Ani Belcheva

Perceived sources of stress in fifth year dental students--a comparative study.

Abstract Introduction: The term “stress” refers to the effect of certain external factors (physical or mental) on the individual’s physical and psychological health. Stress is very high in dental medicine. It may well be generated by the process of training in dentistry. During their training dental students express high levels of stress and considerable stress-related symptoms such as physical problems, depression, obsessive-compulsive and personality disorders. The perceived stress can be dependent on socio-cultural factors. The type of personality, gender, emotional intelligence and other individual characteristics may also influence the stress effects. Aim: To determine the main sources of stress in students during their dental training and compare the level of stress fifth-year dental students experience in the Faculty of Dental Medicine, Plovdiv, Bulgaria and the Faculty of Dentistry in Montpellier, France. Methods: We recruited in the study fifth-year students from the Faculty of Dental Medicine in Plovdiv, Bulgaria and the Faculty of Dentistry in Montpellier, France. The modified Dental Environment Stress (DES) questionnaire was used to assess the effect of the various stressors. The questionnaire survey was conducted between February and March 2008. Results: The living arrangements domain indicates higher levels of stress in Bulgarian students compared to their French counterparts with significant statistical difference for all factors. In personal factors the highest levels of stress were found with respect to the reduced holidays during school year and financial problems. Exams were the highest stressor in academic work domain and for the survey as a whole. In educational environment factors the stressors with the highest significance were the interactions with patients, academic environment (for French students) and risk of cross transmitted infections (for Bulgarian students). The high stress during clinical work is related to completing the assigned clinical workload quota and the shortage of time for clinical work. Conclusions: The students from both faculties report the highest mean levels of stress are related to examinations and clinical factors. Bulgarian students experienced higher mean levels of stress compared to their French colleges. The differences in mean stress levels are associated with socio-cultural factors and variations in educational curriculums at both dental faculties.

Scanning Еlectron Мicroscopy of Еnamel and Dentin of Тeeth with Hypocalcified Аmelogenesis Imperfecta.

Abstract The histological features of teeth with hypocalcified amelogenesis imperfecta (AI) have been poorly studied, which calls into question the effectiveness of modern adhesive techniques used in the treatment of these noncarious defects. Aim: The aim of this study was to investigate the morphological features of the enamel and dentin of teeth with AI using scanning electron microscopy (SEM), and compare these features with those of healthy teeth. Materials and methods: We examined four primary teeth extracted on indication from a 10-year-old girl with hypocalcified amelogenesis imperfecta. The same number of primary teeth extracted from healthy subjects was used as controls. The morphological characteristics of the enamel and dentin are described after investigating the teeth and photographing the specimens with scanning electron microscope. Results: The SEM photos of the enamel of AI teeth show presence of external defects, incorrectly oriented enamel prisms and enlarged interprism spaces. Thickening of the peritubular dentin and partially obliterated dentinal tubules characterize the dentin of these teeth. Conclusion: The enamel and dentin of teeth affected by hypocalcified AI diff er considerably from normal hard dental structures in their morphological characteristics.

Effect of the carbon dioxide 10,600-nm laser and topical fluoride gel application on enamel microstructure and microhardness after acid challenge: an in vitro study

The aim of this in-vitro study was to evaluate positive effects of the carbon dioxide laser (CO2, 10,600xa0nm) with acidulated phosphate fluoride (APF) gel on enamel acid resistance. Twenty extracted human third molars (40 surfaces) were randomly assigned into four groups: group C, untreated control; group L, CO2 laser alone group; group F, APF 1.23% fluoride gel; and group FL, APF 1.23% gel and laser. Samples from group L were irradiated with a CO2 laser for 30s. The parameter settings used were average power, 0.73xa0W; time on, 100xa0μs; time off, 40xa0ms; tip-to-tissue distance, 20xa0mm; tip diameter 700xa0μm; and energy density with movements, 5xa0J/cm2. Samples from group F were treated with the APF gel for 4xa0min, and the gel was washed off with distilled water. The enamel samples from group FL were treated with APF gel for 4xa0min and then irradiated with the CO2 laser for 30s without removing the gel. Each enamel sample was placed in 50xa0ml soft drink (pHu2009=u20092.75) for 10xa0min then rinsed with deionized water and stored in artificial saliva at 37xa0°C for 1xa0h. Samples were assessed for Vickers hardness number (VHN) before and after treatments and subjected to SEM analysis. Data were analyzed using a one-way analysis of variance (ANOVA) and Tukey’s test (αu2009<u20090.05). After the acid challenge, the untreated C group was demineralized to a great extent and the enamel surface was with the lowest mean score of microhardness. The observed VHN in the control (C group) had a mean value of 176.13, the scores in the CO2 laser group (L group) were with mean value of 238.40, the F group with a mean value of 218.45, and the fluoride-treated and laser-irradiated FL group—with a mean of 268.28 VHN. Paired t test performed to compare groups C, L, F, and FL has shown that group FL has greater resistance to decrease in microhardness of dental enamel (Pu2009≤u20090.05) on exposure to acidic protocol. After the acid challenge, the fluoride-treated and laser-irradiated samples (group FL) showed the least diminution in enamel surface microhardness. The sub-ablative carbon dioxide laser irradiation in combination with fluoride treatment is more effective in protecting enamel surface and resisting demineralization than CO2 laser irradiation or fluoride alone.

Local Anesthesia in Pediatric Patients – a Review of Current and Alternative Methods, Devices and Techniques

Abstract Painless treatment is an integral element of quality pediatric dental care. Recent progress in the field of local anesthesia has led to development of newer agents, delivery devices and also modification in injection techniques. Their aim is to allow the clinician a treatment approach associated with the improved pain control and reduced risk of adverse effect essential for pediatric patients. This article reviews available information on current and alternative means, methods and technologies for achieving local anesthesia in pediatric patients intended to minimize the pain associated with the procedure.BACKGROUNDnRare diseases have been continually outlined as one of the causes for the National Health Insurance Funds (NHIF) deficit spending in Bulgaria.nnnAIMnTo estimate the budgetary impact of rare disease medicinal therapies from NHIF perspective for 2014 and 2016.nnnMATERIALS AND METHODSnBudgetary impact of rare diseases is calculated as a percentage of NHIF total pharmaceutical spending. Total expenditure per ICD-10 code, mean annual number of patients reimbursed and mean annual cost per patient are analysed.nnnRESULTSnBudgetary impact of rare diseases reached a plateau of about 9% of NHIF total pharmaceutical spending for 2014-2016. Mean number of patients reimbursed and mean annual cost per patient increased by median rates of 4.27% and 2.54%, respectively. Glycogen storage disease, neuropathic heredofamilial amyloidosis and C1 esterase inhibitor deficiency stood out, as they had the second, fourth and fifth most expensive medicinal treatment cost. While accounting for only 92 patients in 2016, these three conditions contributed for 22.89% of NHIF total expenditure on rare disease medicinal therapies. For comparison, coagulation defects, with the biggest total cost per indication, had a similar budgetary impact - 24.88%, but for 277 patients reimbursed.nnnCONCLUSIONSnOur study does not support the concerns about uncontrolled growth of expenditures for rare disease medicinal therapies. Nevertheless, there is a need for enhanced post-marketing surveillance and performance-based payment of these treatments. Development, collection and analysis of local real-world data have been increasingly applied as a tool to advance these health policy goals.

Root Development of Permanent Incisors and Mandibular Molars in Correlation with Treatment Plan

Abstract Background: The incisors and molars play a major role in the formation and function of permanent dentition. Much research has been devoted to investigating the eruption of teeth and their root development. Aim: To study the root development of permanent incisors and mandibular molars in correlation with treatment plan and proper treatment protocols. Materials and methods: The Demirjian’s method was used to assess the root development of incisors and mandibular molars in children between 7 and 12 years old. Results: In 7-year-old children most of the lower first mandibular molars (76%) had complete root length, but open apices. Eighty-two percent of the roots of the first mandibular molars of the 8-year-old children and 54% of these molars of the 9-year-old children were with open apices. The first mandibular molars had incomplete roots in the 10-year-olds (6%) and even in the 11-year-old children (4%). We detected Stage E in 32% of the 10-year-olds and in 24% of the 11-year-old children. Even in 12-year-old children we found Stage E in 4% of them from their panoramic X-rays. We detected complete root development in all of the children at the age of 12. Conclusions: Dental practitioners have to wait until the age of 10, 11 and even 12 to extract the first molars, when the furcation is formed. Proper clinical examination and diagnostic radiographs should be done before the beginning of the treatment of molars and incisors at the age between 7 and 12.

Influence of Er:YAG Laser on Objective and Subjective Parameters of Stress during Sealant Application in Children

Abstract Background: Acceptance of lasers as alternatives and accessory tools to traditional methods in dental medicine has created an explosion of interest. Er:YAG laser is recommended for enamel conditioning. There is no study evaluating the anxiety in children during fissure sealing procedures when using Er:YAG laser compared to the routine application technique. Aim: To evaluate the objective and subjective stress parameters in children during a preventive procedure when using Er:YAG laser for additional enamel conditioning before pit and fissure sealant application compared to the routine clinical application technique. Materials and methods: The study included sixty-four 6-12-year-old children, divided into two equal treatment groups. A standardized fissure sealant application was performed, as in the intervention group before acid etching, the occlusal surfaces of teeth were conditioned with Er:YAG laser (2940 nm). During the procedure, objective and subjective stress parameters were recorded. Results: Significantly lower degree of dental anxiety was found at the end of the dental visit of the study group (p<0.001). During the professional cleaning of the tooth surface, the mean heart rate was low (95.55±14.29 bpm) within the physiological normal range. The objective and subjective stress parameters show no significant differences between the two subgroups during sealing procedure (p>0.05). Conclusions: Application of Er:YAG laser during sealant application does not provoke anxiety and is well accepted by children in dental environment. Preventive procedures at the beginning of a dental visit decrease the initial levels of dental anxiety and contribute to an effective treatment process.

Behaviour Evaluation Scales For Pediatric Dental Patients - Review And Clinical Experience.

Abstract The present article makes a review of the relevant literature on the scales used in the assessment of behaviour of pediatric dental patients as well as presents the results we have had of using a modified Kurosu Behaviour Evaluation Scale to assess a study sample. The review makes a critical analysis of current evaluation methods and the design of assessment scales. The assessment tools most commonly used in pediatric dentistry are presented in a chronological order from the past to the present. The clinical study we conducted used a modified Behaviour Evaluation Scale developed by Kurosu for the assessment of the behaviour of children. The study showed that during dental treatment of children in the age range of 6 to 12 years the prevailing objective behaviour characteristics in accordance with Kurosu’s behaviour evaluation scale are related to the eyes and the facial expression. The findings from the literature review and the results of our study warrant further studies to develop easy-to-use assessment tools that would enhance the objective assessment of behaviour.