Factors related to treatment and outcomes of avulsed teeth.

BACKGROUND: The aim of this study was to examine factors associated with avulsion injury and to specify the association between these factors and the treatment, as well as the outcomes of avulsed permanent incisors in children. MATERIALS AND METHODS: The sample consisted of 51 children with 62 avulsed permanent incisors, whose injuries had been managed in the period 1998-2006. The study was prospective, recording the history of the accident, concomitant injuries, age, gender, apical maturity of the root, replantation rate, storage media, extra-alveolar duration, endodontic treatment, compliance and recall appointments response. Factors were analysed in relation to postoperative outcomes, classified as functional healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). RESULTS: The average age of patients was 10.7 years (range 7-19). In 16/51 patients, tooth avulsion was caused by a road traffic accident. Avulsion was accompanied by concomitant injuries in all cases. Thirty of 62 avulsed teeth were not replanted and 32 incisors were replanted after dry storage. Time until replantation ranged between 15 min and 9 h (median 60 min). The observation period ranged from 1 to 6 years (median 2 years). FH was observed in 5/32, IRR in 20/32 and RR in 7/32 incisors. Ten teeth were extracted during 5-years of observation. Immature incisors exhibited significantly more complications compared with mature teeth (P = 0.04). Storage media and extra-alveolar duration did not significantly affect the survival of replanted teeth (P = 0.253, P = 0.350). Teeth in which endodontic treatment was in temporary phase exhibited significantly more complications in comparison with teeth with completed endodontic treatment (P = 0.0l6). CONCLUSION: The combination of delayed replantation and unphysiological storage is followed by low survival. Incisors with open apices exhibited lower survival compared with incisors with closed apices. Replanted incisors that required prolonged treatment with calcium hydroxide exhibited more complications compared with incisors with completed root canal treatment.

Unmet oral health needs among persons with intellectual disability.

The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.

[The Presence of Non-Carious Lesions in Children].

INTRODUCTION: A non-carious lesion (NCL) is the loss of hard dental tissue on the neck, tuberculum and incisal edges of the teeth. Interest in clinical presence and in unclear etiology of these lesions allows for their future prevention and treatment. OBJECTIVE: The aim of the study was to determine presence and clinical characteristics of NCLs and dentine hypersensitivity (DH), as well as their possible risk factors in children, in the population of the city of Novi Sad. METHODS: A total of 55 subjects were included in the present study, aged between three and 18 years. Each subject completed a structured questionnaire related to the etiological factors, and all teeth of each subject were examined by two independent clinical dentists to determine NCLs and DH. In the case of small children, their parents or guardians filled out the questionnaire. Teeth with NCLs and DH were diagnosed according to the Basic Erosive Wear Examination (BEWE) index and by a blast of air according to Schiff and Hypersensitivity Index. The review was carried out by inspection and probing. RESULTS: The data were analyzed by clinical examination and comparison of the answers to the questionnaires. We observed an increased presence of non-caries lesions on primary teeth, compared to permanent teeth, with a statistically significant difference (X2=3.86, df=1, p=0.04). The changes were observed in 82 teeth, and were most frequent on the canine deciduous teeth (65%) and canine permanent teeth (51%). BEWE index was 10-11% to 92-100% in permanent, and 51-57% in deciduous teeth. Majority of patients with primary teeth (89.36%) did not respond to air stimulus, while most patients with permanent teeth (74.29%) did not react to Schiff Index. In the estimate of sensitivity, the respondents reported hypersensitivity on 6.38% of the deciduous teeth and 22.86% of the permanent teeth. Comparison of etiology factors did not reveal a direct link with the appearance of NCLs. CONCLUSION: Research has shown that despite the lack of subjective symptoms, these lesions have distinct clinical characteristics. The fact that they occur even in deciduous dentition justifies the need for further investigations.

Pulp vitality preservation after traumatic dental injuries to permanent teeth.

INTRODUCTION: The pulp vitality preservation after a trauma to permanent teeth is of great importance since dental injuries are common. The aim of our study was to investigate the pulp vitality preservation after tooth injuries. MATERIAL AND METHODS: A retrospective analysis of records of patients with a trauma was performed. The sample consisted of all patients who had been referred to the Department of Dentistry of Vojvodina for a trauma to permanent teeth during the period 2005-2010. We recorded the type of injury, treatment, state of vitality during the first visit and subsequent check-ups. RESULTS: The study included 162 children and adolescents aged 6-18 years having a trauma to 314 permanent teeth. The most frequent type of injuries in permanent teeth was fractures (54.5%), whereas luxation was a less common trauma (45.5%). Though different kinds of traumas have different optimal time for treatment, a period of 24 hours was taken as optimal; hence, 189 teeth were treated in optimal time and 55 complications occurred in them; while 105 complications occurred in 114 teeth which were treated 24 hours after the trauma. A year after the trauma the pulp vitality was preserved in 88 teeth (32%), pulp necrosis and other complications developed in 160 teeth (68%). CONCLUSION: The therapy of pulp vitality preservation in injured teeth was found successful in 32% and unsuccessful in 68% of cases at check-ups over one year.

[Traumatic dental injuries in Serbian children--epidemiological study].

INTRODUCTION: Comprehensive epidemiological data regarding factors associated with traumatic dental injuries are scarce. OBJECTIVE: The aim of the present study was to assess the frequency and analyze the factors associated with traumatic dental injuries in Serbian children. METHODS: Research included children and adolescents with traumatic dental injury aged 0-19 year during the period from 2003 to 2010, in four University Dental Centres in Serbia: Belgrade, Nis, Novi Sad and Kragujevac. Patient history, demographic, clinical and radiographic data were obtained from dental trauma forms. RESULTS: Total of 2,194 patients (748 girls, 1,446 boys) (chi2 = 222.1; p < 0.01) with 3,077 injured teeth in permanent and 953 in primary dentition were observed. Most of patients were aged 7 to 12 years (n = 1,191). The most frequent injuries in primary and permanent dentition were dislocations (87.4%) and teeth fractures (50.8%), respectively (chi2 = 706.1; p < 0.01). The most frequent mechanism of injury was fall in children aged 0 to 12 years, while the collisions were most frequent in adolescents (53.9%). The most frequent injuries in adolescents were inflicted outdoor (66.8%), while the injuries in children aged 0 to 3 years occurred at home (68.2%), (chi2 = 360.8; p < 0.01). The most frequent injuries in girls were accidental (48.3%), and in boys these were sport injuries (20.4%) and violence (10.4%) (chi2 = 79.9; p < 0.01). The most frequent cause of injury in children aged 0 to 3 years was accidental (75.6%), while in adolescents it was sport (34.1%) (chi2 = 1102.7; p < 0.01). CONCLUSION: Dental injuries in preschool children most frequently resulted from fall at home. Schoolchildren most frequently injured teeth outdoor during play. Violence and sport injuries were most frequent cause of injury in adolescents.

Microleakage, adaptation ability and clinical efficacy of two fluoride releasing fissure sealants.

BACKGROUND/AIM: Retention of fissure sealants and good adaptation to enamel are essential for their success. Fluoride releasing resin-based materials are widely accepted for pit and fissure sealing, but newly designed glass ionomers can serve as a good alternative. The aim of this study was to evaluate microleakage and sealing ability in vitro, and to clinically assess two fluoride releasing fissure sealants. METHODS: The sample for experimental study consisted of 20 freshly extracted intact human third molars, divided in two experimental groups according to the sealing material: fluoride releasing resin-based (Heliosel F) and glass ionomer (Fuji Triage) material. Digital images and scanning electron microscope were used to assess microleakage and adaptation ability. Sample for clinical study consisted of 60 children, aged 6-8 years, with high caries risk, divided in two groups according to the sealant material. Fissure sealant was applied to all erupted, caries-free first permanent molars. Sealants were evaluated after 3, 6 and 12 months using modified Ryge criteria for retention, marginal adaptation, colour match, surface smoothness and caries. RESULTS: Microleakage was detected in more than half of the specimen, without significant differences between the two groups (p > 0.05). Both materials exhibited acceptable sealing ability. Complete retention at the end of the observation period was 81.8% for resin-based, and 21.1% for glass-ionomer fissure sealant (p < 0.001). The presence of caries in sealed molars has been detected in one patient in both groups. During the 12-month observation period, Helioseal F demonstrated better retention, marginal adaptation and surface smoothness (p < 0.001). There were no differences between the two materials regarding caries and color match (p > 0.05). CONCLUSION: Both tested materials demonstrate satisfactory clinical and caries prophylactic characteristics that justify their use in contemporary preventive dentistry.

[Current trends in dental practice].

INTRODUCTION: This paper reviews recent trends in basic dental disciplines and advantages of new clinical procedures over conventional. PROSTHETIC RECONSTRUCTION OF DEPULPED TEETH: Post and core restoration is one of the most common treatment modalities applied when the remaining coronal tooth structure is not sufficient to provide the necessary retention form for restoration. Nowadays, the restoration of endodontically treated teeth is based on the use of materials with a modulus of elasticity similar to that of dentin. A NEW CONCEPT OF LIGHT INDUCED POLYMERIZATION OF ESTHETIC MATERIALS IN DENTISTRY: Polymerization contraction stress of resin based composite during light-activation process may be reduced by various illumination schemes. Successful curing depends on the calculated energy density values (spatial irradiance x irradiation period - J/cm2) rather than on light irradiance levels (mW/cm2). THE ASSOCIATION BETWEEN PERIODONTAL DISEASE AND GENERAL HEALTH: It is well documented that various systemic diseases have a profound effect on periodontal tissues. Recently, it has been speculated that periodontal disease may influence systemic health and represent the risk factor for cardiovascular diseases or adverse pregnancy outcomes. COMPUTER SYSTEMS FOR AUTOMATIC LANDMARK DETECTION: Computer systems, which will automatically identify relevant skeletal and soft tissue roentgencephalometric landmarks, will represent a great improvement in the field of orthodontic diagnosis. By using the Active Appearance Model, it is possible to identify most of roentgencephalometric bony landmarks with an average error well below 2 mm. CURRENT TRENDS IN CARIES TREATMENT: Chemomechanical caries removal was introduced as an alternative to conventional mechanical procedures. Its advantages are: selective removal of carious tissue, absence of pain, reduced need for local anesthesia and less potentially negative effects on the dental pulp. CONCLUSION: The introduction of the surgical operating microscope, microsurgical instruments, ultrasonic retrotips for root-end cavity preparation and new root-end filling materials opened a new era in periapical surgery, even on multi-rooted teeth, often called endodontic microsurgery.

[Possibilities of preventing traumatic dental injuries--a prospective study].

INTRODUCTION: The aim of this study was to investigate the most important etiological factors related to traumatic dental injuries, type of required treatment, period from injury to initial treatment and frequency of recall appointments. MATERIAL AND METHODS: The sample consisted of 283 children with dental injuries managed at the Department of Dentistry of the Faculty of Medicine in Novi Sad, during the last 7 years. Retrospective data relied on trauma protocols of this department, whereas collected data referred to etiological factors, type of initial treatment, period from injury to initial treatment, recall appointments and complications of traumatic dental injuries. These results were compared with other similar national and international studies, in order to promote implementation of preventive strategies that would reduce the increasing frequency of dental trauma. RESULTS: Fall accidents were the most common cause of dental trauma. Injuries were most frequent in autumn, in the street, and in the afternoon hours. Single tooth injury was predominant, while the injured mostly denied previous injuries. Almost half of the injured patients did not seek professional help in the first 24 hours after the injury. 40% of treated patients missed their recall appointment. CONCLUSION: Knowledge of the etiology is important for planning preventive measures, but because of the complexity of etiological factors, it is difficult to prevent traumatic dental injuries. It is also important to underline the importance of immediate initial treatment of traumatized patients, and significance of their regular professional supervision. Generally speaking, almost all treatment procedures in management of traumatic dental injuries include preventive component.

[Effects of fluoride in drinking water on health of deciduous teeth]. / Uticaj fluorida u pijacoj vodi na zdravlje mlecnih zuba.

INTRODUCTION: High incidence of decayed deciduous teeth, as well as lack of adequate therapy, makes tooth decay prevention very important. One of the simplest ways to reduce tooth decay is fluoridation of drinking water. The optimal concentration of fluoride in drinking water is 1 ppm/l, and many waters naturally contain this quantity. Waters in Vojvodina are mainly poor in fluoride, except in a few regions. It has long been postulated that fluoride has a prophyilactic effect during intrauterine life. Today a theory of greater local impact of fluoride has been accepted, as well as its role in de- and remineralization of solid tooth tissue. MATERIAL AND METHOD: This epidemiological study was performed in the area of Vojvodina, in places with various fluoride concentrations in drinking water (0.18-1.04 ppm/l). Dental examination was performed among 145 children, 6 years of age. For tooth decay detection DMF index was used. RESULTS AND DISCUSSION: In places with low and optimal fluoride concentration in drinking water the percentage of children with decayed teeth is different, but without statistical significance. The percentage of affected deciduous teeth is high in all places. In places with low fluoride concentration it is 24.2-32.3%, in places with optimal concentration is it 27-32%. The average value of DMF in all places is between 4.7-6.4. These results show that the optimal fluoride concentration in drinking water decreases the incidence of tooth decay, but this difference is not significant. CONCLUSION: Presence of fluoride in drinking water doesn't affect health of deciduous teeth. Decreased incidence of decayed deciduous teeth can be achieved only with combined usage of fluoride (local and systemic), as well as with an intensive health education program.

[Oral health in pregnancy]. / Oralno zdravlje u trudnoci.

INTRODUCTION: Good oral health care during pregnancy is essential but often overlooked factor of dental growth as well as of other structures of oral cavity. Pregnancy is the time when conscious approach to preventive oral care should increase. PREVENTIVE MEASURES DURING PREGNANCY: Preventive measures during pregnancy mean usage of fluorides, special dietary measures and increased oral hygiene habits. Preventive measures in pregnant women have one goal: providing conditions for development of fetal teeth as well as preventing tooth decay in pregnant women. The optimal period for introducing preventive measures is the first trimester of pregnancy. ALTERATIONS OF ORAL HEALTH DURING PREGNANCY: Because of hormonal alterations there is an increased incidence of dental diseases: gingivitis and low salivary pH (inflammation and bleeding gums). IMPACT OF NUTRITION DURING PREGNANCY ON ORAL HEALTH: Eating habits of pregnant women may lead to frequent snacking on candy or other decay-promoting foods, thereby increasing the risk of caries. However, very poor oral health, possible dental complications and their consequences to the health as well as emotional status represent very strong reasons for activation of dental health care in this period.

[Effect of smoking on resorption of residual alveolar ridges in complete denture wearers]. / Uticaj pusenja na resorpciju rezidualnog alveolarnog grebena kod nosilaca totalnih zubnih proteza.

INTRODUCTION: Based on literature data it is obvious that there is a connection between smoking and periodontal diseases. Alveolar bone loss increases with smoking. Tobacco smoking affects the proportion of subgingival bacterial flora by influencing oxidoreduction potential of dental plaque and thus making conditions for development of anaerobic bacteria. According to some researchers, smoking affects the mineral component of bone tissue. Orthopantomograms show higher level of alveolar bone loss in smokers than in nonsmokers with the same level of oral hygiene. The aim of this study was to establish if smoking affects alveolar bone loss in complete denture wearers. MATERIAL AND METHODS: Our clinical investigation included 60 patients of both sexes (30 smokers and 30 nonsmokers) all complete dentures wearers. All patients met study criteria: jaw relation and smokers who smoke over 20 cigarettes per day. All subjects were interviewed, and after that orthopantomograms were made. They were used to calculate the degree of alveolar bone loss. RESULTS: The examined subjects were approximately of the same age. Mean age of smokers was 59.9 and nonsmokers 61.8. It was established that differences regarding resorption in men were not significant. The degree of resorption in women smokers and women non-smokers was different, but differences were not significant. DISCUSSION: It has been proven that the number of cigarettes smoked per day is very important. It is considered that the risk of oral epithelial dysplasia increases when smoking more than 20 cigarettes per day. Considering our results regarding resorption of edentulous alveolar ridge in smokers and nonsmokers, we concluded that there were no significant differences. There are opinions in literature that smoking is not an etiological factor in resorption, but there are some opinions that smoking is connected with the degree of resorption in periodontium. The analyses of resorptive changes in edentuolous smokers were done only around implants and it was estimated that smoking has more influence than other clinical risk factors. CONCLUSION: On the bases of our research we may conclude that smoking does not directly affect the degree of resorption of edentulous alveolar ridge with complete denture wearers.