[Oral health related quality of life of patients undergoing physical medicine and rehabilitation]. / Orvosi rehabilitációs kezelésben részesülo betegek orális egészségügyi állapotának vizsgálata.

INTRODUCTION: More than 1 billion people in the world live with some form of disability. According to the 2011 census in Hungary, their number can be around 500 000. These people are considered as a vulnerable group even from a dental point of view, since the loss of function makes regular oral hygienic routine and dentistry control more difficult. In 2015, The Department of Community Dentistry and The National Institute of Medical Rehabilitation started to operate together a dental office to examine the dental and oral hygiene condition of the inpatients and to make their oral rehabilitation. AIM: aAim: A total of 608 patients have gone through a full dental examination including a stomato-oncological screening. From this we gathered comprehensive information on the oral health of patients currently undergoing rehabilitation and living with disabilities. METHOD: This study was approved by the Medical Research Council. Clinical examinations were done on the basis of the recommendation by WHO. We analysed the DMF-T values, restorative index, periodontal status and lesions of the oral mucosa. From a survey of 20 questions we asked about oral hygiene practices, toothbrushing frequency, last visit to a dentist, eating habits, addictions and social background. RESULTS: The patients had poor oral hygiene. The number of lost teeth is high, but the prosthetic care is not satisfying. The DMF-T value was 20.5, from this D-T = 2.6, M-T = 11.2, F-T = 6.7. The patients' complaints about dental and oral mucosal lesions are minimal compared to their general dental condition. A majority of them did not experienced toothaches in the last 12 months. The last dental checkup in the case of most patients exceeds 12 months. CONCLUSIONS: The oral hygiene of patients living with some form of disability is poor since their daily oral hygiene routine and care in practice are not solved. Orv Hetil. 2018; 159(52): 2202-2206.

Late effects of multiagent chemotherapy on salivary secretion in children cancer survivors.

OBJECTIVE: The aim of this study was to investigate the later oral consequences of chemotherapy on the oral health of children with emphasis on the cariological status and the major and minor salivary gland function. METHOD: Thirty-eight 12-year-old children (mean age 12.3 ± 0.58 years) who underwent chemotherapy were evaluated after 5 years of treatment. Forty age- and sex-matched healthy children with similar socioeconomic backgrounds served as controls. Subjects' cariological status was explained by the number of decayed, filled, missing permanent teeth (DMF-T), and unstimulated and stimulated whole saliva flow rates were measured by the spitting method. Palatal saliva flow rate using a Periotron meter (Oraflow Inc., Plainview, NY) and salivary buffer capacity using CRT buffer (Ivoclar Vivadent AG, Schaan, Lichtenstein) were also investigated. RESULTS: Children who underwent chemotherapy had significantly more decayed teeth than healthy controls (3.97 ± 3.58 vs 0.84 ± 1.75, respectively, p < 0.001). Recipients of chemotherapy had significantly lower stimulated whole saliva flow rate (0.84 ± 0.35 vs 1.13 ± 0.46 ml/min, p < 0.05) compared to the controls. Palatal saliva flow rate was at the same time significantly higher in the test group compared to the controls (1.64 ± 0.87 vs 0.46 ± 0.32 ml/min/cm(2), respectively, p < 0.001). High levels of buffer capacity of the saliva could be detected in a significantly higher prevalence in the patient group compared to the controls (high: 81.6% vs 40%). CONCLUSIONS: According to these results, chemotherapy in children might result in a decreased stimulated whole saliva flow rate, hyposalivation, and, consequently, increased caries risk. Although these processes might be compensated to a limited extend by the increased minor saliva flow rate, resulting in a higher buffer capacity, nutrition and oral hygiene control of children obtaining cancer therapy is essential in the preservation of the oral tissues.

Long-term effects of chemotherapy on dental status of children cancer survivors.

BACKGROUND: The aim of this study was to investigate the long-term effects of chemotherapy on the dental and gingival health and dental disturbance parameters of children cancer survivors. PROCEDURE: Thirty-eight children (mean age 12.2 ± 0.5 years) who underwent chemotherapy at 4.29 ± 1.71 years of age formed the study group. Forty age- and gender-matched healthy children with a similar socioeconomic background served as controls. Subjects' caries status (number of decayed, missing, or filled permanent teeth [DMF-T]) was recorded according to World Health Organization criteria. Subjects' periodontal status was recorded according to the community periodontal index system. Radiographic dental examination was used to analyze dental malformations. RESULTS: DMF-T, D-T (number of decayed permanent teeth), and F-T (number of filled permanent teeth) were significantly higher in the study group compared to the controls (4.61 ± 3.71, 3.97 ± 4.45, respectively, and 0.58 ± 0.14 vs. 2.21 ± 1.01, 0.84 ± 1.82, and 1.18 ±1.07, respectively. The most frequent dental disturbances were root malformation (52.6%) and agenesis (47.4%). CONCLUSIONS: According to our examination dental status of long-term survivors is worse than in controls. Hence proper oral hygiene for children cancer survivors (CCS) is critical. In order to meet the need for dental care in CCS health authorities are encouraged to revitalize the dental services Long-term follow-up of CCS is necessary to monitor their dental growth and oral health.

Anatomical changes in the structure of the temporomandibular joint caused by complete edentulousness.

BACKGROUND: The posterior slope of the articular eminence of completely edentulous patients compared to patients with maintained occlusion shows significant flattening. OBJECTIVE: The aim of this present study was to reveal a possible correlation between edentulousness and the flattening of the eminence and to find out whether this deformation is connected to age. MATERIAL AND METHODS: Thirty patients were examined in three groups, each consisting of 10 persons (group I: 18- to 25-year-old patients with maintained occlusion, group II: patients over 60 with maintained occlusion, group III: edentulous patients over 60). The three groups were compared according to dental status, age, sex and side. Measurements were carried out on orthopantomographic images taken with Kodak 8000 Digital Panoramic System. The angle of the posterior slope of the articular eminence relative to the Frankfort plane was measured on both sides. Data were analysed statistically with the one-way anova test (α = 0.05). RESULTS: The highest values were measured in group I (right side: 39.8 ± 5.4°, left side: 43.0 ± 5.9°), values were somewhat lower in group II (right side: 38.9 ± 4.7°, left side: 39.5 ± 7.4°) and were the lowest in group III, which was significantly lower on both sides than the results of group I and group II (right side: 29.8 ± 6.0°, left side: 31.9 ± 5.2°, p < 0.01). The correlation coefficient between age and the flattening of the eminence in group I, II and III was 0.23, 0.35 and 0.92, respectively. CONCLUSION: The flattening of the articular eminence could be correlated with age; however, the rate of deformation is significantly higher in completely edentulous patients than in patients with maintained occlusion.

[The objective assessment of the quality of oral health care and development of quality indicators]. / A fogászati ellátás minoségének objektív mérése, minoségi indikátorok fejlesztése.

Public health care administration and decision-makers need appropriate tools and information to assess and monitor oral health needs and improve the performance of the oral health system. The aim of the article is to introduce the available methods of measurement of the quality of service, to give a brief summary considering the role of quality indicators in domestic and international sources and the European indicator project (EGOHID) and to introduce ICDAS (International Caries Detection and Assessment System), the method used for clinical examinations. The clinical indicators - that are produced from data gained from the questionnaires and screenings--provide an opportunity to improve and develop quality. Quality indicators are objective measure of the process or outcome of patient care. The 40 indicators were created by the experts of EGOHID program which are described in four categories. Part A is indicators for monitoring the oral health of children and adolescents, Part B is in general population, Part C is indicators for monitoring the oral health systems, Part D concerns indicators for monitoring the oral health quality of life. The purpose of developing public health care and--within it--dental care is the effective use of resources and besides it, reaching the popular level of health gain for which it is a necessary tool when forming and continuously developing the quality approach of providers.

[Review of scientific articles on complete edentulousness, published in the journal Fogorvosi Szemle]. / A teljes foghiányok gyógyítása témakörben, a Fogorvosi Szemlében megjelent közlemények tartalmi elemzése.

This publication is an assessment of scientific articles published in the Fogorvosi Szemle over the last 120 years dealing with the evolution of complete dentures and the treatment of complete edentulousness. Qualitative and quantitative analysis was performed to find the annual average number of scientific articles and to find the authors who published the most in this topic. Publications had been collected and categorized according to author, year and subject and an extensive comparative analysis was carried out. Nineteen authors had four or more first author publications during this time period. According to content, publications were divided into four major groups. Finally, the research activity of three academic scholars, Imre Kemény, Miklós Kaán and Géza Prágai, was introduced briefly based on their articles published in the Fogorvosi Szemle. All of them have contributed significantly to the scientific advance and the academic education of complete prosthetics.

[The dental aspects of public health in Hungary. Review article]. / Magyarország népegészségügyi helyzetének fogorvosi vonatkozásai. Osszefoglaló közlemény.

Despite great improvements in the oral health status of the population, public health and dental public health continue to be a major problem in society. A number of epidemiologic studies revealed the importance of the social, behavioral and environmental factors contributing to inequalities in the maintenance and restoration of oral health. Dental public health is the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organized efforts of the public. The aim of the authors was to provide an overview about the development and the functions of the Hungarian public health and dental public health system, its associations with international dental public health organizations and about the present dental public health status of the Hungarian population. According to WHO pathfinder studies, the Hungarian population has a usual cariologic and periodontal status in Europe, but a number of WHO statistical analyses reveal the sad situation regarding the high frequency of oral malignancies in our country. The social support system is given, the tasks are in front of us, and Hungary intends to follow the oral health strategies of the WHO for 2020 in order to improve the dental public health status of the nation, but it is necessary to declare that not only behavioral but also political decisions are necessary for that goal.

[Flow rate of minor salivary glands in elderly patients wearing complete dentures]. / Idoskorú, teljes fogpótlást viselok kisnyálmirigy szekréciójának vizsgálata.

Minor salivary glands show diverse levels of secretion in different regions of the oral cavity. The smallest production can be measured at the palatal glands, the highest in the buccal and the lingual glands. The labial glands show an intermediate value between the palatal and the buccal flow rate. According to the literature, secretion of the minor salivary glands decreases with age, yet only few data are available regarding the influence of removable dentures on the flow rate. The aim of this study was to assess the influence of complete dentures on the palatal, the labial and the whole saliva flow rate on elderly patients. A further aim was to compare the results obtained by the two measuring methods (weighing method and the PERIOTRON method), used to determine the flow rates of the minor salivary glands. According to the results of this study neither whole resting saliva flow rate nor the flow rate of the minor salivary glands (palatal, buccal) was influenced by long term removable denture wearing (denture wearers and controls -- weighing method: palatal: right side 2.4 +/- 3.3 microl/min/cm2, left side 1 +/- 3.8 microl/min/cm2 and labial: 1.4 +/- 2.6 microl/min/cm2; controls: right side 3.7 +/- 5.2 microl/min/cm2, left side 1.4 +/- 2.5 microl/min/cm2 and labial 1.8 +/- 3.9 microl/min/cm whole resting saliva flow: 0.32 +/- 0.26 ml/min and 0.29 +/- 0.24 ml/min respectively) (The data of denture wearers and controls -- PERIOTRON method: palatal right side 4 +/- 4.6 microl/min/cm2, palatal left side 3.5 +/- 3.6 microl/min/cm2 and labial 0.9 +/- 0.6 microl/min/cm2; controls: palatal right side 2.2 +/- 3.1 microl/min/cm2, palatal left side 1.8 +/- 1.8 microl/min/cm2 and labial 1.9 +/- 3 microl/min/cm2). Authors could not show difference between the weighing method and the PERIOTRON method applied in the measurement of the saliva flow rate of the minor glands.

Frequency and location of traumatic ulcerations following placement of complete dentures.

PURPOSE: To determine the location of mucosal injuries that appear following placement of complete dentures, as well as the number of adjustments necessary to achieve patient comfort. The frequency of mucosal injuries in female and male patients and their connection with clinical anatomic features were also investigated. MATERIALS AND METHODS: Sixty-one completely edentulous healthy patients who wore dentures (47 women and 14 men) took part in the study; 122 newly fabricated complete maxillary and mandibular dentures were investigated. All patients were seen for a 1-week adjustment appointment. Areas where signs of denture-induced mucosal injuries appeared were marked on an anatomic illustration. The follow-up period was in 1-week increments as deemed necessary by the patient. Associations between variables were analyzed with analysis of variance. Results were recorded as mean + SD. Statistical significance was set at P < or = .05. RESULTS: Eighty-seven percent of the dentures required adjustment at week 1, 50% at week 2, and only 7% at week 3. No patients required a further visit. Most frequently injured maxillary areas were the vestibular sulcus (41%), maxillary tuberosity (21%), and hamular notch (12%). In the mandible, the most frequently injured areas were the retromylohyoid area (17%), lingual sulcus (14%), and vestibular sulcus (13%). Denture-induced irritations were detected in a higher ratio in the mandible (P < .001), especially in male denture wearers at the first adjustment (P < .05). Men had a higher ratio of lesions at the region of the maxillary vestibular sulcus between the labial and buccal frenum and at the mandibular vestibular sulcus of the buccal shelf region (P < .001). CONCLUSIONS: Denture-induced irritations appeared most often in the vestibular sulcus of the maxilla and mandible, indicating that it is necessary to evaluate the area of the facial seal of the prosthesis by applying a medium- or a heavy-pressure indicator paste to the borders, and to make adjustments at the delivery stage and subsequent adjustment appointments. Denture placement must not be the final patient-clinician encounter when treating with complete dentures. Denture adjustments are very important clinical phases of denture fabrication and essential in patient care.

[Oral rehabilitation of a patient with Wilson-syndrome using MK1 bolt attachment. A case report]. / Wilson-szindróms beteg fogorvosi rehabilitációja MK1 finommechanikai rögzítovel. Esetismertetés.

The oral condition of neurologically compromised patients seemed to be worse as compared to the healthy population, which is confirmed by concrete data in case of epilepsy patients. The dental status of our 33 years old patient with Wilson-syndrome showed the same situation. The Wilson-syndrome is a hepatolenticular degeneration, with the disfunction of copper excretion in liver. Toxic dose of copper is accumulated in liver, in the nuclei of central nerve system, in kidneys, and in cornea. Deficiency of coeruloplasmin characterizes the disease which might occur in a form of acute hepatitis, chronic active hepatitis, cirrhosis or hepatosplenomegaly without any symptom. Initial symptoms might usually be extrahepatic, with the presence of the green and golden brown Kayser-Fleischer copper deposition. Treatment is necessary until the end of life, 1 g Penicillamine/ day. Our patient with Wilson-syndrome has been treated for 17 years at the Department of Neurology Semmelweis University. Dystonia, speech disorder, and intention tremor are rampant among his symptoms. At the time of admittance to dental clinic, both the upper and lower dental arches belonged to class 2B according to the Fábián and Fejérdy classification of partial edentulousness. After root canal fillings and cementation of dowel cores, an upper and lower fix and removable partial denture combination was made. Oral hygiene was controlled every three months. Dentures are worn for half a year without complaint.

[Construction of the new dental arch in the prosthetic rehabilitation of cleft lip and palate. Case report]. / Uj fogív megteremtése szájpadhasadékos páciens protetikai rehabilitáclója során Esetismertetés.

The authors describe the prosthodontic rehabilitation of an adult patient with unilateral cleft lip and palate. After the surgical and orthodontic treatment of cleft lip and palate patients the prosthodontic treatment was started to correct the palatal defect, the malocclusion and the missing teeth. The authors emphasize on preliminary steps by using diagnostic casts and try-in dentures and they also suggest other directives in the dental management of cleft lip and palate patients.

[Use of questionnaires in screening for risk factors in the dental care of elderly patients]. / Kérdoív használata rizikófaktorok kiszurése céljából idoskorú páciensek kezelése esetén.

The medical and dental history is one of the crucial part of the routine dental practice. According to a survey performed in 2001 27% of the total Hungarian population was above the age of 60. The prognosis forecasts an increasing tendency in life expectancy and an even higher percentage of elderly population in the foreseeable future. Due to the increasing life expectancy the risk for complications of common dental treatments is also increasing. More care and attention should be paid to anticipate the occurrence of sudden complications during dental treatment that might also be a life threatening condition. In 1941 the American Dental Association drew up a questionnaire based on the risk groups established by the American Society of Anaesthesiologists (ASA). In 1993 K.J.M. de Jong et al. presented the results of their experience with the clinical application of these questionnaires. Based on their studies the Dental Working Group of the Health Committee of the European Council recommended the European application of this questionnaire. The major objective of our investigation was to evaluate how this questionnaire--developed by ASA--can assist the proper registration of the medical history in dental practice. Our survey also investigated how the risk groups distributed among the subjects. The data of 207 randomly selected individuals from the patient pool of the Dental Faculty of Semmelweis University were processed. The data of risk groups distribution is outlined here: ASAI:35,8%, ASAII:24%, ASAIII:17%, ASAIV:23,2%. In the age group 60+ the following distributions were obtained: ASAI:20,9%, ASAII:13,2%, ASAIII:24,2%, and ASAIV:41,7%. The results of this survey also confirmed that the occurrence of ASAIII and ASAIV risk scores increased in the age of 60+. Consequently the number of patients whose treatment plan should be modified due to health risk factors is also increasing. It can be stated that the ASA classification is appropriate to inform the dentist about the general physical status and health problems of the patients that may influence the dental treatment.

Prosthodontic status and recommended care of patients with epilepsy.

STATEMENT OF PROBLEM: Epilepsy is a chronic disease that can affect oral health and prosthodontic status in different ways. However, epilepsy is a condition of various etiologies and seizure types, and different patients may have differing needs in prosthodontic care. PURPOSE: The purpose of this study was to examine the prosthodontic status of patients with epilepsy to determine if the disease has any effect on prosthodontic treatment and to obtain information regarding the level of prosthodontic care. This information was used to provide recommendations for the prosthodontic treatment of patients with epilepsy. MATERIAL AND METHODS: One hundred one epileptic patients were examined, interviewed, and compared with 101 age-matched control (nonepileptic) subjects of the general population. Epileptic patients were recruited at an epilepsy outpatient clinic. The only exclusion criterion was a mental handicap severe enough to exclude cooperation of the patient during a dental examination. Control subjects were recruited at a community radiographic chest-screening clinic. Epileptic patients were first grouped according to dental risk factors and dental manageability. Dental classification of patients with epilepsy considered the frequency and type of seizures, as seizures may damage the teeth and dental prostheses. The number of missing teeth, the ratio of missing and replaced teeth, and the number of fixed and removable partial dentures and complete dentures, and the characteristics (material, degree of abrasion, and age) of the dentures was determined by dental examination. Finally, the state of oral mucosa and the number of seizure-related injuries was noted. Statistical comparison of the patient and the control group was performed, using the 2-tailed t -test for continuous variables and the chi-squared test or Fisher's exact test for categorical variables (alpha=.05). RESULTS: The number of missing teeth was significantly higher in the epilepsy group than in the control group (P =.021). The ratio of replaced and missing teeth was lower in the epileptic group (P <.01), indicating inadequate prosthodontic care. There was also a significant difference in the age of the fixed prostheses (P =.0016), being lower in the epilepsy group, and in the material of fixed prostheses (P =.033), metal-ceramic being more common in the control group. More epileptic patients were edentulous than control subjects (8 versus 3) and the average age at the time of examination was younger (48 versus 57 years). Seizure-related injuries were reported by 11% of patients, all belonging to the subgroup of patients with frequent generalized tonic-clonic seizures. CONCLUSION: Patients with epilepsy have an increased risk for loosing teeth and, furthermore, the prosthodontic status of epilepsy patients was not as optimal as compared with the control group. Seizure-related injuries to prostheses are also an issue, but only in those suffering from frequent generalized tonic-clonic seizures. Therefore, the large majority of patients can and should receive prosthodontic treatment without restrictions. For a smaller group of patients, however, certain restrictions apply, to prevent potentially dangerous seizure-related complications.

[Forms of appearance of decubuti caused by complete upper and lower dentures]. / A teljes alsó-felso lemezes fogpótlások okozta dekubituszok megjelenési formái.

One of the most usual forms of complaint after the insertion of complete dentures is decubitus. It is an ulcer caused by the mechanical harm during the wearing of complete or removable partial dentures. Its size is about that of a lentil. Its shape is usually round or oval but can also be longish in appearance. Its usual colour is grayish white or scarlet. In their research the authors concentrated on the places where these decubiti appear after the insertion of complete dentures. Also, they focused on the question whether new decubiti tend to appear after check-ups and how long the presence of the bedsores last. They took down the particulars of 61 patients (47 women and 14 men) wearing complete upper and lower dentures and of 122 patients with complete upper and lower dentures. The gender and age of the patients and the number of complete upper and lower dentures were also recorded. It is remarkable that 69% of the patients (70% of the women and 64% of the men) appearing at the first check-up turned up at the second one. At the third check-up, 13% of the patients (15% of the women and 7% of the men) showed up. During the first check-up, 87% of the dentures (meaning 106) had to be modified, while during the second one, this rate was 51% (meaning 61 dentures), and during the third one, it was 7% (9 dentures). Thus, the insertion is not the last stage of making complete dentures, for the short-term check-ups are very important phases, as well.

Dental status and oral health of patients with epilepsy: an epidemiologic study.

PURPOSE: We performed a dental survey of epilepsy patients to examine their oral health by statistical means and to provide a guide for the dental treatment of these patients. METHODS: We first set up four "dental" subgroups of epilepsy patients, based on the types of seizures, seizure frequency, and mental state. One hundred one patients underwent a survey concerning their dental, medical, and epilepsy histories, followed by a dental examination. Indexes quantifying oral hygiene, the number and condition of the remaining teeth, periodontium, and the degree of prosthetic treatment were measured. An age-matched control group of general (nonepilepsy) population underwent an identical dental examination. Statistical comparison was performed between the patient and the control groups and between subgroups of epilepsy patients. RESULTS: In almost all aspects of oral health and dental status, patients with epilepsy showed a significantly worse condition compared with the control group. Comparison of the subgroups of epilepsy patients revealed that the most severe findings concern patients who have poorly controlled epilepsy, especially those who have frequent generalized tonic-clonic seizures. CONCLUSIONS: The observed difference probably results from a combination of factors such as the effect of the seizures themselves, socioeconomic conditions, and the negative attitude of dentists. We recommend that the planning of dental treatment of such patients should start with the assessment of their disease and determination of the "dental" subgroup to which they belong. For each subgroup, specific recommendations for interventions are given.