Periodontal conditions and oral hygiene in rural population of post-war Vukovar region, Croatia in correlation to stress.

OBJECTIVE: The greatest burden of oral diseases is on the socially marginalized population, such as those living in small villages and war areas. The aim of this study was to assess the periodontal conditions of people in post-war area villages in relation to oral hygiene, habits and war stress. METHODS: The study was conducted on a sample of 282 subjects (mean age 41.5 +/- 17.8) in seven Vukovar villages using the questionnaire and clinical periodontal examination. RESULTS: Five years after the war in Croatia the population was still very poor, low educated, and had a low level of periodontal health and oral hygiene habits. The level of periodontal disease and attachment loss tended to increase with age and physical activity and decrease with education level, higher frequency of tooth brushing and toothbrush replacement, dental visits and utilisation of auxiliary devices. Subjects exposed to any kind of war stress had a significantly worse periodontal status and more excluded sextants than those who were not exposed to such stress experience (p<0.05). Better periodontal conditions were found in individuals that were refugees, than those who were in war, wounded or lost a dear person (p<0.05). Individuals who were in war rarely brushed their teeth, visited dentist and changed toothbrushes, but more frequently drank alcohol and smoked, in comparison to other groups, especially those who have not been exposed to war stress. CONCLUSIONS: Specific socio-economic and psychological conditions in post-war areas could be significant risk factors for poor periodontal conditions.

The influence of war on the oral health of professional soldiers.

AIM: Professional soldiers, although trained to deal with specific conditions, are not immune to war stress induced behavioural changes, and since oral diseases are behaviour-related some changes in the oral cavity could be expected. PARTICIPANTS AND METHODS: The study was conducted on 640 professional soldiers in the Croatian Army, aged 19-49 years. The study group consisted of 336 soldiers in active service during the war in Croatia (1991-1997), while control group included 304 soldiers in peacetime service. Decayed, Missing and Filled Teeth Index (DMFT) and Community Periodontal Index (CPI) as well as questionnaires concerning dental behaviour and diet were employed. RESULTS: War group soldiers had significantly poorer oral health with DMFT being 14.4 in the war group and 13.1 in the controls, respectively (p < 0.001). The war group also showed a significantly higher number of periodontal pockets and excluded sextants, but lower numbers of healthy sextants (1.3 war group and 2.1 control; p < 0.001). Significant differences between the war and peacetime groups according to the number of dental visits, daily brushing frequency and diet were found. There was a tendency towards the deterioration of oral health with increase in time spent in battle fields. CONCLUSION: War conditions have a significant influence on the increased prevalence and severity of oral diseases for professional soldiers.

CPITN assessment of periodontal disease in diabetic patients.

The aim of this study was to investigate, using the CPITN system, the periodontal treatment needs in diabetic patients, and to shed additional light on the possible effects of the duration and control of diabetes on the periodontal status in these patients. A comparison was made between 222 diabetic patients (mean age, 46.9 years) and 189 control subjects (mean age, 43.9 years). Edentulous patients were not included in the study. The results indicated that diabetic patients demonstrated significantly more missing teeth (P less than 0.001). The mean number of missing sextants was also significantly higher in diabetics. Pathologic pockets of 6 mm or more were found in 1.3 and 0.3 sextants in the diabetic and control group subjects, respectively (P less than 0.001). Up to the age of 34, no differences were observed between the diabetic and control group subjects regarding pathologic pockets of 6 mm or more. Above this age, diabetics demonstrated significantly more sextants with deep pockets (P less than 0.001). Concerning the type of diabetes, no differences related to CPITN score were found between insulin dependent and non-insulin dependent diabetics. Neither were any differences found in the periodontal condition related to the duration and control of diabetes, whereas diabetics with advanced retinopathy demonstrated more sextants with deep pockets. Oral hygiene instructions and scaling were required in all patients from both study groups. On an average, 1.3 sextants in 50.9% of diabetics and 0.3 sextants in 17.9% of control subjects required complex treatment.

Prevalence of gingivitis in 6- to 11-year-old Croatian children.

OBJECTIVE: The purpose of this study was to assess the prevalence of gingivitis in 6- to 11-year-old children in two urban settlements of Zagreb, Croatia. PARTICIPANTS: Total number of 1025 children was included in the study. The Gingival Bleeding Index was used to determine the condition of the gingiva on mesiobuccal and buccal surfaces of six selected teeth, totaling to 12 surfaces. RESULTS: Forty-three percent of the examined children had healthy gingival tissue, 12% showed bleeding from one surface, 6% from two, 5% from three, 17% from four, and 17% from five to eight surfaces. CONCLUSIONS: Gingivitis was prevalent, but slight to moderate. It is important to instruct and control schoolchildren in excellent oral hygiene in order to prevent gingivitis.

Dental status in a group of adult diabetic patients.

The aim of this study was to determine the prevalence of dental caries, DMFT score and treatment needs in a group of diabetic patients (n = 222), mean age 46.9 yr, and to compare them to those recorded in a control group (n = 189), mean age 43.9 yr, using WHO criteria. Relations between the type and duration of diabetes mellitus, diabetic complications (retinopathy and neuropathy), diabetic control, and the subjects' DMFT status were separately studied. The results obtained revealed no difference in the prevalence of caries between the group of diabetics and the control group. Neither was any difference found in the mean numbers of teeth with fillings, but the number of extracted teeth per subject was significantly higher in the group of diabetics (12.3) than in the control group (9.7) (P less than 0.01). Type I diabetics were found to have a significantly higher number of teeth with fillings (4.05 vs. 2.22) than the non-insulin dependent diabetics (P less than 0.001). Type II diabetics, however, had a significantly higher number of extracted teeth (14.1 vs. 10.4) (P less than 0.001). There was no difference in the caries experience regarding duration of diabetes, diabetic control, or diabetic complications.

CPITN assessment of periodontal treatment needs in the population of Zagreb, Croatia.

The aim of this study was to assess the prevalence and required treatment of periodontal disease in Zagreb using the CPITN system. A total of 3176 subjects of both sexes, divided into reference age groups, was studied using the methods and standards recommended by the World Health Organization, the Community Periodontal Index of Treatment Needs (CPITN). A very high prevalence of periodontal disease in the population of Zagreb was recorded. Gingivitis was found in the entire population of school children and deep pockets were present even in those aged 20 years, the prevalence progressively rising with age. The need for oral hygiene instruction was recorded in almost all subjects examined, and the highest need for specialist periodontal treatment was registered in more than 56 per cent of the oldest subjects, over the age of 64. The data suggests the need for better organisation of preventive services and a more conscientious approach to treatment.

Degree of correlation between two periodontal indices in a rural Croatian population.

AIM: To compare the periodontal status of patients measured by two indices, the Community Periodontal Index (CPI) and the Loss of Attachment Index (LA). METHOD: The CPI and LA index scores were determined for a sample of 367 adult subjects (1,535 dentate sextants) aged 15-65 years from two rural areas in Croatia and analysed according to subject, sextant and jaw. RESULTS: Partial correlation between the CPI and LA indices was found. Cumulative for all age groups, sextants with a CPI code 0, 1 and 2 most often appeared with a LA 0-3mm. Shallow pocket sextants (4-5mm) in 64.04% also correlated with the loss of attachment values 4-5mm. In deep pocket sextants (6-8 mm), a deviation from expectations was found as they appeared more often with a LA 9-11 mm designation (46.24%), rather than with an LA 6-8mm (34.41%) score. Very similar results were found between distribution per sextant, person and jaw in CPI codes 2, 3, 4 and cumulatively. CONCLUSION: CPI itself is not sufficient for periodontal status assessment, especially for the 35-44 years of age, and even more so for the 65+ group, also for the CPI code 4 in all ages.

Histologic difference in epithelial linings between follicular and radicular cysts.

The purpose of this study was to identify histologic differences in epithelial linings between follicular and radicular cysts in relation of their development. Linings and surrounding tissues of 25 radicular and 20 follicular cysts from archival paraffin embedded tissues were obtained and stained with haematoxylin and eosin. Radicular cysts showed orthokeratotic 9-14 cell-layer-thick non-keratinized squamous epithelium and unspecific chronic inflammatory reaction in connective tissue. Follicular cysts showed 2-4 cell-layer-thick of non-keratinized stratified squamous or flattened-low cuboidal epithelium and connective tissue capsule free from inflammatory cell infiltration.

Ten-year evaluation of conservative and surgical treatment of gingival recession. A case series study.

In the last years the treatment of non-inflammatory periodontal diseases has greatly changed. Apico-coronal dimension of gingival tissue is not considered to be of utmost importance, but significance of tissue thickness over each tooth is stressed. Purpose of this study was to show results of conservative and surgical treatment of gingival recession. Sample consisted of two groups of subjects, which have been treated in one of stated ways during ten years. The data was obtained on the beginning and after ten years of recall. Both groups showed increased dimension of keratinized gingiva during observed time with decrease of gingival recession, plaque- and gingival index. It is considered that treatment should start with conservative measures with necessary motivation of the patients. If it does not show improvement, one should consider best surgical method available for each patient. Clinical results show success in both groups, meaning that treatment was properly decided on.

Endocrinological status of patients with periodontal disease.

The aim of the present study was to determine whether changes in the endocrinologic status occur in patients with progressive forms of periodontal disease and, if so, what their role is. For this purpose the function of hypophysis, concentration of pituitary and accessory gland hormones, parathormone, calcium, phosphorous, glucose and lipids in blood were determined. The study was carried out in 77 subjects, 37 patients with advanced periodontal disease, and 40 control subjects with normal periodontium. Blood glucose was significantly lower in the study group (p < 0.01%) which was surprising, since increased glucose values are known to favor the development of periodontal disease. Growth hormone was significantly lower in the study group (p < 0.01%). Concentrations of parathormone calcium and phosphorous were also lower in the study group. Among sex hormones, only estradiol was found to have a significantly lower value in the study group (p = 0.92%). Although the values of nearly all hormones were within the reference range, the within-group analysis showed significant differences for some hormones. In general, these results were lower in subjects with advanced periodontal disease.

Incidence and distribution of dehiscences and fenestrations on human skulls.

The aim of this study was to determine the incidence and distribution of dehiscences and fenestrations of the alveolar plate. The sample used in the study consisted of 163 adult jaw bones (78 maxillae and 85 mandibles) of a recent population from the north-western Croatia. The skulls are part of the skull collection of The Anatomy Institute, Zagreb, Croatia. The number and location of dehiscences and fenestrations for each tooth area above the total number of 2038 teeth were registrated. The total number of 696 (26.67%) dehiscences and 190 (9.32%) fenestrations was measured. Among the maxillary teeth, canines exhibited greatest and most frequent dehiscences and fenestrations. In the mandible, canines were most commonly associated with both defects, too. It was concluded that the canines were most frequently associated with either of the osseous defects.