Alina Pūrienė

Treatment procedures and referral patterns of general dentists in Lithuania.

BACKGROUND AND OBJECTIVE The requirement for dental specialties and the number of specialists in each country depends on the content and execution of undergraduate dental education, the complex oral health care needs of the society and other factors. The aim of our study was to assess specific treatment procedures of Lithuanian general dentists and their need to refer patients to specialists. MATERIALS AND METHODS Census sampling was employed and the data collected by means of a structured questionnaire asking dentists about the frequency of specific treatment procedures they perform and the frequency of referrals they make to different dental specialists. The results are of a self-reported nature. RESULTS From general dental practice, 76.3% of cases needing orthodontic treatment were referred to orthodontists. About half of patients needing specialized care were referred to periodontists (50.2%), orthopedists (46.9%) and oral surgeons (45.0). More than one-third (39%) of the cases needing specialist care were referred to endodontists. Only one-third of patients were referred to pediatric dentists. In about 60% of cases needing respective care general dentists extracted teeth and roots, made incisions in acute jaw infections and treated young children; in about half of cases general dentists performed complex endodontic manipulations and treatment with fixed and removable prostheses. CONCLUSIONS There is a clear need for Lithuanian dental practitioners to refer patients to all types of dental specialists. Undergraduate dental education program and postgraduate training should be more directed toward the extraction of teeth and roots, treatment of young children and provision of dental prostheses to patients.

Dental treatment needs and health care-seeking behaviours of patients with acute odontogenic infections in Lithuania.

AIMS To assess patients with acute odontogenic maxillofacial infections (AOMIs), regarding their functional dentition and dental treatment needs, and identify factors explaining these outcomes. METHODS During a 1-year period, 160 patients with AOMIs were treated at the specialised dental care centre of Vilnius University. Both oral status and specific dental treatment needs were evaluated for each patient. For the restorative dental treatment need, we examined if patients needed fillings, crowns or bridges. Periodontal dental treatment needs were based only on the most severe cases, and patients were allocated either to a group for which periodontal treatment was recommended or to a group that did not need periodontal treatment. Based on these clinical assessments, four ratios for specific dental treatment needs (restorations, extractions, endodontic treatment and periodontal treatment) and two summative ratios (total dental treatment needs and presence of a functional dentition) were calculated. The questionnaire included variables from various domains. RESULTS Patients with AOMIs retained one-third of their functional dentition and the mean ± standard deviation of their total dental treatment needs was 46.0 ± 29.7%, of which 32.4 ± 17.1% related to the need for restorations. Higher dental treatment needs were associated with a low level of education, low income, irregular oral self-care, systemic diseases and self-treatment of acute dental conditions before seeking professional help. CONCLUSIONS Patients with AOMIs retained one-third of their functional dentition, and almost half of their dentition were in need of dental treatment.

Prevalence and etiology of midfacial fractures: a study of 799 cases

BACKGROUND AND OBJECTIVE The prevalence and etiology of midfacial fractures varies among countries. Until now, knowledge about such type of injuries in the region of the Baltic countries was rather scarce. The purpose of the study was to analyze the prevalence, etiology and localization of midfacial fractures treated at the Vilnius University Hospital Žalgiris Clinic, Vilnius, Lithuania. MATERIALS AND METHODS The medical records of patients treated for midfacial fractures during the period January 2005 to December 2010 were analyzed for gender, age distribution, frequency and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma. RESULTS The records of 799 patients were analyzed. The male-to-female ratio was 4.4:1. The mean age of the patients was 33.16±14.0 years (min 1, max 87). As much as 68.8% of injuries were zygomatic fractures, 27.9% were maxillary, and 3.3% were isolated orbital floor fractures. The most frequent causes for injury were interpersonal violence (64%), followed by falls (16.3%) and traffic accidents (8.3%). Most midfacial fractures (65.3%) occurred between April and October (P<0.05), on weekends (58.2%; P<0.05) and at night (62.0%; P<0.05). In 14%, trauma reports indicated the abuse of alcohol. More often such persons received more than one midfacial bone fracture (P<0.05) concurrently. CONCLUSIONS This study revealed that the main cause of midfacial fractures was assault. Male patients, aged 15-34 years, more often sustain midfacial fractures. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions.

Determinants of length of hospitalization due to acute odontogenic maxillofacial infections: a 2009-2013 retrospective analysis.

Objectives: To investigate the determinants of the length of hospitalization (LOH) due to acute odontogenic maxillofacial infections (AOMIs) from 2009 to 2013. Materials and Methods: Dental records of adult patients with AOMIs and related data were retrieved from the Vilnius Universitys dental hospital. The LOH was related to several determinants in each of the following domains: outpatient primary care, severity of AOMIs, lifestyle and disease domains. Determinants were also associated with the LOH using multivariate analysis. Results: A total of 285 patients were hospitalized with AOMIs, of which 166 (58.2%) were males and 119 (41.8%) were females. The mean LOH was 8.3 ± 4.9 days. The bivariate analysis did not reveal any statistically significant differences in LOH between patients with AOMIs who received urgent outpatient primary care and those who did not receive such care prior to hospitalization. All AOMI severity-related determinants were associated with the LOH. The LOH was related to coexisting systemic conditions but not to the higher severity of dental or periodontal diseases. Both bivariate and multivariate analyses revealed similar trends, where the most significant determinants of a longer LOH were related to the severity of AOMIs. Conclusion: The most important determinants regarding longer hospitalization were indicators of infection severity such as an extension of the odontogenic infection and the need for an extraoral incision to drain the infection.

Live cell imaging reveals different modes of cytotoxic action of extracts derived from commonly used luting cements

OBJECTIVE To compare cytotoxicity of extracts derived from commonly used luting cements: Hoffmanns Zinc Phosphate (ZPC), GC Fuji Plus Resin Modified Glass Ionomer (RMGIC) and 3M ESPE RelyX Unicem Resin Cement (RC) on primary human gingival fibroblasts (HGFs). DESIGN HGFs were exposed to different concentrations of the ZPC, RMGIC and RC extracts. The cytotoxicity was assessed with the PrestoBlue Cell Viability Reagent and viable cells were counted by a haemocytometer using the trypan blue exclusion test. In order to determine the primary mechanism of the cell death induced by extracts from different luting cements, the real-time monitoring of caspase-3/-7 activity and membrane integrity of cells was employed. RESULTS The extracts from the RMGIC and ZPC decreased the metabolic activity and numbers of viable cells. Unexpectedly, the extracts from the RC evoked only small effects on the metabolic activity of HGFs with a decreasing number of viable cells in a dose-and time-dependent manner. The live cell imaging revealed that the apoptosis was the primary mechanism of a cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death through a necrotic and caspase-independent pathway. CONCLUSIONS The apoptosis was the primary mechanism of the cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death via a necrotic pathway. We suggest that metabolic assays commonly used to assess the cytotoxicity of luting cements should be validated by alternative methods.