New equation for estimation of dental age by tooth cementum thickness in adolescents and adults: forensic aspects.

OBJECTIVE: Our research was aimed to establish the equation and to determine its precision for dental age estimation in adolescents, adults and the elderly based on the thickness of deposited dental cement. DESIGN: The study sample consisted of 206 donor teeth of both sexes (10 to 82 years of age). The roots were transversely cut (6 cuts) on an ISOMET 1000 cutter at apical, middle, and cervical parts (slice thickness 0.3 to 0.5 µm). Measurements of cement thickness on incisions were made with a light microscope and an Olympus EP50 camera with previous microscope calibration for each measurement episode. Measurements were carried out clockwise at 4 measuring points on each incision. Statistical analyses were conducted using statistical software packages STATISTICA version 12.0 StatSoft, Inc. 2013, and MedCalc® version 22.0. RESULTS: Mean cement thickness (MCT) significantly declined from apical to cervical cuts (P < 0.001, ANOVA) and was thicker in teeth with a destroyed tooth crown (P < 0.001, ANOVA) and in molars compared to incisors (P < 0.001, ANOVA). MCT was greater in men and in teeth with more than one root but without reaching statistical significance. MCT showed a significant increase from the second decade of chronological age with a peek at sixth decade and declined to the ninth decade (P < 0.001, ANOVA). Piecewise linear regression defined a breakpoint age of 53 years, so two different equations were calculated (≤ 53 years and > 53 years). CONCLUSIONS: The resulting equation is recommended for estimating dental age in forensic analyses.

The Cameriere, Haavikko, Demirjian, and Willems methods for the assessment of dental age in Croatian children.

AIM: This study aimed to evaluate the accuracy and precision of the Cameriere European formula, Demirjian, Haavikko, and Willems methods for estimating dental age in a sample of children with permanent dentition in Croatia. MATERIAL AND METHODS: The study consisted of a sample of 1576 panoramic radiographs; a sub-sample of 84 OPGs, in which all first seven mandibular teeth were maturated, was excluded from the study. A final sample of 1492 (704 males and 788 females) aged 6.0 to 13.9 years was evaluated. Seven mandibular teeth from the left side of the mandible were analyzed, and dental age (DA) was determined by the Cameriere European formula, Demirjian method from 1976, Haavikko, and Willems methods and compared to chronological age (CA). In addition, the mean age difference (DA-CA), the mean absolute error (MAE) between dental and chronological age, the percentage of the individuals of dental age within ± 0.25 to ± 2 years of chronological age, and intra-observer and inter-observer statistics were calculated. RESULTS: The Cameriere European formula estimated the best dental age compared to the chronological age; the mean underestimation was - 0.4 years for both sexes, Haavikko underestimated by - 0.17 years, while Demirjian and Willems overestimated by 1.02 years and 0.48 years, respectively. The most significant difference showed the Demirjian method in 11-year-old and 12-year-old females. The MAE were 0.50 years, 1.01 years, 0.61 years, and 0.78 years in males and 0.51 years, 1.18 years, 0.61 years, and 0.70 years in females for the Cameriere European formula, Haavikko, Willems, and Demirjian methods, respectively. Furthermore, the Cameriere European formula showed the highest proportions of individuals with DA within ± 0.5 year difference of the CA, 61.5% in males and 59.6% in females. In addition, the Cameriere method showed the best intra-observer and inter-observer agreements. CONCLUSIONS: Although the Demirjian method was used previously in Croatian children for legal, medical, and clinical purposes, the Cameriere European formula, Haavikko, and Willems were more accurate in the tested sample. According to our findings, the Cameriere European formula showed the best accuracy and precision in dental age assessment in Croatian children following Haavikko, and we recommend it as the method of the first choice in forensic and clinical analyses.

New model for dental age estimation: Willems method applied on fewer than seven mandibular teeth.

Willems method measures the developmental stages of the seven left permanent mandibular teeth and is frequently used for dental age estimation. The aim of this study was to test its accuracy on a large sample of the Croatian population and to develop new models for estimation based on one to seven mandibular teeth. The developmental stages were evaluated on the digital, standardized orthopantomograms of 1868 Croatian children aged 5 to 16. Univariate regression was used for age estimation based on one tooth and regression with forward and backward elimination for selection of the best combination on two to six teeth. Tested in parallel with Willems method, the accuracy of the new models was assessed within intervals of ± 0.5, ± 1, ± 1.5 and ± 2 years and shows the percentage of correct estimations. Using Willems method, the average overestimation was 0.41 years for boys and 0.22 years for girls. Newly developed models that use two to seven teeth proved to be significantly more accurate (p < 0.001). The accuracy of age estimation increases significantly with the number of teeth in a model. Predictably, within the interval ± 0.5 years, a model with three teeth has 3% fewer accurate age estimations than a model including seven teeth. In both theory and practice, Willems method has been considered suitable for age estimation among Croatian children. However, these newly developed models significantly surpass its accuracy. Models using two to seven teeth represent a simple, reliable, and accurate method for age estimation, even in cases with missing mandibular teeth.

The relationship between periodontal disease, tooth loss and decreased skeletal bone mineral density in ageing women.

AIM: Osteoporosis and periodontitis are both chronic diseases characterised by bone loss. Potential association is of great clinical importance because of multifactorial aetiology and common risk factors. The aim of this study was to determine relationship between bone mineral density (BMD), tooth loss and periodontal status taking into account age, number of years since onset of menopause and educational level. With increasing age, number of years since onset of menopause and lower educational level, decreased BMD, deteriorating periodontal status and greater tooth loss are expected. MATERIALS AND METHODS: Cross-sectional study included 112 women aged 45-80 years (mean 58.3 years). BMD was determined for lumbar spine region and proximal femur by DEXA technology. Dental status and periodontal status were evaluated clinically and on panoramic radiographs. For the analysis of tooth loss frequency, participants were divided into four age groups. RESULTS: Significant inverse correlation was found between number of lost teeth and BMD at hip region (r = -.227; P = .028) but not at the lumbar spine (r = -.05; P = .669). Several indicators of the periodontal condition were significantly correlated with BMD, but not with postmenopausal period length. Important result is that participants missing one or more incisors or canines had significantly lower mean value of BMD comparing to those who had all the incisors and canines remained. CONCLUSION: Although osteoporosis is not the main cause of periodontitis, it may be a factor that leads to enhanced periodontal pocket depth and greater risk of tooth loss in ageing women.

Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect.

BACKGROUND: Child abuse and neglect (CAN) is a widespread social phenomenon encompassing all forms of maltreatment with serious lifelong consequences. Dentists and dental team members are in the unique position to identify the symptoms of CAN often visible in craniofacial region. AIM: To evaluate Croatian dentists' level of knowledge, experience, and attitude towards CAN issue. DESIGN: Investigation was conducted in five major Croatian cities (Zagreb, Varazdin, Osijek, Rijeka, and Split). A previously used questionnaire regarding knowledge and experience in child protection was adopted to Croatian terminology and distributed to 544 dentists. RESULTS: A total of 510 dentists who returned a questionnaire with valid data 26.27% reported to have had suspicion of CAN during professional career and 5.1% reported their suspicion within the last 6 months, mostly to social services and police. Fear of violence towards the child and uncertainty about observations were the most frequently reported barriers towards referring and only 11.4% knew the procedure. About 80% of respondents want further training in identifying and reporting of physical abuse. CONCLUSIONS: Study showed a lack of knowledge and uncertainty in recognizing and reporting CAN cases in Croatian dentists. They expressed the need for undergraduate and post-graduate continuing education on this issue.

Artificial neural network model for predicting sex using dental and orthodontic measurements.

Objective: To investigate sex-specific correlations between the dimensions of permanent canines and the anterior Bolton ratio and to construct a statistical model capable of identifying the sex of an unknown subject. Methods: Odontometric data were collected from 121 plaster study models derived from Caucasian orthodontic patients aged 12-17 years at the pretreatment stage by measuring the dimensions of the permanent canines and Bolton's anterior ratio. Sixteen variables were collected for each subject: 12 dimensions of the permanent canines, sex, age, anterior Bolton ratio, and Angle's classification. Data were analyzed using inferential statistics, principal component analysis, and artificial neural network modeling. Results: Sex-specific differences were identified in all odontometric variables, and an artificial neural network model was prepared that used odontometric variables for predicting the sex of the participants with an accuracy of > 80%. This model can be applied for forensic purposes, and its accuracy can be further improved by adding data collected from new subjects or adding new variables for existing subjects. The improvement in the accuracy of the model was demonstrated by an increase in the percentage of accurate predictions from 72.0-78.1% to 77.8-85.7% after the anterior Bolton ratio and age were added. Conclusions: The described artificial neural network model combines forensic dentistry and orthodontics to improve subject recognition by expanding the initial space of odontometric variables and adding orthodontic parameters.

Canine Crown Sexual Dimorphism in a Sample of the Modern Croatian Population.

Sex assessment is a key part of forensic analysis to establish the identity of unknown deceased individuals. Previous studies have shown that canines are the most dimorphic teeth, but population-specific data are necessary for forensic methods. This study explores sex dimorphism in canine crown dimensions and morphology in a contemporary Croatian population. The material consisted of 302 dental casts (147 females, 155 males) of orthodontic patients and dental students (11-25 years). The distal accessory ridge (DAR) of the upper and lower canines was evaluated using the Arizona State University Dental Anthropology System. Mesiodistal (MD) and buccolingual (BL) crown dimensions were measured on 120 casts. Sex differences in MD and BL dimensions were significant (p < 0.05) for all the canines (upper and lower, left and right), while in DAR only for lower canines (p < 0.000001). When all variables were put into the model, backward stepwise discriminant function analysis isolated lower canine DAR and lower left canine MD as the two independent variables differentiating sex. Using these two variables, a discriminant function formula allowed for sex determination with an accuracy of 73.5%. This study shows that both canine crown morphology and dimensions are useful for sex determination, especially for lower canines. These methods can be applied to children, as lower canines erupt at about 9 years of age.

Antibiotic resistance of Helicobacter pylori in pediatric patients -- 10 years' experience.

The aim of this study was to assess the pattern of evolution of resistance to antibiotics in Helicobacter pylori isolated from children who underwent upper endoscopy with antral biopsy during a 10-year period (2001-2010). We retrospectively analyzed data of all children (n = 3,008) who underwent upper endoscopy during the observed period at the Children's Hospital Zagreb, a university tertiary medical center. We calculated the rate, antibiotic susceptibility and risk factors for the H. pylori infection in our cohort. Antral biopsy was performed in 2,313 (76.89%) patients. Altogether, 382 (16.51%) children had positive biopsy for H. pylori (histology and/or culture). There was no significant difference in the incidence of H. pylori during 10 years of observation (p = 0.21). Infected children compared to non-infected group were older (p = 0.005), and had more often antral nodularity (p < 0.0001), and duodenal ulcer (p = 0.002). Altogether, 22.4% of treatment-naïve patients had strains resistant to tested antibiotics: majority to azithromycin (17.9%), followed by clarithromycin (11.9%), metronidazole (10.1%) and amoxicillin (0.6%). In the eradication failure group, 9/11 of children had strains resistant to tested antibiotics, mostly to metronidazole (7/11), followed by azithromycin (3/11) and clarithromycin (1/11). No correlation was found between age or gender and antibiotic resistance (p = 0.32, for both). In conclusion, our data strongly support current guidelines which recommend antibiotic susceptibility testing prior to eradication therapy. Based on our results we recommend the use of amoxicillin-metronidazole-based regimen as the first-line therapy in our study population.

Oral health awareness in Croatian and Italian urban adolescents.

Purpose of this study was to investigate and compare differences in oral health awareness between Croatian and Italian urban adolescents. The sample consisted of primary school last grade students aged between 13 and 15 years, 300 children from Zagreb (Croatia) and 298 children from Bari (Italy). Oral health awareness was evaluated using a self-administered standardized questionnaire. Self-perception of oral health proved to be different between the two groups (p < 0.001). The Croatians reported that their oral health was "excellent" or "very-good" more often than the Italians (68.6% vs. 50.2%). The reasons given for visiting a dentist were different (p < 0.001). The Italians cleaned their teeth more often than the Croatians ("two or more times a day", 83.1% vs. 72.2%, p < 0.003). Wooden toothpicks were preferred by the Croatians (p < 0.001), while floss was preferred by the Italians (p = 0.03). The awareness regarding the use of fluoridated toothpaste was higher in the Italian group (95.6% vs. 72.5%, p < 0.001). The Croatians were consuming sweetened foods more often than the Italians (p < 0.001). Croatian adolescents reported more indicators of a lower level of oral health awareness than the Italians, while on the contrary Croatians had higher esteem of their oral health. Defining national preventive strategies is essential for improving adolescents' attitudes toward oral health in both countries, particularly in Croatia.

[Correlation between pholcodine and perioperative anaphylaxis]. / Povezanost folkodina i perioperativne anafilaksije.

A large number of individuals experiencing anaphylactic reaction to neuromuscular blocking agents have not previously been in contact with them. The search for a substance inducing sensitization to muscle relaxants has led Norwegian and Swedish scientists to pholcodine, a cough suppressant, which is widely used in Europe and worldwide. Ammonium ion is an epitope common to pholcodine and neuromuscular blocking agents and it is the basis of their cross-reactivity. Based on the results of published studies that pointed to a connection of the use of pholcodine and perioperative anaphylactic reaction, pholcodine was withdrawn from the Norwegian market and subsequent research revealed a reduction of anaphylactic reactions in that country. In its latest report, the European Medicines Agency made a decision not to withdraw pholcodine mixtures from the market but it urged further research with the aim to clarify the cross-reactivity between pholcodine and neuromuscular blocking agents.

Teeth macroabrasion for determination of dental age and diet in the Illyrian population from the Kopila necropolis on the Island of Korcula, Croatia.

This paper presents the changes caused by macroabrasion of teeth on skeletal remains found in tomb No 4 in the west necropolis of the archeological site Kopila near Blato on the island of Korcula. The site archeologically dates back to the Late Iron Age, when the island was inhabited by the Illyrians. The aim of this study was to assess the dental age of the buried individuals at death and determine the type of their diet, which could give us a preliminary insight into the socio-economic standard of the inhabitants of the settlement. The analyzed sample is part of the collection of excavated skeletal remains kept in the Vela Luka Cultural Center on the island of Korcula. 284 permanent teeth, 19 fragments of the maxilla and 20 fragments of the mandible were found in the tomb, which were classified into 32 individuals and by sex. Teeth were analyzed by metric and non-metric methods of determining dental status in order to assess the dental age at the time of death and the diet of the inhabitants. The dental age of individuals was determined by the Lovejoy method and the degree of tooth wear by the Smith-Knight method. The analysis of the stable isotope 14C determined the exact time of death of the analyzed individuals. The tooth wear changes were very pronounced and present on 92.9% of teeth, equally on incisors and molars (p = 0.236). There is no significant gender difference (p > 0.05 for all teeth and jaw parts). There was no difference in the degree of tooth wear of the teeth of the mandible and maxilla (t = -0.266, p = 0.791), nor in the degree of tooth wear of the teeth of the maxilla right and left (t = -0.392, p = 0.702) or in the degree of tooth wear of the teeth of the mandible right and left (t = -0.889, p = 0.390). The average age of the analyzed population sample was 35.6 (±3.1) years. They were buried between 360-40 BC. Tooth wear changes observed on the analyzed teeth indicate a diet rich in hard, weakly cariogenic food with particles that were probably of inorganic origin, which caused an increased wear of tooth structures. The population was sedentary, agricultural type and the life expectancy was normal for the Late Iron Age. Besides, their socio-economic status was good. The age at the time of their death was between 30 and 40 years. Further studies should include more accurate and standardized methods for assessing the condition.

Analysis of the soft tissue profile in Croatians with normal occlusions and well-balanced faces.

The aim of the study was to test the hypothesis that there is no difference between the soft tissue profile of Croatian and white North American adults. Facial profile photographs were taken of 110 Croatians (52 males and 58 females) with normal occlusions and well-balanced faces (age 22-29 years). The findings were also compared with a white Brazilian group. An independent Student's t-test (P < 0.05) was used to compare the soft tissue parameters of Croatians with those of North Americans and to assess gender differences. The soft tissue profile measurements that showed significant gender dimorphism (P < 0.001) were the true vertical line [(TVL)-nasal tip (NT)] and TVL-point B, indicating that the males had slightly greater nasal prominence (mean difference: 1.32 mm) and deeper labial sulci (mean difference: 2.04 mm) compared with the females. The upper lip was the same for both genders (1.25 mm), while the lower lip was 0.97 mm more prominent in females than in males. All soft tissue variables, except TVL-NT showed significant differences between Croatian and white American female subjects (P = 0.096). For male subjects, nasolabial angle was the only variable that showed no statistically significant difference between the two populations. A universal standard of facial aesthetic is not applicable to diverse white populations. These differences should be considered in diagnosis and treatment planning for Croatians, together with their individual characteristics.

The chronology of third molar eruption in the Croatian population.

Dental age estimation is common in orthodontics, paedodontics, paleodontology and forensic dentistry. The aim of this study was to assess chronological course of eruptive developmental phases of third molar and to establish parameters for the Croatian population. Sample of this study consisted of 1249 orthopantomograms of 530 (42.4%) male and 719 (57.6%) female subjects, aged 10 to 25 years. Eruptive phases were classified in 4 stages. No significant sex difference was found. Established chronology of the third molar eruption can be used as a standard for the assessment of dental age in clinical and forensic research on samples of Croatian population.

Maintenance of Dental Records and Forensic Odontology Awareness: A Survey of Croatian Dentists with Implications for Dental Education.

Forensic odontology is the application of dentistry within the criminal justice system. Forensic expertise, including dental identification, mostly relies on dental records. We explored the practice of maintaining dental records among Croatian dentists, as well as their knowledge of legal regulations and the application of dental records in forensic odontology. In all, 145 dentists participated in an online survey. Questions covered general information on dentists, maintenance of dental records, and knowledge of legal requirements and forensic odontology. Overall, 70% of dentists obtain and archive written informed consents, while 87% record dental status. Generally, non-carious dental lesions and developmental dental anomalies were not recorded. About 72% of dentists record filling material and surfaces. Only 32% of dentists know the legal requirements for keeping records, whereas 21% have no knowledge of forensic odontology and its purpose. The survey revealed different practices in the maintenance of dental records, including significant flaws and lack of awareness of its forensic importance. This obvious need for additional education on proper maintenance of dental records could be met by including forensic odontology in compulsory undergraduate courses and postgraduate dental education. Establishing national and international standards in dental charting would comply with contemporary trends in health care and the requirements of forensic expertise.

Tooth Crown Morphology in Turner and Klinefelter Syndrome Individuals from a Croatian Sample.

OBJECTIVE: Turner syndrome (TS) and Klinefelter syndrome (KS) represent the two most common X chromosome aneuploidies, each associated with systemic disruptions to growth and development. Effects of these conditions on tooth crown morphology are explored in a sample of Croatian individuals. MATERIALS AND METHODS: The sample included 57 TS, 37 KS and 88 control individuals. Dental crown morphology was scored on dental casts according to the Turner-Scott Dental Anthropology System. RESULTS: Incisor shoveling and the hypocone were significantly different between TS individuals and both control and KS individuals. Individuals with TS exhibit lower grades of expression than either group. Furthermore, the number of lingual cusps on the mandibular premolars, the hypoconulid on the mandibular second molar, and cusp 7 on the mandibular first molar were significantly different, though pair-wise comparisons did not elucidate these differences. Tuberculum dentale, distal accessory ridge, and Carabelli's trait were expressed similarly to the control. KS individuals were not significantly different from control individuals for any trait, though this may be related to sample size. CONCLUSIONS: Previous studies suggest the loss of an X chromosome has a reducing effect on dental crown morphology, which is confirmed in this research. TS individuals exhibit generally simpler dental morphology compared to the control sample, though some traits are expressed comparably to the control sample. The effects of KS are less clear. Though previous studies suggest that the presence of an extra X chromosome increases dental crown dimensions, there was no notable effect on crown morphology in this study.

Acute poisonings in Croatia: differences in epidemiology, associated comorbidities and final outcomes - a single-centre 15-year follow-up.

PURPOSE: To determine the demographic and social characteristics of acutely intoxicated patients in the emergency department (ED), intention of drug/chemical intake, main toxic agents, outcomes and time trends for all variables. METHODS: This prospective, observational study included acutely intoxicated patients treated in the ED of the University Hospital Centre Sisters of Charity, Zagreb, Croatia, during the years 2001, 2010 and 2015. The diagnosis was derived from patient's self-report, clinical observations and laboratory test results (quantitative test for serum ethanol levels and qualitative tests for drugs in urine). RESULTS: A total of 1593 patients were enrolled in the study (331 in 2001, 618 in 2010, 644 in 2015), with a predominance of men (55.9%, 65.2%, 70.7%, respectively). The median age was 28 [18-89], 39 [18-92] and 40 years [18-95], respectively. There was a decline in the number of suicide attempts during the study (46.2%, 22.2%, 17.1% of patients, respectively) with a predominance of women (64.1-68.2%), and an escalation in the number of unintentional overdoses by substances of abuse (50.2%, 72.3%, 81.7% of patients, respectively) with a predominance of men (74.1-79.1%). Ethanol was the main toxic agent (40.2%, 69.4%, 75.8% of patients, respectively), used primarily as a substance of unintentional overdose. Anxiolytics were the most frequently implicated pharmaceuticals among all patients (46.5%, 32.0%, 18.5% of patients, respectively) and the main substance used in suicide attempts. The number of patients hospitalized in the Intensive Care Unit (ICU) decreased during the study from 20.2% of all patients in 2001 to 7.9% in 2010 and 6.8% in 2015. They accounted for 7.2%, 5.8% and 5.6% of all ICU-treated patients, respectively. In-hospital mortality (ED and ICU) caused by acute intoxications was low (0.9%, 0.8%, 0.8%, respectively). CONCLUSIONS: The escalation of overdoses by ethanol was a major medical and public concern in Zagreb. Anxiolytics were the main substance used in suicide attempts, with a low death rate due to their good safety profile.

The First Graduate of Dental Medicine at the University of Zagreb.

Dentistry in Croatia started as a course Dentistry and Dental Medicine for medical students at the School of Medicine in Zagreb in 1922. The first teacher was Professor Eduard Radosevic, doctor of medicine and dentistry specialist. The next stage was formation of the Odontology Department at the School of Medicine in Zagreb in September 1948, which was supported by Professor Ivo Cupar. The first 47 students enrolled in dentistry. Milenko Lainovic was the first student who graduated from the School on May 26, 1954 and he received the title of a graduated doctor of dental medicine. He was the first doctor of dental medicine in the history of the University of Zagreb. Following graduation, Dr. Lainovic returned to his native town Podgorica in Montenegro. He reorganized the dental service in Montenegro and founded the Secondary School for Dentists, Technicians, Sanitary Technicians and Medical Laboratory Technicians. He specialized in oral surgery in 1969, and in 1971 he founded a dental section at the Society of Physicians of Montenegro. Also, he was the initiator and organizer of several scientific and expert meetings in Montenegro. Dr. Lainovic was awarded the title of primarius and his busy career lasted 58 years. Numerous awards and prizes have witnessed the contribution of Primarius Dr. Lainovic to dental development in Montenegro and Yugoslavia. We are grateful to Primarius Dr. Lainovic for the promotion and affirmation of dental profession and the School of Dental Medicine, as well as for collecting numerous data on the development of dental profession, which are precious documents of history. This paper is dedicated to Primarius Dr. Lainovic on the occasion of the 70th Anniversary of Dentistry at the University of Zagreb (1948-2018).

Timing of emergence of the first primary tooth in preterm and full-term infants.

Variations in the timing of emergence of primary teeth are under strong genetic control, but there is also a significant contribution from external factors. The aim of this study was to evaluate the influence of preterm birth, birth weight and length, and feeding practices during the first 6 months of life on the timing of emergence of the first primary tooth. Data on pregnancy duration, birth weight and length, feeding practice, time of emergence and first emerged primary tooth were collected by electronic questionnaires. The study included 409 parents and 592 children of both genders. The sample was divided into two groups according to pregnancy duration (<37 weeks and ≥37 weeks), three groups according to feeding practice (exclusively breastfed, exclusively bottle fed, and a combination of breast feeding and bottle feeding), three groups by birth length (<50, 50-53, >53cm), and four groups by birth weight (<1500, 1500-2500, 2501-3500, >3500g). Data were analyzed considering chronological and postmenstrual age-which is the gestational age plus the infant's chronological age at the month of emergence of the first primary tooth. The mean time of first primary tooth emergence was 7.55±2.67 months when chronological age was considered. The first emerged tooth in most cases was a lower incisor (82.33%). There was a statistically significant difference in the timing of the first tooth emergence between preterm and full-term groups when chronological age was considered (p<0.005). However, no difference was found when age was adjusted. The age of emergence of the first tooth differed significantly when feeding, weight, and length groups (p<0. 05) were taken into account. In conclusion, the study indicates that shortened gestational age and very low birth weight are predictors for later ages of emergence of the first primary tooth.

Bifidobacterium animalis subsp. lactis in prevention of common infections in healthy children attending day care centers - Randomized, double blind, placebo-controlled study.

BACKGROUND & AIMS: The aim of our study was to investigate the role of Bifidobacterium animalis subsp. lactis (BB-12(®)) in the prevention of common (gastrointestinal and respiratory) infections in healthy children who attend day care centers. METHODS: We conducted a randomized, double-blind, placebo-controlled trial in 210 children who attend day care centers. They were randomly allocated to receive placebo (Placebo group, n = 106) or BB-12(®) at a dose of 10(9) colony-forming units (CFU) (Intervention group, n = 104) during the 3-month intervention period. RESULTS: Intention to treat analysis was used. There were overall 99 infections in Placebo group and 97 in Intervention group (incidence rate ratio = 1.0014, p = 0.992, Poisson regression model). Overall 65 children (61.3%) in Placebo group and 67 (64.4%) in Intervention group had common infections (p = 0.642). Mean number of infections per child was 0.93 (range 0-3) in Placebo group and 0.93 (range 0-3) in Intervention group (p = 0.898). There was no difference in secondary (duration of symptoms, number of children with gastrointestinal and respiratory tract infections, absence from day care center due to infections, use of antibiotics) and exploratory (type of gastrointestinal and respiratory tract infection) endpoints between groups. CONCLUSION: Results of performed study show that BB-12(®) has no effect on the prevention of gastrointestinal and respiratory tract infections in healthy children who attend day care centers.

Growth hormone positive effects on craniofacial complex in Turner syndrome.

OBJECTIVE: Turner syndrome occurs in phenotypic females with complete or partial absence of X chromosome. The leading symptom is short stature, while numerous but mild stigmata manifest in the craniofacial region. These patients are commonly treated with growth hormone to improve their final height. The aim of this study was to assess the influence of long-term growth hormone therapy on craniofacial morphology in Turner syndrome patients. DESIGN: In this cross-sectional study cephalometric analysis was performed on 13 lateral cephalograms of patients with 45,X karyotype and the average age of 17.3 years, who have received growth hormone for at least two years. The control group consisted of 13 Turner syndrome patients naive to growth hormone treatment, matched to study group by age and karyotype. Sixteen linear and angular measurements were obtained from standard lateral cephalograms. Standard deviation scores were calculated in order to evaluate influence of growth hormone therapy on craniofacial components. RESULTS: In Turner syndrome patients treated with growth hormone most of linear measurements were significantly larger compared to untreated patients. Growth hormone therapy mainly influenced posterior face height, mandibular ramus height, total mandibular length, anterior face height and maxillary length. While the increase in linear measurements was evident, angular measurements and facial height ratio did not show statistically significant difference. Acromegalic features were not found. CONCLUSIONS: Long-term growth hormone therapy has positive influence on craniofacial development in Turner syndrome patients, with the greatest impact on posterior facial height and mandibular ramus. However, it could not compensate X chromosome deficiency and normalize craniofacial features.