Stomatološko liječenje kod osteogenesis imperfecta

Osteogenesis imperfecta is a very rare heterogeneous genetic disorder associated with the development of connective tissue resulting in fragile bones and frequent fractures. More than 50% of patients aff ected with osteogenesis imperfecta have a hereditary developmental disorder known as dentinogenesis imperfecta. Dentinogenesis imperfecta is caused by irregularities in the formation, composition and organization of dentin matrix during tooth development. It is caused by mutations of the genes that encode basic proteins of the organic matrix, collagens and phosphoproteins. The purpose of this review is to describe the histopathologic and clinical features of teeth typical of dentinogenesis imperfecta type I, which occurs within osteogenesis imperfecta, with special emphasis on targeted dental treatment to achieve optimal rehabilitation of the masticatory system.Osteogenesis imperfecta je vrlo rijetka heterogena genetička bolest udružena s razvojem vezivnog tkiva, što rezultira krhkim kostima i čestim prijelomima. Više od 50% bolesnika s osteogenesis imperfecta ima nasljedni razvojni poremećaj poznat kao dentinogenesis imperfecta. Dentinogenesis imperfecta je uzrokovana nepravilnostima u stvaranju, sastavu i organizaciji zubnog matriksa tijekom razvoja zuba. Uzrokuju ju mutacije gena koji kodiraju osnovne bjelančevine organskog matriksa, kolagena i fosfoproteina. Namjera ovog pregleda je opisati histopatološka i klinička obilježja zubiju koja su tipična za dentinogenesis imperfecta tip I koji se javlja u sklopu osteogenesis imperfecta, s naglaskom na ciljano stomatološko liječenje kako bi se postigla optimalna rehabilitacija žvačnoga sustava

Dental Caries Experience and Tobacco Use in 19-year-old Croatian Army Recruits

The aim of this study is to investigate caries prevalence and smoking habit in the population of 19-year-old Croatian male recruits. Dental examination of 505 male recruits was conducted in 2001 in the military centre in Koprivnica. Caries status was described by the FS-T (Filled and Sound Teeth) index and DMFT (Decayed, Missing and Filled Teeth) index. Mean DMFT scores were 7.32 and FST 23.56. There was a significant statistical difference in comparison of smoking habits depending on the reason to visit the dentist (p=0.001). The subjects who do not smoke tobacco have less decayed teeth (DT index with p<0.001), and more teeth with fillings and/or sound teeth (FT with p=0.005 and FST with p=0.004). There is no statistically significant difference for the DMFT (p=0.657) and MT (p=0.703). In conclusion, it showed that FS-T is a more appropriate index for describing variation in the population with higher caries experience. In the population of Croatian recruits, there were an astonishing 58.6% of smokers

Socioekonomski utjecaj upotrebe duhana i iskustvo zubnog karijesa u različitih hrvatskih populacija muškaraca

The purpose was to evaluate dental caries experience in different male subpopulations of Croatian Army recruits and dental students, and subsequently, smoking habits related to the level of education and place of residence. Croatian army recruits (n=248; mean age 20.2) and male dental students (n=56; mean age 21.5) were evaluated according to DMFT and FST indices, divided according to age and place of residence, and interviewed about their dietary habits and smoking of tobacco. In the subpopulation of recruits, the median value of DMFT was 6 and of FST index 25. A statistically significant difference was recorded between DT and FST index (p<0.05) according to dietary role of carbohydrates reflected in caries development. The number of recruits with finished elementary school coming from a rural area who smoked (in total 57.66% of smokers) was significantly larger (p=0.0041). In dental students, the median value of DMFT was 5, with statistical significance in comparison with recruits (p=0.03). There was a difference in FST index (median 28) (p<0.0001). Students were mostly nonsmokers (71.43%) and had urban residence (p<0.0001). FST index was a more specific indicator in the socioeconomically heterogeneous sample of recruits (more subjects coming from rural areas and with a lower level of education) than in the sample of dental students (more subjects coming from urban areas).Svrha istraživanja je bila procijeniti iskustvo dentalnog karijesa u različitih populacija muškaraca: novaka Hrvatske vojske i studenata dentalne medicine, kao i naviku pušenja vezano za stupanj obrazovanja i prebivalište. Prema indeksima DMFT i FST evaluirani su novaci Hrvatske vojske (n=248, prosječne dobi 20,2 godina) i muški studenti dentalne medicine (n=56, prosječne dobi 21,5 godina) podijeljeni prema dobi i prebivalištu te intervjuirani vezano za njihove prehrambene navike i pušenje duhana. Medijan indeksa DMFT za novake bio je 6, a indeksa FST 25. Statistički značajna razlika zabilježena je između DT i FST indeksa (p<0,05) s obzirom na ulogu prehrane ugljikohidratima vezano za razvoj karijesa. Bilo je značajno više (p=0,0041) novaka koji puše te sa završenom osnovnom školom iz ruralnog područja (ukupno 57,66% pušača). Za studente dentalne medicine medijan indeksa DMFT je bio 5, sa statističkom značajnošću u usporedbi s novacima (p=0,03). Postojala je i razlika za indeks FST (medijan 28, p<0,0001). Studenti su većinom bili nepušači (71,43%) i imali su urbano prebivalište (p<0,0001). Indeks FST bio je specifičniji indikator za socio-ekonomski heterogeni uzorak novaka (više ih je bilo s ruralnim prebivalištem i nižim stupnjem obrazovanja) nego kod studenata dentalne medicine (više ih je bilo s urbanim prebivalištem)

Temporomandibularni poremećaji i okluzija

Occlusion has an important place within the multifactorial concept of the temporomandibular disorder (TMD ) etiopathogenesis as well as in every form of dental treatment. The modern concept of treatment of these disorders differentiates initial and definitive forms of treatment. The aim of this paper is to analyze recent viewpoints on the role of occlusion in the etiopathogenesis and treatment of TMD s. Masticatory muscles and temporomandibular joints are directly connected with occlusal relations and TMD s are traditionally linked with occlusal disorders. The initial occlusal treatment can be applied to all TMD patients, regardless of their having intact teeth with respect to physiological occlusal relations and in patients in need of orthodontic or prosthodontic treatment or an oral surgical procedure. On managing TMD patients, there are doubts about the indications for definitive treatment and whether there has been a possibility of treating a painful TMD by reversible treatment modalities, that is, by initial treatment. Other types of orofacial pain such as trigeminal neuralgia can be comorbid with TMD s but also result in unnecessary procedures on the teeth and prosthodontic work if they are not recognized. Although dental profession mainly recognizes the importance of occlusal treatment of TMD problems, their relationship is controversial because it is not strictly demonstrated in numerous scientific studies. Occlusion is not the dominant cause of TMD problems.Okluzija ima istaknuto mjesto unutar multifaktorijalnog koncepta etiopatogeneze temporomandibularnih poremećaja kao i svakog oblika stomatološkog liječanja. Suvremena koncepcija liječenja tih poremećaja razlikuje inicijalne od definitivnih oblika terapije. Svrha rada je dati pregled suvremenog shvaćanja uloge okluzije u etiopatogenezi i liječenju temporomandibularnih poremećaja. Žvačni mišići i temporomandibularni zglobovi su izravno povezani s okluzijskim odnosima pa su temporomandibularni poremećaji tradicionalno povezani s okluzijskim poremećajima. Inicijalna okluzijska terapija može biti provedena kod svih pacijenata s temporomandibularnim poremećajima bez obzira na to imaju li intaktne zube u okviru fizioloških okluzijskih odnosa, pacijenata kojima je potrebna ortodontska, protetska terapija ili operacijski oralno kirurški zahvat. U liječenju pacijenata s temporomandibularnim poremećajima postoji nedoumica je li postojala indikacija za definitivnu terapiju, ako se bolni temporomandibularni poremećaj mogao izliječiti oblicima reverzibilne terapije, odnosno inicijalnom terapijom. Druge vrste orofacijalnih bolova, npr. trigeminalna neuralgija, mogu biti u komorbiditetu s temporomandibularnim poremećajima, ali i kao neprepoznata bolest imati za posljedicu nepotrebne intervencije na zubima i protetskim radovima. Iako u struci postoji prevladavajuće shvaćanje važnosti okluzijske terapije temporomandibularnih poremećaja, taj međuodnos je kontroverzan, jer to nije strogo dokazano u brojnim znanstvenim istraživanjima. Okluzija se nije pokazala dominatnim uzročnikom temporomandibularnih poremećaja

Temporomandibularni poremećaji i okluzija

Occlusion has an important place within the multifactorial concept of the temporomandibular disorder (TMD ) etiopathogenesis as well as in every form of dental treatment. The modern concept of treatment of these disorders differentiates initial and definitive forms of treatment. The aim of this paper is to analyze recent viewpoints on the role of occlusion in the etiopathogenesis and treatment of TMD s. Masticatory muscles and temporomandibular joints are directly connected with occlusal relations and TMD s are traditionally linked with occlusal disorders. The initial occlusal treatment can be applied to all TMD patients, regardless of their having intact teeth with respect to physiological occlusal relations and in patients in need of orthodontic or prosthodontic treatment or an oral surgical procedure. On managing TMD patients, there are doubts about the indications for definitive treatment and whether there has been a possibility of treating a painful TMD by reversible treatment modalities, that is, by initial treatment. Other types of orofacial pain such as trigeminal neuralgia can be comorbid with TMD s but also result in unnecessary procedures on the teeth and prosthodontic work if they are not recognized. Although dental profession mainly recognizes the importance of occlusal treatment of TMD problems, their relationship is controversial because it is not strictly demonstrated in numerous scientific studies. Occlusion is not the dominant cause of TMD problems.Okluzija ima istaknuto mjesto unutar multifaktorijalnog koncepta etiopatogeneze temporomandibularnih poremećaja kao i svakog oblika stomatološkog liječanja. Suvremena koncepcija liječenja tih poremećaja razlikuje inicijalne od definitivnih oblika terapije. Svrha rada je dati pregled suvremenog shvaćanja uloge okluzije u etiopatogenezi i liječenju temporomandibularnih poremećaja. Žvačni mišići i temporomandibularni zglobovi su izravno povezani s okluzijskim odnosima pa su temporomandibularni poremećaji tradicionalno povezani s okluzijskim poremećajima. Inicijalna okluzijska terapija može biti provedena kod svih pacijenata s temporomandibularnim poremećajima bez obzira na to imaju li intaktne zube u okviru fizioloških okluzijskih odnosa, pacijenata kojima je potrebna ortodontska, protetska terapija ili operacijski oralno kirurški zahvat. U liječenju pacijenata s temporomandibularnim poremećajima postoji nedoumica je li postojala indikacija za definitivnu terapiju, ako se bolni temporomandibularni poremećaj mogao izliječiti oblicima reverzibilne terapije, odnosno inicijalnom terapijom. Druge vrste orofacijalnih bolova, npr. trigeminalna neuralgija, mogu biti u komorbiditetu s temporomandibularnim poremećajima, ali i kao neprepoznata bolest imati za posljedicu nepotrebne intervencije na zubima i protetskim radovima. Iako u struci postoji prevladavajuće shvaćanje važnosti okluzijske terapije temporomandibularnih poremećaja, taj međuodnos je kontroverzan, jer to nije strogo dokazano u brojnim znanstvenim istraživanjima. Okluzija se nije pokazala dominatnim uzročnikom temporomandibularnih poremećaja

Osteoartritične promjene temporomandibularnog zgloba potvrđene magnetskom rezonancijom

Clinical and radiological findings were compared between the patients with osteoarthritis (OA) of temporomandibular joint (TMJ) with or without disc displacement (DD), and asymptomatic volunteers. This study included 30 patients with OA of TMJs (mean age 52.6). All the patients were examined clinically by manual functional analysis and using magnetic resonance imaging. The inclusion criteria for patients comprised: pain referred to the TMJ and/or crepitation in the TMJ. A second group consisted of 20 asymptomatic dental school students (mean age 23.5). There is a statistically significant difference between degenerative changes of the condyle of TMJs with and without clinical signs of OA of patients (p=0.009). In 28% of osteoarthritic joints, flattening of condylar joint surfaces was observed and 17.4% of the joints were without clinical signs of OA. Osteophyte formations were found in 8% of asymptomatic and 25.7% of osteoarthritic patients’ joints. There is a statistically significant difference between patients’ TMJs with and without OA (p=0.0003): pronounced shape loss and severe sclerosation of the articular eminence were found in 12% of the joints without OA, and 42.9% of joints with OA. There is no difference between students’ joints and patients’ TMJs without OA (p=0.804). The most common imaging findings of osteoarthritic TMJs were sclerosis of the condyle and osteophyte formation.Uspoređeni su klinički i radiološki nalazi bolesnika s osteoartritisom temporomandularnog zgloba s ili bez pomaka diska te asimptomatskih dobrovoljaca. Istraživanje je obuhvatilo 30 bolesnika s osteoartritisom temporomandibularnog zgloba (prosječne dobi 52,6 godina). Svi bolesnici pregledani su klinički manualnom funkcijskom analizom i uporabom magnetske rezonancije. Kriterij kojim su obuhvaćeni bolesnici bili su: bol vezan za temporomandibularni zglob i/ili krepitacija u istom zglobu. Drugu skupinu činilo je 20 asimptomatskih studenata dentalne medicine (prosjek dobi 23,5 godina). Postojala je statistički značajna razlika između degenerativnih promjena kondila zglobova bolesnika s i bez znakova osteoartritisa (p=0,009). U 28% osteoartritičnih zglobova bila je deplanacije zglobnih površina kondila, kao i u 17,4% zglobova bez kliničkih znakova osteoartritisa. Osteofitične tvorbe pronađene su u 8% asimptomatskih i 25,7% osteoartritičnih zglobova bolesnika. Postojala je statistički značajna razlika među zglobovima bolesnika s i bez osteoartritisa (p=0,0003): izraženi gubitak kontura i izražena sklerozacija zglobne kvržice nađeni su u 12% zglobova bez osteoartritisa i 42,9% zglobova s osteoartritisom. Nije bilo razlike između zglobova studenata i zglobova bolesnika bez osteoartritisa (p=0,804). Najčešći nalaz na snimkama osteoartritičnih zglobova bile su skleroza kondila i osteofitične tvorbe

Radiografska procjena valjanosti manualne funkcijske analize osteoartritisa temporomandibularnog zgloba

The finding of osteoarthritis of temporomandibular joint (TMJ ) obtained by clinical diagnosis, i.e. manual functional analysis (MF A) and the finding obtained by magnetic resonance imaging (MRI) as the gold standard were compared in 30 patients (mean age 52.6) diagnosed with osteoarthritis, selected out of 140 consecutive patients diagnosed with a TMJ disorder by MRI. The clinical parameters were symptoms of pain in the TMJ region, crepitations, and absence of clicking, which was confirmed by manual examinations as part of MF A. A positive MRI finding included flattening, subchondral degenerative changes with or without intact cortical bone, osteophytes and subchondral degenerative cysts of joint surfaces. The validity of MF A for osteoarthritis was as follows: sensitivity 0.38, specificity 0.91, positive predictive value (PPV) 0.77 and negative predictive value (NPV) 0.65. MRI examination revealed disk displacement (DD ) without reduction in 12 (40.00%) patients and DD with reduction in one (3.33%) patient. The finding of passive compressions for the osteoarthritis diagnosis depending on DD showed sensitivity of 0.29, specificity of 0.95, PPV 0.67 and NPV 0.78. Although MF A significantly improves validity of clinical diagnosis when differentiating a myogenic from TMJ disorder, clinical determination of osteoarthritis is not satisfactory. Nonspecific clinical signs and symptoms accompanied by predominant pain in the TMJ on dynamic but not on passive manual examinations cannot help differentiate DD from osteoarthritis.Uspoređen je nalaz osteoartritisa temporomandibularnog zgloba (TM Z) dobiven kliničkom dijagnostikom provedenom pomoću manualne funkcijske analize (MF A) i magnetskom rezonancijom (MR) kao zlatnim standardom. Od uzastopno prikupljenih 140 bolesnika kojima je pomoću MR utvrđen poremećaj TM Z izabrano je 30 bolesnika prosječne dobi od 52,6 godina s dijagnozom osteoartritisa. Klinički parametri su bili simptomi boli u području TM Z, krepitacije, odsutnost škljocanja, što se je potvrđivalo manualnim pretragama u okviru MF A. Pozitivan nalaz MR obuhvaćao je deplanaciju, subhondralne degenerativne promjene s intaktnom kortikalnom kosti ili bez nje, osteofite i subhondralne degenerativne ciste zglobnih ploha. Valjanost MF A bila je za osteoartritis: osjetljivost 0,38, specifičnost 0,91, pozitivna prediktivna vrijednost (PPV) 0,77 i negativna prediktivna vrijednost (NPV) 0,65. Pregled pomoću MR utvrdio je pomak diska bez redukcije u 12 (40,00%) i pomak diska s redukcijom u jednog (3,33%) bolesnika. Nalaz pasivnih kompresija za dijagnozu osteoartritisa ovisno o pomaku diska bio je: osjetljivost 0,29, specifičnost 0,95, PPV 0,67 i NPV 0,78. Iako MF A znatno poboljšava valjanost kliničke dijagnostike u diferenciranju miogenog od poremećaja TM Z, kliničko utvrđivanje osteoartritisa ipak nije zadovoljavajuće. Nespecifični klinički znaci i simptomi uz dominantnu bolnost TM Z pri dinamičkim, ali i ne i pasivnim manualnim pretragama ne mogu diferencirati pomak diska od osteoartritisa

Radiografska procjena valjanosti manualne funkcijske analize osteoartritisa temporomandibularnog zgloba

The finding of osteoarthritis of temporomandibular joint (TMJ ) obtained by clinical diagnosis, i.e. manual functional analysis (MF A) and the finding obtained by magnetic resonance imaging (MRI) as the gold standard were compared in 30 patients (mean age 52.6) diagnosed with osteoarthritis, selected out of 140 consecutive patients diagnosed with a TMJ disorder by MRI. The clinical parameters were symptoms of pain in the TMJ region, crepitations, and absence of clicking, which was confirmed by manual examinations as part of MF A. A positive MRI finding included flattening, subchondral degenerative changes with or without intact cortical bone, osteophytes and subchondral degenerative cysts of joint surfaces. The validity of MF A for osteoarthritis was as follows: sensitivity 0.38, specificity 0.91, positive predictive value (PPV) 0.77 and negative predictive value (NPV) 0.65. MRI examination revealed disk displacement (DD ) without reduction in 12 (40.00%) patients and DD with reduction in one (3.33%) patient. The finding of passive compressions for the osteoarthritis diagnosis depending on DD showed sensitivity of 0.29, specificity of 0.95, PPV 0.67 and NPV 0.78. Although MF A significantly improves validity of clinical diagnosis when differentiating a myogenic from TMJ disorder, clinical determination of osteoarthritis is not satisfactory. Nonspecific clinical signs and symptoms accompanied by predominant pain in the TMJ on dynamic but not on passive manual examinations cannot help differentiate DD from osteoarthritis.Uspoređen je nalaz osteoartritisa temporomandibularnog zgloba (TM Z) dobiven kliničkom dijagnostikom provedenom pomoću manualne funkcijske analize (MF A) i magnetskom rezonancijom (MR) kao zlatnim standardom. Od uzastopno prikupljenih 140 bolesnika kojima je pomoću MR utvrđen poremećaj TM Z izabrano je 30 bolesnika prosječne dobi od 52,6 godina s dijagnozom osteoartritisa. Klinički parametri su bili simptomi boli u području TM Z, krepitacije, odsutnost škljocanja, što se je potvrđivalo manualnim pretragama u okviru MF A. Pozitivan nalaz MR obuhvaćao je deplanaciju, subhondralne degenerativne promjene s intaktnom kortikalnom kosti ili bez nje, osteofite i subhondralne degenerativne ciste zglobnih ploha. Valjanost MF A bila je za osteoartritis: osjetljivost 0,38, specifičnost 0,91, pozitivna prediktivna vrijednost (PPV) 0,77 i negativna prediktivna vrijednost (NPV) 0,65. Pregled pomoću MR utvrdio je pomak diska bez redukcije u 12 (40,00%) i pomak diska s redukcijom u jednog (3,33%) bolesnika. Nalaz pasivnih kompresija za dijagnozu osteoartritisa ovisno o pomaku diska bio je: osjetljivost 0,29, specifičnost 0,95, PPV 0,67 i NPV 0,78. Iako MF A znatno poboljšava valjanost kliničke dijagnostike u diferenciranju miogenog od poremećaja TM Z, kliničko utvrđivanje osteoartritisa ipak nije zadovoljavajuće. Nespecifični klinički znaci i simptomi uz dominantnu bolnost TM Z pri dinamičkim, ali i ne i pasivnim manualnim pretragama ne mogu diferencirati pomak diska od osteoartritisa

Psoriatic arthritis and temporomandibular joint involvement – literature review with a reported case

In addition to psoriasis, between 5% and 24% of patients will develop psoriatic arthritis simultaneously after or even prior to skin manifestations. Psoriatic arthritis belongs to the group of seronegative spondyloarthritis. Collaboration between a dermatologist and a rheumatologist plays a more important role in cases where there is a complete absence of clinical signs of psoriasis. Since rheumatic diseases may also involve the temporomandibular joints (TMJ), psoriatic arthritis can cause problems that are an aspect of systemic disease. In general, the clinical and radiological description of a population of patients suffering from psoriasis and/or psoriatic arthritis does not mention TMJ involvement. However, as is the case with intraoral psoriasis, psoriatic changes to the TMJ also show characteristic signs of erosion, deplaned condyles, and articular effusion. Magnetic resonance imaging has shown itself to be the gold standard in the diagnostics of joints afflicted by psoriatic arthritis and TMJ disorders, regardless of the existence of a systemic disease. This paper aims to present a review of the relevant literature describing different epidemiological, clinical, and radiological characteristics of psoriasis and psoriatic arthritis, with emphasis on the involvement of TMJs in the general manifestation of the disease, illustrated by a description of the clinical case of a 77-year-old female patient.</p