Patients' Reactions to Local Anaesthetic Application Devices in Paediatric Dentistry.

Local anaesthesia is the most common medium for pain control in most dental treatments. Physical appearance of syringe itself can be considered as a provoking factor for the emergence of dental fear and anxiety (DFA). In this research the patient reactions to local anaesthesia application devices, as one of the main causes for DFA emergence, were inquired. The sample comprised of 120 patients, divided in three age groups, formed of 40 patients aged 8, 12 and 15 years. DFA prevalence was quantified by Children Fear Survey Schedule-Dental Subscale (CFSS-DS). Three different syringes were offered to the patients. Reasons for choosing one of the syringes were detected. Patients assigned statistically highest rank to plastic syringe. Boys chose metal and intraligamental syringe statistically more often than girls. Patients with higher CFSS-DS scores chose metal syringe as last option. None of the reasons for selection was dominant, except pain that could be caused by usage of any of the three syringes. A large number of patients did not mention any of the reasons for choosing particular syringes. Plastic syringe represented the most acceptable device for local anaesthetic application to our patients. Patients often linked pain with dental syringes.

Dental Caries Experience in Children in Public Kindergartens of Sarajevo, Bosnia and Herzegovina.

Objectives: Dental caries first occurs within primary dentition in toddlers and preschool children, in a form of early childhood caries (ECC). In every day's busy and employment burdened parenting, caretakers and institutions have become important even more nowadays, not only for forming child general behavior and character, but also for maintenance of their general and oral health as well. Aims: To evaluate the presence and severity of ECC in children who attended public kindergartens in Sarajevo, and to offer basic information for the maintenance and improvement of child oral health to their parents and kindergarten teachers. Methods: The study included 1722 preschool children aged 3-6 years who attended kindergartens within Sarajevo public kindergarten institution, together with their parents and kindergarten teachers. Dental team members gradually visited all kindergartens situated in four Sarajevo city municipalities and examined kindergarten children according to the WHO Oral Health Survey Manual. Oral health promotion material for parents and kindergarten teachers was also distributed simultaneously during sequential visits. Results: ECC was present in preschool kindergarten children in Sarajevo, with its high prevalence (67.71%); dmft-value (3.97) and severity (SiC index 8.79). There was also a significant lack of dental healthcare to examined children mostly related to lack of visiting dental offices by children's parents (CI=10.55%, RI=10.80%, TI=12.98%). Conclusion: Parental role in preserving and improving of their children oral health should be systematically and profoundly improved. Kindergarten officials and staff should recognize the importance of anticariogenic diet menus and oral hygiene maintenance within their institutions.

Frequency of sweet and salty snack consumption among children in relation to their mothers' education level.

Aim To investigate the frequency of consumption of sweet and salty snacks among children aged 2-18 years in relation to their mothers' education level. Methods A descriptive epidemiological study was conducted in five dental practices at the School of Medicine of the University of Mostar from May to October 2022. The data were collected from medical records. Results: Out of a total of 477 children, 172 (36.1%) had mothers with a high school education, while 305 (63.9%) had mothers with a university degree. In the group of preschool children (aged 2-6 years), there were 42 mothers with high school education and 105 with university degree. In the group of school children (age 7-18 years) there were 130 mothers with high school education and 200 with university degree. The difference in the consumption of sweetened beverages among children of mothers with high school and university was not statistically significant. Similar results were found for the consumption of salty snacks, lollipops, caramels and candies. The frequency of the consumption of biscuits, chocolate and cakes (several times a day) was statistically significantly higher among the children of mothers with high school education (p=0.04), especially among school children. Eating habits of children, regardless of the level of education of their mothers, differed significantly only in the consumption of lollipops, caramels, and candies (p=0.03), which were consumed once a day by 79 (63.7%) schoolchildren and 45 (36.3%) of pre-schoolers. Conclusion A higher level of education among mothers does not necessarily equate to proper nutritional knowledge.

Predictors of Dental Fear and Anxiety in 9-12-year-old Children in Bosnia and Herzegovina.

Objectives: Oral health in children is additionally burdened with the presence of dental fear and anxiety (DFA). These clinical psychologic entities in their progressive stages inevitably lead to avoidance of dental appointments, which makes prevention and therapy of oral diseases more difficult. Upon the onset of DFA in general, as one of the emotional outcomes of stress in a dental office, most children patients could define the specific stressors that were most intense for them, which could predict the presence of DFA. Aim: To examine the predictors of DFA presence in 9-12-year-old children, and investigate how they could explain the DFA occurrence in study participants. Material and Methods: The sample consisted of 200 children aged from 9 to 12 years. The DFA presence was determined by the modified version of the CFSS-DS scale. The child's behavior in the dental office during the treatment was evaluated by the trained observer using Venham anxiety and behavior rating scales. Socioeconomic status, characteristics of dental office visits, and previous caries experience were also analyzed. Results: The main DFA predictors were related to invasive dental treatments, where the behavior during dental treatment was the most accurate expression of the DFA appearance. Conclusions: Invasive dental procedures are the main stressful factor for DFA occurrence. Predisposing factors could strengthen the DFA occurrence.

COVID-19 Impact on Public Dental Healthcare in Bosnia and Herzegovina: Current Situation and Ongoing Perspectives.

BACKGROUND: As the pandemic time went by in Bosnia and Herzegovina (B&H), various patterns toward COVID-19 itself and its impacts, implementation of prescribed preventive measures among the team members, and those of their patients, including immunization process, have been revealed. These patterns were of both empirical and evidence-based kind and consequently formed dental personnel behavior. The aim was to evaluate and compare the COVID-19 status of dentists in B&H, implementation of prescribed preventive measures, and usage of various kinds of PPE, at the beginning of the pandemics and now, 2.5 years later, including dentists' current vaccination status, and their opinions and attitudes toward the national COVID-19 economic impact on dental practice. METHODOLOGY: Study research was in a form of a cross-sectional longitudinally designed online survey and was conducted in two parts. RESULTS AND CONCLUSIONS: Dental professionals in B&H had a high frequency of COVID-19 symptoms in the second pandemic year. The vaccination status of dentists in B&H was in line with the global average values of vaccinated professionals. Dentists used patient management preventive measures and PPE recommended by WHO, but some preventive measures have been changed and prioritized recently. The economic impact of pandemics on dentistry was predominantly negative.

Dental Fear and Anxiety in 9-12 Years Old Children in Clinical Setting in Bosnia and Herzegovina: Normative Values and Types of Informant.

Background: The most commonly used diagnostic tests for evaluation of the dental fear and anxiety (DFA) presence in children were psychometric scales, where interpretation in determining and using of their cut-off scores sometimes was not completely exact. Also, several studies have been conducted where the results were conflicting in terms of who better assessed the DFA presence - the children, their parents, or dentists. Objective: To determine the normative values in the child and parental versions of the Modified version of the CFSS-DS scale (CFSS-DS-mod scale) and to compare the ways in which children, their parents, and the dentist assessed the DFA presence in the dental office. Methods: Survey sample consisted of 200 children aged from 9 to 12 years, whose DFA presence was determined by the CFSS-DS-mod scale. Child parents answered to their version of this scale, and the dentist observed the child behavior in the dental office during the treatment using Venham Anxiety and Behaviour Rating Scales. Results: Parental version of the CFSS-DS-mod scale found to be reliable (Cronbach alpha = 0.955) and valid (67.87% of variance explained) instrument for assessment of the DFA presence in children. Two cut-off scores were determined in a child (37 and 43), as well as in a parental version of CFSS-DS-mod scale (36 and 44), respectively. Dentists assessed the DFA presence in child patients most accurately. Conclusion: The normative values of psychometric instruments should be considered prior to their use. The borderline area of DFA presence should also be taken into account in the future studies. Children could underestimate DFA existence by themselves while interviewing.

Oral Health Behaviour of Nine-Year-Old Children and Their Parents in Sarajevo.

The oral health situation in Bosnia and Herzegovina is among the worst in Europe. We investigated the oral health behaviour of primary schoolchildren and their parents in Sarajevo. This was an anonymous cross-sectional survey among third-grade schoolchildren and their parents' oral health habits in Canton Sarajevo. Cluster random sampling yielded a representative sample from all the public schools in Canton Sarajevo in 2019. The survey targeted a total of 441 children and 365 parents. Two thirds (66.5%) of the children reported brushing their teeth twice daily, and almost half of them failed to use fluoride toothpaste daily. Girls brushed their teeth significantly more often than did the boys (74% vs. 58%, p = 0.004). Children living in residential areas of middle and high socioeconomic status (SES) reported better oral health habits than did those living in areas of low SES. Our study showed that Sarajevo children's oral health habits were poor. One-third of the nine-year-olds failed to brush their teeth according to recommendations, and almost half of them failed to use fluoride toothpaste daily. Improving the children's oral health in the future will urgently require national oral health promotion and prevention programmes.

Pediatric Dentists' Service Provisions in South-East Europe during the First Wave of COVID-19 Epidemic: Lessons Learned about Preventive Measures and Personal Protective Equipment Use.

INTRODUCTION: Having in mind the importance of providing continuous pediatric dental services during the COVID-19 pandemic and the fact that children have similar viral loads to adults, the potential to spread the virus to others, and with variable clinical presentation of COVID-19 infection, this study aimed to analyze the impact of COVID-19 outbreak on pediatric dentistry service provision, risks, and preventive measures before and during dental treatment. METHOD: Structured and closed epidemiological cross-sectional survey involved seven Southeastern European countries. The questionnaire was developed using the modified Delphi method, pretested, and tested in North Italy during April 2020. The sample consisted of licensed dental professionals reached via national dental chambers and social media using the best strategies according to the national setting. RESULTS: A total of 3227 dentists participated in the survey, and we included 643 specialists in this study-among them, 164 were pediatric dentists. Most pediatric dentists worked in the public sector (61.0%) and provided emergency (64.6%) and routine dental treatment (18.3%) during the outbreak. One-third of pediatric dentists were COVID-19 tested, statistically significantly more than other specialties, and 3.0% tested COVID-19 positive. In addition, significantly more pediatric dentists (13.4%) reported the presence of at least one symptom related to COVID-19 compared to other specialists (6.1%). None of the pediatric dentists reported PPE shortage. However, 26.2% of all specialists stated that they lacked clear step by step professional guidance in a national language. Similarly, in both groups, around 10% of specialists attended education on coronavirus. CONCLUSIONS: Considering that most pediatric dentists provided dental treatment during lockdown in their countries in public health centers and that they will continue to work during pandemic, our results suggest that pediatric dentists might be at higher risk of COVID-19 infection. Further research should focus on finding better ways to promote and adapt preventive, protective measures and PPE in the pediatric dental setting to be behaviorally acceptable. Moreover, additional efforts should be invested in dental education regarding COVID-19 in the mother tongue.

Demarcated Opacities as Predictors of Progression of the Molar Incisor Hypomineralisation: a Pilot Study.

OBJECTIVES: Demarcated opacities (DO) on teeth affected by Molar Incisor Hypomineralisation (MIH) were observed to investigate if parameters of DO existence and the number of teeth affected could be used to predict the progression of disease. MATERIAL AND METHODS: In 2009, the MIH prevalence was 11.5% (n=51) among 446 subjects in Sarajevo, aged from 6 to 9 years. In subjects with MIH who gave consent for further participation (n=25), the teeth with DO were observed after a 12-month period. RESULTS: our sample included 29 permanent incisors and 14 first permanent molars with DO. The number of teeth with light opacities was significantly higher than the number of teeth with dark opacities. Opacities were more numerous on surfaces which were not exposed to masticatory pressure. The size of tooth surface affected by DO occurrence ranged from 1.33% to 56.56%. The number of affected teeth ranged from two to six. A strong positive correlation between MIH progression and dark colored opacities located on the occlusal/incisal surface of teeth was noted. Larger part of tooth surface was affected by hypomineralisation in the case of dark-colored opacities. The DO presence on incisors was more likely to be located on vestibular surfaces and on the first permanent molars on their occlusal surfaces. CONCLUSIONS: The color of DO occurrence was the best predictor for MIH progression both independently and in combination with the number of affected teeth. Location of DO occurrence was a good independent predictor for MIH progression. It is important to collect information about color and location of DO presence.

Socioeconomic Status as Oral Health State Determinant of the Active Working Displaced Persons and Domicile Inhabitants.

INTRODUCTION: Socioeconomic changes have a significant impact on the health of the population. Socioeconomic development of society is one of the basic determinants of the health condition and needs of the individual and in the population as well. AIM: To explore the existence of differences in indicators of oral health status between the displaced persons and domicile population, considering the socioeconomic status (SES) of the respondents. PATIENTS AND METHODS: A total of 310 people, aged 35-44 (mean 40.19 ± 3.60), were interviewed and examined, with 157 of them in a subsample of domicile inhabitants and other 153 respondents in displaced persons subsample. The SES of respondents was determined using a survey. After conducted examinations in study participants, determined results were recorded as dental status (DMFT Index), and periodontal status (CPI Index). RESULTS: There was a significant difference in the mean value of caries existence between displaced persons of low and middle SES. In domicile inhabitants, there were no statistically significant differences in mean values of caries existence between the individuals with low and middle SES, while the differences existed between the individuals with low and high and between the middle and high SES. Domicile inhabitants with high SES had significantly less carious lesions than those with lower SES. Domicile inhabitants with high SES had significantly fewer extractions and more teeth with fillings. CONCLUSION: People with low SES have worse oral health status. Displacement and low socioeconomic status significantly influence the state of oral health.

The Reliability and Validity of the Three Modified Versions of the Children's Fear Survey Schedule-Dental Subscale of 9-12 Year Old Children in a Clinical Setting in Bosnia and Herzegovina.

OBJECTIVE: This study sought to obtain a comprehensive, reliable and valid instrument for evaluation of the presence of dental fear and anxiety (DFA) in children, through evaluation of the reliability and validity of three modified versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). MATERIALS AND METHODS: The study sample comprised children aged 9, 10, 11 and 12 years. The first sample group (200 patients) filled in a modified version of the CFSSDS scale, the second sample group (100 patients) filled in a short form of the Dental Fear Survey Schedule, and the third sample group (100 patients) filled in a short version of the CFSS-DS scale, prior to dental treatment, respectively. In order to determine test-retest reliability, the 184 patients from the first sample group filled in the modified version of the CFSS-DS scale again, prior to their next scheduled dental appointment. RESULTS: The modified version of the CFSS-DS scale had the best internal consistency reliability (α=0.907), as well as validity results, compared to the other two instruments used. Test-retest reliability was moderate (Intraclass correlation coefficient: 0.58). CONCLUSIONS: Of the three psychometric instruments used for evaluation of DFA presence in children, the modified version of the CFSS-DS scale showed the most clinically adequate reliability and validity values. This study thus provides a new psychometric instrument that should be considered for clinical use in evaluation of DFA presence in 9-12 year-olds, in a clinical setting sample type of children.

Reliability and Validity of the Modified Version of Children's Fear Survey Schedule-dental Subscale in 9-12 Years Old Schoolchildren in Bosnia and Herzegovina.

BACKGROUND: Dental fear and anxiety (DFA) are present worldwide globally, as well as in children. These psychological clinical entities in its progressive phase lead to avoiding of dentists and dental appointments, and consequtive impairments of oral health. If we ignore these facts, we would have the strenghtening of this relationship in a way of further oral health impairments and lost of dental hard and soft tissues, as well as appearance of dental phobia as the most negative form of psychological reaction to dental stimuli. Original CFSS-DS scale and its modifications, as the most used instruments for evaluation of DFA presence so far, showed various disadvantages. These were the reasons why we wanted to design new psychometric instrument for better evaluation of DFA presence in children compared to evaluation which the existed scales could offer nowadays, in a form of the Modified Version of CFSS-DS scale (CFSS-DS-mod scale). MATERIALS AND METHODS: There were 809 schoolchildren from 8 cities of Bosnia and Herzegovina aged 9-12 years that participated in the study. There was one school per city where the schoolchildren answered to the questions from the CFSS-DS-mod scale. RESULTS: 636 schoolchildren correctly answered to the scale questions. The CFSS-DS-mod scale showed excellent internal consistency reliability values (with Cronbach α>0.9), and also validity results (mostly over 60% of explained variance of obtained results) with two-dimensional concept of DFA presence. CONCLUSION: The CFSS-DS-mod scale represents good psychometric instrument for evaluation of the DFA presence in 9-12 year old schoolchildren in Bosnia and Herzegovina. Some of normative values of this psychometric instrument should be determined, in order to expand its usage in children.

KNOWLEDGE AND ATTITUDES REGARDING CHILD ABUSE AND NEGLECT.

PURPOSE: The aim of this study was to assess knowledge and attitude of dentists in Bosnia and Herzegovina (BH) regarding signs and symptoms of child abuse and neglect (CAN), reporting procedure and level of education. METHODS: Data were collected through a self-administrated structured questionnaire adopted and modified from previous studies. It was administrated to 300 dentists out of which a total number of 210 subjects were in final sample for statistical analyses. Response rate was seventy percent. Descriptive statistics, Chi-square and Kruskal-Wallis H test were used to analyze statistical differences in responses. The level of significance was set at p<0.05. RESULTS: Dentists in BH are very rarely provided (80%) with training related to recognition and reporting of CAN. Sixty six percent of dentists had never suspected CAN in their practice. Only nine percent of dentists would report suspicious of CAN. Prevailing reasons for not reporting suspected case of CAN was lack of knowledge of the reporting procedure (43%), and combination of indicated answers that never had a case and lack of knowledge about the procedure (31%). CONCLUSION: Results of this study suggest that dentists need an effective education to increase their knowledge and awareness of all aspects of CAN.

Caries prevalence of children and adolescents in Bosnia and Herzegovina.

OBJECTIVE: The aim of this study was to present epidemiological parameters of caries prevalence in children and adolescents in index age groups on a national and regional level in Bosnia and Herzegovina (BH). MATERIALS AND METHODS: The study was conducted during 2004 year for children aged 6 and 12, and during 2007 for adolescents aged 15. An oral health survey was performed on a total number of 1,240 children and adolescents in line with World Health Organization methodology and criteria. Results for caries prevalence and treatment needs were presented and discussed in this paper. RESULTS: Mean dmft (decay, missing, filled teeth for primary dentition) for children aged six was 6.7 (SD±3.9) in that the decayed teeth constituted the major part of the index (88.8%), followed by extracted teeth (8.9%) and a small percentage of filled teeth (2.3%). In 12-year-olds DMFT (Decay, Missing, Filled Teeth for permanent dentition) was 4.2 (SD±2.9), Significant Caries index (SiC) was 7.7 (SD±2.9), the decayed teeth constituted the major part of the index (45.4%), followed by 42.1% of FT and 12.5% of extracted teeth. Among 15-year-olds the DMFT was 7.6 (SD±4.1), SiC was 9.2 (SD±1.2), and filled teeth constituted the major part of the index. CONCLUSION: The present study provides some evidence of relatively high caries prevalence and severity in comparison with Western European countries. It is necessary to devote more attention to the oral health of children and adolescents. Community based oral health promotion, preventive programs and preventive oriented public dental health care services should be made available and accessible to all children in Bosnia and Herzegovina.

Reliability and validity of Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS) in children in Bosnia and Herzegovina.

The most frequently used measuring instrument for determination of dental fear and anxiety (DFA) in children nowadays is the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). In this study we wanted to explore the reliability and validity of CFSS-DS scale in Bosnian children patients' sample. There were 120 patients in the study, divided in three age groups (8, 12, and 15 years of age), with 40 patients in each group. Original CFSS-DS scale was translated into Bosnian language, and children's version of a scale was used. The high value of the Cronbach's coefficient of internal consistency (α=0.861) was found in the entire scale. Four factors were extracted by screen-test method with Eigen values higher than 1, which explained 63.79% variance of results. CFSS-DS scale is reliable and valid psychometric instrument for DFA evaluation in children in Bosnia and Herzegovina. The differences between our research and those of others may appear due to many factors.