Understanding and Practices of Oral Hygiene in the Intensive Care Units: Perspectives of Medical Staff at Two University Hospital Centers.

Objective: This study assesses the knowledge, practices, and attitudes of medical staff in intensive care units (ICUs) regarding oral hygiene care for critically ill, bedridden patients. Material and methods: A cross-sectional study included 65 employees from the Intensive Care Units of the Sestre Milosrdnice Clinical Hospital Centre (CHC SM) and the Clinic for Anesthesiology and Intensive Care at the University Clinical Hospital Centre Zagreb (CHC ZG). A self-administered questionnaire was used to assess knowledge, methods, frequency, and attitudes towards oral care for mechanically ventilated patients. The data were examined through descriptive statistical methods, presented in terms of proportions (percentages). For the purpose of comparing the feedback across the two hospital centers and different educational backgrounds, the Chi-square and Fisher's exact tests were employed. Results: Results of a survey of 65 participants (18 from CHC SM and 47 from CHC ZG) revealed a notable disparity in oral hygiene knowledge, with graduate nurses displaying the highest proportion of adequate knowledge (100%) and regular nurses showing the least (30.3%) (p<.001). Although the execution of oral care practices did not vary significantly among the groups, graduate nurses performed oral care more frequently (80% vs. baccalaureate technicians 33.33% and nurses 57.6%, three or more times a day) and demonstrated better proficiency in both mechanical (p=.005) and chemical (p<.001) biofilm management compared to their counterparts. No significant difference was observed in the delivery of oral care to orotracheally intubated patients across different educational levels (p=.127). However, a marked difference was noted in the perception of being adequately trained for such care, with nurses feeling less prepared (12.1%, p<.001). Despite these variances, all respondents recognized the importance of oral hygiene, thus showing a strong dedication to oral health care. Conclusions: This study highlights variability in ICU oral hygiene practices and points to the importance of standardized care protocols and improved training for healthcare staff.

Assessment of dental students' knowledge of infection control and prevention during the COVID-19 pandemic.

INTRODUCTION: Since the start of the COVID-19 pandemic, new guidelines for dental practice were published. This research aims to examine the knowledge of dental students and their attitudes towards current guidelines. MATERIALS AND METHODS: The study involved 76 fourth-year dental medicine students from three public universities in Croatia. A survey questionnaire was developed based on in-depth interviews and a pilot pretesting. The online questionnaire consisting of 36 questions was published using Google Forms. The survey data were analysed using Microsoft Excel and presented with descriptive statistics. RESULTS: Survey data showed the dental students' knowledge of the guidelines for dental practices is at an insufficient level (average score of 67% correct answers). Students who have come across the guidelines outside the faculty environment through assistantships have demonstrated lesser knowledge (65%) of the guidelines than the ones who do not (68%). A similar trend is observed with dental students who grew up in a family of doctors of dental medicine (61%) and ones who did not (68%). Students also independently assessed their knowledge of the guidelines as moderate (3.15 out of 5), while evaluating the application of current guidelines as very important (4.38 out of 5). CONCLUSION: Awareness of dental students should be improved by adapting the curriculum of dental studies and increasing the availability of information on current guidelines. Dental students need to be motivated to independently inform themselves about the current guidelines for dental practices, thus improving their clinical work.

Treatment priorities and arrival time of traumatic dental injuries-An 8-year retrospective study.

BACKGROUND/AIM: Most of the previous studies in the available literature discussed the time of arrival in general to the healthcare system, while a minority studied the relationship between the type of trauma and arrival. The aim of this retrospective study is to assess the arrival time of traumatic dental injuries (TDIs) depending on the urgency of treatment according to Andreasen. MATERIALS AND METHODS: This 8-year retrospective study was carried out at the Department of Pediatric Dentistry at the University Dental Clinic in Zagreb, Croatia. Andreasen's classification was used to define the kind of TDI as well as to divide them by the need for urgent treatment or treatment priorities in three groups: acute, subacute, and delayed. RESULTS: The sample consisted of 1040 children (59% male and 41% female) with a median age of 7. Each year, the age group most affected by TDIs was 6-12 years old. While there is a general increase in the prevalence of TDIs overall, there is a decline in TDIs among children aged 6-12 and an increase among preschoolers and adolescents (below 6 and above 12 years old). Throughout the years, 52.73% red/acute and 41.16% yellow/subacute TDIs were not treated on time due to delayed arrival. More patients from Zagreb come in the first 24 h, while more patients from outside Zagreb come to the clinic a month or more after their injuries. Patients which suffered TDI accompanied with soft-tissue injury arrived sooner. CONCLUSIONS: It is necessary to introduce monitoring and education of patients under the age of 6 and over 12, as well as their parents/caregivers. New programs should be implemented and new referent centers that specialize in treating TDIs outside of Zagreb should be established.

Relationship between COMT Gene Polymorphism, Anxiety, and Pain Perception during Labour.

BACKGROUND: The COMT gene polymorphism is associated with neurological and psychiatric disorders and pain perception. The present study investigates the existence of anxiety and pain perception in relation to the COMT (catechol-O-methyltransferase) gene polymorphism in labouring women (during "natural" childbirth) with or without inhaled analgesia. METHODS: A total of 181 women who chose vaginal birth were enrolled in this study. To present the difference in pain perception, the parturients were divided into one group (n = 90) that chose labour analgesia with inhaled nitrous oxide (50% nitrous oxide and 50% oxygen) and one group (n = 91) without analgesia. The blood samples were taken during the pregnancy as a part of routine pregnancy controls in the hospital. The COMT gene polymorphism was detected with the PCR technique. The pain perception of parturients was self-evaluated two times according to the VAS (Visual Analogue Scale), and anxiety as a personality trait was determined with the STAI-T (State Trait Anxiety Inventory). Pain perception as well as anxiety were compared according to COMT genotypes. RESULTS: In the 181 pregnant women, there were 40 women (22%) of wild homozygotes (GG) of COMT, 95 women (53%) of mutant heterozygotes (GA), and 46 women (25%) of mutant homozygotes (AA). A negative association of pain perception with the GA (mutant heterozygote) polymorphism of the COMT gene versus the wild-type (GG polymorphism) was observed. The GA polymorphism of the COMT gene was associated with 0.46 units lower pain perception compared to the wild type (GG). The anxiety trait score in group AA was lower than in groups GA and GG. The difference reached statistical significance only when comparing AA versus GA (p > 0.042). Analgesic efficacy of nitrous oxide was noticed in 22% of labouring women who reported moderate pain (VAS score 4-7). CONCLUSIONS: The COMT gene polymorphism was associated with pain perception and anxiety among parturients. The COMT gene polymorphism GA was associated with negative pain perception among labouring women. Nitrous oxide showed statistical significance in anxiolytic efficacy during labour in women with mild anxiety as a personality trait. Anxiolytic efficacy of nitrous oxide has shown better efficacy in parturients with the COMT gene polymorphism AA.

Assessment of Cytotoxic and Genotoxic Effect of Modern Dental Materials in vivo.

Objectives: The aim of the study was to assess the biocompatibility of modern composite and amalgam dental fillings. Material and Methods: The research was conducted on 150 healthy patients between the ages of 10 and 20 who had amalgam and composite fillings between 6 and 12 months. Under in vivo conditions, a swab of buccal cells near the fillings was taken, and the cytotoxic and genotoxic impact of composite and amalgam fillings on these cells was analyzed using the extended micronucleus test (cytomeassay). Results: The results showed statistically significant differences between the groups of subjects with amalgam and composite fillings and subjects without fillings for the following parameters: number of micronuclei (p=0.006), number of buds (p<0.001), number of binuclear cells (p<0.001), number of nucleoplasmic bridges (p<0.001).The number of micronuclei was statistically significantly higher in the group of subjects with amalgam and composite fillings compared to the group without fillings. The results for nuclear buds, for the number of binuclear cells and the number of nucleoplasmic bridges showed that the group with amalgam fillings had a statistically significantly higher number of these changes compared to other groups.The results of the analysis of the relationship between the parameters of the micronucleus test and the number of amalgam and composite surfaces did not show statistically significant values. Parameters indicating cell cytotoxicity were not statistically significantly elevated in subjects with fillings. The results of the analysis of the influence of the patients' lifestyle on the results of the micronucleus test showed statistically significant results for certain predictors (diagnostic X-ray radiation, coffee consumption, consumption of cooked, dried meat and baked food). Conclusion: Based on the results, it can be concluded that the buccal cells of subjects with amalgam fillings showed the highest degree of genotoxic changes, followed by those with composite fillings and the least buccal cells of patients without fillings.

Relationship between Children's and Parents' Dental Anxiety: A Cross-Sectional Study on the Six European Countries.

Background: The purpose of this study is to investigate the relationship between children's and parents' dental anxiety. Methods: 731 children of different ages and their parents from six European countries participated in this study. Dental anxiety was investigated through an online questionnaire, which consisted of general questions and the Corah Dental Anxiety Scale (CDAS), which is a questionnaire that measures respondents' reactions on a 5-point scale for four different situations. Results: CDAS results were calculated for all children and their parents. A total of 12.5% of children from Croatia, 26.67% from Macedonia, 10.94% from Bosnia and Herzegovina, 20.31% from Montenegro, 23.08% from Slovenia and 16.10% from Serbia showed a high level of anxiety. The correlation between dental anxiety of parents and children was 0.4 (p < 0.01). Conclusions: Parents with negative experience from a dental office can have a bad effect on their child's behaviour, which results in the creation of a non-active patient. Due to the clear and existing cause-and-effect relationship of dental anxiety in children and parents, it is extremely important to educate parents about the proper psychological approach to children in order to promote positive experiences from dental offices, as well as to emphasize the importance of regular visits to the dentist.

Retention and caries-preventive effect of four different sealant materials: A 2-year prospective split-mouth study.

AIM: The aim of this observational split-mouth study was to compare the retention and caries protective effect of four different sealant materials in children aged 6-13 years during a 2-year follow-up period. DESIGN: Eighty children were included in this study, which was conducted in Blato (Korcula island), Croatia. Each participant received at least two different sealant materials on caries-free permanent molars in two different quadrants. Sealant materials (M1 - glass-ionomer cement; M2, M4 - resin-based filled sealants; M3 - resin-based unfilled sealant) were delivered in a random order. RESULTS: The results of this study showed that M2 (30 teeth, 46.2%) and M4 (27 teeth, 46.6%) showed statistically significantly higher number of teeth with total retention after 2-year follow-up period, in comparison with M1 (10 teeth, 19.2%) or M3 (12 teeth, 20.7%) (p < .001). There was no statistically significant difference in caries occurrence between different groups in which the sealant material was totally retained. CONCLUSIONS: According to the results of this study, filled resin-based sealant materials showed better retention during the 2-year follow-up period while both resin-based and glass-ionomer sealants demonstrated protection against dental caries if totally retained on the occlusal surface.

Self-Massage and Low-Level Laser in Treatment of Masseter Myalgia: Short-Term Effect.

INTRODUCTION: The aim of this study was to explore the efficiency of massage in the treatment of masseter myalgia compared with biostimulatory laser. MATERIALS AND METHODS: The instrument Diagnostic Criteria for Temporomandibular Disorders was used to select subjects and monitor treatment outcome. 54 subjects with masseter myalgia of more than 3 months in duration were invited to participated and 42 cases were available at the end and analyzed. Age range was 16-67 years (median 33, interquartile range 25-53), 36% subjects was ≥40 years and there were 62% females in both groups. Both treatment groups (self-massage and laser) had 21 participants and were monitored one months after the start of treatment. Age, gender, distress, somatization, catastrophizing, hypervigilance, health competence and oral parafunctions were also assessed as factors that could influence effectiveness of treatment. RESULTS: Laser and massage are effective in reducing symptoms of chronic myalgia of the masseter in self-reported limitation of jaw function and reducing pain intensities (p<0.001). Increase of mouth opening was present in both groups, but mainly significant in laser group. The differences in the amount of change between groups were not significant. Psychological characteristics and parafunctions, present before the treatment, age and gender did not have major affect the effectiveness of treatment. CONCLUSION: Both treatment modalities are effective in treatment of chronic myalgia in short-term.

Influence of Different Surface Pretreatments of Zirconium Dioxide Reinforced Lithium Disilicate Ceramics on the Shear Bond Strength of Self-Adhesive Resin Cement.

AIM: To analyze the influence of different surface pretreatments of zirconium dioxide reinforced lithium disilicate ceramics on the shear bond strength of self-adhesive resin cement. MATERIALS AND METHODS: Eighty-four zirconium reinforced lithium disilicate disc Vita suprinity (Vita Zahnfabrick, Bad Säckingen, Germany) 14x12x2 mm specimens were fabricated according to the manufacturer's recommendations. The specimens were embedded in acrylic resin blocks and randomly divided in seven groups (n=12/each) accorrding to the treatment: Group 1- 10% hydrofluoric acid; Group 2- silane; Group 3- hydrofluoric and silane; Group 4- sandblasting with silane; Group 5- Er: YAG laser+ silane; Group 6- Nd: YAG laser + silane; and the control group, in which the specimens were not treated. Round shape composite discs (Filtek Bulk fill, 3M ESPE, St.Paul, Minnesota, USA) with 3.5 mm diameter, were made for shear bond strength testing, and then cemented to the ceramic sample surface using composite cement (RelyX U200 Automix, 3M ESPE, Neuss, Germany). After cementing the composite disc on the sample, the samples were subjected to shear bond strength test of 10 N with a "stress rate" of 1 MPa / s. To determine the nature of the fracture (adhesive, cohesive or adhesive-cohesive), the broken samples were examined under a stereomicroscope. The ANOVA test and the Tukey test were used to compare the values ​​of the bond strength characteristics between different types of materials. All tests were performed with a significance level of α = 0.05. RESULTS: There was a significant difference in the shear bond strength of self-adhesive cement to dental lithium-disilicate ceramics reinforced with zirconium dioxide after different preparation protocols (p<0, 05). The treatment of lithium disilicate ceramics reinforced with zirconium dioxide by silanization, sandblasting + silanization, Nd: YAG + silanization resulted in significantly higher bond strength compared to the control group. There was statistically higher bond strength of self-adhesive cement after pretreatment of lithium disilicate ceramics Nd: YAG + silanization compared to Er: YAG + silanization (p <0.05). Adhesive fracture dominated in the control group, sandblasting + silanization group, and in the laser groups, while mixed fracture dominated in other groups. CONCLUSION: Under the limitations of this study, the Nd:YAG irradiation with silanization could be used as pretreatment for providing greater shear bond strength of self-adhesive resin cement to zirconium reinforced lithium disilicate.

The Best Dentistry Professional Visual Acuity Measured under Simulated Clinical Conditions Provides Keplerian Magnification Loupe: A Cross-Sectional Study.

Visual acuity plays an important role in dentists' vision in their daily clinical routine. This study aimed to determine dental students' visual acuity without optical aids and when using magnification devices in simulated clinical conditions. The participants were forty-six students at the School of Dental Medicine with a visual acuity of 1.0 in decimal values or 100% in percentage. The central visual acuity was tested using a miniature Snellen eye chart placed in the molar cavity of a dental phantom, in simulated clinical conditions under five different settings (natural visual acuity, by applying head magnifying glasses x1,5 and binocular magnifying devices using Galileo's x2,5/350 mm, Keplerx3,3/450 mm and Keplerx4,5/350 mm optical system). The Wilcoxon Signed Rank test shows that the distribution of measurements of the visual acuity undertaken by the application of magnifying devices (VNL, VGA2,5, VKP3,3, VKP4,5) contained higher values of visual acuity than those received by the use of natural vision (VSC) (p < 0.001 for the comparison to the VNL, VGA2,5, VKP3,3 and VKP4,5 groups). The highest and statistically most significant increase in visual acuity is achieved using the Keplerian telescope x4.5/350 mm. The application of magnifying devices provided dentistry professionals with better visual acuity, improving detail detection in an oral cavity during dental procedures by magnifying the oral structure. The use of magnification devices means much more precise work, decreases the operating time, improves posture and reduces muscle pain in the shoulder during dental treatment.

The Effect of Transcoutaneous Electrical Nerve Stimulation on Pain Control during Dental Procedure in Children 9-14 Years Old.

INTRODUCTION: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological method widely used by medical specialists to manage acute and chronic pain in different circumstances. It can be used to manage pain during many dental procedures, as well as pain due to various conditions affecting the maxillofacial region. The aim of this study was to provide insight into the clinical research evidence for the analgetic application of TENS in pediatric patients. The hypothesis was that TENS device will achieve analgetic effect on teeth during dental procedure. METHODS: This study included 125 patients treated at the School of Dental Medicine, University of Zagreb clinic during two-year period. After diagnosis of caries and need for restorative treatment, patients were randomly selected in three groups. Group 1 received local anesthesia, group 2 had no anesthesia and group 3 used TENS device. Level of pain was measured with Visual Analogue Scale (VAS). Research was conducted by one therapist that was calibrated. RESULTS: We found no statistically significant difference between TENS group and group without anesthesia(p>0.05). CONCLUSION: TENS device is not as efficient in achieving analgetic impact during dental procedure as local anesthesia.

THE ROLE OF NEW TECHNOLOGIES IN DEFINING SALIVARY PROTEIN COMPOSITION FOLLOWING PLACEMENT OF FIXED ORTHODONTIC APPLIANCES - BREAKTHROUGH IN THE DEVELOPMENT OF NOVEL DIAGNOSTIC AND THERAPEUTIC PROCEDURES.

Human saliva is rich in proteins of variable functions (e.g., enzymes, immunoglobulins, cytokines) and origin (blood plasma, salivary glands, or oral microflora). Circadian dynamics, volume and composition (electrolytes, pH, protein, etc.) of secreted saliva vary with local and systemic physiological and pathophysiological conditions. Therefore, the composition of saliva, protein in particular, has been intensively investigated to identify the potential markers and/or mechanisms of systemic and local diseases. Proteomic techniques used for the analysis of biological fluids have enabled great advances in salivary protein stabilization (as the main precondition for their analysis) and detection of those found in saliva in very low concentrations, including small proteins and peptides. This review brings the main characteristics of current proteomic techniques such as liquid chromatography-mass spectrometry, two-dimensional electrophoresis-mass spectrometry, and surface-enhanced laser desorption ionization/time of flight/mass spectrometry. These techniques enable simultaneous identification of hundreds and thousands of protein molecules, as well as identifying those of a potential biological value in particular states. This literature review is focused on the state-of-the-art and possibilities offered by proteomic techniques in analyzing the effects of orthodontic appliances on salivary protein composition and searching for potential markers of therapeutic success/failure or for the molecules by which therapeutic effects are achieved.

The Effect of Transcutaneous Electric Nerve Stimulation (TENS) on Anxiety and Fear in Children Aged 9-14 Years.

INTRODUCTION: Dental fear or dental phobia is caused by previous unpleasant dental experiences and pain. It can result in delaying or avoiding dental visits. Most often it leads to individuals avoiding visiting the dentist until physical pain completely impairs the quality of life. OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) is a method of pain relief involving the use of a mild electrical current. The main aim of this study was to examine whether the TENS device affects the reduction of anxiety and fear during dental procedures. MATERIAL AND METHODS: The study was conducted on a sample of 125 respondents, aged 9-14 years. Statistical significance of differences between pre- and post-treatment results on all applied measuring instruments was verified by the t-test for dependent samples. The calculation was performed for all respondents and individually for the three observed groups. The Children`s Fear Survey Schedule - Dental Subscale test was used to assess anxiety and fear. RESULTS: The results on the CFSS-DS scale in all subjects did not differ statistically significantly before and after treatment (p > 0.05). The results on the CFSS-DS scale in subjects who received TENS were statistically significantly different before and after treatment (p < 0.01). The results on the CFSS-DS scale in subjects who received local anesthesia were statistically significantly different before and after treatment (p < 0.05). CONCLUSION: The TENS device had an anxiolytic effect after the first visit.

Clinical and patient reported outcomes of bleaching effectiveness.

OBJECTIVE: The objective of this study is to evaluate clinical and patient reported outcomes of different bleaching products. MATERIALS AND METHODS: Thirty participants were randomly divided into three bleaching groups (n = 10). Bleaching was performed with high concentrations of hydrogen peroxide (HP) - Boost (40%) and Dash (30%), and with prefabricated splints Bite&White (6% HP). Tooth colour was measured before, immediately after, and 1 and 6 months after the bleaching by using classical shade guide and spectrophotometer. Tooth hypersensitivity was self-rated by patients on the Wong-Baker's face scale. Patient satisfaction was evaluated on a 7-point Likert-type scales that measured perceived performance and importance of different characteristics of bleaching treatment. RESULTS: All products were effective in teeth colour change (ΔE > 3.3), which was significantly higher for Boost (p = .016) and Dash (p = .024) than Bite&White treatment. Perception of hypersensitivity was the highest in Boost group, followed by Dash and Bite&White treatment. Most of the patients were satisfied with final tooth colour, length and comfort during treatment, but were dissatisfied with the stability of bleached tooth colour. CONCLUSION: Materials with the higher concentrations of bleaching agent demonstrated greater bleaching effectiveness than at-home bleaching product, but also a greater hypersensitivity. Lengthening the treatment process, but achieving a more stable tooth colour may improve the perceived value of a bleaching service.

General dentists' awareness of how to cope with medical emergencies in paediatric dental patients.

BACKGROUND: General dentists (GDs) should be aware of the symptoms, signs, diagnoses and treatment of medical emergencies in paediatric patients. AIM: To evaluate the knowledge of GDs in coping with medical emergencies, and to identify whether they are confident to diagnose and treat medical emergencies in paediatric patients. DESIGN: The questionnaire was conducted immediately before the beginning of national dental meetings and continuing education seminars in Croatia, attended by the GDs, in order to obtain a representative sample. RESULTS: Of a total of 498 GDs who returned the questionnaire with valid data, 51.2% reported that a medical history was regularly taken. A high proportion (81.3%) of the GDs had never received any basic life support (BLS) training and education for paediatric patients during their undergraduate studies. After graduation, this value rose to 86.1% of GDs. However, more than two-thirds (68.7%) had experienced some emergency situation in their practice. The most frequent emergency was vasovagal syncope (83.6%) and the most rare was cardiac arrest (8.2%). One-fifth (20.5%) of GDs experienced some emergency but could not make a diagnosis. The more BLS training undergone by a GD, the more self-confident s/he felt in an emergency situation. CONCLUSIONS: Most GDs have a lack of knowledge to cope with medical emergencies in paediatric patients, and do not feel confident to diagnose and treat emergency situations in children. It is suggested that adequate training and education should be provided for all GDs to address this shortcoming.

Dental Fear in Children with Repeated Tooth Injuries.

Tooth injuries are serious clinical conditions. Some children experience dental trauma only once, while others are more prone to repeated tooth injuries. Repeated dental trauma occurs in 19.4% to 30% of patients. Pain and dental trauma are the most common reasons for fear and anxiety. The main objective of this study was to investigate how dental trauma, as well as repeated dental trauma affects the occurrence and development of dental fear in children. The study was conducted on a random sample of 147 subjects (88 boys and 59 girls) aged 5-8 and 9-12 years. Subjects in both age groups were divided into subroups without dental trauma, with one dental trauma and with repeated dental trauma. The validated Children's Fear Survey Schedule ­ Dental Subscale was used on fear assessment. Results showed that only 12.2% of children without trauma, 33.3% with one trauma and 51.7% with repeated trauma were not afraid of injection. Older children had a significantly lower fear of injections, touch of an unknown person, choking, going to the hospital and people in white uniforms. Dentist was not the cause of fear in 65.5% of patients with repeated trauma. With each repeated injury of teeth, the degree of their fear of dental treatment was lower.