisable to treat the room acoustically in order to reduce undesired consequences of the noise, such as the patient’s fear, stress and anxiety

Dental Age Estimation in Children Using Orthopantomograms

Razvojne faze zubi koriste se za određivanje zrelosti i procjenu dobi u brojnim disciplinama; poput dječje i preventivne stomatologije, ortodoncije, forenzične stomatologije, i dr. Cilj: Točnost različitih metoda nije dosad sistematično proučena u hrvatskoj populaciji pa je cilj ovog istraživanja bio odrediti točnost dvije metode; prema Demirjian-u i Haavikko. Materijal i metode: Razvojne faze zuba promatrale su se na ortopantomogramima (OPG) zdrave djece, pacijenata Stomatološkog fakulteta, Sveučilišta u Zagrebu. Uzorak se sastojao od 324 ortopantomograma djece u dobi od 6-16 godina (149 dječaka i 175 djevojčica). Na OPG-ovima je promatrano sedam mandibularnih zuba i određen im je stadij po skalama zrelosti zuba prema Demirjian-u i Haavikko. U obradi podataka primijenjena je deskriptivna statistika, korelacijska analiza (Spearmanov test korelacije rangova) te testovi (Lilliefors test za testiranje normalnosti distribucije, t-test za testiranje značajnosti Spearmanovog koeficijenta korelacije rangova te Mann-Whitneyev test za testiranje razlika između dječaka i djevojčica). Rezultati: Dentalna dob i srednja vrijednost (±S.D. u godinama) između dentalne i realne dobi izračunata je za obje metode. Rezultati su pokazali da Demirjian-ova metoda precjenjuje dob dok Haavikko podcjenjuje dob. Svi podaci bili su obrađeni korelacijskom i regresijskom analizom koja je pokazala da su obje aplicirane metode pokazale signifikantnu korelaciju s realnom dobi (Demirjian-ova metoda imala je koeficijent korelacije 0.93, a metoda po Haavikko 0.89, p< 0.05). Zaključak: Ovo istraživanje na populaciji hrvatske djece pokazalo je visoki koeficijent korelacije za obje metode i ukazalo na njihovu mogućnost primjene u kliničkoj, znanstvenoj i forenzičnoj primjeni.Developing teeth are used to assess maturity and estimate age in a number of disciplines, such as pediatric and preventive dentistry, orthodontics, forensic odontology, etc. Aim: The accuracy of different methods has not been systematically investigated within the Croatian population, so the aim of this investigation was to determine the accuracy of two methods; Demirjian’s and Haavikko’s. Material and Methods: Tooth formation was assessed from orthopantomograms (OPGs) belonging to healthy children, patients of the School of Dental Medicine, University of Zagreb. The sample consisted of 324 children (149 boys, 175 girls, ages 6–16 years). The OPGs were examined and seven mandibular teeth were staged according to Demirjian’s dental maturity scale and according to Haavikko. Descriptive statistics were used together with relation analysis (Spearman correlation) and tests (Lilliefors test for normality of distribution, t-test for significance of Spearman’s rank-order correlation coefficient, and Mann-Whitney test for testing the differences between boys and girls). Results: Dental age and the difference between dental and actual chronological age was calculated for both methods. Results showed that Demirjian’s method overestimated the age while Haavikko’s method underestimated the age. All data was subjected to both correlation and regression analysis, which showed that both applied methods gave results with significant correlation to the actual age (Demirjian’s method yielded a 0.93 coefficient of correlation, Haavikko’s method yielded a correlation coefficient of 0.89, p<0.05). Conclusion: This study on Croatian children has shown high correlation coefficients for both methods and demonstrated their potential benefit in clinical and scientific use

The Chronology of Third Molar Eruption in the Croatian Population

Dental age estimation is common in orthodontics, paedodontics, paleodontology and forensic dentistry. The aim of this study was to assess chronological course of eruptive developmental phases of third molar and to establish parameters for the Croatian population. Sample of this study consisted of 1249 orthopantomograms of 530 (42.4%) male and 719 (57.6%) female subjects, aged 10 to 25 years. Eruptive phases were classified in 4 stages. No significant sex difference was found. Established chronology of the third molar eruption can be used as a standard for the assessment of dental age in clinical and forensic research on samples of Croatian population