Anxiety, Stress and Coping Patterns in Children in Dental Settings.

BACKGROUND: Fear of the dentist and dental treatment is a common problem. It can cause treatment difficulties for the practitioner, as well as severe consequences for the patient. As is known, the level of stress can be evaluated thought electrodermal activity, cortisol measure in saliva, or indirectly by psychometric tests. AIM: The present study examined the psychological influence of dental interventions on the child as well as coping patterns used for stress diminution. METHODS: We examined two matched groups of patients: a) children with orthodontic problems (anomalies in shape, position and function of dentomaxillofacial structures) (N = 31, mean age 10.3 ± 2.02) years; and b) children with ordinary dental problems (N = 31, mean age 10.3 ± 2.4 years). As psychometric instruments, we used: 45 items Sarason's scale for anxiety, 20 items simple Stress - test adapted for children, as well as A - cope test for evaluation coping patterns. RESULTS: Obtained scores confirmed the presence of moderate anxiety in both groups as well as moderate stress level. For Sarason's test obtained scores for the group with dental problems are 20.63 ± 8.37 (from max 45); and for Stress test 7.63 ± 3.45 (from max 20); for the orthodontic group obtained scores are 18.66 ± 6.85 for Sarason's test, while for the Stress test were 7.76 ± 3.78. One way ANOVA confirmed a significant difference in values of obtained scores related to the age and gender. Calculated Student t - test shows non-significant differences in obtained test results for both groups of examinees. Coping mechanisms evaluated by A - cope test shows that in both groups the most important patterns used for stress relief are: developing self-reliance and optimism; avoiding problems and engaging in demanding activity. CONCLUSION: This study confirmed that moderate stress level and anxiety are present in both groups of patients (orthodontic and dental). Obtained scores are depending on gender and age. As more used coping patterns in both groups are developing self-reliance and optimism; avoiding problems and engaging in demanding activity. Some strategies for managing this problem are discussed.

Oral Hygiene Index in Early Childhood Caries, Before and After Topical Fluoride Treatment.

BACKGROUND: Circular caries occurs in the earliest age of the children (1 - 1.5 year), immediately after the eruption of the deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces. OBJECTIVE: The main objective of this clinical trial was to determine the correlation between oral hygiene shown with Oral Hygiene index, and the initial stages of circular caries (initial lesion and superficial form), before and after topical fluoride treatment. MATERIAL AND METHODS: For determination of the OHI - index we used the method of Green - Vermillion. It was determined two times in 117 patients, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years old and diagnosed with initial stages of circular caries. Amino fluoride solution was applied once a week, during six months. RESULTS: We obtained statistically significant improvement of OHI - index at the end of the test, among treated subjects from both major groups. CONCLUSION: It can be concluded that the level of oral hygiene is correlated with the progression of changes in enamel. Topical fluoride treatment has a positive impact on reducing ECC.

Matrix Matalloproteinase-8 Gene Polymorphism in Chronic Periapical Lesions.

BACKGROUND/AIM: Increased levels of matrix metalloproteinase-8 (MMP-8) have been associated with risk of developing chronic periapical lesion (CPL). Gene polymorphisms are contributing factors in the pathogenesis of the inflammation. The aim of this study was to analyze polymorphism in the gene MMP-8 and its association and influence on clinical manifestation of CPL. METHODS: A total of 240 unrelated Macedonian subjects were included in the present study. Polymorphism -799 C/T in the gene MMP-8 detected with restriction enzyme BgIII was studied in 120 patients with CPL and 120 controls without any signs of chronic or acute inflammatory process in the jaw. The amplification of the region of selected gene was made with polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP). RESULTS: Our results showed that there were differences in the allele and genotype frequencies of the MMP8 -799 C/T polymorphisms between patients with CPL and controls (p < 0.05). Also this study suggests that MMP-8 polymorphism -799 C/T was a risk for expression of CPL (OR=8.27<3.44

White spot lesions: prevention and management during the orthodontic treatment.

The formation of white spot lesions, or enamel demineralization, around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which marks the result of a successfully completed case. This article is a contemporary review of the risk factors and preventive methods of these orthodontics scars. Preventive programmes must be emphasized to all orthodontic patients. The responsibility of an orthodontist is to minimize the risk of the patient having decalcification as a consequence of orthodontic treatment by educating and motivating the patients for excellent oral hygiene practice. Prophylaxis with topical fluoride application should be implemented: high-fluoride toothpastes, fluoride mouthwashes, gels and varnishes during and after the orthodontic treatment, especially for patients at high risk of caries.

The influence of etiological factors in the occurence of diastema mediana.

Even from the distant past the aesthetic perception in an individual was diminished by the presence of gap between the central incisors. This condition is found under the term "dents du bonheur" or "lucky teeth" and is encountered even among world famous figures including Brigitte Bardot, Eliah Wood, Madonna, Zac Efron, Amy Winehouse and Elton John. The teeth gaps are still considered main reasons for dissatisfaction of the dental patients and reasons for the requirement of aesthetic treatment. The purpose of this study is to exhibit the influence of the etiological factors in the occurrence of diastema mediana classified according to the dominance of their occurrence expressed in percentage values. Materials of this investigation were 100 patients with diastema mediana from the following factors: inheritance, disproportion in the dental arches, inborn or acquired missing teeth, harmful oral habits, high insertion of the labial frenulum as well as mesiodens. After the diagnosis and evaluation of the etiological factor for diastema mediana was performed, a decision regarding the course of treatment was made in direction of the removal of the etiological factor at an early age and orthodontic treatment. The end of the orthodontic treatment in a group of the patients was the beginning of prosthodontic reconstruction. From our clinical investigation we came to the realization that in 49 patients (49%) the hereditary influence was a dominant factor, next followed disproportions and discrepancies in the dental arch in 14 (14%), inborn or acquired missing teeth in 11 patients (11%), harmful oral habits in 10 (10%), high frenulum insertion in 4 (4%), and pathological objects between central incisors, mesiodens, iatrogenic factors and periodontal disease, in 3 of the clinical cases (3%) each. We concluded that the occurrence of diastema mediana is multi-causal. The dominant place is occupied by the hereditary factors. With regard to the mutual relationship between the multitudes of factors in the occurrence of diastema mediana, the diagnosis should be made conciliary and the clinical treatment should be interdisciplinary including a prosthodontist, orthodontist and oral surgeon.

Chronic periapical lesions: correlations with clinical finding.

OBJECTIVES: The aim of this study was to evaluate the relationship between periapical lesions with and without clinical symptoms. MATERIAL AND METHOD: This study was performed on cases with chronic periapical lesion diagnosis. During oral surgery procedures, 80 tissue samples were obtained. Anamnesis data were taken from each subject included in the study. Periapical tissue samples were processed for laboratory procedures including: histological and pathological examination of lesions by light microscopy analysis and microbiological status assessment by qualitative and semi-quantitative analysis of bacteriological findings. RESULTS AND CONCLUSION: The results obtained illustrate that symptomatic apical periodontitis was more frequent with teeth without previous endodontic therapy. Even though a pathological type of periapical inflammation is significantly associated with the presence or absence of clinical symptoms (p=0.0002), they do not have an effect on making a clinical diagnosis. Statistical analysis showed no significant difference (p>0.05). Comparative analysis of symptom persistence and infection severity was performed. It was found that positive symptoms were in relation to the quantity of the bacterial growth only in the group previous endodontically treated and these two factors do show relation with an accuracy of 95%. The growth of a mixture of several, mainly anaerobic, bacterial species is closely related to the presence of clinical symptoms.

Evaluation of buffer capacity of saliva in caries-free and caries-active children.

OBJECTIVES: The aim of this study was to evaluate the relationship between the physicochemical properties of saliva, such as buffering capacity, in caries-free and caries-active children. MATERIAL AND METHOD: Eighty children aged 12-14 years were included in this study. They were divided into two groups: a caries-free and a caries-active group, with 40 children in each group. Material for biochemical testing of saliva--a sample was taken from all subjects at different time intervals: 5, 30 and 60 minutes after the daily meal. The examined parameters were followed in the same examinees in a sample of saliva taken in the morning before consuming any food or implementation of oral hygiene: they represent basic information compared with the results of the examination. The concentration of salivary bicarbonates was determined by the enzyme method of continuous measurement. RESULTS: Salivary concentration of bicarbonates, measured fasting in the morning (basic values) in the caries-free group, ranging in limits from 6.60 to 9.70 mmol/l, and significantly lower values in the caries-active group (from 1.00 to 3.80 mmol/l). The same was the case with the concentration of salivary bicarbonates in different time intervals after taking the meal--5, 30 and 60 minutes in the examined groups. By increasing the time interval after taking a meal, the concentration of salivary bicarbonates continuously and significantly declined compared to its baseline concentration. The largest decrease of concentration of bicarbonate in terms of its basic value in both examined groups (caries-free and caries-active) took place during the 60 minutes after having the meal. CONCLUSION: Salivary bicarbonates to maintaining the acidobasic balance of saliva, and thus affects the incidence of caries. The positive effect of salivary bicarbonates was confirmed by the values found in this study: the caries-free group presented a higher concentration of bicarbonate than the basic values. The value of bicarbonate in saliva in adolescents can serve as a parameter for determining the risk of caries, and this, in turn, can be used in the planning and implementation of appropriate caries-preventive measures.

Technology and the use of acrylics for provisional dentine protection.

Acrylics are compounds polymerized from monomers of acrylic, metacrylic acid or acrylonitrates. The purpose of this paper is to present the technology and use of acrylics for provisional dentine protection in the practice of dental prosthodontics. For this reason, we followed 120 clinical cases from the everyday clinical practice, divided into 4 groups of 30 patients who needed prosthetic reconstruction. The first group included cases in which we applied celluloid crowns for dentine protection, for the second group we used acrylic teeth from a set of teeth for complete dentures; in the third and fourth groups the fabrication was done with the system of an impression matrix and the acrylic resin block technique respectively. In all the examined patients, the gingival index by Silness and Loe and the vitality of the dental pulp were verified clinically, after preparation and 8 days from the placement of the provisional crown. The value for dental sensitivity measured after preparation was 2.59, and 8 days after the placement of the provisional crown it bwas 3.1. From these results we can conclude that after the 8th day from the placement of the provisional crown, there was an adaptation period, characterized by a decrease in the painful sensations. The value of the Silness and Loe gingival index measured after the preparation was 1.34, and 8 days from the placement of the provisional crown was 0.94. The results inclined us to the fact that the provisional acrylic crowns facilitated the reparation of the periodontal tissue.