Dental fear and caries in 6-12 year old children in Greece. Determination of dental fear cut-off points.

AIM: To present: the normative data on dental fear and caries status; the dental fear cut-off points of young children in the city of Thessaloniki, Greece. METHODS: Study Design: This is a cross-sectional study with two independent study groups. A first representative sample consisted of 1484 children from 15 primary public schools of Thessaloniki. A second sample consisted of 195 randomly selected age-matched children, all patients of the Postgraduate Paediatric Dental Clinic of Aristotle University of Thessaloniki. First sample: In order to select data on dental fear and caries, dental examination took place in the classroom with disposable mirrors and a penlight. All the children completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Second sample: In order to define the cut-off points of the CFSS-DS, dental treatment of the 195 children was performed at the University Clinic. Children⁁s dental fear was assessed using the CFSS-DS and their behaviour during dental treatment was observed by one calibrated examiner using the Venham scale. STATISTICS: Statistical analysis of the data was performed with IBM SPSS Statistics 20 at a statistical significance level of <0.05. RESULTS: First sample: The mean CFSS-DS score was 27.1±10.8. Age was significantly (p<0.05) related to dental fear. Mean differences between boys and girls were not significant. Caries was not correlated with dental fear. Second sample: CFSS-DS< 33 was defined as 'no dental fear', scores 33-37 as 'borderline' and scores > 37 as 'dental fear'. In the first sample, 84.6% of the children did not suffer from dental fear (CFSS-DS<33). CONCLUSION: Dental fear was correlated to age and not to caries and gender. The dental fear cut-off point for the CFSS-DS was estimated at 37 for 6-12 year old children (33-37 borderlines).

Oral feeding in necrotizing pancreatitis.

BACKGROUND: Restoration of gastrointestinal function is a crucial determinant of favorable outcome in severe acute pancreatitis (SAP). The purpose of this study was to retrospectively review our experience with early oral feeding in patients with the necrotizing form of SAP. Over the last 10 years, we have routinely gradually increased oral feeds in order to restore gastrointestinal function. METHODS: Early low volume oral (ELVO) feeds containing 248-330 kcal/daily were routinely provided for all patients to help stimulate gastrointestinal function. Patients who received ELVO feeding within 72 hours of admission were allocated to Group I; those who received ELVO feeds after 72 hours were allocated to Group II. The volume and calories of the feed, magnitude of systemic inflammation, levels of C-reactive protein (CRP) and lipase, incidence of organ dysfunction, main outcomes, and complications were analyzed. RESULTS: In total, 129 patients received ELVO feedings. The mean CRP level on day 7 was 160 +/- 77.6 mg/l in Group I compared to 200.2 +/- 103.2 mg/l in Group II, p = 0.043. Normalization of CRP below 100 mg/l was observed on day 14 in both groups. The rate of infection and the need for surgical intervention (46.8% vs. 26%) were significantly higher in Group II (p = 0.026). Group II also had longer ICU/hospital stays (p = 0.039/p = 0.002). Overall mortality was 10%. CONCLUSIONS: ELVO feeding provides physiologic stimulation and promotes recovery of bowel function, preparing the gastrointestinal tract for low-fat hospital food in patients with necrotizing SAP. The majority of patients required no additional nutritional support.

[Outcomes of surgical correction of congenital tibia pseudarthrosis depending on the activation of HHV-6/HHV-7 viral infection in a child with neurofibromatosis type-1].

Neurofibromatosis type-1 (NF-1)--is a common genetic disease effecting the skin, subcutaneous tissue peripheral nerves and bones (tibia pseudarthrosis). Immunomodulatory viruses HHV-6 and HHV-7 are classifying as a genus of roseoloviruses of subfamily beta-herpesviruses. Reactivation of HHV-6 and HHV-7 inhibits immune system and indirectly promote to other infectious agents. The article deals with a unique case repot of two repeated transplantations of fibula due to congenital tibia pseudarthrosis caused by NF-1. Results of the transplantations, related to active and latent HHV-6 and HHV-7 infection in a 6 years old child are discussed in the paper.

Psychometric properties of the Greek version of the Jefferson Scale of Empathy and empathy levels in Greek dental postgraduate students.

PURPOSE: The aims of this study were to: (1) examine the psychometric properties of the Greek version of JSE-HP and (2) explore empathy among Greek dental postgraduate students. METHODS: The JSE-HP scale was translated into Greek using the back translation method. The questionnaire was given to 111 dental postgraduate students between November 2017 and February 2018. A random sample of 25% was retested to assess test-retest reliability. The reliability of the Greek version of JSE-HP was measured with Cronbach's alpha (α) and Discrimination Indices (DIs). Exploratory Factor Analysis, with varimax rotation of the factorial axes, was used to examine the dimensionality and the factorial validity of the Greek version of the JSE-HP. Comparisons between groups of postgraduate students were performed as appropriate with the Kruskal-Wallis or the Mann-Whitney U test. RESULTS: The response rate was 100%. The mean age was 28.9 years. The reliability, in the sense of internal consistency of the questionnaire was considered satisfactory (Cronbach's alpha: 0.76, average DI: 0.33.) The test-retest reliability was satisfactory (Pearson's r = 0.77, p < 0.001). Factor Analysis revealed 7 significant factors. No statistically significant differences in empathy scores were found among groups of postgraduate students. CONCLUSIONS: The Greek version of the JSE-HP shows good psychometric properties. Empathy scores do not differ among Greek dental postgraduate students.

Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with severe acute pancreatitis: a prospective feasibility study.

BACKGROUND: Experience with administration of synbiotics (prebiotics/probiotics) in patients with severe acute pancreatitis (SAP) has demonstrated immunomodulatory capacity. The aim of this trial was evaluation of the feasibility and perspective of early clinical application of oral synbiotic/prebiotic supplements in patients with SAP. METHODS: 90 SAP patients were enrolled during the period from 2005-2008. Patients were stratified according to the feeding mode. CONTROL (n = 32) group received standard whole protein feeding formula. SYNBIO (n = 30) and FIBRE groups (n = 28) received early (within first 24-48 hours) synbiotic or prebiotic supplements. Oral administration of synbiotics or prebiotics was commenced when patients were able to sip water. RESULTS: Daily provided average volume and calories of synbiotic/prebiotic blends were smaller compared to the CONTROL, p = 0.001. Oral administration of synbiotic/prebiotic supplements was associated with lower infection rate (pancreatic and peripancreatic necrosis) compared to the CONTROL, (p = 0.03; p = 0.001), lower rate of surgical interventions, p = 0.005, shorter ICU (p = 0.05) and hospital stay (p = 0.03). Synbiotic supplemented enteral stimulation of the gut resulted in reduced mortality rate compared to the CONTROL, p = 0.02. CONCLUSION: Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut seems to be a potentially valuable complement to the routine treatment protocol of SAP.

[The laparoscopic splenectomy in patients with hypersplenism, caused by liver cirrhosis].

The study aimed to assess the efficacy of the laparoscopic splenectomy in hematologic patients. The retrospective study included 147 patients with various hematologic diseases and hypersplenism operated during 2002-2010 yy. 125 (85.03%) conventional and 22 (14.97%) laparoscopic operations were carried out. The statistical difference were revealed only for the size and weight of the spleen and duration of the operation. The conventional group had 23.2% of complications and the laparoscopic group showed the 22.7% complication rate. The laparoscopic splenectomy was successfully carried in patients with the unchanged organ linear size (12.4 sm) and in younger patients. The choice of the surgical method was defined mainly by the spleen linear size.

[Experience of laparoscopy application in the treatment of the patients, suffering hematological diseases in Latvia].

Laparoscopic splenectomy (LS) is performed on stages of treatment of various benign and malignant hematological diseases. Retrospective investigation was done, in whom 129 patients were included, which were operated on in 2002-2010 yrs in "Linazers" clinic for benign and malignant hematological diseases. In 107 (82.94%) of them open splenectomy (OS) was performed and in 22 (17.06%)--LS. Trustworthy differences of the age median were established in patients, in whom OS and LS were performed, the spleen size before the operation have constituted 19 cm in OS group and 12,4 cm--in LS group. LS is affordable and safe, in comparison with OS, as operative procedure option for patients of younger age with a normal spleen. For more complete estimation of LS application in hematological diseases it is necessary to prolong a work on creation of a data base of operations, performed on spleen.

A study of parental presence/absence technique for child dental behaviour management.

AIM: To examine the effectiveness of parental presence/absence (PPA) technique on the dental behaviour management of children. MATERIALS AND METHODS: This randomised control study recruited 61 child dental patients with uncooperative behaviour (Frankl 1 or 2) managed with AAPD-endorsed non-pharmacological techniques at a post-graduate university clinic. PPA was only used in the test group (31 children). Using a mini video-tape device, recording commenced at the onset of uncooperative behaviour and this was later rated, minute by minute, by a blinded experienced paediatric dentist. STATISTICAL ANALYSIS: Data were analysed with SPSS v.13.0. The Kolmogorov-Smirnov test was used for normality analysis. The Mann-Whitney U-test and Log Rank analysis were also performed. RESULTS: The mean point in time, after behavioural problems commenced that PPA or alternatives were applied was 1.82 ± 1.04 min. Behaviour improvement (technique success) was shown by 65.6% of all children. There was no statistically significant difference between the study and control groups in age, gender, mean Frankl score, in Frankl score 2 min before/after technique application or regarding the time point at which the technique was first applied. Behaviour improvement was seen in 17 patients (54.8%) in the PPA group and in 23 patients (76.7%) in the control group. CONCLUSION: PPA applied to various dental sessions as a behaviour management technique showed no advantage over other basic, non-pharmacological techniques.

Dental treatment of a child with congenital central hypoventilation syndrome.

BACKGROUND: Congenital Central Hypoventilation Syndrome (CCHS) is a rare condition combining respiratory hypoventilation with symptoms of autonomic dysregulation. Management of patients requires both medical and dental expertise to achieve a successful outcome. The aim of this paper is to present the dental management of a child diagnosed with CCHS, without pharmacological measures and in cooperation with medical expertise. CASE REPORT: A 7-year-old girl was referred to a private dental practice with the chief complaints being pain and poor aesthetics. The child had been diagnosed with CCHS since infancy and had undergone several courses of medication. Although the patient was uncooperative, the paediatric pulmonologist advised against general anaesthesia. As a result, she was treated in the operating theater (OT) without sedatives, being monitored throughout the entire procedure. A total of eight primary teeth needed dental treatment (3 were restored, 4 were extracted and 1 was restored with a preformed metal crown). A mandibular lingual holding arch was placed, two weeks later. FOLLOW-UP: The patient was seen after 6 months and 1 year. Her oral hygiene had improved significantly and her mother reported that the child ate better, brushed her teeth on a daily basis and was careful with dietary habits. CONCLUSION: The collaboration between medical experts and a paediatric dentist was of crucial importance. The use of basic behaviour management techniques in conjunction with monitoring the patient's vital signs led to a successful outcome and an improvement in the behaviour of the patient.

Molar incisor hypomineralisation (MIH): correlation with dental caries and dental fear.

AIM: This cross-sectional study was to investigate correlations between molar incisor hypomineralisation (MIH), dental caries and child dental fear. MATERIALS AND METHODS: The subjects in the study were representative samples of 8 and 14 year old children from three Greek cities (total N = 2335). Dental examinations were performed by one calibrated examiner in classrooms, after the children had brushed their teeth, using an intraoral mirror and artificial room light supplemented by a penlight. All the children completed the children's fear survey schedule-dental subscale (CFSS-DS) questionnaire. MIH scores were recorded using EAPD criteria and dental caries experience by DMFS/dmfs index. Data were analysed with the Chi-squared (χ (2)), Mann-Whitney and Spearman's rank correlation coefficient tests. RESULTS: The mean DMFS in children with MIH (8-year olds: 1.60 ± 2.01, 14-year olds: 4.60 ± 4.41) was statistically significantly higher than children without MIH (8-year olds: 1.01 ± 1.78, 14-year olds: 3.46 ± 4.28) (p < 0.001 for both age groups). Children with severe MIH had statistically significantly higher mean DMFS scores than children with mild or no MIH (p < 0.001), while the dmfs of the 8 year olds were unrelated to their MIH status (p = 0.332). Caries experience was associated with the MIH status of the first permanent molars in both age groups (p < 0.001). The mean CFSS-DS scores did not differ significantly between the groups of children without (26.2 ± 9.9) or with MIH (26.5 ± 9.6) (p = 0.339), regardless of MIH severity. CONCLUSIONS: A positive association between MIH and dental caries was confirmed and a lack of association found between MIH and dental fear in Greek children.

Parental acceptance of behaviour-management techniques used in paediatric dentistry and its relation to parental dental anxiety and experience.

AIM: The aim of this study was to examine the acceptance by Greek parents of nine behaviour-management techniques and its association with several possible confounding factors. STUDY DESIGN: Following ethical approval, 106 parents whose 3- to 12-year-old children had been receiving treatment in a university postgraduate paediatric dental clinic, and 123 parents of children from a private paediatric dental practice agreed to participate. METHODS: After being shown a video with nine behaviour-management techniques, parents rated the acceptance of each technique on a 0-10 scale. They were then asked to complete a questionnaire about demographics, their previous dental experience and dental anxiety (modified Corah dental anxiety scale). RESULTS: The best accepted technique was tell-show-do (9.76 ± 0.69), followed by parental presence/absence (PPA) technique (7.83 ± 3.06) and nitrous oxide inhalation sedation (7.09 ± 3.02). The least accepted techniques were passive restraint (4.21 ± 3.84) and general anaesthesia (4.21 ± 4.02). No correlations were found between acceptance of any individual management technique and parental age, gender, income, education, dental experience and dental anxiety or the child's age, gender and dental experience. Parents whose children had been treated at the University clinic had lower income and educational levels, and rated passive restraint, oral sedation and general anaesthesia higher than those from the private practice. When the parents were specifically asked to choose between general anaesthesia over any of the active or passive restraint, hand-over-mouth and voice control techniques, 10% preferred general anaesthesia, and these parents reported statistically significant more negative dental experience but not higher dental anxiety. STATISTICS: Statistical significance of differences was explored using the Tukey-Kramer method. CONCLUSION: There was no correlation between parental dental experience and dental anxiety and the acceptance of any specific behaviour-management technique. However, parents with negative dental experience would prefer general anaesthesia over any of active or passive restraint, hand-over-mouth and voice control techniques. PPA is a highly acceptable technique for Greek parents.

Dental caries and oral health-related factors in a sample of Greek preschool children.

AIM: To assess the caries prevalence and some background factors in 3- to 5.5-year-old children in the municipality of Thessaloniki, Greece. METHODS: One calibrated examiner examined the children of all municipal day care centres for dmfs, existence of visible dental plaque and presence of black stain. Examination was made on site using disposable dental mirrors. Questionnaires were given to parents for assessing socio-economic status, oral hygiene habits (brushing frequency, toothpaste use) and sucking/feeding at sleep habits (nursing bottle, its content and pacifier use). RESULTS: Out of a total of 950 children, both clinical examination and questionnaire data were available for 804 children. The overall mean dmfs was 1.3 (SD = 3.8). The caries prevalence was 22.6 %, while the presence of black stain was evident in 2.4 % of the children. Intra-examiner agreement was estimated with Kendall's τ b = 0.99. A generalised linear model used to fit a Poisson regression for the analysis of count outcome data (dmfs) and logistic regression was used for binary outcome data (presence or absence of visible dental plaque). Statistically significant association was found between dmfs and the presence of visible dental plaque. The country of origin and education status of the parents were found to be significant factors for dmfs. The presence of black stain was negatively correlated with dmfs. CONCLUSIONS: The mean dmfs was lower than earlier Greek data. Country of origin, education status of the parents and visible dental plaque seemed to be important caries risk factors, while the presence of black stain was a strong caries resistance predictor.

Short communication: Dmfs and BMI in preschool Greek children. An epidemiological study.

AIM: To investigate the relationship between dental caries (dmfs) and body mass index (BMI) categories in 3-5.5 year old children in Thessaloniki, Greece. METHODS: The study was conducted in 18 municipal day care centres and involved 361 children. The dmfs was determined on site by one calibrated examiner using disposable dental mirrors and a penlight. The height and weight of the children were measured on site by a nutritionist, who grouped them into four BMI categories, shown in the results. STATISTICS: The estimation of the relationship between the BMI and dmfs values was based on a generalized linear model (Poisson log-linear regression) while the sequential Bonferroni method was used for pair-wise comparisons between BMI categories. RESULTS: Mean dmfs values for each BMI category were: 1.02 (SD=2.41) for the underweight (n=44), 0.74 (SD=2.24) for the normal weight (n=281), 1.88 (SD=4.28) for the overweight (n=26) and 0.80 (SD=2.53) for the obese (n=10). Overweight children were found to show statistically significant differences in dmfs values compared with both children of normal weight (p<0.001) and those underweight (p=0.015). CONCLUSION: Overweight Greek pre-school children are at higher risk of dental caries.

Surgical treatment of gastric cancer in Latvia: results of centralized experience.

BACKGROUND: Although the mortality for gastric cancer is decreasing in Western Europe and United States, it still remains high in Eastern Europe. This study was aimed at evaluating short- and long-term results of surgical treatment of gastric cancer performed in Latvia Oncology Center. METHODS: Retrospectively collected data from 461 patients who underwent gastrectomy with curative intent in Latvia Oncology Center from January 2001 to December 2005 were analyzed statistically. RESULTS: An average (range) of 92.2 (81-102) R0-R1 gastrectomies was performed each year. Post-operative complications occurred in 75 patients (16.3%); in-hospital mortality was 3.3%. The overall 5-year survival was 50.8%. In 444 cases (96.3%) there was histopathologic confirmation of R0-resection with a 5-year survival of 52.5% (P<0.001). Considering pT category, 5-year survival was 88.6% for pT1 patients, 65% for pT2, 42.3% for pT3 and 27% for pT4 (P<0.001). Considering pN category, 5-year survival was 67% for pN0 patients, 30% for pN1 and 29% for pN2-3 (P<0.001). CONCLUSIONS: Clinico-pathologic characteristics of patients who underwent resection with curative intent are comparable to other Western experiences. Short- as well as long-term results are also similar if not for pN+ patients where no difference between pN1 and pN2 cases was observed.