Ričardas Kubilius

Oral health-related quality of life after dental general anaesthesia treatment among children: a follow-up study

BackgroundMany young paediatric patients with severe dental caries receive dental treatment under general anaesthesia. Oral health-related quality of life (OHRQoL) can be evaluated to assess the outcome of dental general anaesthesia (DGA) treatment. The aim of our study was to examine the OHRQoL of young Lithuanian children in need of DGA treatment and analyse the impact of DGA treatment on children’s OHRQoL.MethodsWe carried out a prospective clinical follow-up study on OHRQoL among all young Lithuanian child patients who received DGA treatment at the Lithuanian University of Health Sciences Hospital during 2010–2012. The study consisted of clinical dental examinations of patients younger than six years, data collected from their patient files, and an OHRQoL survey completed by their parents prior to the child’s dental treatment. We conducted a follow-up OHRQoL survey one month after the DGA treatment. The Early Childhood Oral Health Impact Scale (ECOHIS) and its effect size (ES) served to evaluate children’s OHRQoL, and the Wilcoxon signed-rank test served for statistical analyses.ResultsWe obtained complete baseline and follow-up data for 140 and 122 participants, respectively (84.7% follow-up rate). Pain and eating problems among children and parents feeling upset and guilty were the most frequently reported impacts at baseline. The parents reported greater impacts on boys than on girls. The ECOHIS score decreased significantly (69.5%, p < 0.001) after DGA treatment, revealing a large ES for the child (1.6) and family (2.4) sections of the ECOHIS.ConclusionsThe OHRQoL of young Lithuanian children requiring DGA treatment is seriously impaired. Dental general anaesthesia treatment results in significant improvement of the children’s OHRQoL. The children’s parents also greatly appreciate this treatment modality for its positive impact on the family’s quality of life.

Relationship of clinical and microbiological variables in patients with type 1 diabetes mellitus and periodontitis.

Background The aim of the study was to analyze how metabolic control of type 1 diabetes is related to clinical and microbiological periodontal parameters. Material/Methods The study involved 56 subjects aged from 19 to 50 years divided into 2 groups: healthy subjects (the H group), and diabetic (type 1 diabetes) patients with chronic untreated generalized periodontitis (the DM group). The glycosylated hemoglobin value (HbA1c) was determined using the UniCel DxC 800 SYNCHRON System (Beckman Coulter, USA), and the concentration in blood was measured by the turbidimetric immunoinhibition method. A molecular genetic assay (Micro-IDent plus, Germany) was used to detect periodontopathogenic bacteria in plaque samples. Periodontitis was confirmed by clinical and radiological examination. Results Fusobacterium nucleatum, Capnocytophaga species, and Eikenella corrodens were the most frequently found bacteria in dental plaque samples (77.8%, 66.7%, and 33.4%, respectively), whereas Aggregatibacter actinomycetemcomitans was identified 40.7% less frequently in the DM group than in the H group. The strongest relationship was observed between the presence of 2 periodontal pathogens – F. nucleatum and Capnocytophaga spp. – and poorer metabolic control in type 1 diabetes patients (HbA1c) and all clinical parameters of periodontal pathology. Conclusions Periodontal disease was more evident in type 1 diabetic patients, and the prevalence of periodontitis was greatly increased in subjects with poorer metabolic control.

New method of sedation in oral surgery.

Local anesthesia, the well-known method of sedation, usually is insufficient for dental implantation and the augmentation of the alveolar ridge, because the operations last for 1 to 2 hours and patients may experience fear and strain. This article examines a new complex sedation method using ketorolac, midazolam, and a local anesthetic 4% solution of articaine hydrochloride and epinephrine (Septanest) in combination with a vasoconstrictor. This method was applied to 67 patients operated on for dental implantation with screw implants or for the alveolar ridge augmentation with biocompatible materials. The control group, which consisted of 20 patients, received local anesthesia with articaine-epinephrine only. Most of the control patients were found to have experienced fear and strain during the aforementioned surgical procedures; their blood pressure and pulse rate increased, and more than half of them experienced pain. No disorders of hemodynamics or the psychoemotional status of the patients were observed during sedation with ketorolac, midazolam, and articaine-epinephrine. Furthermore, anterograde amnesia was determined for the 80% of the patients in the test group.

Influence of Peri-Implant Soft Tissue Condition and Plaque Accumulation on Peri-Implantitis: a Systematic Review

ABSTRACT Objectives To systematically examine influence of soft tissue condition and plaque accumulation around dental implants on peri-implantitis development. Material and Methods An electronic literature search was conducted of two databases - MEDLINE (Ovid) and EMBASE from 2011 to 2016. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported soft tissue condition or plaque accumulation influence on peri-implantitis development were included. The resulting articles were independently subjected to clear inclusion and exclusion criteria by two reviewers as follows. Results The search resulted in 8 articles meeting the inclusion criteria. These studies reported gingival index, plaque index, pocket depth, bleeding on probing/modified bleeding index for sites with “adequate” (≥ 2 mm) and “inadequate” (< 2 mm) width of keratinized mucosa. Results demonstrated that the amount of keratinized mucosa has little influence on soft-tissue inflammation in the presence of good oral hygiene. However, suboptimal oral hygiene due to difficulty in access for plaque control in the areas of minimal keratinized mucosa may lead to greater tissue damage. Conclusions In cases with insufficient keratinized gingiva in the vicinity of implants, the insufficiency does not necessarily mediate adverse effects on the hygiene management and soft tissue health condition. Nonetheless, the risk of the increase of gingival index, plaque index, pocket depth, bleeding on probing/modified bleeding index is present. Therefore, the presence of an appropriate amount of keratinized gingiva is required.

Descriptive study of mandibular canal visibility: morphometric and densitometric analysis for digital panoramic radiographs

OBJECTIVES To assess the visibility of the mandibular canal (MC) morphology in different jaw dental segments (JDSs) in relation to morphometric and densitometric parameters on digital panoramic radiographs (DPRs). METHODS 32 DPRs (155 JDSs) were selected randomly after retrieval. MC visibility in conjunction with superior and inferior border visibility was scored on a 5-point scale in four places on the JDS-that is, for the medial, distal, superior and inferior MC parts. Morphometric and densitometric analyses were made horizontally and vertically in the JDS region. Descriptive statistics, Fishers exact test, Mann-Whitney U test and additional tests were performed. RESULTS There was no significant difference in MC visibility for the superior, inferior, medial and distal parts of the JDSs. Statistically significant (p < 0.05) differences were identified between particular visibility scores of the superior and inferior MC borders. In 22.0-24.7% of JDSs, the superior MC border was not visible, more than twice as often as the inferior MC border was not visible (9.1-10.2%). The visibility of superior and inferior MC borders in JDSs was not related to the morphometric or densitometric assessment parameters, or to age, gender, JDS location, condition or the visibility of neighbouring MC parts or contralateral JDSs. CONCLUSIONS DPRs failed to provide MC visibility based on a single factor. Particular differences were identified between the levels of visibility of the superior and inferior MC borders. More advanced radiological investigation methods could be required for the evaluation of about 25% of JDSs when superior MC border identification is obligatory.

Effects of β-1.3/1.6 glucan on cytokines production by leukocytes in vitro

BackgroundThe aim of the study was to investigate the immunomodulating effect of β-1,3/1,6 glucan from yeast on the production of interleukin-4 (IL-4), interleukin-5 (IL-5) in a medium of peripheral venous blood leukocytes from patients with periodontitis.Material/MethodsThe study was performed using venous blood of 22 patients, aged 20 to 45 years, suffering from untreated severe chronic generalized periodontitis confirmed by clinical and radiological examination, and 22 periodontally healthy subjects. The effects of β-1,3/1,6 glucan on the production of the cytokines IL-4 (pg/ml) and IL-5 (pg/ml) levels by unstimulated and stimulated leukocyte incubation medium with unopsonized E. coli were determined using the Enzymes Linked Immunosorbent Assay (ELISA) method.ResultsWe found that the incubation medium of stimulated leukocytes by unopsonized E. coli and treated with 0.2 mg and 0.4 mg of ß -1,3/1,6-glucan of patients with periodontitis produced significantly higher (P<0,001; P<0,001) levels of IL-4 and IL-5 than the analogous medium of healthy subjects.ConclusionThis study indicates that β-1,3/1,6-glucan may significantly increase production of IL-4 and IL-5 cytokine levels in a stimulated peripheral blood leukocytes incubation medium from periodontitis patients.

Comparison of Sino-Nasal Outcome Test 22 Symptom Scores in Rhinogenic and Odontogenic Sinusitis

Background Odontogenic maxillary sinusitis (OMS) and rhinogenic sinusitis (RS) are the main types of chronic rhinosinusitis (CRS) and have a significant impact on health-related quality of life (HRQL), but the difference in HRQL and symptom presentation between them has not been specifically evaluated to date. Obejctive: Our aim was to compare patterns of symptoms and HRQL disease-specific domains in patients affected with these 2 types of CRS. Methods A group of 201 patients with CRS (99 with rhinogenic and 102 with odontogenic origin) completed the Sino-Nasal Outcome Test 22 (SNOT-22) questionnaire before treatment. Data sets were analyzed by using principal component analysis (PCA) to identify a set of symptom components together with the items excluded from PCA, which were then analyzed for differences between patients with OMS and RS. Results PCA of SNOT-22 items identified 5 components: “rhinologic,” “extranasal rhinologic,” “ear/facial,” “sleep and functional disturbance,” and “emotional disturbance.” Sneezing was excluded from PCA and treated as separate outcome variable and was significantly worse in RS patients. Patients with OMS scored significantly higher scores with regard to emotional disturbance, while RS patients scored significantly worse in sleep and functional disturbance. The extra symptom “malodor” was the most different symptom and was significantly worse in OMS patients. The total SNOT-22 score was not significantly different between the groups. Conclusion With controlling of covariates that may influence the severity of the disease, this study showed some significant differences in symptom patterns and HRQL impairment between patients with OMS and RS. Malodor is the most characteristic feature of OMS. Therefore, OMS should always be suspected in patients complaining of bad breath.

Oral Behaviors and Parafunctions: Comparison of Temporomandibular Dysfunction Patients and Controls

Abstract The aim of this study is to evaluate the frequency of oral behaviors in patients with temporomandibular disorders (TMD) and a control group without TMD. In this baseline case–control study, 260 controls and 260 subjects with TMD completed the oral behaviors checklist defined as a “self-report scale for identifying and quantifying the frequency of jaw overuse behavior” and underwent clinical examinations using the DC/TMJ international examination form (version May 12, 2013). Relationships of oral parafunctions’ frequencies between groups were examined. The statistical analysis was performed with IBM SPSS Statistics 23 software. Age and gender distribution in the study groups did not reveal statistical differences (P > 0.05). Multivariate logistic regression analysis was conducted to establish system of independent oral behaviors for prognosis TMD. The stepwise regression analysis demonstrated that very frequent expression of holding, tightening, or tense muscles is associated with 10.83 times (P < 0.05) higher risk of TMD, grinding teeth together during waking hours with 4.94 times (P < 0.05) higher risk, and sustained talking with 2.64 times (P < 0.05) higher risk of TMD. By contrast, it was determined that 3 oral behaviors were less common in the TMD patients compared with the control group: clenching teeth together during waking hours, facing grimaces, and yawning (P < 0.05). The individuals with TMD reported a significantly higher frequency of 10 behaviors (P < 0.05), 3 of which may be regarded as independent risk factors for TMD. In addition, 3 oral behaviors were more frequently observed in the healthy subjects than in the TMD patients.

Validation of Therapeutic Anatomy–Oriented Classification in Endosseous Dental Implant Treatment: A Pilot Study

Background: The purpose of the study was to validate a newly proposed therapeutic anatomically based clinical and radiological classification for dental implant treatment. Methods: Eighty-one patients with at least 1 edentulous jaw segment (EJS) from 2 dental clinics were included in this study. Both clinical and radiological parameters were assessed in aesthetic and nonaesthetic zones. The data were then compared at preoperative, intraoperative, and postoperative (subdivided into early and late stage) study stages. Results: Based on the hard and soft tissue support, EJSs were divided into 3 types. The outcomes were then validated at preoperative, intraoperative, and early postoperative stages. Data were then analyzed using paired sample t test and the Wilcoxon signed ranks test. No statistically significant difference (P > 0.05) was identified between any the measurements. Conclusions: The proposed therapeutic anatomically based clinical and radiological classification for the dental implant treatment seems to be reproducible, objective, and helpful in planning dental implant treatment. Future studies with a larger sample size are needed to further validate the outcome obtained in this pilot study.

Relationship between the mandibular cortical index and calcaneal bone mineral density in postmenopausal women

BACKGROUND AND OBJECTIVE In clinical practice, a comparative analysis of bone mineral density (BMD) is carried out by examining different skeletal bones. This is useful for screening of postmenopausal osteoporosis (OP). The objective of this study was to determine the relation between the mandibular cortical index (MCI) and calcaneal BMD among postmenopausal women. MATERIALS AND METHODS The study sample included 129 randomly selected postmenopausal women aged 50-77 years. The participants were examined using panoramic radiography for the analysis of the cortical layer in the mandibular base for MCI determination and using DXL for the examination of calcaneal BMD. According to T scores, the subjects were divided into three groups (Groups 1, 2, and 3). The panoramic radiographic examination of the mandible was performed; the MCI was determined and distributed into groups (C1; C2; C3). The MCI validity in determining the calcaneus BMD status was analyzed. RESULTS The differences in BMD were statistically significant between Groups C1 and C3 (P<0.01), Groups C2 and C3 (P=0.01), and between the calcaneal BMD groups (P<0.001). There was a statistically significant inverse correlation between the MCI and calcaneal BMD (r=-0.3; P<0.001). The changes characteristic of Group C2 were documented more frequently than those of other morphological groups. The analysis of the MCI validity in BMD status showed low sensitivity (69.4%) and specificity (53.9%). CONCLUSIONS The relation between MCI and calcaneal BMD was determined. The diagnostic discrimination of the MCI was found to be not sufficient in screening the women with postmenopausal osteoporosis and its application in clinical practice might be limited.