EVAULATION OF BLINK REFLEX BETWEEN PATIENTS WITH IDIOPATHIC TRIGEMINAL NEURALGIA AND HEALTHY VOLUNTEERS.

The purpose of the study was to find differences in the parameters of the response to the blink reflex (BR) between patients with idiopathic trigeminal neuralgia (TN) and health volunteers. A prospective cohort study was conducted over 2 years. The TN-subgroup included 15 patients (mean age / SD 62.3 ± 10.7 years). Pain-free and healthy volunteers as a HV-subgroup (mean age / SD: 30.8 ± 8.1 years) were recruited from asymptomatic students of dental medicine. Diagnostic parameters were determined by measuring latency to the onset of the BR components from electric stimulation. The following branches of the trigeminal nerve were affected: maxillary branch only (26.7%), mandibular branch only (20%), combined: ophthalmic branch with maxillary branch (6.7%), and ophthalmic branch with mandibular branch (6.7%) respectively, combined maxillary and mandibular branch (26.7%) and affected all three branches (13.4%). The latencies of the BR, left and right side together, between subgroups were significantly higher for values R1 (homolateral early response), R2 (homolateral late response), R2c latency (contralaterally expressed response) in the TN-subgroup (p < 0.05). On the basis of the presence of R1c and R3 latencies and upon considering the abnormal findings of the BR, no statistically significant differences were found between the examined subgroups (p > 0.05). Blink-reflex parameters (R1, R2 and R2c) were significantly abnormal comparing TN-patients with healthy volunteers. The R3 component of the BR was related to noxious stimuli, likewise by innocuous stimuli.

Alcohol Abuse in the Dental Patient and Temporomandibular Disorder Caused by Trauma.

The aim of the paper was to describe the multidimensional character of alcoholism and its effects on oral health, with a review of the relation between the traumatogenic factor of temporomandibular disorders (TMDs) and bruxism development. The difference between moderate drinking and the development of alcohol addiction which leads to alcoholism-related medical, social, legal and economic issues is not always clear. Alcoholism is often hidden within the private and wider social framework of a patient. Oral diseases are easy to notice in recorded alcoholics as well as in, for example, smokers. TMDs consist of a disorder of masticatory muscles and/or a disorder of temporomandibular joint (TMJ). Since the traumatogenic factor of individuals under the influence of alcohol is clearly evident, it can potentially become an initializing factor of TMJ disorder's clinical signs and symptoms development. A modern approach to the etiopathogenesis is to include the multifactorial model, that is, combinations of potential factors with various individual importances. In everyday dental practice, co-morbidities of oral diseases and alcoholism are expected more often, as well as oral diseases with their etiopathogenesis partially related to alcohol use.

SOCIOECONOMIC INFLUENCE OF TOBACCO USE AND DENTAL CARIES EXPERIENCE IN DIFFERENT MALE CROATIAN POPULATIONS.

- The purpose was to evaluate dental caries experience in different male subpopulations of Croatian Army recruits and dental students, and subsequently, smoking habits related to the level of education and place of residence. Croatian army recruits (n=248; mean age 20.2) and male dental students (n=56; mean age 21.5) were evaluated according to DMFT and FST indices, divided according to age and place of residence, and interviewed about their dietary habits and smoking of tobacco. In the subpopulation of recruits, the median value of DMFT was 6 and of FST index 25. A statistically significant difference was recorded between DT and FST index (p<0.05) according to dietary role of carbohydrates reflected in caries development. The number of recruits with finished elementary school coming from a rural area who smoked (in total 57.66% of smokers) was significantly larger (p=0.0041). In dental students, the median value of DMFT was 5, with statistical significance in comparison with recruits (p=0.03). There was a difference in FST index (median 28) (p<0.0001). Students were mostly nonsmokers (71.43%) and had urban residence (p<0.0001). FST index was a more specific indicator in the socioeconomically heterogeneous sample of recruits (more subjects coming from rural areas and with a lower level of education) than in the sample of dental students (more subjects coming from urban areas).

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.

Artificial Intelligence in Medicine and Dentistry.

Introduction: Artificial intelligence has been applied in various fields throughout history, but its integration into daily life is more recent. The first applications of AI were primarily in academia and government research institutions, but as technology has advanced, AI has also been applied in industry, commerce, medicine and dentistry. Objective: Considering that the possibilities of applying artificial intelligence are developing rapidly and that this field is one of the areas with the greatest increase in the number of newly published articles, the aim of this paper was to provide an overview of the literature and to give an insight into the possibilities of applying artificial intelligence in medicine and dentistry. In addition, the aim was to discuss its advantages and disadvantages. Conclusion: The possibilities of applying artificial intelligence to medicine and dentistry are just being discovered. Artificial intelligence will greatly contribute to developments in medicine and dentistry, as it is a tool that enables development and progress, especially in terms of personalized healthcare that will lead to much better treatment outcomes.

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.

The Asymmetry of the Mandible in Patients with Unilateral Temporomandibular Joint Disc Displacement Confirmed by Magnetic Resonance Imaging.

Objectives: The study aimed to determine the relationship between the mandibular asymmetry index according to Kjellberg between patients with painful unilateral anterior disc displacement (DD) and asymptomatic volunteers without disc displacement. Vertical measurements were performed on a panoramic single-image radiograph, and the disc status was confirmed by magnetic resonance imaging (MRI). Material and methods: Two groups of subjects were retrospectively selected, 40 patients (the overall mean age was 35.5 years; 75% female) with temporomandibular disorder symptoms confirmed by RDC/TMD axis I and manual functional analysis. Unilateral DD was determined by MRI. A comparative group of asymptomatic volunteers (20 dental students with a mean age of 23.4 years; 72% female) had the physiological position of the disc determined by MRI. The vertical asymmetry of the condyle was determined by the method of Kjellberg et al. The symmetry of the gonial angle of the mandible was also measured. Results: A comparison of the mean of the asymmetry index between patients (average 90.89±7.08%) and asymptomatic volunteers (mean 95.86±4.44%) showed a statistically significant difference (p=0.0029). There was no difference (p=0.088) in gonial angle symmetry between the patients (mean 96.48±2.96°) and the asymptomatic volunteers (mean 97.52±2.31°). The distribution of the presence of individual DD diagnoses (partial and total displacement with reduction, displacement without reduction) in patients diagnosed with asymmetry of the mandible was without statistical significance (p>0.05). Conclusion: This study actually points to the asymmetry of the mandible as a potential morphological risk of anterior DD.

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.

Occupational Injuries among Dentists in Croatia.

OBJECTIVES: Dental profession is characterized by a high risk of injuries at work due to exposure to specific working conditions. The operating area in a patient's mouth is small, and it is handled by a large number of sharp instruments and drills that rotate at high speed, which creates an aerosol contaminated with particles of saliva and blood. This poses a risk of transmitting infections from patients to the dentist through stabbing incidents and cuts, which are some of the most common occupational injuries that are reported in the scientific literature. OBJECTIVE: The aim of this study was to examine the frequency of occupational injuries among dentists in Croatia, to establish most common injuries, and to determine the main risk factors. The aim of this research was also to determine the dentists' opinion on causes that are responsible for the occupational diseases and injuries. MATERIALS AND METHODS: The survey was conducted based on a sample of 406 dentists from Croatia as respondents to an electronic survey. RESULTS: 63.05% of the respondents suffered injuries caused by dental practitioners. The most common injuries were needle puncture incidents (57.75%) and cuts (20.86%), followed by eye injuries (13.37%), patient bite (4.81%) and punches (1.60%). The largest number of respondents stated the improper posture as the most important cause of occupational diseases and injuries, followed by stress, infection and noise. CONCLUSION: Knowledge of risk factors is the first step of injury prevention. Our respondents were largely aware of the dangers surrounding them. Nevertheless, the frequency of injuries was high and there is still a need for preventive measures to minimize the frequency of injuries in dentistry.

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.

Zygomatic Air Cell Defect - Magnetic Resonance Imaging of the Temporomandibular Joint Compared with Panoramic Radiographs.

The aim of the study was to analyze zygomatic air cell defect (ZACD) incidence using magnetic resonance imaging (MRI) and validity of panoramic radiograph as a comparative method of ZACD diagnostics. The connection between ZACD incidence, age, left/right temporomandibular joint (TMJ) and comorbidity with diagnosis of TMJ disorder was analyzed. Panoramic radiographs and MRIs of 140 TMJs of 70 consecutive patients with previously confirmed TMJ diagnosis were compared in the study. A grading system (4-point scale from '0' for absence to '3' for most extended pneumatization) was used to determine low signal on MRIs as pneumatization of temporal bone. ZACD was diagnosed in 22 joints of 15 patients (incidence, 20.4%), with seven patients having bilateral appearance. In the joints of nine patients, ZACD was identified as extensive accord-ing to the grading scale. The validity of ZACD findings on panoramic radiographs compared with MRI findings yielded 0.45 sensitivity and 0.98 specificity. There was no relation (p>0.05) between comorbidity of ZACD and TMJ disorder, either by age or side of the body. More prevalent ZACD in our MRI analysis than in other researches based on panoramic radiographs could be explained by the expected superimposed osseous structures in the area of articular eminence.

Psoriatic arthritis and temporomandibular joint involvement - literature review with a reported case.

In addition to psoriasis, between 5% and 24% of patients will develop psoriatic arthritis simultaneously after or even prior to skin manifestations. Psoriatic arthritis belongs to the group of seronegative spondyloarthritis. Collaboration between a dermatologist and a rheumatologist plays a more important role in cases where there is a complete absence of clinical signs of psoriasis. Since rheumatic diseases may also involve the temporomandibular joints (TMJ), psoriatic arthritis can cause problems that are an aspect of systemic disease. In general, the clinical and radiological description of a population of patients suffering from psoriasis and/or psoriatic arthritis does not mention TMJ involvement. However, as is the case with intraoral psoriasis, psoriatic changes to the TMJ also show characteristic signs of erosion, deplaned condyles, and articular effusion. Magnetic resonance imaging has shown itself to be the gold standard in the diagnostics of joints afflicted by psoriatic arthritis and TMJ disorders, regardless of the existence of a systemic disease. This paper aims to present a review of the relevant literature describing different epidemiological, clinical, and radiological characteristics of psoriasis and psoriatic arthritis, with emphasis on the involvement of TMJs in the general manifestation of the disease, illustrated by a description of the clinical case of a 77-year-old female patient.

Radiographic validation of manual functional analysis of temporomandibular joint osteoarthritis.

The finding of osteoarthritis of temporomandibular joint (TMJ) obtained by clinical diagnosis, i.e. manual functional analysis (MFA) and the finding obtained by magnetic resonance imaging (MRI) as the gold standard were compared in 30 patients (mean age 52.6) diagnosed with osteoarthritis, selected out of 140 consecutive patients diagnosed with a TMJ disorder by MRI. The clinical parameters were symptoms of pain in the TMJ region, crepitations, and absence of clicking, which was confirmed by manual examinations as part of MFA. A positive MRI finding included flattening, subchondral degenerative changes with or without intact cortical bone, osteophytes and subchondral degenerative cysts of joint surfaces. The validity of MFA for osteoarthritis was as follows: sensitivity 0.38, specificity 0.91, positive predictive value (PPV) 0.77 and negative predictive value (NPV) 0.65. MRI examination revealed disk displacement (DD) without reduction in 12 (40.00%) patients and DD with reduction in one (3.33%) patient. The finding of passive compressions for the osteoarthritis diagnosis depending on DD showed sensitivity of 0.29, specificity of 0.95, PPV 0.67 and NPV 0.78. Although MFA significantly improves validity of clinical diagnosis when differentiating a myogenic from TMJ disorder, clinical determination of osteoarthritis is not satisfactory. Nonspecific clinical signs and symptoms accompanied by predominant pain in the TMJ on dynamic but not on passive manual examinations cannot help differentiate DD from osteoarthritis.

Temporomandibular joint development and functional disorders related to clinical otologic symptomatology.

Temporomandibular disorders (TMDs) are a form of musculoskeletal pain of the temporomandibular joint (TMJ) and/or masticatory muscles of nonspecific etiology. In this study, the relationship between embryonic and anatomic-topographic similarities of the TMJ and the ear was analyzed, i.e. secondary otologic symptoms that can be closely connected to TMJ disorder. Nonspecific otologic symptoms are not primary diagnostic symptoms of TMD, but may cause diagnostic confusion due to patients' inability to correctly locate the origin of pain. The most common otologic symptoms that can be related to TMDs are otalgia, tinnitus and vertigo. Otorhinolaryngologists have to differentiate between primary otologic symptoms and those caused by TMJ disorders. In TMD diagnosis, manual techniques are used to determine the arthrogenic or myogenic form, whereas in the diagnosis of arthrogenic disorders magnetic resonance imaging is indicated as the highly specific imaging method ofjoint disk and osteoarthritic changes. Symptomatic treatments for TMD as well as the etiologic diagnosis of the pain require multidisciplinary cooperation between dentists and medical specialists.