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.

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.

Comparison of Shear Bond Strength of Orthodontic Brackets Using Direct and Indirect Bonding Methods in Vitro and in Vivo.

AIM: Aim of article was to compare the shear bond strength of indirectly and directly bonded orthodontic brackets. MATERIALS AND METHODS: The experimental in vitro study included 60 maxillary and mandibular premolars. Teeth were mounted on cold-cure acrylic blocks for each tooth separately and divided into two groups: directly bonded brackets (30 teeth) and indirectly bonded brackets (30 teeth). Brackets (Discovery, Roth 0.022", Dentaurum, Ispringen, Germany) were bonded using Transbond XT (3M Unitek, Monrovia, CA, USA) in direct method, while in indirect technique, a combination of Transbond XT and Sondhi Rapid Set (3M Unitek, Monrovia, CA, USA) was used. The shear bond strength and adhesive remnant index (ARI) were evaluated. The in vivo study included 30 subjects - 15 with indirectly bonded brackets and 15 with directly bonded brackets. Survival rate was assessed during the period of 6 months. RESULTS: No statistically significant difference in the shear bond strength was found in direct (7.48±1.61 MPa) and indirect labial bonding methods (7.8.2±1.61 MPa). Both methods produced very similar amount of adhesive remnant on tooth surface (median = 1; interquartile range 1-2). There were no significant differences in bracket survival rate between methods. CONCLUSION: Regarding the shear bond strength, adhesive remnant on tooth surface, and survival rate, both indirect and direct methods of orthodontic bracket bonding seem to be equally valuable methods in clinical practice.

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.

The prevalence and severity of early childhood caries in preschool children in the Federation of Bosnia and Herzegovina.

OBJECTIVE: The aim of this study was to assess caries prevalence and severity in preschool children in the Federation of Bosnia and Herzegovina. In addition, the relationship between the frequency and clinical types of early childhood caries and behavioral factors, oral hygiene and eating habits were assessed. SUBJECTS AND METHODS: An oral health survey was performed in line with the World Health Organization methodology and criteria. The research consisted of clinical examinations of children to determine dentition status, oral hygiene and severity of caries distribution according to Wyne's classification. Information about behavioral factors was collected by means of a questionnaire administered to parents/guardians. RESULTS: The sample consisted of a total of 165 preschool children aged 3-5 years. Mean dmft (decay, missing, filled teeth index for primary dentition) was 6.79. The percentage of caries-free children was 17.0%. The results showed a statistically significant correlation between oral hygiene and eating habits, and also the frequency and types of early childhood caries. CONCLUSION: The present study demonstrates high caries prevalence in preschool children in the Federation of Bosnia and Herzegovina. Community based preventive programs should be developed and urgently implemented, in order to achieve the WHO goals, improve oral and general health, thus improving the quality of life of these populations.

Cariogenic Potential of Inhaled Antiasthmatic Drugs.

INTRODUCTION: The organism of children with asthma is exposed to the effects of the disease but also the drugs for its treatment. Antiasthmatic drugs have different modes that promote the caries formation which varies according to their basic pharmacological composition. Namely, these drugs have a relatively low pH (5.5), can contain sweeteners such as lactose monohydrate in order to improve the drug taste or both. Frequent consumption of these inhalers in combination with reduced secretion of saliva increases the risk of caries. MATERIAL AND METHODS: The study sample consisted of 200 patients, age from 7-14 years, divided into two groups: control group (n1 = 100) consisted of healthy children and the experimental group consisted of children suffering from asthma (n2 = 100). In both groups of respondents are determined the DMFT index, plaque index value and hygienic-dietary habits using the questionnaire. The subjects in the control group had significantly higher DMFT index than subjects in the experimental group (p = 0.004). It is determined that there are no significant differences in the values of plaque index (p>0.05). CONCLUSION: The effect of different diseases or medications from their treatment, diet and fermentable carbohydrates in the etiology of dental caries cannot be observed outside the living conditions of subjects, their social epidemiologic status, age, habits, oral hygiene, fluoride use, etc.

Antiasthmatic Inhaled Medications as Favoring Factors for Increased Concentration of Streptococcus Mutans.

INTRODUCTION: The negative impact of inhaled antiasthmatic drugs (IAD) on oral health is reflected primarily in the increased incidence of caries in asthmatic children compared to healthy children. It is believed that one of the causes of the increased incidence of caries in asthmatic children is from bronchodilator effect in reduced secretion of saliva. Decreased salivation favors bacterial colonization and studies have shown that the concentration of Streptococcus mutans, a bacterium that has the primary role in the development of caries, is higher in asthmatic than in healthy children. MATERIAL AND METHODS: The study sample consisted of 200 patients, age from 7-14 years, divided into two groups: control group (n1 = 100) consisted of healthy children and the experimental group consisted of children suffering from asthma (n2 = 100). In both groups of respondents are identified the DMFT values, the concentration of Streptococcus mutans, the amount of stimulated saliva and plaque index value. RESULTS: It was found that there are significant differences in the values of plaque index, salivary index and streptococcus mutans between the control and experimental groups (p> 0.05 for each of the examined variables). Those in the control group had significantly higher DMFT index than subjects in the experimental group (p = 0.004). CONCLUSION: IAD does not cause reduced saliva production and thus do not represent a factor favoring increased concentration of Streptococcus mutans.

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.

In vitro fluoride release from a different kind of conventional and resin modified glass-ionomer cements.

Fluoride release is important characteristic of glass-ionomer cements. Quantity of fluoride ions released from the glass-ionomer cements has major importance in definition of their biological activity. The objectives of this study were to define the quantity of fluoride ions released from the experimental glass-ionomer cements and to define the effect of fluoride ions released from the experimental glass-ionomer cements on their cytotoxicity. Concentrations of the fluoride ions released in the evaluated glass-ionomer cements were measured indirectly, by the fluoride-selective WTW, F500 electrode potential, combined with reference R503/D electrode. Statistical analyses of F-ion concentrations released by all glass-ionomers evaluated at two time points, after 8 and after 24 hours, show statistically higher fluoride releases from RMGICs: Vitrebond, Fuji II LC and Fuji Plus, when compared to conventional glass-ionomer cements: Fuji Triage, Fuji IX GP Fast and Ketac Silver, both after 8 and after 24 hours. Correlation coefficient between concentrations of fluoride ion released by evaluated glass-ionomer cements and cytotoxic response of UMR-106 osteoblast cell-line are relatively high, but do not reach levels of biological significance. Correlation between concentrations of fluoride ion released and cytotoxic response of NIH3T3 mouse fibroblast cell line after 8 hours is high, positive and statistically significant for conventional GICs, Fuji Triage and Fuji IX GP Fast, and RMGIC, Fuji II LC. Statistically significant Correlation coefficient between concentrations of fluoride ion released and cytotoxic response of NIH3T3 cell line after 24 hours is defined for RMGIC Fuji II LC only.

A comparison of the in vitro cytotoxicity of conventional and resin modified glass ionomer cements.

To evaluate cytotoxicity of experimental conventional and resin modified glass-ionomer cements on UMR-106 osteoblast cell cultures and cell cultures of NIH(3)T(3) mouse fibroblasts specimens were prepared for every experimental material and divided into: group 1.Conventional glass-ionomer cements: GC Fuji IX GP Fast, GC Fuji Triage and Ketac Silver; group 2. Resin modified glass-ionomer cements: GC Fuji II LC, GC Fuji Plus and Vitrebond; group 3. Positive control was presented by specimens of composite Vit-l-ecence® and negative control-group 4. was presented by α-minimum essential medium for UMR-106 - osteoblast-like cells and Dulbecco's Modified Eagle's Medium for NIH(3)T(3) mouse fibroblast cells. Both cell cultures were exposed to 10% of eluate of each single specimen of each experimental material. Experimental dishes were incubated for 24 h. Cell metabolism was evaluated using methyltetrazolium assay. Kruskal-Wallis test and Tukey-Kramer post hoc test for the materials evaluated on NIH(3)T(3) mouse fibroblast cells, as well as UMR-106 osteoblast-like cells showed significantly more cytotoxicity of RMGICs, predominantly Vitrebond to both GICs and composite- Vit-l-ecence®.The lowest influence on cell's metabolism on UMR-106 osteoblas-like cells was shown by Ketac Silver and the lowest influence on cell's metabolism on NIH(3)T(3) mouse fibroblast cells was shown by Fuji IX GP Fast. Statistical evaluation of sensitivity of cell lines UMR-106 osteoblast-like cells and NIH(3)T(3) mouse fibroblast cells, using Mann-Whitney test, showed that NIH(3)T(3) mouse fibroblast cells were more sensitive for the evaluation of cytotoxicity of dental materials.

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.

Oral health related to demographic features in Bosnian children aged six.

The main aim of this paper is to present epidemiological indicators of oral health among six-year olds in Bosnia and Herzegovina (BH) and to analyze values of dmft index and dental treatment needs in order to identify differences in parts of the country. Another aim is to identify the needs from the public oral health care system in Bosnia and Herzegovina related to early permanent dentition by analyzing the condition of first permanent molars (FPM) as an indicator of oral health of permanent dentition. Survey was carried out in 2004 in 8 cantons of the Federation of BH (FBH) and in the Republic of Srpska (RS). Final sample included 560 participants aged six (mean 6.2, SD +/- 0.87). One dental team clinically examined all participants according to WHO methodology and criteria. The parameters used were: dmft index, DMFT index of first permanent molars (FPM), presence of sealants and treatment needs. A questionnaire about oral health habits had been administered. Dmft was 6.71 in that the d-component constituted the major part of the index. DMFT index of FPM was 0.61 (SD +/- 1.08). Percentage of caries free participants aged 6 was 6.8%. Average number of FPM with fissure sealants in BH was 0.25 (SD +/- 0.78). Significant demographic differences in dmft index, DMFT FPM and treatment needs were identified. Most participants (48.5%) had their first dental visit between the ages of five and seven. National oral health goal for Bosnia and Herzegovina should be to develop and implement disease prevention programs based on education of both parents and dental practitioners. It is necessary to improve access to dental care and shift focus from curative to preventive procedures. It is also necessary to set real goals for improvement of oral health which can be achieved within a desired time frame, as well as to precisely define measures to be taken.

Caries risk assessment in Bosnian children using Cariogram computer model.

AIM: To examine caries risk using the Cariogram model, interactive PC program for caries risk evaluation in 12-year-old children and to correlate caries risk in children of different socioeconomic backgrounds. MATERIAL AND METHODS: 109, Sarajevo 12-year-olds in three groups based on socioeconomic background. Baseline data on general health condition, diet frequency and use of fluoride were obtained. DMFT and plaque scores were calculated. Saliva analyses included lactobacillus and mutans streptococci levels in saliva, saliva secretion and buffer capacity. Scores were entered into the Cariogram model and risk was calculated for each child. RESULTS: Most 12-year-old children have a medium risk of caries, with a 59.4% chance of avoiding future caries. In an average caries risk profile of children from Sarajevo the dominant sector is diet, with 12.5% risk; bacteria sector (plaque and mutans streptococci level) 10.8% risk; susceptibility (fluoride, saliva secretion and buffering capacity) 9.7% risk; circumstances (caries experience and medical history) 7.4% risk. Caries risk profiles showed that there are differences in the socioeconomic status of children with significantly greater risk in children with poor living conditions who also have the most unfavourable caries risk profiles. CONCLUSIONS: The Cariogram model can successfully determine caries risk profiles for 12-year-old children of different socioeconomic status and can be used in developing preventive strategies for reducing caries risk in children.