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Background/Aim: The aim of this study was to conduct a comparative analysis of the national oral health programmes in the Balkan countries, to compare key measures and activities in the implementation of the general and specific objectives of the programme, and to analyse the results achieved after the implementation of the programme. Material and Methods: The data were obtained through an electronic search of publicly available documents published by the relevant institutions in the field of dental health care in the Balkan countries. The search terms were: "national programme", "strategy", "action plan", "project", and "oral health". The search was conducted in English and in the native languages of the Balkan Peninsula countries. A comparative analysis of valid documents and those whose validity period has expired was carried out. Results: Bulgaria and the Republic of North Macedonia have valid national preventive programmes. In Cyprus, a strategic plan for the provision of dental services is described. An oral health promotion programme for elementary school children and universal preventive programme for children ("dentist pass") have been implemented in Greece. Serbia has a national preventive programme that has expired, but the programme activities still apply. Albania, Bosnia and Herzegovina, Montenegro, Romania, and Turkey do not have national oral health preventive programmes. Countries in the region with no oral health promotion programmes have poorer oral health indicators compared to countries with existing programmes. Conclusions: While countries in the Balkan Peninsula have made progress in improving the oral health of their inhabitants, the absence of national oral health promotion programmes is striking in many countries in the region. Greater involvement of the community in activities to maintain and improve oral health is needed, as is more comprehensive dental care for vulnerable populations. This paper (Part I) compares national oral health promotion programmes of the Balkan countries, the key measures and activities, and general and specific objectives of the programme.

To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities.

The possibility to utilize the antibacterial and antibiofilm potential of essential oils (EOs) in dentistry is recognized and best seen in the design of EO-based mouthwashes. The up-to-date results, obtained with the most commonly used formulation being consisted of thymol, eucalyptol, menthol, and methyl salicylate (Listerine), proved its efficacy against plaque and gingival inflammation. However, novel alcohol-free products remain to be further investigated. Commercially available mouthwash containing curcumin, clove oil, mentha oil, eucalyptol, thymol and tea tree oil, and the mouthwash based on ginger EO (a-zingiberene, b-bisabolene, b-sesquiphellandrene, curcumene), reduced plaque index and improved periodontal status of the patients. The plaque index was also reduced and overall healing was improved after the surgical removal of the third molar by mouthwash containing John wort oil. In addition, Cinnamomum zeylanicum EO-based mouthwash and mouthwash containing peppermint oil were efficient against stomatitis and xerostomia, respectively. In addition to beneficial effects achieved in the mouth, i.e. at the appropriate site of application, novel investigations pointed-out that EO-based mouthwashes could be recognized as efficient in the reduction of bacterial and viral aerosols. This has been shown for Listerine, and for several mouthwashes containing following active substances of plants' EO origin: a-farnesene, b-farnesene, farnesol, nerolidol, a-bulnesene, eremanthin, b-sesquiphellandrene, spiroether, cinnamylacetate, cinnamaldehyde, eugenol, menthol, and carvacrol. This finding could be of special interest, in order to be included in further clinical studies related to COVID -19 pandemic.

Background/Aim: The requirements for dental specialties and the number of specialists in each country are unique and strong indicator of the availability and affordability of primary health care for children and adolescents. The aim of this study was to determine the pattern, type and the extent of dental services, as well as the influence of regional factors and data on whether services are provided by a pediatric dentist or general dentist have effect on these parameters, based on information obtained from dentists providing dental care to children and youth. Material and Methods: Within the project "Program for the improvement of oral health of children and youth in the Republic of Serbia", supported by the Ministry of Health of Serbia, a research was conducted among dentists involved in dental care for children and youth in Serbia. Data collection from primary health care facilities was performed through a specially designed questionnaire. A total of 445 questionnaires were collected from dentists from 102 health centers in Serbia in the period June - October 2019. Results: There are significant differences between regions in the pattern, type and the extent of dental services. In the quantitative analysis, there are no significant differences in the type of dental services between pediatric and preventive dentistry specialists and general dentists. Conclusions: The data from the conducted research speak in favor of a large daily workload of dentists who deliver oral health care for children and youth in Serbia. Additional multifactorial analysis, which includes epidemiological data from the region, but also environmental, demographic and cultural parameters of oral health could be the basis for improving the provision of preventive dental and preventive oral care

Background/Aim: Autism spectrum disorder (ASD) is pervasive neurodevelopmental condition with raising prevalence over the last decades. Oral health related problems arise mostly due to challenging behavior, communication limitation, and resistance to receiving dental treatment. The aim of this retrospective study was to investigate the frequency, quality and type of dental care during routine appointments and under general anesthesia (GA) in persons with ASD. Matreial and Methods: The data were obtained in retrospective cross-sectional study by analyzing patients' records from the central electronic database of the Clinic for Dentistry of Vojvodina. Demographic, medical and dental data were analyzed employing Mann Whitney U test, Kruskal Wallis test and CATREG regression analysis. Results: A total of 51 patients from 4.2-47.6 years of age had an average of 13.2 ±13.5 dental appointments, with 2.27±4.23 treatments done under GA in a period of 7 years. The average number of restored teeth was 3.64±4.42 and 4.64±5.95 teeth were extracted. Only 21.5% of participants regularly attended scheduled appointments. Patients who started oral health care earlier had more teeth restored and extracted during RDT, and were less subjected to treatment under GA. Conclusions: Dental services to patients with ASD are commonly limited to more radical approach comprising multiple teeth extractions and repeated treatment under GA. It is of utmost importance to tailor comprehensive plan for dental care provision in individuals with ASD at earliest possible age.

Chemical composition of the essential oils (EO) of Pelargonium graveolens, Leptospermum petersonii and Cymbopogon martinii var. motia, and the absolute of Rosa centifolia and their bioactivity were examined. Major compounds in P. graveolens EO were monoterpene alcohols citronellol, geraniol and linalool; in L. petersonii EO monoterpene aldehydes geranial, neral and citronellal; in C. martiniii var. motia EO monoterpene alcohol geraniol and ester geranyl acetate, while in absolute of R. centifolia aromatic alcohol 2-phenylethanol. The EO of L. petersonii showed the strongest antibacterial while the EO of C. martinii var. motia the strongest antifungal potential. The best biofilm inhibition capacity was observed with R. centifolia absolute. The results of scanning electron microscopy analysis indicated that the EOs of L. petersonii and P. graveolens changed the number and morphology of C. albicans cells. The L. petersonii EO was the most potent toward tumour cells and exhibited the best biological activity. This is first comparative report summarizing efficacy of studied aromatic samples against pathogenic microbes, providing deeper insight into the modes of antimicrobial action, and at the same time describing their cytotoxicity against cell lines.

Background/Aim: Understanding the composition of bacteria in infected root canals is important for ameliorating the treatment strategies that lead to the elimination of pathogens and infection control, but also prevent reinfection. Aim of this study was to investigate microbial composition of primary infected root canals with apical periodontitis of young permanent teeth, originating form school children in Serbia, and its association with clinical symptoms.

Introduction. Root resorption may occur as a consequence of avulsion injury and may lead to the progressive loss of tooth structure. The aim was to report the outcome of root resorption treated with mineral trioxide aggregate in a replanted immature permanent incisor after 10 years of follow-up. Case outline. This case presents external root resorption that was detected 18 months after the avulsion injury in a nine-year-old child. Apical portion of the canal was filled with mineral trioxide aggregate and the rest of the canal was filled with a canal sealer and gutta-percha. Control examinations were performed six months after the completion of the endodontic treatment and afterwards yearly. The tooth was asymptomatic clinically and radiographs did not show progression of root resorption up to four years of follow-up. Infraposition of the injured tooth was detected five years after the replantation, but without significant radiographic changes, until the eight-year follow-up, when root resorption was detected again. However, the tooth was still hard and symptomless at the 10-year follow-up. Conclusion. Mineral trioxide aggregate may have an important role in the preservation of replanted immature teeth for a prolonged period.

Introduction/Objective. The purpose of this study was to compare clinical efficacy of casein phosphopeptide – amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) with 0.05% NaF, and to assess their influence on the quality of life among individuals with Sjogren’s syndrome. Methods. Thirty patients were randomized into three groups treated with different remineralizing agents: CPP-ACP, CPP-ACFP, and 0.05% NaF. Oral health was evaluated at the beginning of the study, after 28 days (short-term effects), and after six months. The diagnosis of dental caries was performed using the decayed, missing, and filled teeth (DMFT) / decayed and filled surfaces (DFS) criteria. Enamel demineralization was visually examined using the white spot lesion index (Gorelick). The gingival health was evaluated with the gingival index (Loe–Silness). Assessment of oral hygiene was done using the simplified oral hygiene index (Greene–Vermilion). The Xerostomia Inventory was used to quantify dry-mouth symptoms. The oral health-related quality of life was analyzed using the short form of the Oral Health Impact Profile (OHIP-14). Results. During the evaluation period, caries increment was not significant. Considerable regression of white spot lesions was noted in all three experimental groups (p < 0.001). No significant improvement in gingival health and oral hygiene was observed. Physical pain was decreased in all three experimental groups, and subjective feeling of dry mouth was reduced in CPP-ACP and CPP-ACFP groups. Conclusion. CPP-ACP and CPP-ACFP may reduce the caries activity and relieve the dry-mouth symptoms in patients with Sjogren’s syndrome.

Background/Aim: Toothbrushes are one of the main means of cleaning teeth and maintaining oral hygiene, but toothbrushes are also potential reservoir of microorganisms, including pathogens. The aim of this paper was to evaluate the oral health, oral hygiene awareness and assess the degree of contamination of toothbrushes among students attending Secondary Medical School.

Introduction/Objective. The purpose of this study was to assess effectiveness of endodontic root canal procedures in traumatized permanent teeth with necrotic pulps and chronic periapical lesions after definitive obturation with mineral trioxide aggregate (MTA) products. Adobe Photoshop CS (San Jose, CA, USA) image-analysis software was used for healing assessment. Methods. Twenty-seven traumatized single-rooted permanent teeth diagnosed with necrotic pulps and chronic periapical lesions were treated with non-surgical procedure using a tri-antibiotic paste and calcium hydroxide as intra-canal medication. Definitive obturation was performed with ProRoot MTA (Dentsply Tulsa Dental Specialties, Tulsa, OK, USA) or MTA+ Cerkamed (Cerkamed, Stalowa Wola, Poland). Control follow-ups were done three, six, 12, and 24 months following the completion of treatment. Results. The positive clinical outcome was recorded in 24 (88.9%) cases, while radiographic success was present in 26 (96.3%) cases. A statistically significant decrease in the sizes of periapical lesions was consistently observed at follow-up periods (p < 0.001). There was no statistically significant difference between the two tested MTA materials (p > 0.05). Conclusion. The MTA products were effective for the root canal obturation and appeared to contribute to the significant reduction or complete regression of periapical lesions in teeth treated. The presented procedure may be proposed for everyday clinical practice. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 172026]

Background/Aim. The main task of endodontic treatment is to eliminate pathologically altered tissue, to disinfect root canal space and to obtain its three-dimensional hermetic obturation. The main purpose of this study was to evaluate antimicrobial activity of new endodontic nano-structured highly active calcium silicates based materials albo-mineral plyoxide carbonate aggregate (ALBO-MPCA) and calcium silicates (CS) in comparison to mineral trioxide aggregate (MTA+) and UltraCal XS (CH). Methods. The antimicrobial activity of materials was tested against Staphylococcus aureus (ATCC 25923) and Enterococcus faecalis (ATCC 14506) strains, and following clinical isolates: Rothia dentocariosa, Enterococcus faecalis, Staphylococcus aureus, Streptococcus anginosus and Streptococcus vestibularis using a double layer agar diffusion test. The pH measurements were performed using the pH meter. Total amount of released ions was determined by inductively coupled plasma optical emission spectrometry (ICP-OES). Results. All tested materials showed the best antibacterial potential after 1 h of incubation. After 3h and 24h of the incubation period, the antibacterial potential of all tested materials were similar. The Agar diffusion test showed that ALBO-MPCA, CS and MTA+ had similar inhibition zones (p > 0.05), except in the activity against Staphylococcus aureus where ALBO-MPCA showed better antimicrobial properties than MTA+ in 3h and 24h of the incubation period (p < 0.05). Following 24h of the incubation, the inhibition zones were the strongest with CH against Staphylococcus aureus (16.67 ± 2.34 mm) followed by ALBO-MPCA (14.67 ± 1.21 mm) and the weakest with CS against Enterococcus faecalis (6.50 ± 1.76 mm). CH showed the highest pH, followed by ALBO-MPCA, CS and MTA+. Conclusion. The expressed antibacterial effects indicate that materials based on nano-structured highly active calcium silicates represent effective therapeutic agents for root canal obturation in one-visit apexification treatment, therefore they are recommend for further examination and clinical trials as they are proposed for MTA substitution. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 172026 Grant no. TR31079]

We report of a 39 years old male patient who was admitted to hospital for a surgical treatment of endocarditis of the prosthetic aortic valve. Just after surgery, he had developed a severe inflammatory response with acute kidney and liver injury. Because of that, beside the usual therapy, on the second postoperative day, continuous renal replacement therapy (CRRT) started in CVVHDF mode with hemadsorption using Cytosorb. The Cytosorb therapy is based on an extracorporeal blood purification that reduces excessive levels of inflammatory mediators. After 5 days of CRRT and Cytosorb therapy patient was stable, extubated, with normal kidney and liver function. On the next day, patient was unstable again with significant leukocytosis. Performed reoperation was done due to cardiac tamponade and after that CRRT and Cytosorb therapy were re-established. A few hours later patient was hemodynamically stable. Summary: The Cytosorb treatment can be very useful in postoperative treatment of acute kidney injury and sepsis in patients after the surgical treatment of bacterial endocarditis.

Stem cells have shown great potential for in vitro tissue engineering, regenerative medicine, cell therapy and pharmaceutical applications. All these applications, especially in clinical trials, will require guided production of high-quality cells. Traditional culture techniques and applications have been performed for the majority of primary and established cell lines and standardized for various analyses. Still, these culture conditions are unable to mimic dynamic and specialized three-dimensional microenvironment of the stem cells' niche from in vivo conditions. In an attempt to provide biomimetic microenvironments for stem cells in vitro growth, three-dimensional culture techniques have been developed. In our study advantages of newly developed porous scaffolds as the most promising in vitro imitation of niche that provides physical support, enables cell growth, regeneration and neovascularization, while they are replaced in time with newly created tissue was explained. Furthermore, dynamic cultivation techniques have been described, as new way of cell culturing that will be the main subject of our future research. In that manner, by developing an optimal dynamic culturing method, high-quality new cells and tissues would be possible to obtain, for any future clinical application.

Introduction. Implantation of the new-generation left ventricular assist device (LVAD) is an efficient therapeutic option as a bridge to transplantation in adults, as well as in children and adolescents with small body surface. The aim of this work was to present a case of a successful surgical treatment of terminal heart failure in a male adolescent who had an LVAD implanted as a bridge to heart transplantation. Case outline. The patient, a 17-year-old male, was admitted with the end-stage heart failure due to the dilated cardiomyopathy and implanted LVAD. Fourteen months after LVAD implantation, a successful “second stage” surgical procedure was performed – orthotopic heart transplantation preceded by the LVAD explantation. Conclusion. Long-term mechanical circulatory support is an effective and safe method in treatment of the end-stage heart failure as a bridge to transplantation in the adolescent period.

Background/Aim: Lately, fully innovative sol-gel method with high-temperature self-propagating reaction was used for the synthesis of new nanostructured endodontic materials, in combination with different radiopacifiers: bismuth (ALBO-MPCA1) and barium (ALBO-MPCA2). The aim of this study was to investigate the biocompatibility of nanostructured endodontic materials based on highly active calcium silicates and mixed with different radiopacifiers in comparison to MTA+ using human stem cells from the apical papilla- SCAP cells. Material and Methods: Morphology of the samples was studied by SEM. The tested materials were mixed with distilled water in a ratio 2:1 (m/m). Fifteen minutes fter the preparation, samples were used in the experiment. The biocompatibility of fresh materials, after 3h and 7 days, was tested using 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide- MTT test. Results: Samples mostly consisted of spherical and rode-like. The relative viability of cells increased following the exposure time. Conclusion: The biocompatibility of synthesized materials is comparable to the control material MTA+, and therefore these materials can be recommended for for further clinical stuadies.

Background/Aim: The aim of this in vitro study was to investigate the influence of irradiation cycles and resting periods, on thermal effects on the external root surface during root canal irradiation of two diode laser systems (940 nm and 975 nm), at output powers of 1 W and 2 W in continuous mode. In previous studies the rising of temperature above 7°C has been reported as biologically accepted to avoid periodontal damage on the external root surface. Material and Methods: Twenty human inferior incisors were randomly distributed into four groups, the 940 nm, and the 975 nm diode laser irradiation, both with an output power of 1 W and 2 W, in continuous mode. The thermographic camera was used to detect temperature variations on the external root surface. Digital radiography of the samples was made. Results: After three cycles of irradiation, at apical third of the root, mean temperature variation by 940 nm diode laser irradiation was 2.88°C for output power of 1 W, and 6.52°C for output power of 2 W. The 975 nm laser caused a higher temperature increase in the apical region, with temperature variation of 13.56°C by an output power of 1 W, and 30.60°C at 2 W, with a statistical significance of p ≤ 0.0001 between two laser systems compared for the same power. The resting periods of 20 s between cycles were enough to lower temperature under 7°C in the case of 1 W and 2 W for 940 nm diode laser, while for 975 nm laser, after three irradiation cycles overheating occurred at both output power rates. Conclusion: Three cycles irradiation of 940 nm diode laser, with resting periods of 20 seconds, allowed safe usage of 1 W and 2 W in CW for endodontic treatment. For 975 nm at a power rate of 1 W, the last resting period drop the temperature near the safe limit and it came under 7°C in a period less than a minute, while at the power of 2 W the resting periods were not long enough for the safe temperature decrease.

The provision of universal postal service involves high costs for operator, especially in rural areas. The aim of this paper is to propose and test tool for managing the cost of providing universal postal service and maintaining the postal network in order to facilitate understanding of the problem in the sector. The proposed approach use standard prices and standard quantities (the redefined number of postal units, the number of employees, etc.) as well as average costs for calculation of the costs of the universal postal service and postal network. The methodology provides the efficiency analysis, benchmarking and identification of causes of poor performance of management and resource allocation. It can be used for postal operators that do not have modern accounting systems.

Background/Aim. Apical periodontitis is mainly caused by bacterial infection within the root canal and periapical bone destruction which are prominent features of this lesion. The aim of this study was to determine the quantity of interleukin-1β in the tissues of periapical lesions and to analyze its relationships with: lesion size, previous treatments and pathohistological finding of involved teeth. Methods. Periapical tissues were obtained from patients undergoing periapical surgery. Out of all 80 cases included in the study, 24 had no previous endodontic treatment (open lesions), 37 were with endodontic failure (closed lesion) and in 15 cases root canal retreatment was performed few months before the surgery. By excluding four samples, the total of 76 samples, consisted of periapical lesions and the apical part of the tooth root, was collected. Each periapical tissue sample was divided into two equal parts. The one half of each lesion was used for quantification of interleukin-1β in tissue homogenates by the enzyme-linked immunosorbent assay (ELISA) method. The other part of each lesion was used for histopathological evaluation. Results. For each of the tissue homogenates, the quantity of interleukin-1β was measured, and it ranged from 0.6 pg/mg up to 74 pg/mg. There was no significant difference between the symptomatology and amount of interleukin-1β. Statistical data analysis showed a moderate correlation between lesion size and interleukin-1β measured values. The highest levels of interleukin-1β corresponded with chronic lesions in the stages of acute exacerbation and granulomas in early developing stages. Persistant granulomas, scar tissues, non-inflamed cysts and teeth with recently finished endodontic treatments showed a significantly lower level of interleukin-1β. Conclusion. The study results suggest that the differences in quantity of interleukin-1β correlate to lesion progression and phases of development.

Heart transplantation is a method of choice for the surgical treatment of a terminal stage of cardiac insufficiency. The lack of donors that all health systems in the world are experiencing has led to the intensive development of devices for permanent mechanical support of circulation. Implantable devices, such as the LVAD circulation pump, are widely accepted as a therapeutic option for improving the quality of life and survival of patients with terminal heart failure. Indications for incorporation include bridge to transplant (BTT), bridge to candidacy (BTC) and destination therapy (DT). The article presents a case of successful surgical treatment of terminal heart failure. The patient was implanted with a circular support device for left heart chamber for the maintenance of vital parameters and bridging the period to heart transplantation.