Analysis of Hospital-Based Dental Procedures Under General Anesthesia in Uncooperative Patients: a Retrospective Study.

Background: General anesthesia is a well-documented therapeutic option for the provision of dental treatment, particularly in patients with special healthcare needs and uncooperative pediatric patients. Objectives: This retrospective study aimed to analyze the characteristics of dental general anesthesia (DGA) procedures for uncooperative patients of all ages in a tertiary healthcare facility, Clinical Hospital Dubrava, in Zagreb, Croatia. Material and methods: The hospital records for the patients treated for various dental reasons under GA were obtained at the Clinical Hospital Dubrava in Zagreb, Croatia. Results: Between 2014 and 2019, a total of 810 DGA procedures were performed including 607 patients. The median age was 18 years. Almost half of the patients referred to undergo DGA procedures were from the City of Zagreb and Zagreb County, 27.8% (N=225) and 21.0% (N=170), respectively. More than 90% of patients undergoing DGA procedures were referred with 1 to 3 medical conditions. 47.9% of patients had 1 to 3 dental conditions, of which caries was the most common condition (95.7%). The mean waiting time (±SD) was 113.06 (±62.62) days. 90 patients (14.8%) were referred for dental procedures under GA more than once, accounting for 203 procedures (25.1%). Conclusions: DGA remains a single dental treatment option for specific individuals. There is an institutional and, also, an organizational need to address the long waiting times and high repeated DGA rates.

Therapeutic Manuka Honey as an Adjunct to Non-Surgical Periodontal Therapy: A 12-Month Follow-Up, Split-Mouth Pilot Study.

Periodontitis is recognized as one of the most common diseases worldwide. Non-surgical periodontal treatment (NSPT) is the initial approach in periodontal treatment. Recently, interest has shifted to various adjunctive treatments to which the bacteria cannot develop resistance, including Manuka honey. This study was designed as a split-mouth clinical trial and included 15 participants with stage III periodontitis. The participants were subjected to non-surgical full-mouth therapy, followed by applying Manuka honey to two quadrants. The benefit of adjunctive use of Manuka honey was assessed at the recall appointment after 3, 6, and 12 months, when periodontal probing depth (PPD), split-mouth plaque score (FMPS), split-mouth bleeding score (FMBS), and clinical attachment level (CAL) were reassessed. Statistically significant differences between NSPT + Manuka and NSPT alone were found in PPD improvement for all follow-up time points and CAL improvement after 3 and 6 months. These statistically significant improvements due to the adjunctive use of Manuka amounted to (mm): 0.21, 0.30, and 0.19 for delta CAL and 0.18, 0.28, and 0.16 for delta PPD values measured after 3, 6, and 12 months, respectively. No significant improvements in FMPS and FMBS were observed. This pilot study demonstrated the promising potential of Manuka honey for use as an adjunct therapy to nonsurgical treatment.

Diagnostic Accuracy of Salivary aMMP-8 Test in Infertile Women and Blood Finding Analysis.

Introduction: The literature reviewed in this paper suggests that infertile patients present worse periodontal status, which may be causative to conception complications. This study aimed to validate an aMMP-8 point-of-care mouth rinse test in the population of women with unexplained infertility and compare it to age-matched fertile women with and without periodontitis. Furthermore, blood sampled inflammatory parameters were analyzed and compared between the two groups. It was hypothesized that the infertile women would present worse periodontal status and a greater number of positive aMMP-8 tests than fertile women, and they would have increased inflammatory blood parameters. Material and methods: The study included 50 healthy norm-ovulatory females aged 25-45 years with strictly defined unexplained (idiopathic) infertility, and 50 healthy norm-ovulatory women of the same age who had conceived and delivered naturally. Results: The sensitivity and specificity of the test for detecting periodontitis was 84% and 72% in the group of infertile patients, 88% and 68% in the group of fertile patients and 86% and 70% in the overall patient population. Infertile patients with periodontitis had less advanced periodontitis than the control group although this difference was not statistically significant. Blood inflammatory markers were significantly higher in infertile than in fertile women. Conclusion: This study has shown that infertile patients had better periodontal status and less advanced periodontitis than fertile women of the same age. Therefore, when interpreting the results of aMMP-8 tests for diagnosis of periodontitis, one should keep in mind the periodontal status of the examined population.

Impact of rehabilitation versus edentulism on systemic health and quality of life in patients affected by periodontitis: A systematic review and meta-analysis.

AIM: To investigate the effect of rehabilitation in fully/partially edentulous patients with stage IV periodontitis on oral-health-related quality of life (OHRQoL) and systemic health. MATERIALS AND METHODS: A systematic electronic and manual search was conducted. Three authors independently reviewed, selected, and extracted the data. Outcomes were OHRQoL (Oral Health Impact Profile 14 [OHIP-14] and OHIP-49, General Oral Health Assessment Index [GOHAI], visual analogue scale, symptoms registration) and systemic health-related outcomes (incidence and prevalence of systemic diseases, values of systemic disease indicators). Qualitative data were synthesized for OHRQoL and systemic health-related outcomes. Meta-analysis was conducted on available quantitative data. RESULTS: The search identified 59 articles (6724 subjects in total). OHRQoL improved across all the studies, irrespective of the number of missing teeth, their location, or treatment modality. Meta-analysis showed significant improvement of OHIP-49 (36.86, p < .01) in manuscripts including subjects affected by periodontitis, consistently with the remaining literature (reduction of score points post rehabilitation: OHIP-14 = 10.52, OHIP-49 = 56.02, GOHAI = 5.40, p < .01 for all). Non-rehabilitated subjects exhibited inferior cognitive status, higher medication intake, and frailty. However, our data are limited and should be interpreted with caution. CONCLUSIONS: Oral rehabilitation improves OHRQoL and, potentially, systemic health in edentulous patients. It is unclear whether these findings may be extrapolated to patients with stage IV periodontitis.

Dental Students' Attitudes and Perspectives regarding Online Learning during the COVID-19 Pandemic: a Cross-sectional, Multi-university Study.

Objectives: The aim of the study was to evaluate the attitude and perspectives of dental students of four Croatian universities towards online learning during the COVID-19 pandemic. Material and methods: An anonymous internet-based survey was administered to undergraduate dental medicine students at the Universities of Zagreb, Rijeka, Split and Osijek. The 29-item questionnaire collected data on students' demographics, online learning organization and management, and perception of online classes. Results: Five hundred and four participants (85.1% female) took part in the survey. The majority of the participants (63.5%) were from the University of Zagreb. 39.6% of students reported agreement regarding online learning satisfaction. Individual university satisfaction ratings on overall online learning were: Osijek 3.69, Zagreb 3.22, Split 3.05 and Rijeka 2.64. Most students considered that lectures (82.9%) and seminars (78.9%) could be successfully delivered in an online learning format. The online learning format cannot successfully deliver laboratory, preclinical, clinical practicals or clinical clerkship, as agreed by more than 80% of the total student sample. 60% of students consider online learning a valuable alternative to face-to-face instruction. Conclusion: Online learning was highly praised for educational formats such as lectures and seminars, and was considered a useful substitute for conventional learning. Conventional practical courses cannot be substituted with online learning. Overall perspective about online learning was mixed among the students of four universities. The findings of the present study can serve to help individual universities address the shortcomings and reinforce the strengths of their OL programs.

Treatment of Intrabony Defects with a Combination of Hyaluronic Acid and Deproteinized Porcine Bone Mineral.

BACKGROUND: this study evaluates the clinical outcomes of a novel approach in treating deep intrabony defects utilizing papilla preservation techniques with a combination of hyaluronic acid (HA) and deproteinized porcine bone mineral. METHODS: 23 patients with 27 intrabony defects were treated with a combination of HA and deproteinized porcine bone mineral. Clinical attachment level (CAL), pocket probing depth (PPD), gingival recession (REC) were recorded at baseline and 6 months after the surgery. RESULTS: At 6 months, there was a significant CAL gain of 3.65 ± 1.67 mm (p < 0.001) with a PPD reduction of 4.54 ± 1.65 mm (p < 0.001), which was associated with an increase in gingival recession (0.89 ± 0.59 mm, p < 0.001). The percentage of pocket resolution based on a PPD ≤4 mm was 92.6% and the failure rate based on a PPD of 5 mm was 7.4%. CONCLUSIONS: the present findings indicate that applying a combined HA and xenograft approach in deep intrabony defects provides clinically relevant CAL gains and PPD reductions compared to baseline values and is a valid new approach in treating intrabony defects.

The Impact of the COVID-19 Pandemic on Dental Education: An Online Survey of Students' Perceptions and Attitudes.

PURPOSE: Dental education institutions worldwide experienced disruptive changes amid the COVID-19 pandemic, with a rapid switch to the online learning format. Thus, this study aimed to assess the impact of the COVID-19 pandemic on dental education and evaluates the perceptions and attitudes of students towards the introduction of online learning in the School of Dental Medicine in Zagreb, Croatia. METHODS: A survey was conducted on a population of undergraduate students. It was comprised of perceptions and attitudes of students on the impact of the COVID-19 pandemic on their psychoemotional status, changes introduced in the educational system, and online learning in particular. RESULTS: Of the 352 students that completed the survey, 66.2% of students reported being psychoemotionally affected by the lockdown. The most significant impact of the switch from in-person to online learning was observed in terms of missing contact with lecturers (60.3%) and peers (90.3%) and loss of practical courses, regarding which 65% of students agreed that they could not be compensated. While only 36.1% reported that online teaching fully met their expectations, the majority of the students (61.9%) agreed that online lectures were as valuable as in-person lectures and that the theoretical courses could be carried out online in the future as well (69.9%). CONCLUSIONS: Students reported relative satisfaction with changes in the learning format and a positive attitude towards online learning; however, several challenges and obstacles were identified.

Relationship Between Halitosis and Periodontitis: a Pilot Study.

OBJECTIVE: Halitosis, or oral malodour, is an unpleasant smell emanating from the oral cavity. It is a common complaint among patients with periodontitis, however, their relationship is not fully elucidated. This study aimed to evaluate the association between halitosis measures, clinical indicators of periodontitis and tongue coating, as well as a novel measure, periodontal inflamed surface area (PISA). MATERIAL AND METHODS: Data of 10 patients with periodontitis and halitosis were included in this study. Halitosis was assessed by the organoleptic method and the portable sulphide monitor, measuring volatiles sulphur compounds. A comprehensive periodontal examination was conducted, and the parameters of probing depth, gingival recession, clinical attachment level, bleeding on probing, plaque and tongue coating were registered. The PISA was calculated using clinical attachment level, gingival recession and bleeding on probing. RESULTS: A correlation between organoleptic score and tongue coating (r=0.554) and plaque (r=0.614) could be observed. No correlation between measures of halitosis and probing depth or the PISA could be detected. A significant correlation was found between organoleptic scores and volatiles sulphur compounds values (r=0.931). CONCLUSION: This pilot study has shown and further reiterated a complex interplay between different factors causative to halitosis in patients affected by periodontitis. The results suggest that tongue coating and oral hygiene may have an important role in halitosis in patients with periodontitis.

Assessment of Health-Promoting Lifestyle among Dental Students in Zagreb, Croatia.

As future healthcare professionals, dental medicine students are expected to exhibit healthy lifestyle behaviors. This study aims to assess the health-promoting behaviors among undergraduate dental medicine students of all six academic study years at the University of Zagreb, and determine their predictors. Students were invited to complete a two-part survey, consisting of a self-reported sociodemographic questionnaire and the Health-Promoting Lifestyle Profile II (HPLP II). Three hundred and forty-nine students completed the survey; the response rate was 60.3%. The total mean HPLP II score was 2.64 ± 0.34. Students in the second academic study year scored the lowest (2.50 ± 0.33), and students in the sixth academic study year scored the highest (2.77 ± 0.32). Health responsibility was the overall lowest scored subcategory, while interpersonal relations was scored the highest. Female students reported lower spiritual growth and stress management than male students. Higher body mass index (BMI) was related to lower health responsibility. Smoking, place of residence and the age of participants did not seem to have an impact on health-promoting behaviors. Dental students at our faculty exhibit moderate health-promoting behaviors, even in the absence of a formal health-promoting course in the existing curriculum.

Is periodontitis and its treatment capable of changing the quality of life of a patient?

While clinical indicators, or so-called surrogate outcomes in periodontology, allow us to assess periodontal health and evaluate outcomes of periodontal therapy from a clinician's perspective, they cannot be used to evaluate patients' subjective perceptions of their health status or satisfaction with the received treatment. These can be assessed through patient-based outcomes, such as quality of life. The aim of this paper is to give an overview of the multidimensional concept of oral health-related quality of life (OHRQoL), its measures and association with plaque-induced, inflammatory periodontal diseases. Periodontitis and its clinical consequences, such as tooth loss, have a considerable negative effect on OHRQoL, while periodontal treatment and alleviation of the symptoms can lead to improvement in OHRQoL. Implant rehabilitation of missing teeth also seems to positively influence OHRQoL.

Anxiety and Depression Scores in Patients with Burning Mouth Syndrome.

BACKGROUND: Burning mouth syndrome is a condition of unknown etiology, characterized by burning symptoms on the otherwise clinically healthy oral mucosa. Central and/or peripheral neuropathy is one of the proposed causes for this condition. Psychological component in these patients is also very present, as it is known that BMS patients exhibit high levels of pain, anxiety, and depression. The aim of this study was to evaluate anxiety and depression among patients with burning mouth syndrome and a control group. We also further review and discuss the literature available on this subject. SUBJECTS AND METHODS: A total of 93 subjects, divided into two groups, participated in this study. The group of patients with BMS included 43 participants, while the control group consisted of 50 participants. Self-reported STAI (State anxiety and Trait anxiety) and BDI questionnaires were used to evaluate anxiety and depression in subjects in both groups. RESULTS: BMS group had higher average total scores of state anxiety, trait anxiety and depression. The difference between the BMS group and control group was statistically significant for state anxiety scores and BDI scores. CONCLUSION: We might conclude that BMS patients are more anxious (state) and depressed when compared with the control group. However, they do not differ from the control group regarding anxiety as a trait. Thus we might conclude that feeling of anxiety in general starts after the BMS symptoms first occur and last for a longer period of time.

Quorum Sensing of Periodontal Pathogens.

The term 'quorum sensing' describes intercellular bacterial communication which regulates bacterial gene expression according to population cell density. Bacteria produce and secrete small molecules, named autoinducers, into the intercellular space. The concentration of these molecules increases as a function of population cell density. Once the concentration of the stimulatory threshold is reached, alteration in gene expression occurs. Gram-positive and Gram-negative bacteria possess different types of quorum sensing systems. Canonical LuxI/R-type/acyl homoserine lactone mediated quorum sensing system is the best studied quorum sensing circuit and is described in Gram-negative bacteria which employ it for inter-species communication mostly. Gram-positive bacteria possess a peptide-mediated quorum sensing system. Bacteria can communicate within their own species (intra-species) but also between species (inter-species), for which they employ an autoinducer-2 quorum sensing system which is called the universal language of the bacteria. Periodontal pathogenic bacteria possess AI-2 quorum sensing systems. It is known that they use it for regulation of biofilm formation, iron uptake, stress response and virulence factor expression. A better understanding of bacterial communication mechanisms will allow the targeting of quorum sensing with quorum sensing inhibitors to prevent and control disease.