Oral health difficulties in children and adolescents with autism spectrum disorder: Parental perception

Introduction/Objective Autism spectrum disorder (ASD) is characterized by features that have the potential to make oral hygiene and dental appointments challenging. The aim of this study was to investigate difficulties related to oral hygiene and dental appointments that may be encountered in children and adolescents with ASD, in comparison to their typically developing peers. Methods A 48-item questionnaire was prepared for the purpose of the study and distributed to parents of children and adolescents with ASD in three specialized daycare centers, as well as to parents of typically developing children and adolescents at the Clinic for Pediatric and Preventive Dentistry in Belgrade, Serbia. Ninety-two questionnaires were considered and statistically analyzed in the SPSS program, using χ2 and Mann-Whitney U-test. Results The following statistically significant differences were found between children and adolescents with ASD and their typically developing peers: general difficulties in everyday oral hygiene, need of help for basic oral hygiene tasks, tooth brushing frequency, sensory difficulties related to toothbrush and toothpaste, level of anxiety prior to dental appointment, cooperation during appointment, sensory difficulties related to touch, operatory light and sound of dental unit, number of treatments under general anesthesia, and the number of refused dental treatments. Conclusion Children and adolescents with ASD face significantly more difficulties concerning everyday oral hygiene and dental appointments in comparison to their typically developing peers. Dentists' awareness of issues that are specific to this population of patients is important in order to enable quality dental care.Uvod/Cilj Poremećaji autističnog spektra (PAS) mogu biti uzrok poteškoća vezanih za održavanje oralne higijene, kao i za posete stomatologu. Cilj rada je bio da se utvrde razlike između dece i adolescenata sa PAS i kontrolne grupe neurotipičnih vršnjaka sa aspekta održavanja oralne higijene i poseta stomatologu. Metode Upitnik od 48 pitanja distribuiran je roditeljima dece i adolescenata sa PAS u tri specijalizovana dnevna boravka, kao i roditeljima kontrolne grupe neurotipičnih vršnjaka. Devedeset dva upitnika je uzeto u obzir i statistički analizirano u programu SPSS. Rezultati Statistički značajne razlike između dece i adolescenata sa PAS i njihovih tipično razvijenih vršnjaka utvrđene su u sledećim kategorijama: teškoće u svakodnevnoj oralnoj higijeni, potreba za pomoći u održavanju oralne higijene, učestalost pranja zuba, senzorne teškoće vezane za četkicu i zubnu pastu, nivo anksioznosti pre posete stomatologu, saradnja tokom stomatološkog tretmana, senzorne teškoće vezane za dodir stomatologa, svetlo i zvuk stomatološkog uređaja, broj tretmana pod opštom anestezijom i broj odbijenih stomatoloških usluga. Zaključak Deca i adolescenti sa PAS suočavaju se sa znatno većim poteškoćama u pogledu svakodnevne oralne higijene i poseta stomatologu u poređenju sa tipično razvijenim vršnjacima. Svest stomatologa o pitanjima koja su specifična za ovu populaciju pacijenata je važna kako bi se deci i adolescentima sa PAS omogućila kvalitetna stomatološka nega

The application of air abrasion in dentistry

One of the main objectives of contemporary dentistry is to preserve healthy tooth structure by applying techniques of noninvasive treatment. Air abrasion is a minimally invasive non mechanical technique of tooth preparation that uses kinetic energy to remove carious tooth structure. A powerful narrow stream of moving aluminum-oxide particles hit the tooth surface and they abrade it without heat, vibration or noise. Variables that affect speed of cutting include air pressure, particle size, powder flow, tip's size, angle and distance from the tooth. It has been proposed that air abrasion can be used to diagnose early occlusal-surface lesions and treat them with minimal tooth preparation using magnifier. Reported advantages of air abrasion include reduced noise, vibration and sensitivity. Air abrasion cavity preparations have more rounded internal contours than those prepared with straight burs. This may increase the longevity of placed restorations because it reduces the incidence of fractures and a consequence of decreased internal stresses. However, air abrasion cannot be used for all patients, i.e. in cases involving severe dust allergy, asthma, chronic obstructive lung disease, recent extraction or other oral surgery, open wounds, advanced periodontal disease, recent placement of orthodontic appliances and oral abrasions, or subgingival caries removal. Many of these conditions increase the risk of air embolism in the oral soft tissues. Dust control is a challenge, and it necessitates the use of rubber dam, high-volume evacuation, protective masks and safety eyewear for both the patient and the therapist.Jedan od osnovnih ciljeva savremene stomatologije jeste očuvanje zdravog zubnog tkiva primenom preventivnih metoda i tehnika neinvazivnog lečenja. Vazdušna abrazija je minimalno invazivna tehnika preparacije kaviteta koja koristi kinetičku energiju za uklanjanje karijesa. Usmeravanje pravolinijskog mlaza čestica aluminijum- oksida na površinu zuba koja se obrađuje dovodi do abrazije supstrata bez toplote, vibracija i zvuka. Faktori koji utiču na brzinu preparacije uključuju intenzitet vazdušnog pritiska, veličinu čestica abraziva, brzinu protoka čestica, prečnik vrha kanile, veličinu ugla kanile i udaljenost vrha kanile od površine zuba koja se obrađuje. Njena upotreba se savetuje u dijagnostici rane karijesne lezije gleđi na okluzalnim površinama zuba i minimalnoj preparaciji kaviteta. Pojedini autori preporučuju i upotrebu optičkih pomagala. Prednosti tehnike vazdušne abrazije uključuju smanjenje buke, vibracija i operativne osetljivosti, koja je veoma subjektivna i promenljiva kod pacijenata. Kaviteti preparisani vazdušnom abrazijom imaju zaobljene ivice, za razliku od kaviteta preparisanih standardnim tehnikama. To može povećati dugotrajnost postavljenih ispuna, jer se smanjuje mogućnost nastanka njihovog odlamanja, neutralisanjem sila unutrašnjeg napona u poređenju sa stresom koji se javlja kod angularnih preparacija. Primena tehnike vazdušne abrazije je kontraindikovana kod osoba alergičnih na prašinu, obolelih od astme ili hronične opstruktivne bolesti pluća, pacijenata sa postekstrakcionim ranama, parodontopatijom, ortodontskim aparatima ili dubokim karijesom, jer se ovom tehnikom preparacije ne odstranjuje uspešno mekana dentinska struktura. Mnoga ova stanja povećavaju rizik od nastanka vazdušne embolije u mekim oralnim tkivima. Kontrola rasejanja čestica abraziva predstavlja izazov kliničkom stomatologu, a zahteva i primenu koferdama, jakih aspiratora, zaštitnih maski i zaštitnih naočara kako kod pacijenta, tako i kod terapeuta

Hard dental tissue minimal-invasive preparation using contemporary polymer rotating instruments and laser

Goal of contemporary dentistry is to decrease the patient's discomfort during treatment. Dentists aim to achieve maximum with the newly developed dental materials as well as with new cavity preparation techniques in the shortest time span. Since the development of the first constructed borer (drilling machine) for caries removal, the preparation techniques have considerably changed. The progress of dental materials as well as the cavity preparation techniques has led us to contemporary carbide tungsten and diamond borers that are used with obligatory water cooling. The innovation within this field represents newly developed polymer borers that can detect the difference between carious lesions and healthy tooth structure. In this way the cavity preparation may be performed without damaging dental healthy tissue. This is possible owing to their hardness which is lower than the hardness of intact dentin. Polymer borer preparation is painless with less vibration, while the increase in temperature is negligible. Lasers have been used in clinical dentistry since 1980s so it can be said that they represent a new technology. The function of lasers is based on ablation which requires water. Erbium lasers have shown the highest potential with their ability to produce effective ablation of hard dental tissues. Laser application in dentistry requires special training as well as some protective measures. Laser advantages, compared to traditional preparation techniques, involve the absence of vibration, painless preparation, possibility of preparation without anesthetic and easier patient's adjustment to dental intervention which is of importance, especially in pediatric dentistry.Savremena stomatologija teži ka što manjoj traumatizaciji pacijenta prilikom rada uz maksimalni učinak. Savremeni materijali uz nove vidove preparacije kaviteta pružaju mogućnost sanacije karijesnih lezija u najkraćem vremenskom roku. Vidovi preparacije kaviteta su se znatno promenili otkako je uvedeno prvo mašinski napravljeno svrdlo za uklanjanje karijesa. Tehnološki napredak materijala za ispune i načina preparacije doveli su do savremenih karbidnih i dijamantskih svrdla koja se koriste uz obavezno vodeno hlađenje. Inovaciju na polju rotirajućih instrumenata predstavljaju polimerna 'pametna' svrdla, koja uklanjaju karijesnu leziju bez mogućnosti povređivanja i uklanjanja zdrave zubne strukture. Ovo je moguće zahvaljujući čvrstoći koju poseduju, koja je manja od čvrstoće zdravog dentina. Zahvaljujući prirodi materijala od kojih su izrađena, ova svrdla omogućuju bezbolniji rad uz manje vibracija i slabije zagrevanje zubne supstance. Laseri su relativno novo tehnološko sredstvo u stomatologiji, a njihova klinička upotreba počela je osamdesetih godina dvadesetog veka. Laseri funkcionišu po principu ablacije, za šta je neophodno prisustvo vode. Najveći potencijal među ispitivanim laserima pokazali su erbijumski laseri, kojima je moguće uraditi efikasnu ablaciju čvrstih zubnih tkiva. Za korišćenje lasera u stomatologiji neophodni su posebna obuka i odgovarajuće mere zaštite. Prednosti lasera u poređenju sa drugim metodama preparacije čvrstih zubnih tkiva su nepostojanje vibracija, bezbolan rad, mogućnost rada bez anestezije i lakše prilagođavanje pacijenta stomatološkim intervencijama, što je veoma značajno u dečjoj stomatologiji

Scanning electron microscopic examination of enamel surface after fixed orthodontic treatment: In-vivo study

Introduction. Therapy with fixed orthodontic appliances starts with bracket bonding and ends with debonding of brackets, leaving enamel surface varied. Objective. The aim of this pilot study was to examine enamel surface before and after debonding of orthodontic brackets by the use of scanning electron microscopy (SEM). Methods. Epoxy replicas of four patients' premolars indicated for therapy with fixed orthodontic appliances were made and brackets were bonded to their teeth with a different adhesives (Enlight, No-mix, Fuji Ortho LC and Heliosit Orthodontic) (n=4). Two months later, brackets on premolars were debonded and amounts of adhesive left on the tooth surfaces and the bracket bases were evaluated with the adhesive remnant index (ARI). After resin removal, epoxy replicas were made and the surface of premolars was evaluated with the enamel surface index (ESI). All replicas of premolars (n=32) were prepared for SEM examination and compared under different magnifications. Tooth damage was estimated based on correlation between ARItooth and ESI. Results. Pearson's χ2 test showed no significant differences between ARItooth and ARIbracket of four materials used. Nonparametric correlations showed significant differences between ARItooth and ARIbracket, ESI and ARItooth, and between ESI and ARIbracket. Increasing of ARItooth is followed with the descent of ARIbracket and the ascent of ESI. Multivariate regression analysis showed a significant correlation between ESI and ARItooth. Conclusion. Most bond failures took place at enamel-adhesive interface. ARItooth was a predictor to enamel surface damage. The type of material did not affect enamel surface damage.Uvod. Terapija fiksnim ortodontskim aparatom počinje postavkom bravica, a završava se njihovim uklanjanjem na kraju terapije, nakon čega je površina gleđi izmenjena. Cilj rada. Cilj ove pilot- studije bio je da se ispita površina gleđi pre i posle skidanja ortodontskih bravica primenom skening- elektronske mikroskopije (SEM). Metode rada. Izrađene su replike premolara šest pacijenata kod kojih je indikovana terapija fiksnim ortodontskim aparatom i svakom od njih zalepljene su bravice različitim adhezivom (Enlight, No-mix, Fuji Ortho LC i Heliosit Orthodontic). Dva meseca kasnije bravice na premolarima su uklonjene, a količina preostalog adheziva na zubu i bravici određena je indeksom zaostalog adheziva (engl. adhesive remnant index - ARI). Posle uklanjanja adheziva načinjene su replike zuba i površina premolara je procenjena pomoću indeksa površine gleđi (engl. enamel surface index - ESI). Sve 32 replike premolara pripremljene su za ispitivanje primenom SEM i upoređivane pri različitom uveličanju. Oštećenja zuba su procenjivana korelacijom vrednosti ARI zuba i ESI. Rezultati. Pirsonov χ2-test nije pokazao značajne razlike između vrednosti ARI zuba i ARI bravica u odnosu na četiri korišćena materijala. Neparametarske korelacije ukazale su na značajne razlike između vrednosti ARI zuba i ARI bravica, ESI i ARI zuba i ESI i ARI bravica. Povećanje vrednosti ARI zuba bilo je praćeno smanjenjem vrednosti ARI bravica i povećanjem ESI. Multivarijantna regresiona analiza pokazala je značajnu povezanost ESI i ARI zuba. Zaključak. Prekid veze najčešće se javljao na spoju između gleđi i adheziva. ARI zuba se pokazao kao prediktor oštećenja gleđi. Vrsta materijala nije uticala na oštećenja površine gleđi