Clinical characteristics and caries risk assessment of tobacco heating systems smokers, cigarette smokers and non-smokers: a cross-sectional study.

OBJECTIVES: The study compared clinical characteristics and caries risk assessments between tobacco heating system (THS) smokers, cigarette smokers and non-smokers. MATERIALS AND METHODS: General data, data regarding fluoridation, smoking and dietary habits was obtained through a questionnaire. Caries experience was assessed by the DMFT index; the amount of biofilm by the Full mouth plaque score index; the amount of salivation by the quantum of stimulated salivation test; salivary pH with pH indicator strips and salivary number of S.mutans and Lactobacilli by cultivation on agar plates. The Cariogram method was used to assess caries risk. RESULTS: No differences between the groups was detected regarding education level, average daily number of meals, fluoridation programs, systemic diseases, and caries experience. The groups significantly differed in the amount of salivary S.mutans and Lactobacilli (p < 0.001), accumulated biofilm (p = 0.034), salivation quantum (p < 0.001), and saliva pH (p = 0.009). Exposure to tobacco smoke and heated tobacco aerosol increased the accumulation of biofilm and decreased salivary pH. Smoking increased S. mutans, while THS consumption decreased salivation and Lactobacilli the most. The Cariogram analysis found no differences in chances of avoiding new caries lesions between the groups, but a significant difference in developing caries lesions due to dietary habits was detected (p < 0.001) with non-smokers having higher risk than smokers, but not than THS consumers. CONCLUSIONS: THS and cigarette smoking were related to clinical characteristics that affect caries activity even though the caries risk assessment revealed no significant difference in the chances of avoiding new caries lesions between the groups. CLINICAL RELEVANCE: THS and cigarette smokers could have higher caries activity than non-smokers. The clinical study protocol has been registered on ClinicalTrials.gov under the ID number: NCT06314100.

Impact of Smoking on the Healing of Apical Periodontitis after Nonsurgical Endodontic Treatment.

OBJECTIVES: The aim of this prospective study was to compare the healing of periapical bone between smokers and nonsmokers after root canal therapy. The effects of duration and intensity of smoking on the healing rate of apical periodontitis were analyzed. MATERIALS AND METHODS: Fifty-five smokers were included in this study. The control group consisted of healthy nonsmokers who matched the smoker group in age and sex. Only teeth with a favorable periodontal prognosis and adequate coronal restoration were included in the study. The periapical status of treated teeth was assessed using the periapical index system at follow-ups after 6 and 12 months. STATISTICAL ANALYSIS: The chi-squared test and Mann-Whitney U test were used to assess the changes in periapical index score at baseline and in subsequent time intervals between the two groups examining dichotomized and ordinal data, respectively. Multivariate logistic regression analysis was used to test the association of independent variables age, gender, tooth type, arch type, and smoking index with the outcome variable. The outcome variable was set as the presence versus absence of apical periodontitis. RESULTS: The analysis at 12-month follow-up revealed a significantly higher healing rate in control group than in smokers (90.9 vs. 58.2; χ2 = 13.846; p < 0.001). Smokers had significantly higher periapical index scores than the control group (p = 0.024). The multivariate logistic regression analysis demonstrated that an increase in the value of the smoking index significantly increases the risk of apical periodontitis persistence (odds ratio [OR] =7.66; 95% confidence interval [CI]: 2.51-23.28; p < 0.001) for smoking index < 400 and (OR = 9.65; 95% CI: 1.45-64.14; p = 0.019) for smoking index 400 to 799. CONCLUSION: The results from this study show a lower rate of apical periodontitis healing in a group of smokers at 1-year follow-up. Delayed periapical healing seems to be associated with the cigarette smoking exposure.

Healing of apical periodontitis in type II diabetes mellitus patients: A prospective study.

OBJECTIVE: This study aimed to compare the healing of periapical bone between type II diabetes patients and healthy patients after root canal treatment. SUBJECTS AND METHODS: This study included 26 diabetic patients and the control group with healthy patients matching the diabetic group in age and sex. The study included only teeth with satisfactory coronal restoration. The periapical index system was used to evaluate the periapical status of treated teeth at follow-ups after 6 and 12 months. RESULTS: Analysis of the results revealed a significantly higher healing rate in the control group compared to the diabetic group only at the 6-month follow-up (66.6 vs. 33.3%; Χ2 = 4.857; p = 0.0275). Analysis of the full-scale PAI index disclosed significantly higher PAI values in the diabetic subjects at 6- and 12-month follow-up. The regression analysis showed that the risk of apical periodontitis persistence increased significantly with female gender (OR = 3.92; 95% CI = 1.04-14.79; p = 0.043), diabetes mellitus (OR = 4.27; 95% CI: 1.18-15.50; p = 0.027) and higher household income (OR = 5.39; 95% CI = 1.33-21.89; p = 0.018). CONCLUSION: Root canal treatment remains an effective means of conservative treatment in diabetic patients. While the healing is not compromised, regular follow-ups are necessary to monitor the healing process.

Association of the self-reported socioeconomic and health status with untreated dental caries and the oral hygiene level in adult patients.

BACKGROUND: Dental caries is a multifactorial disease and its management requires a thorough analysis of its etiological factors. OBJECTIVES: The present study used a multivariate approach to investigate the associations of socioeconomic and health-related determinants with untreated tooth decay and level of oral hygiene in adult individuals. MATERIAL AND METHODS: A cross-sectional study involved 597 adult patients. Health and socioeconomic status were assessed using a self-administered structured questionnaire. The presence of decayed teeth was recorded clinically using the World Health Organization diagnostic thresholds. Oral hygiene level was estimated using the plaque index. Multiple linear regression analysis was used to explore the associations of socioeconomic and health-related variables with the number of decayed teeth and level of oral hygiene. RESULTS: Socioeconomic and health-related variables explained 34.1% of the observed variation in the number of decayed teeth (p < 0.001) and 19.2% of the observed variation in the plaque index (p < 0.001). Analysis revealed several significant associations for both decayed teeth and plaque index scores. Males had 2.3 more untreated decayed teeth than women and an increased plaque index score of 0.3 units (unique contributions of 6.6 and 4.2%, respectively). An increase in self-assessed household economic status decreased the average number of decayed teeth by 1.3 and the plaque level score by 0.13 (unique contributions of 3.13% and 1.46%, respectively). Smokers presented with 1.78 more decayed teeth than non-smokers (unique contribution of 2.1%) and an increase in the plaque index by 0.48 units (unique contribution of 8.5%). CONCLUSIONS: Untreated dental caries and dental plaque severity share the same socioeconomic and health-related determinants.

Oral Mucosal Lesions in Childhood.

Childhood diseases are a continuous source of interest in all areas of general and dental medicine. Congenital, developmental, and hereditary diseases may either be present upon birth or appear in early childhood. Developmental anomalies, although often asymptomatic, may become grounds for different infections. Furthermore, they can indicate certain systemic disorders. Childhood age frequently brings about benign tumors and different types of traumatic lesions to the oral mucosa. Traumatic lesions can be caused by chemical, mechanical, or thermal injury. Mucocele and ranula are, by definition, traumatic injuries of the salivary glands or their ducts. Recurrent aphthous lesions are the most common type of ulcerations in childhood, and their etiology is considered multifactorial. Oral mucosal lesions in children require different treatment approaches depending on etiological factors and clinical presentation. Clinicians should have adequate knowledge of oral anatomy in order to diagnose and treat pathological conditions.

Is Coronal Restoration a Predictor of Posttreatment Apical Periodontitis?

OBJECTIVES: To investigate the posttreatment apical periodontitis (AP) in endodontically treated teeth through a multivariate approach and to analyze the relative importance of quality and type of coronal restoration as predictors of periapical disease. MATERIALS AND METHODS: The present study sample was drawn within 2-year period from the 1,072 consecutive patients older than 18 years, first time attending the Dental Clinic of the Clinical Hospital Center Rijeka, Croatia. A total of 1,350 endodontically treated teeth were included in the study. For each tooth, the periapical status, root filling quality, intracanal post, separated file presence, marginal bone loss, and quality and type of coronal restoration were recorded. STATISTICAL ANALYSIS: Chi-square tests were used to analyze the variations in the periapical status, quality of root canal filling, and quality of coronal restoration in different tooth types. The effect of explanatory variables on periapical status was explored using univariate and multivariate logistic regression models. The outcome variable was set as the presence versus absence of AP in the tooth. RESULTS: Multivariate logistic regression analysis revealed statistically significant associations and increased risk for AP presence in molars (odds ratio [OR] = 2.15; p < 0.001), teeth positioned in mandible (OR = 1.49; p = 0.007), teeth with short length of root filling (OR = 4.08; p < 0.001), overfilled teeth (OR = 2.99; p = 0.001), and teeth with inadequate density of root filling (OR = 4.14; p < 0.001). Considering variables related to coronal restoration, neither coronal restoration type nor quality was found to be predictive for posttreatment AP. Merely, the presence of intracanal post significantly increased the odds of AP presence (OR = 1.57; p = 0.009). CONCLUSION: The results of the present study did not indicate that type or quality of coronal restoration may be predictors of posttreatment AP. Periapical disease was significantly associated with molars, mandibular teeth, substandard quality of root fillings, and intracanal post presence.

Coronal Restoration as a Predictor of Periapical Disease in Non-Endodontically Treated Teeth.

OBJECTIVES: To compare the frequency of apical periodontitis (AP) in non-endodontically treated teeth restored with full coverage crowns, amalgam and resin composite fillings, and to disclose the association of type and quality of coronal restoration with periapical disease. MATERIAL AND METHODS: The cross-sectional study involved 597 subjects who attended the Dental Clinic of the Clinical Hospital Centre, Rijeka, Croatia for the first time. Data were collected by means of a clinical and radiological survey. The following data were recorded for all permanently restored non-endodontically treated teeth: the type, the quality of coronal restoration according to clinical and radiographic criteria for marginal integrity as well as the recurrent caries presence, periapical status and marginal bone loss. Chi-square tests were used to analyze the difference in periapical status regarding the type and the quality of restoration. The multivariate logistic regression analysis was used to assess the effect of explanatory tooth-specific variables on periapical status. RESULTS: There was no significant difference in the proportion of AP with regards to the type and material of adequate quality coronal restorations (χ2=5.000, P=0.082). The regression analysis revealed significant positive associations with outcome variable (AP) for crowns (OR=3.39; P<0.001), recurrent caries (OR=4.67; P<0.001) and premolar teeth (OR=1.73; P=0.002). CONCLUSION: If the quality of restorations is adequate, there is no difference in the periapical status of non-endodontically treated teeth regarding the type and material of coronal restoration.

Empathy amongst dental students: An institutional cross-sectional survey in Poland and Croatia.

AIM: To determine and compare levels of empathy and its dimensions in Polish and Croatian dental students. METHODS: Fourth- and fifth-year dental students (N = 193) at the University of Rijeka and University of Silesia completed questionnaires to determine levels of overall empathy and its dimensions: compassionate care (CC), perspective taking (PT) and ability to stand in someone else's shoes (ASSES). Total empathy and its dimensions were analysed depending on the country of origin, year of study and gender of the participants. The HPS version of the Jefferson Scale of Physician Empathy was used to conduct the research. Statistical analysis was performed using the Mann-Whitney U test. RESULTS: The analysis showed no significant differences in total empathy level between Polish and Croatian students (P = .838). However, separate analysis of empathy items showed significant differences between the two groups. Croatian students obtained significantly higher average PT values (P = .021), whilst Polish students had significantly higher CC scores (P < .001). Analysis of Croatian respondents revealed significantly higher ASSES scores in the fourth- and fifth-year students (P = .047). Analysis in the Polish group demonstrated an increase in PT scores from the fourth to the fifth year of study (P = .008). CONCLUSION: Croatian students scored higher on items associated with cognitive empathy, whilst Polish students displayed higher values in the aspect of emotional empathy. The present results demonstrated an increase in cognitive empathy level in Polish students, whilst in their Croatian colleagues, the level of cognitive empathy decreased with the progression of the academic programme.

Comparison of apical irrigant solution extrusion among conventional and laser-activated endodontic irrigation.

The aim of this study was to determine the amount of extruded endodontic irrigant among needle-syringe irrigation (NSI) and laser-activated irrigation (LAI) regimens. Twenty extracted maxillary central incisors were prepared utilizing GT professional rotary files (size 40, taper 0.06). Irrigation was performed with two 27 G irrigation needles (notched open ended (ON) and single side vented (SV)) each at two different irrigant volumetric flow rates (VFR)-0.05 ml/s (3 ml/min) and 0.10 ml/s (6 ml/min). LAI was performed with Er:YAG (erbium-doped yttrium aluminum garnet) using different fiber types (X-Pulse-14/400 cylindrical tip, Preciso- 14/300 flat cylindrical tip, PIPS- 14/400 quartz tapered tip). The Er:YAG laser with a wavelength of 2940 nm (Lightwalker AT, Fotona, Ljubljana, Slovenia) was used according to the following protocol: 10 mJ per pulse, 15 Hz, pulse duration 50 µs. Irrigation time was 60 s for all protocols. Precision syringe pump (PSP) maintained constant irrigant volumetric flow rate. Apically extruded irrigant was collected and net weighed for each protocol (N = 10). Data were analyzed by t tests and Kruskal-Wallis. All LAI regimens had statistically significant lower irrigant extrusion compared with NSI except for the SV 27 G needle used with 0.05 ml/s VFR when compared with the Preciso fiber tip (p = 0,230). The largest amount of extruded irrigant was with the ON 27 G needle at the 0.10 ml/s VFR, while the smallest was after LAI with PIPS fiber tip. The lower quantity of apically extruded irrigant during LAI (X-Pulse and PIPS) points out a safer endodontic irrigation method compared with conventional irrigations.

Socio-economic and health status as a predictor of apical periodontitis in adult patients in Croatia.

OBJECTIVE: A few studies focused on determinants of apical periodontitis other than technical or biological factors. This research aimed to investigate to what extent socio-economic and health status can predict apical periodontitis in adult patients. SUBJECTS AND METHODS: The cross-sectional study included 599 adult patients. Medical history, health habits and socio-economic status of each participant were recorded using a self-administered structured questionnaire. For caries detection, the World Health Organization diagnostic thresholds were used, and oral hygiene level was estimated using plaque index. Periapical index system was used to analyse the periapical status of all teeth. Dental, socio-economic and health-related variables were tested against dependent variable (periapical disease ratio) in a multiple linear regression analysis. RESULTS: Dental independent variables explained 71.7% of the observed variation in periapical disease ratio (R2  = 0.717; p < 0.001). Periapical disease ratio increased with the increase in number of carious teeth, plaque index and number of root-filled teeth, but also with decrease in number of coronal fillings (all p < 0.001). Socio-economic and health-related variables accounted for lower portion of variability, 15.5% and 12.9%, respectively (both p < 0.001). CONCLUSIONS: Dental variables are more important predictors of periapical status than socio-economic and health-related variables.

Conservative endodontic management of a fused tooth: A case report.

OBJECTIVE: To report a conservative treatment of a rare developmental anomaly. CASE REPORT: A 73-year-old patient with previously initiated therapy and acute apical abscess of a maxillary right central incisor fused with the supernumerary tooth sought treatment. The conservative approach included nonsurgical root canal treatment and composite restoration. CONCLUSION: This case illustrates the importance of an individual approach when treating anomalous teeth. Priorities in pain and infection management to properly and functionally restore teeth should be unaffected by age.

Influence of tobacco smoking on dental periapical condition in a sample of Croatian adults.

BACKGROUND: Since current evidences support a negative influence of tobacco smoking on the periodontal bone, an increased prevalence or severity of periapical lesions would be expected among smokers. The aim of this study was to investigate the difference in the periapical status of endodontically treated and untreated teeth in current smokers and never-smokers. METHODS: The cross-sectional study included 259 subjects, 108 current smokers and 151 never-smokers, presenting as new patients at the Dental Clinic of the Clinical Hospital Centre Rijeka, Croatia. The periapical index (PAI) was used to assess the periapical status of all teeth, excluding third molars. RESULTS AND CONCLUSIONS: Current smokers had higher fraction of teeth with apical periodontitis (AP) than never-smokers (0.13 vs. 0.10; P = 0.025), while fractions of endodontically treated teeth and endodontically treated teeth with AP did not differ significantly. When overall number of teeth was controlled for, smokers were 16.4 times more likely to have AP than a non-smokers (95% CI: 5.7-47.7; P < 0.001) and if a person was male, he was 3.1 times more likely to have AP than if the person was female (95% CI: 1.1-8.9; P = 0.039). The probability of AP increases with increase of age. Smokers will on average have two teeth with AP more than non-smokers, while controlling for gender, age and overall number of teeth.