Understanding and Practices of Oral Hygiene in the Intensive Care Units: Perspectives of Medical Staff at Two University Hospital Centers.

Objective: This study assesses the knowledge, practices, and attitudes of medical staff in intensive care units (ICUs) regarding oral hygiene care for critically ill, bedridden patients. Material and methods: A cross-sectional study included 65 employees from the Intensive Care Units of the Sestre Milosrdnice Clinical Hospital Centre (CHC SM) and the Clinic for Anesthesiology and Intensive Care at the University Clinical Hospital Centre Zagreb (CHC ZG). A self-administered questionnaire was used to assess knowledge, methods, frequency, and attitudes towards oral care for mechanically ventilated patients. The data were examined through descriptive statistical methods, presented in terms of proportions (percentages). For the purpose of comparing the feedback across the two hospital centers and different educational backgrounds, the Chi-square and Fisher's exact tests were employed. Results: Results of a survey of 65 participants (18 from CHC SM and 47 from CHC ZG) revealed a notable disparity in oral hygiene knowledge, with graduate nurses displaying the highest proportion of adequate knowledge (100%) and regular nurses showing the least (30.3%) (p<.001). Although the execution of oral care practices did not vary significantly among the groups, graduate nurses performed oral care more frequently (80% vs. baccalaureate technicians 33.33% and nurses 57.6%, three or more times a day) and demonstrated better proficiency in both mechanical (p=.005) and chemical (p<.001) biofilm management compared to their counterparts. No significant difference was observed in the delivery of oral care to orotracheally intubated patients across different educational levels (p=.127). However, a marked difference was noted in the perception of being adequately trained for such care, with nurses feeling less prepared (12.1%, p<.001). Despite these variances, all respondents recognized the importance of oral hygiene, thus showing a strong dedication to oral health care. Conclusions: This study highlights variability in ICU oral hygiene practices and points to the importance of standardized care protocols and improved training for healthcare staff.

Epstein - Barr Virus Salivary Shedding in Patients with Acute Infectious Diseases: A Pilot Study.

Background: Epstein-Barr virus (EBV) is a widely disseminated herpesvirus for which antibodies have been demonstrated in over 90% of adults worldwide. After subclinical primary EBV infections, as well as after infectious mononucleosis, the virus can be shed in saliva for a prolonged period of time. Aim: Diseases and disorders that can induce EBV salivary shedding include mental disorders and sex, connective tissue disease, multiple sclerosis, systemic lupus erythematosus, malaria and HIV infection. Since the occurrence of EBV in saliva during acute infectious diseases has not yet been systematically researched, we aimed to investigate the possible relationship between acute infectious diseases and salivary shedding of EBV. Material and methods: This pilot cross-sectional study included consenting adults hospitalized for acute infectious conditions and their peers free of acute infectious diseases. A total of 40 patients with acute infectious diseases were enrolled, along with 41 adults free of acute infections. Peripheral venous blood samples for serodiagnosis and saliva samples for EBV PCR testing were collected from both groups. We fitted logit and general linear models to proportions and to ln (viral copy counts) to generate adjusted proportions and geometric mean values in the two groups of subjects. We used SAS for Windows 9.4. Results: The most common acute infectious disease was COVID-19 pneumonia, followed by hemorrhagic fever with renal syndrome. Crude proportions of people with positive serological test results and those with saliva viral shedding were similar in the two groups. Conclusions: The presented preliminary data do not indicate acute infectious conditions as a marked "contributor" in increasing salivary EBV shedding.

Perceived Stress, Salivary Cortisol, and Temperament Traits among Students of Dental Medicine: A Prospective and Interventional Study.

Academic stress affects students' psychological and physiological well-being. Dental undergraduate programs are known for their demanding curriculum, leading to significant stress symptoms. The objective was to determine if salivary cortisol levels were higher in students exposed to academic stress, assess the relationship between stress severity/temperament and cortisol values, and explore relaxation technique effects. Salivary cortisol was measured at two time points for all participants: Before exams and during a relaxation period after summer break. A third measurement was conducted for students with high pre-test cortisol levels who received instructions on progressive muscle relaxation (PMR) before subsequent exams. Additionally, participants completed two questionnaires: Perceived Stress Scale (PSS) and Fisher's Temperament Questionnaire. The group analysis based on the PSS indicated that 39 participants reported high stress. Women demonstrated significantly higher stress than men (p = 0.042054). A significant difference in stress levels was observed between director and builder temperament types (p = 0.029276). Cortisol levels showed a significant decrease from the first measurement to the second measurement, and the third measurement after implementing PMR. The grade in the "Dermatovenereology" course correlated with stress level according to the PSS (k = 0.578467). Pre-test cortisol levels correlated with the frequency of using PMR guidelines during winter test periods (k = 0.416138). Stress negatively affects the immune system and poses health risks. Implementing stress reduction techniques in dental/medical education could benefit students and the healthcare system.

The Impact of Vitamin Deficiencies on Oral Manifestations in Children.

Vitamins play a vital role in human health, particularly in the development and maintenance of oral health in children. These nutrients are broadly categorized into fat-soluble and water-soluble types, crucial for children's well-being. The objective of this study is to investigate the impact of vitamin deficiencies on the oral health of children, focusing on how these deficiencies contribute to various oral health issues and determining the relationship between specific vitamin shortages and oral diseases. Findings indicate that shortages in vitamins A and D lead to enamel issues and a higher susceptibility to dental diseases, vitamin E assists in treating oral mucositis, and vitamin K is essential for blood clotting in dental surgeries. Deficits in B-complex and vitamin C result in enamel hypomineralization and soft tissue ailments, including aphthous stomatitis and gingival petechiae. Additionally, a lack of vitamin B7 compromises the immune response, increasing oral candidiasis risk. Therefore, vitamin deficiencies markedly affect children's oral health, highlighting the need for joint efforts between dental professionals and caregivers for effective pediatric care. Addressing vitamin deficiencies through supplementation and tailored dental care emphasizes the significance of nutritional health in children's overall and dental well-being, advocating for a collaborative approach to achieve optimal health outcomes.

Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study.

BACKGROUND/AIM: Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen. MATERIALS AND METHODS: This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed. RESULTS: The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner. CONCLUSIONS: It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.

Possible Risk Factors for Dental Fear and Anxiety in Children Who Suffered Traumatic Dental Injury.

BACKGROUND: Children who undergo painful experiences such as traumatic dental injury (TDI) during their early years are more likely to be at an increased risk of developing dental fear and anxiety (DFA). The purpose of this study was to identify potential risk factors for DFA of these children. METHODS: The study participants were 220 parents/caregivers and their children who experienced TDI. Their socio-demographic backgrounds were investigated with the modified WHO Oral Health Questionnaire for Children that included questions about parents' knowledge and attitudes, while the DFA level was determined using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the Simplified Oral Hygiene Index (OHI-S Index) was used to assess oral hygiene status. RESULTS: The confirmed risk factors are parental knowledge, female gender, and degree of oral hygiene and pain in the last three months, while age, type of TDI, presence of soft-tissue injury, and number of subjective complaints were not confirmed. The overall model predicted approximately 54% of variance in DFA, R2 = 0.545, F (4.215) = 64.28 p < 0.001. CONCLUSIONS: These findings emphasise the importance of addressing pain management, improving oral hygiene, and enhancing parental knowledge to mitigate DFA in children with TDIs.

Prolonged Face Mask Wearing Worsens Self-Reported Dry Eye Symptoms during the COVID-19 Pandemic in Dental Healthcare Practitioners.

Objectives: The aim of the study was to evaluate self-reported MADE during the COVID-19 pandemic in dental healthcare practitioners and identify their possible risk factors. Material and Methods: An anonymous questionnaire was sent to doctors of dental medicine in the time period from February 2022 to August 2022. The online questionnaire included demographic characteristics and clinical characteristics: presence and deterioration of DED symptoms while wearing the face mask, personal protective face equipment, use of contact lenses, history of eye surgery, current use of medications, number of hours wearing face mask, and evaluation of subjective DED symptoms using modified Ocular Surface Disease Index (OSDI). Results: A total of 405 participants were included in the study and an overall prevalence of MADE was 29.1% (95% CI: 24.7 - 33.6). The participants who used masks more than 6 hours per day during the whole day reported a higher OSDI score (12.5 (IQR = 2.6 - 29.2)) compared to the participants who used masks less than 6 hours/day (6.25 (IQR = 0 - 22.92); Mann-Whitney U Test p = 0.066). Multivariable logistic regression revealed the following possible risk factors for self-reported MADE: age (older than 61 years) OR: 3.522 (95% CI 1.448 - 8.563); p=0.05, and wearing the face mask more than 6 h at work OR: 1.779 (95% CI 1.017 - 3.113); p=0.044. Conclusion: The prevalence of self-reported MADE among dental healthcare practitioners appears to be significant. The use of a face mask for a prolonged duration increases OSDI scores. MeSH Terms: face masks, dry eye, MADE, ocular discomfort, COVID-19, protective face equipment.

Proposition of New Testing Procedure for the Mechanical Properties of Bulk-Fill Materials.

This study analysed flexural properties, microhardness, and the degree of conversion (DC) of five bulk-fill composites under clinically relevant conditions (4 mm thick specimens) in comparison to 2 mm specimens according to ISO 4049. Additionally, the effect of rapid polymerisation on 4 mm specimens was evaluated after accelerated aging. DC was measured using Fourier transform infrared spectrometry at 2 and 4 mm thick layers, while flexural properties and Vickers microhardness were tested using 16 × 2 × 2 mm or 16 × 2 × 4 mm specimens. Three polymerisation protocols were used: (I) "ISO": 2 mm thickness, 1000 mW/cm2, double-sided; (II) "10 s": 4 mm thickness, 1000 mW/cm2, one-sided; and (III) "3 s": 4 mm thickness, 2600 mW/cm2, one-sided. Mechanical properties were tested after 1 day, after 10,000 thermocycles, and after 10,000 thermocycles followed by a 7-day immersion in absolute ethanol. The "ISO" protocol produced a higher DC and microhardness of all materials. Elastic modulus was significantly higher for the "ISO" protocol compared to the 4 mm specimens. The differences in flexural strength for all polymerisation protocols were equalised after thermocycling and immersion in absolute ethanol. All tested materials met the ISO 4049 flexural strength requirement (80 MPa) for all polymerisation methods and all aging conditions. Rapid polymerisation achieved nearly optimal properties (ISO), except for elastic modulus, which was significantly reduced in 4 mm samples.

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.

Cheilitis: A cross-sectional study-multiple factors involved in the aetiology and clinical features.

OBJECTIVE: Since the aetiologies of cheilitis are broad and overlapping, the purpose of this cross-sectional clinical study was to examine the multiple factors involved in aetiology and the disease's clinical features. SUBJECTS AND METHODS: We analysed cheilitis prevalence, demography, clinical features, patients' habits, psychological stress, systemic diseases, vitamin B9, B12 and iron serum levels and allergy test results in a total of 130 subjects with cheilitis, plus 22 healthy subjects. RESULTS: The most common cheilitis types were: cheilitis simplex and eczematous cheilitis (28.5%); herpetic cheilitis (16.9%); and exfoliative and angular cheilitis (7.7%). Concerning bad habits, there was a significant association/connection between self-reported saliva at the corners of the mouth and angular cheilitis, and between lip licking/biting and exfoliative cheilitis. Common associated conditions were skin diseases (56.5%) and atopy (84%). Vitamin B9 and B12 serum and iron values were mostly within the normal reference range. The patients suffering from herpetic cheilitis had significantly higher psychological/mental stress levels than the control group. CONCLUSION: To our knowledge, this is the first study of cheilitis patients that has simultaneously analysed aetiological factors, characteristics of the disease and diagnostic parameters.

Relationship between Children's and Parents' Dental Anxiety: A Cross-Sectional Study on the Six European Countries.

Background: The purpose of this study is to investigate the relationship between children's and parents' dental anxiety. Methods: 731 children of different ages and their parents from six European countries participated in this study. Dental anxiety was investigated through an online questionnaire, which consisted of general questions and the Corah Dental Anxiety Scale (CDAS), which is a questionnaire that measures respondents' reactions on a 5-point scale for four different situations. Results: CDAS results were calculated for all children and their parents. A total of 12.5% of children from Croatia, 26.67% from Macedonia, 10.94% from Bosnia and Herzegovina, 20.31% from Montenegro, 23.08% from Slovenia and 16.10% from Serbia showed a high level of anxiety. The correlation between dental anxiety of parents and children was 0.4 (p < 0.01). Conclusions: Parents with negative experience from a dental office can have a bad effect on their child's behaviour, which results in the creation of a non-active patient. Due to the clear and existing cause-and-effect relationship of dental anxiety in children and parents, it is extremely important to educate parents about the proper psychological approach to children in order to promote positive experiences from dental offices, as well as to emphasize the importance of regular visits to the dentist.

A Review of Psychological Stress among Students and Its Assessment Using Salivary Biomarkers.

Numerous psychoneuroimmune factors participate in complex bodily reactions to psychological stress, and some of them can be easily and non-invasively measured in saliva (cortisol, alpha-amylase, proinflammatory cytokines). Cortisol plays a crucial role in the stress response; thus, stressful events (academic examinations, cardiac surgery, dental procedures) are accompanied by an increase in cortisol levels. (A correlation between cortisol blood levels and salivary values has already been confirmed, particularly during stress). Academic stress is defined as everyday stress among students that has an impact on aspects of their psychological and physiological well-being. For example, exams are considered one of the most acute stressful experiences for students. The strength of the association between academic self-efficacy, psychological stress, and anxiety depends on a variety of factors: the type of academic challenge (e.g., oral exam), the presence of an audience, etc. Higher stress levels were predominantly recorded among younger students, primarily regarding their academic tasks and concerns (grades, exams, competing with peers for grades, fear of failing the academic year, etc.). The measurement of stress levels during academic stress can improve our understanding of the character and influence of stressful events in populations of students, preventing adverse reactions to long-term stress, such as a decreased immune response and increased anxiety.

SKIN FEATURES IMPORTANT FOR THE OCCURRENCE OF CONTACT DERMATITIS IN HEALTHCARE WORKERS.

The occurrence of skin lesions in healthcare workers is associated with a negative impact on important skin functions, including protection from mechanical injuries, sunlight, dehydration, and penetration of chemical substances or pathogenic microorganisms. In healthcare professionals, the most common occupational skin disease is contact dermatitis (CD), either irritant (ICD) or allergic (ACD), and typically on the hands. ICD accounts for about 80% of occupational CD, making it the most frequent cause. According to the literature, CD frequency is higher among healthcare professionals than other occupations, with critical occupational risk factors including contact with irritants and allergens at the workplace. Furthermore, ICD is a multifactorial disorder influenced by many constituent and environmental factors. Constituent factors include age, gender, body location, atopy, and genetic factors, while environmental factors include temperature, airflow, humidity, and occlusion. Commonly encountered irritants are water, detergents and surfactants, solvents, oxidizing agents, acids, and alkalis; however, use of protective gloves or equipment, hand-washing habits, use of cleansers and creams, active inflammatory skin diseases, and daily activities are also important for ICD onset. Additionally, ICD is known to predispose to ACD. Important risk factors for ACD development include occupation, age, history of atopic dermatitis, genetics, female gender, and fair skin phototype. In summary, numerous skin features and other occupation-related factors contribute to CD among healthcare practitioners. Given the high level of exposure to contact irritants/allergens in the healthcare setting, implementation of preventive measures is crucial for a safer work environment.

SIALORRHEA AND XEROSTOMIA IN PARKINSON'S DISEASE PATIENTS.

Parkinson's disease (PD) is generally considered as a primary movement disorder, but the majority of patients also suffer from non-motor oral, salivary symptoms. The most common salivary symptoms, sialorrhea and xerostomia, have a considerable negative impact on the quality of life. Although these symptoms are completely opposite ones, both significantly impair oral health of patients. Sialorrhea is defined as an increased amount of the retaining saliva. It is related to salivary overproduction, or it may be associated with impaired clearance of saliva. Opposed to sialorrhea, xerostomia is subjectively defined as dryness of mouth and it is related to insufficient salivary secretion. Xerostomia promotes imbalance of oral microflora and oral pathology that often leads to malnutrition in PD patients. It is mostly related to autonomic dysfunction, or it might be considered as a side effect of dopaminergic or anticholinergic medication. In PD, different assessments are used for evaluation of sialorrhea and xerostomia, including validated scales for non-motor symptoms and standardized questionnaires on oral health. Consequently, treatment of salivary symptoms includes pharmacological and nonpharmacological approach, and surgical interventions. A multidisciplinary approach in clinical neurology and dental medicine, which includes accurate evaluation of salivary symptoms and effective treatment, indicates successful management of PD patients.

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.

Cognitive Aspects in Multiple Sclerosis.

BACKGROUND: Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive impairment is present in up to 40% of MS patients and severe cognitive decline affects more than 50% of patients in progressive course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised word fluency, complex attention deficit and executive dysfunction. METHODS: In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the recently published literature on cognitive decline in MS. RESULTS: Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging parameters of the disease. CONCLUSIONS: Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely, irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection of cognitive relapse in MS patient.