Prosthodontics Status and Treatment Needs among the Elderly in the Republic of Macedonia.

BACKGROUND: Oral health care management among the elderly differs from the rest of the population, due to some specific physiological changes and general health status related to age. We know very little about the oral health in elderly in the Republic of Macedonia, because there are only a few articles published about dental health status and edentulism of this population. AIM: The study aimed to evaluate the prosthodontic status of older adults over 65 years in the Republic of Macedonia, about their socio-economic status and individual factors. MATERIAL AND METHODS: A cross-sectional study was conducted in 8 regions, in rural and urban areas of Macedonia and a representative sample of 432 people (age > 65 years) was examined. Statistical analyses of the data were made by chi-square tests and the corresponding C-coefficient. RESULTS: Only 6% of all participants had not any prosthetic appliance, 9.5% had more than one bridge, 28.7% of examinees had partial dentures, both bridge(s) and partial denture(s) had 10.7% participants, and 45.1% of examinees were toothless. There was a significant difference between patients who visited the dentist more than once a year and those who did not (χ2 = 14.2; df = 4, p < 0.01). From all of the participants, 40.3% used public dental care organisations. CONCLUSIONS: We found a high prevalence of edentulousness among older adults over 65 years in Macedonia. The study confirmed the necessity for establishing healthcare educational programs for the dental treatment of elderly in Macedonia.

Morphological alterations in the position of the mandibular foramen in dentate and edentate mandibles.

The technique of inferior alveolar nerve (IAN) block must be based on precise anatomical knowledge regarding the correct position of the mandibular foramen (MF). The aim of the investigation reported here was to determine the anatomic and topographic localization of the MF according to mandibular ramus anatomic landmarks and to identify morphological alterations in the position of the MF and size and shape of the ramus in terms of the impact of tooth socket loss in the molar and premolar region. Seventy-three dry human adult mandibles were divided into two groups according to dental status. These were measured to determine the distances from the anterior and posterior ramus border (AB, PB) to the midpoint of the MF fossa, and from the mandibular notch (MN) and inferior ramus border (IB) to the MF entering point. A number of relevant ramus anatomic features were analyzed, such as ramus width (RW), height (RH), and thickness (RT). The MF was closer to the PB and IB in edentate mandibles (right/left mean PB-MF 10.66 ± 1.84/11.06 ± 2.05 mm; right/left mean IB-MF 21.77 ± 3.23/21.8 ± 2.27 mm) compared to dentate mandibles (right/left mean PB-MF 11.87 ± 2.08/12.04 ± 1.94 mm; right/left mean IB-MF 22.94 ± 3.09/22.74 ± 3.74 mm). Edentate mandibles demonstrated reduced RW (right/left mean RW 26.03 ± 3.53/26.49 ± 3.90 mm), significantly reduced (p = 0.03) right RH (right/left mean RH 43.56 ± 4.74/45.43 ± 4.86 mm), and significantly reduced (p < 0.05) RT in the area of the MF fossa depression (right/left mean RT 5.52 ± 1.21/5.21 ± 0.91 mm) compared to dentate mandibles (right/left mean RW 27.34 ± 3.84/27.48 ± 3.80 mm; right/left mean RH 46.33 ± 4.52/47.40 ± 4.20 mm; right/left mean RT 7.86 ± 1.98/8.10 ± 1.92 mm). Alterations in MF position and mandibular ramus anatomic features in edentate mandibles increase the potential risk of complications and failure of IAN block.

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.

An assessment of career satisfaction among Macedonian dentists.

AIM: The aim of this study was to assess the level of overall career satisfaction in relation to various personal and work-related factors among the dentists in the Republic of Macedonia. MATERIALS AND METHODS: The sample comprised 118 registered dentists, working in different conditions (34 public practice dentists, 32 completely private, 42 private dentists who work with a health insurance fund and 10 concessioners). All of them filled in a questionnaire which contained 16 items, divided into five groups. The different clusters of questions were related to various working conditions and personal factors. The first four groups of questions were answered with a--point Likert format with a score range from 1 (very dissatisfied) to 4 (very satisfied). In the fifth group, dentists chose one of four offered answers. The statistical analyses were made by one-way ANOVA and chi-square tests. RESULTS: Significant differences related to working conditions were found between public practitioners (moderately dissatisfied) and private practitioners (very satisfied) (F=41.41 (df=3); p<0.01). A high prevalence of dentists (89.83%) had felt stressed on their work place and 61.8% of public dental health practitioners had felt stressed at work "very often". The main sources of job-related stress for public dental practitioners were their supervisors (50%) and patients (26. 47%), while private practitioners were mostly stressed by inspectors (76.19%) and patients (21.87%) (χ2=44.5 (df=9); p<0.01). CONCLUSION: The findings in our study showed overall low levels of career satisfaction among the dentists (public and private) in the Republic of Macedonia. The finding that high percentages of dentists feel stress at their work place very often requires further exploration.

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.

Bruxism and TMD disorders of everyday dental clinical practice.

Bruxism, as an etiological factor for the development of TMD, includes different disorders of the TMJ and the masticatory muscles, exhibiting pain and disruption of the stomatognathic functions. Our goal was to study patients with bruxism and TMD from everyday dental clinical practice, in terms of diagnosis, identification of etiological factors, classification and treatment of these disorders. We treated 120 patients, divided into 2 groups of 60 patients. The first group had disorders of the TMJ, and the second of the masticatory muscles. The groups were divided into subgroups of 20 patients with dislocation of the articular disk with or without reduction and inflammation of TMJ. The second group was organized from patients with myofascial pain, myositis and muscular trismus. Our conservative treatment consisted of patient education, NSAID, myorelaxants, fabrication of prosthetics, repositioning and stabilization splints. The progress of the patients was followed immediately after the delivery of the prosthetics and the splint, after 1, 6 and 12 months. The results showed that in patients with disorders of the TMJ there were visible signs of recovery after 6 months in 68.3% patients, and in 85% after 12 months. In the second group we achieved faster results with the elimination of symptoms. Patients with afflictions of the muscles in 88.3% of cases noticed relief of symptoms even after 6 months and in 98.3% after 12 months. As therapists we concluded that timely treated complications of bruxism and TMD prevent the destruction of the TMJ, masticatory muscles and the entire stomatognatic system.

[Ultrastructural investigation of root canal dentine surface after application of active ultrasonic method].

INTRODUCTION: The basic work principle of all ultrasonic techniques is the piezoelectric effect of producing high frequency ultrasounds of small length, which are transmitted over the endodontic extensions or canal instruments into the root canal. When in contact with the tissue, ultrasonic vibrations are converted into mechanical oscillations. Ultrasonic waves and the obtained oscillations along with the synergic effect of irrigation bring about the elimination of smear layer from the root canal walls. OBJECTIVE: The aim of the study was to ultrastucturally examine the effect of smear layer removal from the walls of canals by the application of the active ultrasonic method without irrigation, that is by the application of ultrasound and irrigation using distilled water and 2.5% NaOCl. METHOD: The investigation comprised 35 single-canal, extracted human teeth. After removal of the root canal content, experimental samples were divided into three groups. According to the procedure required, the first group was treated by ultrasound without irrigation; the second one by ultrasound with irrigation using distilled water; and the third group was treated by ultrasound and irrigation using 2.5% NaOCl solution. The control samples were treated by machine rotating instruments (Pro-File) and were rinsed by distilled water. RESULTS: The obtained results showed that the ultrasonic treatment of the root canal without irrigation did not remove the smear layer. The dentine canals are masked, and big dentine particles are scattered on the intertubular dentine. The ultrasonic treatment by using irrigation with distilled water provides cleaner dentine walls and open dentine tubules but with smaller particles on the intertubular dentine. The ultrasound treatment by using irrigation with 2.5% NaOCl solution provides a clean intertubular dentine surface without a smear layer and clearly open dentine tubules. CONCLUSION: Instrumentation of the root canal by application of ultrasound by using NaOCl as irrigation provides a clean dentine surface of the root canal without a smear layer.