Relationship between COMT Gene Polymorphism, Anxiety, and Pain Perception during Labour.

BACKGROUND: The COMT gene polymorphism is associated with neurological and psychiatric disorders and pain perception. The present study investigates the existence of anxiety and pain perception in relation to the COMT (catechol-O-methyltransferase) gene polymorphism in labouring women (during "natural" childbirth) with or without inhaled analgesia. METHODS: A total of 181 women who chose vaginal birth were enrolled in this study. To present the difference in pain perception, the parturients were divided into one group (n = 90) that chose labour analgesia with inhaled nitrous oxide (50% nitrous oxide and 50% oxygen) and one group (n = 91) without analgesia. The blood samples were taken during the pregnancy as a part of routine pregnancy controls in the hospital. The COMT gene polymorphism was detected with the PCR technique. The pain perception of parturients was self-evaluated two times according to the VAS (Visual Analogue Scale), and anxiety as a personality trait was determined with the STAI-T (State Trait Anxiety Inventory). Pain perception as well as anxiety were compared according to COMT genotypes. RESULTS: In the 181 pregnant women, there were 40 women (22%) of wild homozygotes (GG) of COMT, 95 women (53%) of mutant heterozygotes (GA), and 46 women (25%) of mutant homozygotes (AA). A negative association of pain perception with the GA (mutant heterozygote) polymorphism of the COMT gene versus the wild-type (GG polymorphism) was observed. The GA polymorphism of the COMT gene was associated with 0.46 units lower pain perception compared to the wild type (GG). The anxiety trait score in group AA was lower than in groups GA and GG. The difference reached statistical significance only when comparing AA versus GA (p > 0.042). Analgesic efficacy of nitrous oxide was noticed in 22% of labouring women who reported moderate pain (VAS score 4-7). CONCLUSIONS: The COMT gene polymorphism was associated with pain perception and anxiety among parturients. The COMT gene polymorphism GA was associated with negative pain perception among labouring women. Nitrous oxide showed statistical significance in anxiolytic efficacy during labour in women with mild anxiety as a personality trait. Anxiolytic efficacy of nitrous oxide has shown better efficacy in parturients with the COMT gene polymorphism AA.

Metal Ions Release from Welded Co-Cr Dental Alloys.

Cobalt-chromium alloys (Co-Cr) are widely used in dentistry due to their excellent mechanical properties and corrosion resistance. Since prosthetic materials must be permanently stable in the oral cavity, it is very important to determine the release of ions from alloys in the oral cavity. In dentistry today, metals and alloys are mainly joined by laser and tungsten inert gas (TIG) welding. Therefore, in this work, the release of metal ions from six different Co-Cr alloys joined by these two welding methods was quantified to determine the effects of the welding method on an ion release. Static immersion tests, atomic absorption spectrometry and statistical analysis were performed for this purpose. The results showed that laser-welded alloys release a lower amount of metal ions compared to TIG-welded alloys.

Microscopic and Mechanical Characterization of Co-Cr Dental Alloys Joined by the TIG Welding Process.

Due to their good mechanical and other properties, cobalt-chromium alloys (Co-Cr) are often used in prosthetic therapy. The metal structures of prosthetic works can be damaged and break, and depending on the extent of the damage, they can be re-joined. Tungsten inert gas welding (TIG) produces a high-quality weld with a composition very close to that of the base material. Therefore, in this work, six commercially available Co-Cr dental alloys were joined by TIG welding, and their mechanical properties were evaluated to determine the quality of the TIG process as a technology for joining metallic dental materials and the suitability of the Co-Cr alloys used for TIG welding. Microscopic observations were made for this purpose. Microhardness was measured using the Vickers method. The flexural strength was determined on a mechanical testing machine. The dynamic tests were carried out on a universal testing machine. The mechanical properties were determined for welded and non-welded specimens, and the results were statistically evaluated. The results show the correlation between the investigated mechanical properties and the process TIG. Indeed, characteristics of the welds have an effect on the measured properties. Considering all the results obtained, the TIG-welded I-BOND NF and Wisil M alloys showed the cleanest and most uniform weld and, accordingly, satisfactory mechanical properties, highlighting that they withstood the maximum number of cycles under dynamic load.

Post-Cure Development of the Degree of Conversion and Mechanical Properties of Dual-Curing Resin Cements.

This study investigated the effect of different curing conditions on the degree of conversion and mechanical properties of contemporary dual-curing resin cements. The material specimens were either light-cured directly, light-cured through a 1-mm lithium disilicate glass-ceramic layer, or self-cured. The degree of conversion was measured in 0.1-mm films using Fourier-transform infrared spectroscopy 1 day, 7 days, and 28 days post-cure. Specimens used to study the flexural strength and modulus were prepared according to the ISO 4049 protocol, stored for 28 days post-cure, and subjected to accelerated aging by absolute ethanol immersion. The degree of conversion values ranged between 44.3-77.8%. Flexural strength varied between 11.4-111.1 MPa, while flexural modulus amounted to 0.7-5.5 GPa. The degree of conversion was significantly affected by material type, curing conditions, and post-cure time; however, variations in curing conditions were the least influential factor. A statistically significant effect of curing conditions on the degree of conversion was identified for only one of the five materials tested, whereas the flexural strength and modulus of all tested materials were significantly reduced in the experimental groups that were light-cured through a ceramic layer or self-cured. The effect size analysis showed that mechanical properties were most affected by the material type, while the differences in curing conditions were less influential. A comparison of the degree of conversion and mechanical properties indicated that different curing conditions may lead to significantly different flexural strength and modulus, which are not necessarily accompanied by identifiable variations in the degree of conversion.

Roughness of the Surface of Zirconia Reinforced Lithium Disilicate Ceramic Treated by Different Procedures.

Lithium disilicate and zirconia are the two most popular materials for aesthetic and dental prosthetic work; however, due to their limitations, a new material is being researched, namely zirconia-reinforced lithium disilicate, the surface of which is treated with different procedures to achieve the best possible surface properties. In this study, the surface of zirconia-reinforced lithium disilicate glass-ceramic was treated using different methods (conventional and laser) to determine the effects of the treatment procedures on the surface properties and surface roughness to achieve a higher strength of adhesion from the self-adhesive resin cement to zirconia-reinforced lithium disilicate. The treated surfaces were investigated using profilometry, X-ray diffraction and energy dispersive X-ray fluorescence. The results obtained were statistically evaluated. The results show that the surface roughness is highest for the samples treated with Er:YAG (erbium-doped yttrium aluminium garnet laser) and silanisation. Furthermore, the surface treatment procedures applied did not change the composition of the surface.

Influence of Different Surface Pretreatments of Zirconium Dioxide Reinforced Lithium Disilicate Ceramics on the Shear Bond Strength of Self-Adhesive Resin Cement.

AIM: To analyze the influence of different surface pretreatments of zirconium dioxide reinforced lithium disilicate ceramics on the shear bond strength of self-adhesive resin cement. MATERIALS AND METHODS: Eighty-four zirconium reinforced lithium disilicate disc Vita suprinity (Vita Zahnfabrick, Bad Säckingen, Germany) 14x12x2 mm specimens were fabricated according to the manufacturer's recommendations. The specimens were embedded in acrylic resin blocks and randomly divided in seven groups (n=12/each) accorrding to the treatment: Group 1- 10% hydrofluoric acid; Group 2- silane; Group 3- hydrofluoric and silane; Group 4- sandblasting with silane; Group 5- Er: YAG laser+ silane; Group 6- Nd: YAG laser + silane; and the control group, in which the specimens were not treated. Round shape composite discs (Filtek Bulk fill, 3M ESPE, St.Paul, Minnesota, USA) with 3.5 mm diameter, were made for shear bond strength testing, and then cemented to the ceramic sample surface using composite cement (RelyX U200 Automix, 3M ESPE, Neuss, Germany). After cementing the composite disc on the sample, the samples were subjected to shear bond strength test of 10 N with a "stress rate" of 1 MPa / s. To determine the nature of the fracture (adhesive, cohesive or adhesive-cohesive), the broken samples were examined under a stereomicroscope. The ANOVA test and the Tukey test were used to compare the values ​​of the bond strength characteristics between different types of materials. All tests were performed with a significance level of α = 0.05. RESULTS: There was a significant difference in the shear bond strength of self-adhesive cement to dental lithium-disilicate ceramics reinforced with zirconium dioxide after different preparation protocols (p<0, 05). The treatment of lithium disilicate ceramics reinforced with zirconium dioxide by silanization, sandblasting + silanization, Nd: YAG + silanization resulted in significantly higher bond strength compared to the control group. There was statistically higher bond strength of self-adhesive cement after pretreatment of lithium disilicate ceramics Nd: YAG + silanization compared to Er: YAG + silanization (p <0.05). Adhesive fracture dominated in the control group, sandblasting + silanization group, and in the laser groups, while mixed fracture dominated in other groups. CONCLUSION: Under the limitations of this study, the Nd:YAG irradiation with silanization could be used as pretreatment for providing greater shear bond strength of self-adhesive resin cement to zirconium reinforced lithium disilicate.

Alcohol Abuse in the Dental Patient and Temporomandibular Disorder Caused by Trauma.

The aim of the paper was to describe the multidimensional character of alcoholism and its effects on oral health, with a review of the relation between the traumatogenic factor of temporomandibular disorders (TMDs) and bruxism development. The difference between moderate drinking and the development of alcohol addiction which leads to alcoholism-related medical, social, legal and economic issues is not always clear. Alcoholism is often hidden within the private and wider social framework of a patient. Oral diseases are easy to notice in recorded alcoholics as well as in, for example, smokers. TMDs consist of a disorder of masticatory muscles and/or a disorder of temporomandibular joint (TMJ). Since the traumatogenic factor of individuals under the influence of alcohol is clearly evident, it can potentially become an initializing factor of TMJ disorder's clinical signs and symptoms development. A modern approach to the etiopathogenesis is to include the multifactorial model, that is, combinations of potential factors with various individual importances. In everyday dental practice, co-morbidities of oral diseases and alcoholism are expected more often, as well as oral diseases with their etiopathogenesis partially related to alcohol use.

Fixed Prosthodontic Patient Satisfaction Survey.

BACKGROUND: This study aimed to assess the level of satisfaction with fixed prosthodontic work among patients in Croatia and investigate the level of awareness about maintaining oral hygiene and the importance of regular check-ups. SUBJECTS AND METHODS: The study included 235 participants from Croatia, 163 women, and 72 men. As a data source, we used a questionnaire previously filled in by patients. The questions asked were short and simple to understand. 25 patients were in the preparation phase of prosthetic therapy, 34 in the middle of the process, and 176 already had the whole procedure done. RESULTS: Most study patients were satisfied with fixed prosthodontic work's aesthetic and functional parameters. Aesthetic aspects such as the color and appearance of the prosthodontic work positively affected the patient's self-confidence and further quality of life. Most of the environment noticed the patient's new smile after prosthodontic work. CONCLUSION: Patients must be aware of the importance of maintaining proper oral hygiene because it directly affects a fixed prosthetic replacement's lifespan and indirectly affects the subjective impression and level of patient satisfaction with the overall work.

Anxiety and Depression Scores in Patients with Burning Mouth Syndrome.

BACKGROUND: Burning mouth syndrome is a condition of unknown etiology, characterized by burning symptoms on the otherwise clinically healthy oral mucosa. Central and/or peripheral neuropathy is one of the proposed causes for this condition. Psychological component in these patients is also very present, as it is known that BMS patients exhibit high levels of pain, anxiety, and depression. The aim of this study was to evaluate anxiety and depression among patients with burning mouth syndrome and a control group. We also further review and discuss the literature available on this subject. SUBJECTS AND METHODS: A total of 93 subjects, divided into two groups, participated in this study. The group of patients with BMS included 43 participants, while the control group consisted of 50 participants. Self-reported STAI (State anxiety and Trait anxiety) and BDI questionnaires were used to evaluate anxiety and depression in subjects in both groups. RESULTS: BMS group had higher average total scores of state anxiety, trait anxiety and depression. The difference between the BMS group and control group was statistically significant for state anxiety scores and BDI scores. CONCLUSION: We might conclude that BMS patients are more anxious (state) and depressed when compared with the control group. However, they do not differ from the control group regarding anxiety as a trait. Thus we might conclude that feeling of anxiety in general starts after the BMS symptoms first occur and last for a longer period of time.

Undergraduate Students' Knowledge on Temporomandibular Disorders in Croatia.

The aim of this study was to evaluate Croatian undergraduate students' knowledge based on what they learned in the recent course, as well as the students' own judgment and opinions about geriatric dentistry education concerning temporomandibular disorders (TMDs) of the elderly. The study was carried out by means of a questionnaire administered in the last study year to students of the School of Dental Medicine, University of Zagreb and students of the Department of Dental Medicine at the School of Medicine, University of Rijeka. Th e questionnaire included questions about relevant specific knowledge on TMD, and statements related to their own opinion about geriatric dentistry education received during the study. Regarding students' knowledge related to TMDs, students from Rijeka gave more positive answers (p=0.012). Students from Rijeka gave more positive answers regarding physical therapy for treatment of TMD (p=0.004) and disc displacement and osteoarthritis as the most common disorders of the temporomandibular joint (p=0.031). Students from Zagreb were more unsatisfi ed with the skills in the field of geriatric dentistry (disagreed 57.45%) than students from Rijeka (45.83% had neutral standpoint and 37.50% agreed) (p=0.005). The level of the participants' knowledge pointed to the need of improving undergraduate dental teaching about the specific geriatric education, including knowledge about TMD.

Dental Fear in Children with Repeated Tooth Injuries.

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.

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.

Pathophysiology of osteonecrosis of the jaw in patients treated with bisphosphonate.

Apart from the well-known mechanism of bisphosphonates' cellular effect, embryonic development and the specific features of alveolar bone homeostasis have been discussed. The unique ethiopathogenic mechanism which relates osteonecrosis of the jaw and bisphosphonates treatment has not been explained. The emphasis lies on the toxicological effects of bisphosphonates on the physiology of the alveolar bone and on the lasting effect of tooth extraction followed by an infection of the extraction wound and consequent progression into deeper layers of osseous tissue. Epithelial infection includes microbiological findings of Actinomyces species. The risk is pronounced in oncological patients treated with bisphosphonates intravenously in relatively large doses and during a longer period of time, especially with highly potent nitrogen-containing bisphosphonates pamidronate and zoledronate. This review of bisphosphonate-related osteonecrosis of the jaw stresses the significance of some other risk factors (corticosteroids, chemotherapy, tumour tissue etc.) of necrosis development--more precisely of osteomyelitis of the jaw if the microbiological component of the diseases has been taken into account, while the role of the bisphosphonates becomes minor. There is no gold standard for the treatment of jaw osteonecrosis; rather, palliative and minimally invasive treatment is applied, without subsequent oral surgical interventions. Since there is a significant risk of jaw osteonecrosis in oncological patients, the level of oral health is an important factor for the indication of intravenous bisphosphonates treatment.

Effects of low-level laser treatment on mouth dryness.

UNLABELLED: Mouth dryness (MD) is usually followed by inadequate mechanical cleaning of the mouth and decrease in the levels of salivary antimicrobial proteins (including secretory immunoglobulin A (sIgA)). It is accompanied by difficulties during speaking and food swallowing, with an unpleasant taste, burning sensations in the mouth and higher susceptibility to oral diseases. Low-level laser treatment (LLLT) can intensify cell metabolism and its application on salivary glands could improve salivation. The purpose of this study was to evaluate the effects of LLLT on salivation of patients suffering from MD. The study included 17 patients with MD. Their major salivary glands were treated with low intensity laser BTL2000 on 10 occasions. The whole unstimulated and stimulated saliva quantities were measured just before the 1st, after the 10th and thirty days following the last (10th) treatment. In the samples of unstimulated saliva concentrations of sIgA were estimated by using ELISA method and its quantity in the time unit was calculated. The visual analogue scale (VAS) score was used to assess burning and/or pain intensity at these three time points. Statistical tests revealed significant salivation improvement quantitatively and qualitatively, i.e. increase in the quantity of saliva and sIgA. VAS score was also significantly improved and no side effects were observed. CONCLUSIONS: According to the results of this study, application of LLLT to xerostomic patients' major salivary glands stimulates them to produce more saliva with better antimicrobial characteristics and improves the difficulties that are associated with MD. This simple non-invasive method could be used in everyday clinical practice for the treatment of MD.

Temporomandibular joint disorder in a patient with multiple sclerosis--review of literature with a clinical report.

Temporomandibular disorders are a form of musculoskeletal disorders, which reduce the function of stomatognathic system and they are related to some other diseases causing painful conditions and disorders of oral function. The aim of this paper is to describe a one year follow up clinical case of a female patient with comorbid multiple sclerosis and a relatively rare form of articular disc disorder. Primary clinical diagnostics encompassed manual methods of TMJ examination. Definite diagnosis included radiologic examination. Clinical hyperextensive condyle position was palpated bilaterally and subsequently confirmed by a functional panoramic radiograph of TMJ. The anterior displacement of disc with reduction was diagnosed by magnetic resonance and in the right joint there was a disc displacement upon excursive movement. From relevant literature, the relationship of a number of diseases that can be related to functional disorder of the orofacial system, such as multiple sclerosis, has been described from many aspects. Also, apart from the standard classification of one form of anterior displacement of the disc, made primarily by magnetic resonance, cases of disc displacement upon excursive mandibular movement can rarely be found in literature.

Influence of the partial denture on the articulation of dental and postalveolar sounds.

Dental prosthesis is a foreign body in oral cavity and thus necessarily interferes with speech articulation. The purpose of this study was to examine influence of partial denture on speech quality and to show eventual differences in pronunciation of dental sounds c[ts], z [z], s [s] and postalveolar sounds c [t], z [3] and s [integral of]. We have examined differences in pronunciation between subjects with removable partial dentures, the same group without partial dentures and a control group. The study was performed on 30 subjects with removable partial dentures and 30 subjects with complete dental arch. All subjects were recorded while reading six Croatian words containing the examined sounds. Recordings were analyzed with Multispeech Program (Kay Elemetrics Inc.). Acoustic analysis--LPC (linear prediction coding) provided formant peaks (Hz) for each examined sound, its intensity (dB) and formant bandwidths (Hz). Results showed that subjects with partial dentures had 50% less distorted variables and that prostheses did not completely restore articulation of postalveolar sounds. Groups with and without prostheses had lower formant peaks intensities and wider formant bandwidths in comparison to the control group. Partial dentures have not significantly interfered with resonance frequency. At the same time, pronunciation of the examined sounds was significantly improved. However, precision of the articulation movements has deteriorated.