Effectiveness of an intraoral thermoformed splint with magnet device in patients with xerostomia and hyposalivation: A pilot study.

AIM: The aim of the study was to examine the effectiveness of intraoral thermoformed splint with a magnet device over a period of 3 months, that is, to assess acceptability of this method of treatment using both objective and self-reported measures. MATERIALS AND METHODS: This study was designed as a prospective clinical pilot trial. 22 patients with xerostomia and hyposalivation were included. Xerostomia was assessed using a 4-question xerostomia questionnaire score and a test for unstimulated salivary flow rates. Evaluations were performed before the treatment and 3 months after the treatment using a thermoformed splint with a magnet device. RESULTS: There was a significant reduction in subjective symptoms after using a thermoformed splint with a magnet device for 3 months. For all 4 scored items, there was a statistically significant difference (P < .001) in median VAS scores before and 3 months after treatment. There was also a statistically significant difference in USFR before (0,15 ± 0,04 ml/min) and after treatment (0,24 ± 0,03 mL/min). CONCLUSION: Our findings indicate that the use of this device alleviated oral dryness and stimulated the function of the submandibular salivary gland. An intraoral thermoformed splint with a magnet device is safe, physiologically indifferent, useful, and effective in treating xerostomia and hyposalivation.

Effect of augmented reality simulation on administration of local anaesthesia in paediatric patients.

BACKGROUND: Augmented reality (AR) is a simulation of a three-dimensional environment created using hardware and software that provides the user with realistic experiences and ability to interact. The aim of the study was to evaluate the impact of AR simulator on the perception of learning and acute stress level in students administering local anaesthesia to paediatric patients relative to standard teaching methods. MATERIAL AND METHODS: The prospective study included 21 fourth- and fifth-year students enrolled in 5-year dental programme. In addition to conventional training, the students of the study group used the augmented reality simulator in a dental office 2 hours weekly in 2 weeks. The level of salivary cortisol was measured before and after the anaesthetic procedure as one of the indicators of acute stress. RESULTS: A statistically significant shorter time to perform infiltrative anaesthesia technique for the anterior superior alveolar nerve was observed in students using the AR technique (28.91 ± 9.06 seconds in the study group and 39.80 ± 9.29 seconds in the control group). The level of cortisol before and after anaesthesia was statistically significant in all subjects (cortisol concentration was 0.53 µg/dL before anaesthesia and 2.44 µg/dL after the procedure); however, there was no statistically significant difference between the groups. CONCLUSION: The AR concept may influence better manipulation and control of the syringe in students administering their first anaesthetic injection to paediatric patients, but may not reduce acute stress.

Efficiency of chewable toothbrush in reduction of dental plaque in students.

BACKGROUND: Besides classical and electrical toothbrushes market offers tooth brushes that can be chewed, like chewing gums. The aim of this study was to show the effectiveness of chewable toothbrush versus a conventional brush in the students' population. METHODS: The prospective study included 346 students. For this research, we used a e-questionnaire for "smart" phones, that students completed outside the dental office. Respondents are divided into two groups: control group used conventional toothbrushes, respondents from the tested group used chewable toothbrush. For assessment of accumulation of the plaque we used TQHI index. For testing statistical hypotheses, the following were used: t-test for two independent samples and analysis of the variance of repeated measurements. RESULTS: Before brushing teeth, the average TQHI value for chewable brushes is 2.8 ± 0.3, while conventional is 2.7 ± 0.3, which is not a statistically significant difference (p = 0.448). After brushing teeth, the average TQHI value for chewable brushes is 2.0 ± 0.1, while conventional 2.0 ± 0.3, which is also not statistically significant (p = 0.729). Observing the index of the plaque values on the tooth surfaces in the upper jaw, in both groups, there was a statistically significant change in the amount of plaque in time (p < 0.001). There is a statistically significant interaction between groups and changes in the amount of plaque in the observed period (p = 0.013). CONCLUSIONS: The fact that there is no significant difference in the effectiveness of the tested brushes indicates the benefits of using chewable toothbrushes in order to reduce plaque, primarily in the inability to use conventional brushes.

Clinical Characteristics of Abutment Teeth with Gingival Discoloration.

PURPOSE: The grey-bluish discoloration of gingiva (known as "amalgam tattoo") does not appear only in the presence of amalgam restorations. It may also be seen in cases of teeth restored with cast dowels and porcelain-fused-to-metal (PFM) restorations. The aim of this article was to determine the clinical characteristics of abutment teeth with gingival discoloration. MATERIALS AND METHODS: This research was conducted on 25 patients referred for cast dowel and PFM restorations. These restorations were manufactured from Ni-Cr alloys. Ninety days after cementing the fixed prosthodontic restorations, the abutment teeth (n = 61) were divided into a group with gingival discoloration (GD) (n = 25) and without gingival discoloration (NGD) (n = 36). The control group (CG) comprised the contralateral teeth (n = 61). Plaque index, gingival index, clinical attachment level, and probing depth were assessed before fabrication and also 90 days after cementation of the PFM restorations. RESULTS: The gingival index, clinical attachment level, and probing depths of the abutment teeth that had GD were statistically higher before restoration, in comparison with the abutment teeth in the NGD and control groups. Ninety days after cementation, the abutment teeth with GD had significantly lower gingival indexes and probing depths, compared to the abutment teeth in the NGD group. Both abutment teeth groups (GD and NGD) had significantly higher values of clinical attachment levels when compared to the control group. There were no statistically significant differences in plaque index values between the study groups. CONCLUSIONS: The results of this study indicated that impairment of periodontal status of abutment teeth seemed to be related to the presence of gingival discolorations. Therefore, fabrication of fixed prosthodontic restorations requires careful planning and abutment teeth preparation to minimize the occurrence of gingival discolorations. CLINICAL RELEVANCE: With careful preparation of abutment teeth for cast dowels and crown restorations it may be possible to decrease the frequency of gingival discolorations adjacent to abutment teeth.

Association of Cytokine Gene Polymorphism with Peri-implantitis Risk.

PURPOSE: To investigate whether polymorphisms of cluster of differentiation 14 (CD14), tumor necrosis factor alpha (TNFα), interleukin (IL)6, IL10, and IL1ra genes are associated with the risk of peri-implantitis susceptibility in patients with dental implants in the Serbian population. MATERIALS AND METHODS: Isolated DNA from the blood was used for IL10-1082, TNFα-308, IL6-174, CD14-159, and interleukin 1 receptor antagonist (IL1ra) genotyping using polymerase chain reaction (PCR)-based methodology. Clinical parameters included: peri-implant pocket depth (PPD), Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), and radiologic bone loss. RESULTS: The study included 98 patients with dental implants in function for at least 1 year, divided into peri-implantitis (34) and healthy peri-implant tissue (64) groups. The percentage distribution of smokers was significantly different between patients who developed peri-implantitis and patients with healthy peri-implant tissue (71% vs 42%, respectively) and associated with increased peri-implantitis risk (OR: 3.289, 95% CI: 1.352 to 8.001; P = .007). A positive history of periodontitis was more frequent in the peri-implantitis group (62%) than in the healthy peri-implant tissue (20%) group and associated with increased peri-implantitis risk (OR: 6.337, 95% CI: 2.522 to 15.927; P = .0001). Frequencies of CD14-159, TNFα-308, IL10-1082, and IL6-174 genotypes were significantly different between patients with and without peri-implantitis. However, logistic regression revealed only TNFα-308 polymorphic GA/AA genotypes (OR: 8.890, 95% CI: 2.15 to 36.7; P = .003) and smoking (OR: 6.2, 95% CI: 1.44 to 26.7; P = .014) as independent factors associated with increased peri-implantitis risk, while CD14-159 polymorphic CT/TT genotypes were associated with decreased risk for peri-implantitis (OR: 0.059, 95% CI: 0.009 to 0.355; P = .002). CONCLUSION: The findings suggest that smoking and the presence of TNFα-308 GA/AA genotypes may increase the risk for peri-implantitis, while CD14-159 polymorphic CT/TT genotypes decrease the risk. The results also indicate significant association of CD14-159, TNFα-308, and IL6-174 genotypes and clinical parameters in the Serbian population. However, future studies in larger patient groups are necessary to confirm these observations.

Comparison of cefixime and amoxicillin plus metronidazole in the treatment of chronic periodontitis.

BACKGROUND/AIM: Despite significant advances in current medicine and improvement of overall health education, chronic periodontitis is still a widespread disease. Losing teeth is the most serious complication of this particular illness. The aim of this study was to examine patients with chronic periodontitis in order to evaluate the efficacy of non-surgical therapy and combination of amoxicillin and metronidazole compared with cefixime, which has not been so far used for the treatment of this disease. METHODS: Adult patients with chronic periodontitis (n = 90) underwent non-surgical periodontal treatment (zero-day) and then randomly divided into three groups. The group I served as a control, the group II was additionally treated with the combination of amoxicillin and metronidazole (for 7 days), while the group III was treated with cefixime (also for 7 days). To assess the condition of periodontium before and seven days after the therapy, four clinical parameters were used: gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL). RESULTS: On the day 7 after the beginning of the therapy, we found that all the three groups of patients had statistically significant clinical improvement of three parameters: GI, BOP and PD, but not of the CAL. However, the improvement of PD was only statistically, but not clinically significant. The improvement in the control group of patients on the day 7 was 19% in BOP and 28% in GI; this improvement was statistically highly significant after the addition of amoxicillin plus metronodazole (71% in BOP and 77% in GI) or cefixime (62% in BOP and 82% in GI). Compared to the combination of amoxicillin and metronidazole, cefixim was statistically significantly more effective for GI (p < 0.05), while for the other three clinical parameters their effects were equal. CONCLUSION: The conjunction of amoxicillin plus metronidazole or cefixime to the causal treatment of patients with chronic periodontitis led to statistically significant improvement in efficacy in relation to GI and BOP parameters, while cefixime was statistically significantly more efficient than the combination of amoxicillin and metronidazole for GI.

Treatment of teeth in the esthetic zone in a patient with amelogenesis imperfecta using composite veneers and the clear matrix technique: A case report.

INTRODUCTION: Restorative dental treatment of patients with a generalized form of amelogenesis imperfecta (AI) remains a challenge even today. The treatment approach is multidisciplinary and includes action of several dental disciplines such as restorative, orthodontic, and prosthetic dental specialties. CASE REPORT: A 18-year-old female patent was referred to the Department of Restorative Dentistry and Periodontology at the Military Medical Academy of Belgrade, Serbia. She was diagnosed with Al and formerly had been treated for a long period of time at the Department of Pediatric Dentistry and Orthodontics. Her primary concern upon arrival was discomfort and concern for the esthetic appearance of the anterior teeth. The treatment was done with the modified clear matrix technique used in composite veneer restoration of teeth in the esthetic zone. CONCLUSION: Because fixed prosthetic restoration with crowns, is the final treatment of AI patients it involves severe tooth structure loss. The clear matrix method which was done in this case allowed for greater comfort, functionality, simplicity, speed, greater economic efficiency and tooth structure preservation.

Assessment of the periodontal health and community periodontal index in the Army of Serbia.

BACKGROUND/AIM: Promotion of oral health in military population is not only a significant component of general health, but also of the military readiness and represents the strategic orientation of each country. The basic task of military dentistry is to provide oral health of military personnel and to enable their operational readiness at the optimal level. The aim of the study was to assess the periodontal condition in Serbian military population using the community periodontal index of treatment needs (CPITN), and the influence of general life habits and local risk factors on periodontal health. METHODS: This prospective cross-sectional pilot study was conducted on 101 examinees at the mean age of 38.94 ± 11.63 years who had dental check-ups at the Dental Clinic of the Military Medical Academy in Belgrade. All the categories of military personnel aged 20-64 years were divided into five groups. The frequency distribution of general and local factors on periodontal health, oral hygiene index, and the assessment of the mean number of sextants by CPITN compared to age were examined. RESULTS: The examinees at the age of 51-60 years had the best oral hygiene index (0.95 ± 0.65), whereas the oldest population had the worst (1.63 ± 0.42). Only one person (5.6%) at the age group of 51-60 years had a completely healthy periodontium. Observed in relation to the age groups, the mean values of sextants increased linearly, but in general population, the most frequent CPITN categories were in sextant with the periodontal pockets 4-5 mm (score 3). CONCLUSIONS: Compared to the results from other countries shown by the World Health Organization, the periodontal condition in our examinees is below the average. The appropriate preventive program preparation and its implementation are needed, including primarily the appropriate training on oral hygiene, as well as education based on periodontal disease prevention and treatment.

Periodontal disease in children and adolescents with type 1 diabetes in Serbia.

BACKGROUND: The purpose of this study was to evaluate periodontal health in young patients with type 1 diabetes mellitus in Serbia. METHODS: Periodontal disease was clinically assessed and compared in 187 children and adolescents (6 to 18 years of age) with type 1 diabetes mellitus and 178 control subjects without diabetes. RESULTS: Children and adolescents with type 1 diabetes mellitus had significantly more plaque, gingival inflammation, and periodontal destruction than control subjects. The main risk factors for periodontitis were diabetes (odds ratio [OR] = 2.78; 95% confidence interval [CI]: 1.42 to 5.44), bleeding/plaque ratio (OR = 1.25; 95% CI: 1.06 to 1.48), and age (OR = 1.10; 95% CI: 1.01 to 1.21). In case subjects, the number of teeth affected by periodontal destruction was associated with mean hemoglobin A1c (regression coefficient 0.17; P = 0.026), duration of diabetes (regression coefficient 0.19; P = 0.021), and bleeding/plaque ratio (regression coefficient 0.17; P = 0.021). CONCLUSIONS: Compared to children and adolescents without diabetes, periodontal disease is more prevalent and widespread in children and adolescents with type 1 diabetes mellitus and depends on the duration of disease, metabolic control, and the severity of gingival inflammation. Gingival inflammation in young patients with diabetes is more evident and more often results in periodontal destruction.

The prevalence of cutaneous manifestations in young patients with type 1 diabetes.

OBJECTIVE: The aim of the study was to assess the prevalence of cutaneous disorders and their relation to disease duration, metabolic control, and microvascular complications in children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: The presence and frequency of skin manifestations were examined and compared in 212 unselected type 1 diabetic patients (aged 2-22 years, diabetes duration 1-15 years) and 196 healthy sex- and age-matched control subjects. Logistic regression was used to analyze the relation of cutaneous disorders with diabetes duration, glycemic control, and microvascular complications. RESULTS: One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous disorder vs. 52 (26.5%) control subjects (P < 0.01). Diabetes-associated skin lesions were found in 81 (38%) patients. Acquired ichthyosis, rubeosis faciei, diabetic hand, and necrobiosis lipoidica were seen in 22 vs. 3%, 7.1 vs. 0%, 2.3 vs. 0%, and 2.3 vs. 0% of type 1 diabetic and control subjects, respectively. The frequency of cutaneous reactions to insulin therapy was low (-2.7%). The prevalence of fungal infections in patients and control subjects was 4.7% and 1.5%, respectively. Keratosis pilaris affected 12% of our patients vs. 1.5% of control subjects. Diabetic hand was strongly (odds ratio 1.42 [95% CI 1.11-1.81]; P < 0.001), and rubeosis faciei weakly (1.22 [1.04-1.43]; P = 0.0087), associated with diabetes duration. Significant association was also found between acquired ichthyosis and keratosis pilaris (1.53 [1.09-1.79]; P < 0.001). CONCLUSIONS: Cutaneous manifestations are common in type 1 diabetic patients, and some of them, like acquired ichthyosis and keratosis pilaris, develop early in the course of the disease. Diabetic hand and rubeosis faciei are related to disease duration.

[Changes in the oral caused by scurvy]. / Promene u usnoj duplji uzrokovane skorbutom.

This report presents a case of a psychiatric patient with scurvy. Upon the clinical examination of the oral cavity, dry and pale lips were noted. Gingiva was highly edematous, soft, purple blue with ulcerated margins. Bleeding was noted upon slightest provocation. Teeth were also affected by the vitamin C deficiency with multiple caries. The patient was asthenic and adynamic. Petechial bleeding and hematomas were present on the skin of extremities. Therapy consisted of rehydration and vitamin C compensation--2 g daily i.v. during 10 days period, and 1.5 g daily orally during the following 2 months. The patient maintained only partial plaque control, and complete recovery of the oral cavity was not established because the patient didn't comply. Concerning that scurvy is a rare disease nowadays, it is very important to recognize its clinical signs, and to establish a valid and prompt diagnosis, because, when untreated, scurvy can have severe consequences on the entire organism.