Objective Evaluation of Craniofacial Features in Patients with Down’s Syndrome

Klinička antropometrija primjenjuje se za prosudbu obilježja kraniofacijalne regije. Cilj istraživanja bio je utvrditi antropometrijske varijable koje najbolje određuju razlike između mlade populacije s Downovim sindromom (DS) i zdravih osoba te stvoriti kraniofacijalni antropometrijski profil (KAP) specifičan za DS. Istraživanje je provedeno na uzorku od 56 ispitanika (33 muška i 23 ženska) s DS-om koji je podijeljen u dvije dobne skupine (7-12 i 13 18 god.). Kontrolnu skupinu činilo je 322 zdrava ispitanika (151 muška i 171 ženska) iste dobi kao kod DS-a. Izmjereno je 20 standardnih kraniofacijalnih mjera, instrumentima po Martinu, prema protokolu Farkasa. Izmjerene vrijednosti svih ispitanika s DS-om izražene su prosjekom i standardnom devijacijom. KAP je izveden konvertiranjem individualnih mjera u standardizirane vrijednosti. Odstupanje od srednjih vrijednosti smatralo se znatnim kada je z vrijednost odstupala više od +2 ili manje od -2. Rezultati pokazuju da su varijable koje razlikuju skupinu ispitanika s DS-om od zdravih osoba u subnormalnom području, u prvoj dobnoj skupini - dužina glave: dužina uške i opseg glave, a u drugoj dobnoj skupini su četiri, i one su: dužina glave, dužina uške, širina uške i opseg glave. KAP se može smatrati korisnom i objektivnom metodom u određivanju specifičnih kraniofacijalnih obilježja DS-a.Clinical anthropometry is used for evaluation of the features of the craniofacial region. The aim of this study was to determine the anthropometric variables which best discriminate a young population with Down’s Syndrome (DS) from healthy subjects and to produce a craniofacial anthropometric profile (CAP) specific for DS. The study was performed on a sample of 56 subjects (33 male and 23 female) with DS, divided into two age groups (7-12 and 13-18 years). The control group comprised 322 healthy subjects (151 male and 171 female) of the same age as the examined groups. Twenty standard craniofacial measurements were measured with instruments according to Martin and in accordance with Farkas protocol. The measured values of all subjects with DS were expressed by mean and standard deviation. CAP was performed by converting individual measurements to standard values. Deviation from mean values was considered significant when z-value deviated by more than +2 or less than -2. The results showed that the variables which discriminated the group of subjects with DS from healthy subjects in the subnormal area in the first age group were - length of the head, length of the auricles and head circumference, and in the second age group - length of the head, length of the auricles, width of the auricles and head circumference. CAP can be considered a useful and objective method in defining specific craniofacial features of DS

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 INFLUENCE OF DIFFERENT TYPES OF BRACKETS AND EFFICACY OF TWO CHLORHEXIDINE MOUTHWASHES ON ORAL HYGIENE AND THE INCIDENCE OF WHITE SPOT LESIONS IN ADOLESCENTS DURING THE ORTHODONTIC THERAPY

Background: To detect the effect of two different types of brackets (ceramic and stainless steel) and investigate the effectiveness of two chlorhexidine mouthwashes 0.2% (CHX) on oral hygiene status and incidence of white spot lesions (WSLs) in adolescents wearing fixed orthodontic appliance. Subjects and methods: One hundred and twenty subjects (aged 11 to 18 years, mean age 14.5 years) were divided into six equal groups according to brackets type and to different mouthwashes: Group 1: metal brackets and conventional CHX, Group 2: metal brackets and CHX with anti-discoloration system (CHX-ADS), Group 3: ceramic brackets and conventional CHX, Group 4: ceramic brackets and CHX-ADS, Group 5: metal brackets and water correction flavors mouthwash (placebo), Group 6: ceramic brackets and placebo. Four weeks after the placement of fixed orthodontic appliance the subjects were provided with three different mouthwashes for use during the next two weeks. Assessment was carried out according to oral hygiene index-simplified (OHI-S) and WSL index performed: prior to placement of the appliance (baseline), four weeks, six weeks, eighteen weeks, and thirty weeks after the placement. The data were then subjected to statistical analysis. Results: Group 4 showed reduction in the OHI-S scores when compared to the Group 5 (in the 6th week), and Group 6 (in the 6th and 18th week), which was statistically significant, P<0.05. Group 4 showed decrease in the WSLs scores when compared to the Group 1 (in the 4th, 6th, 18th and 30th week), Group 5 (in the 18thand 30th week) and Group 6 (in the 6th, 18th and 30th week), which was statistically significant, P<0.05. Conclusion: The ceramic brackets and the usage of CHX-ADS resulted in better oral hygiene status and lower incidence of WSLs

Utjecaj polimorfizma gena serotoninskog sustava na izraženost dentalne anksioznosti

The aim of the study was to test the correlation between 5-HTTLPR polymorphism and dental anxiety. Research hypothesis was that positive relation between the expression of dental anxiety and the S allele exists in the population of healthy Caucasians. We conducted a prospective study on 159 subjects, volunteers made up of medical and non-medical staff of the Sestre milosrdnice University Hospital Centre. Both genders were included, age range 19 to 59, mentally and physically healthy (according to DSM-5 classification of mental disorders). For the purpose of this research, we used a sociodemographic questionnaire containing the following information: age, gender, education level, work status, marital status and residence. Corah’s Dental Anxiety Scale-Revised (DAS-R) was used to measure dental anxiety. Data distribution was tested by Kolmogorov-Smirnov test, difference between the groups by χ2-test and one-way analysis of variance, and correlation of variables by logistic regression. In the study population, we found positive correlation between S-allele and total result in DAS-R questionnaire. The presence of S allele suggests that the person will have a higher result in DAS-R questionnaire, i.e. higher expression of dental anxiety.Cilj studije bio je ispitati povezanost polimorfizma 5-HTTLPR i dentalne anksioznosti. Naša hipoteza pretpostavlja pozitivnu povezanost izraženosti dentalne anksioznosti s S alelom u populaciji zdravih bijelaca. Provedena je prospektivna studija na 159 ispitanika, dobrovoljaca koje je sačinjavalo medicinsko i nemedicinsko osoblje KBC-a “Sestre milosrdnice”. U istraživanje su uključeni ispitanici obaju spolova, dobnog raspona od 19 do 59 godina, tjelesno i psihički zdravi (bez poremećaja prema klasifikaciji DSM-5). U istraživanju smo rabili sociodemografski upitnik sa sljedećim podacima: dob, spol, stupanj naobrazbe, radni status, bračno stanje, mjesto stanovanja. U svrhu mjerenja dentalne anksioznosti primijenjen je Corahov upitnik o dentalnoj anksioznosti (Corah Dental Anxiety Scale-Revised, DAS-R). Raspodjela podataka testirana je Kolmogorov-Smirnovljevim testom. Za testiranje razlike među skupinama primijenjen je χ2-test i jednosmjerna analiza varijance. Za utvrđivanje povezanosti među varijablama primijenjena je logistička regresija. U ispitivanoj populaciji našli smo pozitivnu povezanost S alela i ukupnog rezultata na upitniku DAS-R. Prisutnost S alela ukazuje na to da će osoba imati veći rezultat na upitniku DAS-R, odnosno veću izraženost dentalne anksioznosti

Učinkovitost Er:Yag lasera u preparaciji kaviteta za retrogradno punjenje – in vitro studija

The purpose of this study was to determine the sealing quality of Super EBA cement in laser prepared root-end cavities in comparison with root-end cavities classically prepared with steel burrs. Two groups of three millimeter root sections were prepared. The first group was prepared with the Er:YAG laser and the second group with a steel burr mounted on a surgical handpiece. The sections were filled with Super EBA cement and tested for leakage with fluid transport techniques. The sealing quality of Super EBA cement in the classically prepared root-end cavities was better, but there was no statistically significant difference between the two preparation techniques. The possible reason for greater leakage in the laser prepared root-end cavities was probably the irregular shape of the root-end cavity.Svrha ovoga rada bila je utvrditi kakvoću brtvljenja Super EBA cementa za retrogradno punjenje u laserom izrađenim kavitetima naspram kavitetima izrađenim mikromotorom klasičnom tehnikom. U tu svrhu korijenske sekcije debljine 3 mm preparirane su laserskim uređajem i čeličnim svrdlom montiranim na kirurški mikromotor. Kaviteti su ispunjeni Super EBA cementom i njihova propusnost je mjerena pomoću modificirane aparature za prijenos tekućine. Utvrđeno je da je brtvljenje ispuna u klasično izrađenim kavitetima bolje, makar razlika propuštanja prema laserski izrađenim kavitetima nije bila statistički značajna. Takav rezultat pripisuje se nepravilnom obliku kaviteta i nemogućnosti dobre adaptacije cementa na stijenke nepravilnog kaviteta

ORAL CAVITY COLONIZATION WITH MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERIA AFTER PREOPERATIVE PROPHYLACTIC USE OF ANTIBIOTICS AS A RISK FACTOR FOR VENTILATOR-ASSOCIATED PNEUMONIA

Background: Although it was previously shown that prolonged prophylactic antibiotic exposure and multiple inadequate antibiotic therapies are independent risk factors for multidrug-resistant ventilator associated pneumonia there were no studies investigating whether pre-operative prophylactic dose of antibiotics changes oral microbiome and increases the risk of ventilator associated pneumonia. The aim of the study was to determine if pre-operative prophylactic dose of antibiotics affects the oral microbiome, increases the colonization with Gram-negative bacteria and subsequent risk of ventilator associated pneumonia. Subjects and methods: Mechanically ventilated adult patients receiving surgical antibiotic prophylaxis were included in the study. The presence of Gram negative microorganisms in the pre-prophylactic and post-prophylactic oral swabs and tracheal aspirates, as well as the occurrence of ventilator associated pneumonia, were analyzed. Results: Number of patients colonized with Gram negative bacteria in post- prophylactic oral swab was significantly higher compared to oral swab taken before prophylactic antibiotic. On the other hand, the number of patients with Gram- negative bacteria in tracheal aspirates remained similar as in post- prophylactic oral swabs. Moreover, we found that presence of Gram- negative bacteria in both pre- and post- prophylactic oral swabs was in the positive correlation with the presence of Gram- negative bacteria in tracheal aspirates. Conclusions: This study showed increased colonization of oral cavity with Gram- negative bacteria after preoperative prophylactic antibiotics. Furthermore, receiving two prophylactic antibiotics from WHO Watch list increased the incidence of Gramnegative bacteria in oral swabs and tracheal aspirates, and the risk of ventilator associated pneumonia development

Developmental Deffects of Enamel in Children with Intellectual Disability

Svrha: Istražiti frekvenciju razvojnih defekata cakline (RDC) kod djece s intelektualnim teškoćama. Ispitanici i postupci: U istraživanju su sudjelovala djeca u dobi od 5 do 18 godina (72 djeteta s intelektualnim teškoćama i 72 kontrolna ispitanika). Ispitivala se pojavnost razvojnih defekata cakline na svim zubima koristeći se modificiranim indeksom razvojnih defekata cakline. Rezultati: Od 72 djeteta s intelektualnim teškoćama u ovom istraživanju, njih 20 (27,78 %) imalo je razvojne defekte cakline, za razliku od 8 djece (11,11 %) u kontrolnoj skupini, što je bilo statistički značajno (p = 0,021). Većina djece u objema skupinama imala je ograničena zatamnjenja. Dječaci i djevojčice u jednoj i drugoj skupini češće su imali zahvaćene gornje zube od donjih, a asimetrična ograničena zatamnjenja bila su češća od istovrsnih simetričnih defekata. Djeci u objema skupinama većinom su bili zatamnjeni gornji sjekutići. Zaključak: Djeca s intelektualnim teškoćama češće imaju razvojne caklinske defekte od kontrolnih ispitanika. Caklinski defekti povećavaju rizik od nastanka karijesa, a slabija mehanička svojstva cakline utječu na neuspjeh konzervativne terapije.Objectives: To investigate the frequency of developmental defects of enamel (DDE) in children with intellectual disability. Subjects and methods: Children aged 5–18 years (72 children with intellectual disabilities and 72 controls) were included in the study. All the teeth were screened for developmental defects of enamel using the modified Developmental defects of enamel (mDDE) index. Results: Out of the 72 children with intellectual disabilities in this study, 20 (27.78%) presented dental defects of enamel, compared with 8 (11.11%) of those in the control group, which was considered statistically significant (p = 0.021). The majority of children in both groups had white demarcated opacities. Children in both groups were more likely to have maxillary teeth affected than the mandibular teeth and the asymmetrical demarcated enamel defects were more common than the symmetric ones. Majority of opacities in children in both groups were on the maxillary incisors. Conclusions: Children with intellectual disabilities have more developmental defects of enamel than children in the control group. Enamel defects increase caries risk and cause reduction in enamel mechanical properties leading to restoration failures

Dentalni strah u djece s ponovljenom traumom zuba

Tooth injuries are serious clinical conditions. Some children experience dental trauma only once, while others are more prone to repeated tooth injuries. Repeated dental trauma occurs in 19.4% to 30% of patients. Pain and dental trauma are the most common reasons for fear and anxiety. The main objective of this study was to investigate how dental trauma, as well as repeated dental trauma affects the occurrence and development of dental fear in children. The study was conducted on a random sample of 147 subjects (88 boys and 59 girls) aged 5-8 and 9-12 years. Subjects in both age groups were divided into subroups without dental trauma, with one dental trauma and with repeated dental trauma. The validated Children’s Fear Survey Schedule – Dental Subscale was used on fear assessment. Results showed that only 12.2% of children without trauma, 33.3% with one trauma and 51.7% with repeated trauma were not afraid of injection. Older children had a significantly lower fear of injections, touch of an unknown person, choking, going to the hospital and people in white uniforms. Dentist was not the cause of fear in 65.5% of patients with repeated trauma. With each repeated injury of teeth, the degree of their fear of dental treatment was lower.Ozljede zubi su ozbiljno kliničko stanje. Neka djeca doživljavaju dentalne traume samo jednom, dok su druga sklonija ozljedama i ponavljanju trauma zubi. Ponovljene traume zuba javljaju se u 19,4% do 30% bolesnika. Bol i trauma zuba su najčešći razlozi straha i tjeskobe. Glavni cilj ovoga istraživanja bio je ispitati kako zubna trauma utječe na pojavu i razvoj dentalnog straha. Istraživanje je provedeno na slučajnom uzorku od 147 ispitanika (88 djevojčica i 59 dječaka) u dobi od 5-8 i 9-12 godina. Ispitanici u obje dobne skupine podijeljeni su u tri poskupine: bez dentalne traume, s jednom dentalnom traumom i s ponovljenom dentalnom traumom. U procjeni straha korišten je validirani test Children’s Fear Survey Schedule – Dental Subscale test. Starija djeca su imala značajno niži stupanj straha od injekcija, dodira nepoznate osobe, gušenja, odlaska u bolnicu i ljudi u bijelim uniformama. Strah od stomatologa nije imalo 65,5% djece s ponovljenom traumom. Samo 12,2% djece bez trauma, 33,3% s jednom i 51,7% s ponovljenom traumom se ne boje injekcije. Sa svakom ponovljenom ozljedom zuba stupanj njihovog straha od stomatološkog liječenja je manji

ORAL CAVITY COLONIZATION WITH MULTIDRUG-RESISTANT GRAM-NEGATIVE BACTERIA AFTER PREOPERATIVE PROPHYLACTIC USE OF ANTIBIOTICS AS A RISK FACTOR FOR VENTILATOR-ASSOCIATED PNEUMONIA

Background: Although it was previously shown that prolonged prophylactic antibiotic exposure and multiple inadequate antibiotic therapies are independent risk factors for multidrug-resistant ventilator associated pneumonia there were no studies investigating whether pre-operative prophylactic dose of antibiotics changes oral microbiome and increases the risk of ventilator associated pneumonia. The aim of the study was to determine if pre-operative prophylactic dose of antibiotics affects the oral microbiome, increases the colonization with Gram-negative bacteria and subsequent risk of ventilator associated pneumonia. Subjects and methods: Mechanically ventilated adult patients receiving surgical antibiotic prophylaxis were included in the study. The presence of Gram negative microorganisms in the pre-prophylactic and post-prophylactic oral swabs and tracheal aspirates, as well as the occurrence of ventilator associated pneumonia, were analyzed. Results: Number of patients colonized with Gram negative bacteria in post- prophylactic oral swab was significantly higher compared to oral swab taken before prophylactic antibiotic. On the other hand, the number of patients with Gram- negative bacteria in tracheal aspirates remained similar as in post- prophylactic oral swabs. Moreover, we found that presence of Gram- negative bacteria in both pre- and post- prophylactic oral swabs was in the positive correlation with the presence of Gram- negative bacteria in tracheal aspirates. Conclusions: This study showed increased colonization of oral cavity with Gram- negative bacteria after preoperative prophylactic antibiotics. Furthermore, receiving two prophylactic antibiotics from WHO Watch list increased the incidence of Gramnegative bacteria in oral swabs and tracheal aspirates, and the risk of ventilator associated pneumonia development

Chronology, Dynamics and Period of Permanent Tooth Eruption in Zagreb Children (Part II)

The aim of the present paper is to determine the beginning, order, median time, termination, dynamics, continuity and intensity of the permanent tooth eruption, as well as its calendar, in a sample of Zagreb children. The study included 2768 children (1398 boys and 1370 girls). All subjects were classified in one-year age groups. The continuity of tooth eruption occurs from 5.1 years to 14.97 years, i.e., for a period of 9.87 years. Each particular tooth has its own dynamics of eruption (V5–V95) which on the average amounts to 4.25 years. The continuity of eruption is 10.1 years in boys and 9.8 years in girls. The dynamics of eruption is 4.15 years in boys and 4.35 years in girls. A certain asymmetry in eruption has been described