Analysis of Hospital-Based Dental Procedures Under General Anesthesia in Uncooperative Patients: a Retrospective Study.

Background: General anesthesia is a well-documented therapeutic option for the provision of dental treatment, particularly in patients with special healthcare needs and uncooperative pediatric patients. Objectives: This retrospective study aimed to analyze the characteristics of dental general anesthesia (DGA) procedures for uncooperative patients of all ages in a tertiary healthcare facility, Clinical Hospital Dubrava, in Zagreb, Croatia. Material and methods: The hospital records for the patients treated for various dental reasons under GA were obtained at the Clinical Hospital Dubrava in Zagreb, Croatia. Results: Between 2014 and 2019, a total of 810 DGA procedures were performed including 607 patients. The median age was 18 years. Almost half of the patients referred to undergo DGA procedures were from the City of Zagreb and Zagreb County, 27.8% (N=225) and 21.0% (N=170), respectively. More than 90% of patients undergoing DGA procedures were referred with 1 to 3 medical conditions. 47.9% of patients had 1 to 3 dental conditions, of which caries was the most common condition (95.7%). The mean waiting time (±SD) was 113.06 (±62.62) days. 90 patients (14.8%) were referred for dental procedures under GA more than once, accounting for 203 procedures (25.1%). Conclusions: DGA remains a single dental treatment option for specific individuals. There is an institutional and, also, an organizational need to address the long waiting times and high repeated DGA rates.

Effects of midazolam co-induction to general anesthesia: A randomized clinical trial.

BACKGROUND: This study aimed to determine the potential advantages of midazolam co-induction with general anesthesia (GA) over the use of propofol alone. METHODS: We conducted a randomized, placebo-controlled, single-blinded clinical trial of 102 patients, aged 18 to 65, American Society of Anesthesiologists II and III, who underwent elective laparoscopic gallbladder surgery. Patients were randomly divided into 3 groups: the placebo group (C) received 1 mL of 0.9% saline intravenously and the test groups received intravenous midazolam at doses of 0.03 mg/kg (M1) or 0.06 mg/kg (M2) before induction of GA. We assessed effects of midazolam co-induction on arterial pressure and heart rate (HR) in the early stage of GA prior to surgical incision and effects on perioperative and postoperative glycemia and cortisol levels. Systolic/mean/diastolic (SAP/MAP/DAP) arterial pressure and HR were measured 4 times (preoperative, on the third, sixth and ninth minute after atracurium administration). Cortisol was measured on 3 occasions (preoperatively, 60 minutes after surgical incision, and the following morning) and glucose on 4 occasions (preoperatively, 15 and 60 minutes after incision, and the following morning). We also assessed the incidence of postoperative anxiety, postoperative nausea and vomiting (PONV), and propofol requirement for induction. RESULTS: SAP/MAP/DAP were significantly higher in M2 immediately after induction compared to the other study groups (P = .002/.004/.013). Midazolam co-induction led to a significant reduction in postoperative anxiety (P = .03), reduced cortisol concentration 60 minutes after surgical incision (P < .001) and propofol requirements (P < .001). CONCLUSION SUBSECTIONS: Midazolam co-induction prevented a marked decline in SAP/MAP/DAP immediately after induction of GA, led to reduced postoperative anxiety and cortisol response to surgery, and reduced propofol requirements for induction.

LEVEL OF PAIN AND ANALGESICS TAKEN AFTER CESAREAN SECTION AND DIFFERENCES ACCORDING TO TYPE OF ANESTHESIA AND DEMOGRAPHIC FACTORS.

The aim of this study was to investigate the level of pain and analgesic consumption in puerperas after cesarean section according to the type of anesthesia administered. This was a prospective study conducted at the Department of Obstetrics and Gynecology, Mostar University Hospital, in the period from September 2015 to June 2016. The study included 111 puerperas. Experimental group included 54 puerperas operated on under spinal anesthesia, while comparative group included 57 puerperas operated on under general anesthesia. Primary endpoints of the study were pain score and dose number of analgesics used. Input parameters of the study were age, gestational age, education, and place of residence. To determine the level of pain, visual analog scale for pain was used. Results showed that puerperas operated on under spinal anesthesia had significantly lower pain sensation (p=0.031) and less need for analgesic consumption in the postoperative period as compared to those operated on under general anesthesia (p=0.024). Increased age was associated with lower pain sensation (p=0.014) and need for analgesics (p<0.05). Higher level of education was associated with greater need for analgesics (p=0.016). Living in urban area was associated with greater pain sensation (p=0.023) and less need for analgesics (p<0.17). Spinal anesthesia for cesarean section resulted in less pain and less need for analgesics in the postoperative period compared to general anesthesia.

Satisfaction of Parents and Caregivers with Dental Treatment of Children Under General Anesthesia in a Day Care Surgery Setting.

Objective: The aim of this study was to examine the satisfaction of parents and caregivers of patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting. Material and Methods: Anonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA. The survey consisted of 4 parts: general data, data about procedure, satisfaction with various aspects of care and the perception of parents/caregivers about the condition of their child in relation to the time before dental treatment in GA. Results: 66 parents/caregivers (30.5%) responded to the questionnaire. Overall satisfaction with the treatment was high (4.69). Respondents expressed the highest degree of satisfaction with communication with nurses (4.92), and the lowest with the waiting time for the procedure (3.89). Parents/caregivers of patients who reported difficulty eating expressed significantly lower overall satisfaction than the subjects whose children did not report difficulty eating. Also, the more treatments the patients underwent, the lower was the overall satisfaction than of those subjects whose children were never treated in such a manner before. Conclusions: Since patient satisfaction has a beneficial impact on treatment outcome and adherence to preventive recommendations, all health care providers should strive to achieve it.

The Best Dentistry Professional Visual Acuity Measured under Simulated Clinical Conditions Provides Keplerian Magnification Loupe: A Cross-Sectional Study.

Visual acuity plays an important role in dentists' vision in their daily clinical routine. This study aimed to determine dental students' visual acuity without optical aids and when using magnification devices in simulated clinical conditions. The participants were forty-six students at the School of Dental Medicine with a visual acuity of 1.0 in decimal values or 100% in percentage. The central visual acuity was tested using a miniature Snellen eye chart placed in the molar cavity of a dental phantom, in simulated clinical conditions under five different settings (natural visual acuity, by applying head magnifying glasses x1,5 and binocular magnifying devices using Galileo's x2,5/350 mm, Keplerx3,3/450 mm and Keplerx4,5/350 mm optical system). The Wilcoxon Signed Rank test shows that the distribution of measurements of the visual acuity undertaken by the application of magnifying devices (VNL, VGA2,5, VKP3,3, VKP4,5) contained higher values of visual acuity than those received by the use of natural vision (VSC) (p < 0.001 for the comparison to the VNL, VGA2,5, VKP3,3 and VKP4,5 groups). The highest and statistically most significant increase in visual acuity is achieved using the Keplerian telescope x4.5/350 mm. The application of magnifying devices provided dentistry professionals with better visual acuity, improving detail detection in an oral cavity during dental procedures by magnifying the oral structure. The use of magnification devices means much more precise work, decreases the operating time, improves posture and reduces muscle pain in the shoulder during dental treatment.

Dental Treatment for Special Needs Patients Under General Anaesthesia: A 14-year Experience from South Bosnia and Herzegovina.

We conducted a retrospective analysis of records of special needs patients (SNPs) who received dental treatment under orotracheal-intubation general anaesthesia (OIGA) at Caritas Centre St. Family in Mostar, Bosnia and Herzegovina during the 14-year period from January 2005 to December 2018. Of the 7,085 SNPs who received dental treatment, 1,220 (17.2%) received dental treatment under OIGA: 829 (67.9%) males and 391 (32.1%) females. The patients' mean age was 18.3±10.9 years (747 paediatric and 473 adult patients). Mental retardation and psychiatric problems were the most common medical conditions (81.22%). The most common indication for dental treatment under OIGA was behaviour management (87.21%), and 81% of the patients had an urgent need for treatment. Many of the patients had restorative treatment (3,833) and tooth extractions (3,681). From 2011 onwards, the number of tooth extractions decreased significantly. Annual trends revealed a rapid increase of patients every year. The mean dental treatment duration was 95.3±12.1 min; the mean time under OIGA was 98±8.5 min. No serious adverse effects occurred. There was increase of annual trend of SNP in OIGA. The number of extractions decreased while the number of preventive and restorative dental treatments increased.

Molar Incisor Hypomineralization in Children with Intellectual Disabilities.

The aim of the study is to compare the frequency and the distribution of molar incisor hypomineralization (MIH) in children with intellectual disabilities. METHODS: Seventy-two children with intellectual disabilities and 72 healthy children were included in the study. They ranged in age from 5 to 18 years with the same distribution by age and sex. Standard clinical examination was performed, at a dental clinic or in the institution where the children lived, by using a dental mirror and a probe, according the European Academy of Paediatric Dentistry judgment criteria for MIH. RESULTS: Among the 72 children with intellectual disabilities, eight children (11.1%) presented MIH with 19 affected teeth. In the control group, one child (1.4%) presented MIH with two affected teeth. The difference was statistically significant (p = 0.033). There were no statistically significant differences between boys and girls. The molars, especially the first right molars were the most affected tooth. Brown defects were less common than white defects. CONCLUSION: Children with MIH should be identified because this condition is a common problem in children with intellectual disabilities.

The Effect of Transcoutaneous Electrical Nerve Stimulation on Pain Control during Dental Procedure in Children 9-14 Years Old.

INTRODUCTION: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological method widely used by medical specialists to manage acute and chronic pain in different circumstances. It can be used to manage pain during many dental procedures, as well as pain due to various conditions affecting the maxillofacial region. The aim of this study was to provide insight into the clinical research evidence for the analgetic application of TENS in pediatric patients. The hypothesis was that TENS device will achieve analgetic effect on teeth during dental procedure. METHODS: This study included 125 patients treated at the School of Dental Medicine, University of Zagreb clinic during two-year period. After diagnosis of caries and need for restorative treatment, patients were randomly selected in three groups. Group 1 received local anesthesia, group 2 had no anesthesia and group 3 used TENS device. Level of pain was measured with Visual Analogue Scale (VAS). Research was conducted by one therapist that was calibrated. RESULTS: We found no statistically significant difference between TENS group and group without anesthesia(p>0.05). CONCLUSION: TENS device is not as efficient in achieving analgetic impact during dental procedure as local anesthesia.

Effects of Pressure-Controlleda Volume-Controlled Ventilation on Hemodynamic and Respiratory Parameters in Patients During Laparoscopic Cholecystectomy.

Many papers have been published investigating the effects of intraoperative mechanical ventilation on the incidence of intra- and postoperative respiratory complications. The potential advantages of protective pressure over volume-controlled ventilation mode during laparoscopic surgery have yet to be proven. This study included 60 patients aged between 18 and 70 with ASA score 1-3, body mass index (BMI) ≤35 kg/m2, and without prior history of chronic respiratory diseases, who were scheduled for laparoscopic cholecystectomy under general anesthesia. Patients were assigned randomly to protective pressure or volume-controlled mechanical ventilation mode. The initial results showed no significant differences in respiratory and hemodynamic parameters between the groups. Comparison of patients with BMI ≥25 showed significantly lower peak inspiratory pressure (Ppeak) at 15 (18.52 vs. 21.83 cm H2O, p=0.022), 30 (18.73 vs. 21.83 cm H2O, p=0.009) and 45 (18.94 vs. 22.667 cm H2O, p=0.010) minutes after tracheal intubation in the pressure-controlled ventilation (PCV) group. Other measured parameters were of similar characteristics. It is concluded that PCV and volume-controlled ventilation were equally effective in maintaining adequate ventilation, oxygenation and hemodynamic stability in the groups of patients observed. However, comparison of obese patients revealed some advantages of PCV which, given the present pace of change, should be additionally investigated.

Psychosocial and Economic Status of the Parents with Children with and without Tooth Trauma.

BACKGROUND: The main goal of this research is to try and understand influence of psychological and social factors in children with tendencies to repeat tooth trauma. SUBJECTS AND METHODS: Research included 147 patients, children of preschool and school age (88 boys and 59 girls). In the research patients were divided in two age groups: 5-8 and 9-12 years. In both groups there were 49 patients with no experience of dental trauma and 69 patients with experience of one dental trauma and 29 patients with repeated dental trauma. All patients that were involved in the study had previous experience with dental and medical treatment. Study included evaluation of dental anxiety and also factors that caused dental phobia previous their visit to the office in the children with no dental trauma compared to repeat dental trauma patients. On the whole study group differences considering sex, age and psychosocial status in the level of dental anxiety and dental fear were also measured. RESULTS: Categories of children without trauma and with one or multiple trauma showed that it is a similar sex division in the categories. In the no trauma group participation of the boys is lower (46.9%) while in the group with repeated trauma their participation is significantly higher (79.3%). Based on that the risk of repeated dental trauma is characteristic of boys. CONCLUSIONS: Results of this study show that tested psychosocial variables do not differentiate participants according to the tested groups or in other words there is no difference between tested groups in their psychosocial standing.

Developmental Defects of Enamel in Children with Intellectual Disability.

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.

Platelet serotonin concentration and depressive symptoms in patients with schizophrenia.

Depressive symptoms seem to be frequent in schizophrenia, but so far they have received less attention than other symptom domains. Impaired serotonergic neurotransmission has been implicated in the pathogenesis of depression and schizophrenia. The objectives of this study were to investigate platelet serotonin concentrations in schizophrenic patients with and without depressive symptoms, and to investigate the association between platelet serotonin concentrations and symptoms of schizophrenia, mostly depressive symptoms. A total of 364 patients were included in the study, 237 of which had significant depressive symptoms. Significant depressive symptoms were defined by the cut-off score of 7 or more on Calgary Depression Rating Scale (CDSS). Platelet serotonin concentrations were assessed by the enzyme-linked immunosorbent assay (ELISA). Prevalence of depression in patients with schizophrenia was 65.1%. Schizophrenic patients with depressive symptoms showed lower platelet serotonin concentrations (mean±SD; 490.6±401.2) compared to schizophrenic patients without depressive symptoms (mean±SD; 660.9±471.5). An inverse correlation was established between platelet serotonin concentration and depressive symptoms, with more severe symptoms being associated with lower platelet serotonin concentrations. Depressive symptoms in schizophrenic patients may be associated with reduced concentrations of platelet serotonin.

Knowledge, Attitudes and Habits Regarding Oral Health in First- and Final-Year Dental Students

The purpose of the research was to compare oral health behavior and plaque indices between Croatian first-year and final-year dental students. Therefore, 46.9% of first-year and 47% of final-year dental students were surveyed using the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire and had their plaque indices determined. Descriptive statistics analysis, nonparametric tests, and correlation analysis were performed (p<0.05). Sixth-year students had a significantly better mean HU-DBI score (8.06) than first-year students (6.45). Significantly more first-year students thought that they could not help having false teeth at their old age (p=0.007), had never been taught professionally how to brush (p=0.019), and used a toothbrush with hard bristles (p=0.001). Significantly more final-year students brushed each of their teeth carefully (p=0.008), thought they could clean their teeth well without using tooth paste (p=0.000), used a dye to see how clean their teeth were (p=0.002), and had their dentist telling them they brushed very well (p=0.028). Plaque index values were significantly lower (p<0.05) among first-year (7.94±0.72) than among final-year (9.13±0.77) students. With advancement in dental training, oral health attitudes improved, but the level of dental students' oral hygiene decreased.

Effectiveness of Er:YAG laser in cavity preparation for retrograde filling--in vitro study.

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.

The prevalence of idiopathic osteosclerosis and condensing osteitis in Zagreb population.

The aim of this study was to determine the prevalence of idiopathic osteosclerosis (IO) and condensing osteitis (CO) in Zagreb patient population sample according to age and sex, localization in the jaw, as well as dental relationship between IO and CO lesions. A retrospective study was performed using orthopantomograms of 1200 patients who underwent dental treatment. Descriptive characteristics of radiopacities, including the size and information concerning the tooth involved, were recorded and processed using chi2-test. A total of 114 radiopacities were identified, 34 IO in 29 subjects (16 female and 13 male, mean age 35), and 80 CO in 69 subjects (38 female and 31 male, mean age 37). There were no significant sex differences. Both CO and IO showed greater predilection for occurrence in the premolar to molar region of the mandible. Our results indicated a low prevalence of IO and CO in the population of Zagreb. Our findings support the theory that IO lesions should be considered developmental variants of normal bone architecture unrelated to local stimuli, whereas CO lesions could be considered reactive formations related to teeth with deep caries, large restoration, or pulpitis.

Tumor necrosis factor-alpha in peripical tissue exudates of teeth with apical periodontitis.

AIM: The aim of this study was to determine tumor necrosis factor-alpha (TNF-alpha) levels in periapical exudates and to evaluate their relationship with radiological findings. METHODOLOGY: Periapical exudates were collected from root canals of 60 single-rooted teeth using absorbent paper points. TNF-alpha levels were determined by enzyme-linked immunosorbent assays. The samples were divided into three groups according to the periapical radiolucent area. RESULTS: Nonparametric Kruskal-Wallis test revealed significant differences between TNF-alpha concentrations in control group (40, 57+/-28, 15 pg/mL) and group with larger radiolucent areas (2365, 79+/-582, 95 pg/mL), as well as between control and canals with small radiolucent areas (507, 66+/-278, 97) (P<.05). CONCLUSIONS: The levels of TNF-alpha increase significantly in teeth with periapical pathosis, from smaller to bigger lesions. This research and its results have shown that objective analysis of the TNF-alpha levels enables establishment of a relationship between different concentrations of TNF-alpha and different radiological changes.

Erbium:YAG laser versus ultrasonic in preparation of root-end cavities.

The aim of this in vitro study was to compare the sealing effectiveness of the Erbium:YAG laser to the sealing effectiveness of an ultrasonic device in the preparation of similar retrograde cavities using different retrograde filling materials. After root-canal instrumentation and filling, apices of 60 single-rooted teeth were resected. Retrograde class I cavities 3 mm deep were prepared using an ultrasonic device (group A) and Er:YAG laser (group B). An ultrasonic unit was used with CT-5 retrotip at the frequency of 32 KHz. Laser beam parameters were a pulse of very short duration (100 micros), energy of 280 mJ, and repetition rate of 10 Hz. Cavities of each group of 10 samples were filled with mineral trioxide aggregate (MTA), Super-EBA, and IRM. Microleakage was measured using a fluid transport model. The results showed that cavities prepared with Er:YAG laser have significantly lower microleakage for all tested materials.

In vitro study of the variable square pulse Er:YAG laser cutting efficacy for apicectomy.

BACKGROUND AND OBJECTIVES: Variable square pulse (VSP) Er:YAG laser should be quicker than older Er:YAG lasers. The objectives were: (1) comparison of VSP laser and mechanical handpiece efficacy for apicectomy and (2) determination of optimal pulse width/energy/frequency combination. STUDY DESIGN/MATERIALS AND METHODS: Sixty extracted, single-rooted mature human teeth with round apical parts were instrumented, root filled, cleaned, and divided into four groups. Apical 2 mm of each root were apicectomized with mechanical handpiece and Er:YAG laser with three different settings (LaserA = 200 mJ/300 microseconds/ 8 Hz; LaserB = 200 mJ/100 microseconds/8 Hz; LaserC = 380 mJ/100 microseconds/20 Hz). Timing results were statistically compared. RESULTS: LaserC was the most efficient setting. Differences between groups were significant except between LaserC-Mechanical and LaserA-LaserC (P < 0.05). CONCLUSIONS: VSP Er:YAG laser used for apicectomy is slower by a factor of 7-31 than mechanical handpiece, but treatment outcome is acceptable. Optimal settings for apicectomy with VSP laser are 380 mJ/100 microseconds/20 Hz.

The cytotoxicity of RoekoSeal and AH plus compared during different setting periods.

The aim of this study was to evaluate the cytotoxicity of the root canal sealers RoekoSeal Automix (RSA) and AH Plus in vitro on human cervical carcinoma (HeLa) cells and mouse skin fibroblasts (L929). The sealers were covered with a 3 x 10(4) cell suspension 1 h, 24 h, 48 h, 7 days and 1 month after mixing. Four samples and respective controls without sealer were prepared. After 5 days of incubation, the number of cells was determined using an electronic counter; the number of viable cells was determined under light microscopy following the addition of nigrosin dye. The experiment was repeated twice for each sealer and each period. AH Plus was significantly more cytotoxic after 1 h, 24 h, and 48 h, compared to the 7 day and 1 month setting period on both cell lines. RoekoSeal had no cytotoxic effect on either cell line at any setting time.

Apical leakage of five root canal sealers after one year of storage.

A fluid transport model study was used to compare the sealing ability of five root canal sealers (AH26, AH Plus, Apexit, Diaket, and Ketac-Endo) on 60 single-rooted teeth after 1 yr of storage. The root canals were prepared with Gates Glidden drills by using a step-back technique before lateral condensation of gutta-percha with the tested sealers. The specimens were stored in saline solution for 1 yr at 37 degrees C. The leakage was measured by the movement of an air bubble in a capillary glass tube connected to the experimental root section. Apexit (0.490 microl) leaked significantly more than AH Plus (0.378 microl) and Ketac-Endo (0.357 microl), whereas AH26 (0.390 microl) and Diaket (0.429 microl) showed no significant difference from either Apexit or from AH Plus and Keto-Endo.