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.

Aim To investigate the frequency of consumption of sweet and salty snacks among children aged 2-18 years in relation to their mothers' education level. Methods A descriptive epidemiological study was conducted in five dental practices at the School of Medicine of the University of Mostar from May to October 2022. The data were collected from medical records. Results: Out of a total of 477 children, 172 (36.1%) had mothers with a high school education, while 305 (63.9%) had mothers with a university degree. In the group of preschool children (aged 2-6 years), there were 42 mothers with high school education and 105 with university degree. In the group of school children (age 7-18 years) there were 130 mothers with high school education and 200 with university degree. The difference in the consumption of sweetened beverages among children of mothers with high school and university was not statistically significant. Similar results were found for the consumption of salty snacks, lollipops, caramels and candies. The frequency of the consumption of biscuits, chocolate and cakes (several times a day) was statistically significantly higher among the children of mothers with high school education (p=0.04), especially among school children. Eating habits of children, regardless of the level of education of their mothers, differed significantly only in the consumption of lollipops, caramels, and candies (p=0.03), which were consumed once a day by 79 (63.7%) schoolchildren and 45 (36.3%) of pre-schoolers. Conclusion A higher level of education among mothers does not necessarily equate to proper nutritional knowledge.

Objectives Dental caries first occurs within primary dentition in toddlers and preschool children, in a form of early childhood caries (ECC). In every day’s busy and employment burdened parenting, caretakers and institutions have become important even more nowadays, not only for forming child general behavior and character, but also for maintenance of their general and oral health as well. Aims To evaluate the presence and severity of ECC in children who attended public kindergartens in Sarajevo, and to offer basic information for the maintenance and improvement of child oral health to their parents and kindergarten teachers. Methods The study included 1722 preschool children aged 3-6 years who attended kindergartens within Sarajevo public kindergarten institution, together with their parents and kindergarten teachers. Dental team members gradually visited all kindergartens situated in four Sarajevo city municipalities and examined kindergarten children according to the WHO Oral Health Survey Manual. Oral health promotion material for parents and kindergarten teachers was also distributed simultaneously during sequential visits. Results ECC was present in preschool kindergarten children in Sarajevo, with its high prevalence (67.71%); dmft-value (3.97) and severity (SiC index 8.79). There was also a significant lack of dental healthcare to examined children mostly related to lack of visiting dental offices by children’s parents (CI=10.55%, RI=10.80%, TI=12.98%). Conclusion Parental role in preserving and improving of their children oral health should be systematically and profoundly improved. Kindergarten officials and staff should recognize the importance of anticariogenic diet menus and oral hygiene maintenance within their institutions.

Background/Aim: Deep carious lesions on primary teeth usually have been causing infectious dental pulp changes. If indicated, traditional endodontic root canal treatment for these kinds of pulpal infections in primary teeth usually should involve the performing of pulpectomy methods, but often with questionable prognosis. The lesion sterilization and tissue repair (LSTR) approach is one of the good endodontic therapeutic alternatives for affected primary teeth with a poor prognosis, which could otherwise be condemned to premature extraction. Aim was to evaluate the medium-term clinical success in everyday practice of the LSTR method applied in affected primary teeth with irreversible pulpal tissue infections by observation of reduction/absence of their clinical symptoms. Material and methods: The study sample included child patients who had one or more of their affected primary molars with irreversible pulpal tissue changes of poor prognosis treated with the LSTR method. For each patient whose primary molar tooth was endodontically treated with the LSTR method a clinical evaluation of treated tooth was performed at intervals of 1 and 12 months afterwards. Results: Study sample was consisted of 40 child patients aged 4 to 9 years, with 45 primary molars included in total. It was obvious that the symptoms related to affected sample teeth have already been decreased almost immediately after initial action of triple antibiotic paste. Final outcome after 12-months follow-up period was success of applied LSTR method in 43 (95.6%) affected sample teeth in a way that initial clinical symptoms completely decreased and disappeared. Conclusions: LSTR method has been shown as successful pulpotomy technique for noninstrumental endodontic approach in non-vital pulp treatment of primary molar teeth in a 12-months follow-up period.

Background/Aim: The aim of the research was to examine the general attitude, knoweledge and practice of pediatricians about caries in children of preschool age. Material and Methods: The research was conducted from November 2019 to the end of January 2020. The research consisted of a survey of pediatricians. The questionnaire consisted of 4 modules and 37 questions, which related to the attitude, knowledge and practice of pediatricians on the prevention of early childhood caries. Results: The majority of pediatricians (84.9%) stated that they assess the nutrition of their patients, while 32.1% of them always do oral health assessment, and half of them in the second month of the child's life; and 39.6% assess oral health only if there is a problem. The majority of pediatricians (86.8%) recommended the first dental examination, most often in the first year of the child's life (79.5%), and then every 6 months (43.5%). The majority of respondents did not required information about the dental health of their patients' mothers, fluoride toothpastes and topical application of fluoride as well (62.3-75.5%). The majority of pediatricians (79.2%) have never provided or sometimes provided educational material on caries prevention and control to the parents of their patients. The most accurate answers and the highest percentage of correct answers that the pediatricians had were about attitudes (Z=8.98, 66.63%), while the fewest correct answers and the lowest percentage of correct answers regarding the practices on the prevention of early childhood caries (Z=11.91, 58.90%). Conclusions: The research showed that pediatricians have the good attitudes and knowledge, but do not implement prevention of early childhood caries in practice. The basic deficiency of attitude, knowledge and perception of the importance of prevention is a consequence of insufficient education of pediatricians.

Introduction: Dental fear and anxiety (DFA) is a ubiquitous entity among dental patients in terms of their prevalence and incidence. It is among the major clinical problems in dentistry. In addition, the differences in DFA prevalence were present considering the age and gender of patients and over time, but with some opposite reports. The aim of this study is to examine the prevalence of DFA presence in children concerning their age, gender, and over time. Methods: The survey sample comprised 200 of 9–12-year-old children. The DFA presence was determined twice by the modified version of the CFSS-DS scale (CFSS-DS-mod scale) during a 6-months long period between the first and the subsequent dental appointment due to the need for restorative dental treatment. The scale was applied before the restorative treatment started on both occasions. Results: The prevalence of DFA was 17.5% in the study sample and decreased over time. It was slightly higher in girls. Conclusions: The DFA prevalence in 9–12-year-old children is decreasing over time. Latent manifestations of DFA presence should be considered for evaluation in the future.

Background: As the pandemic time went by in Bosnia and Herzegovina (B&H), various patterns toward COVID-19 itself and its impacts, implementation of prescribed preventive measures among the team members, and those of their patients, including immunization process, have been revealed. These patterns were of both empirical and evidence-based kind and consequently formed dental personnel behavior. The aim was to evaluate and compare the COVID-19 status of dentists in B&H, implementation of prescribed preventive measures, and usage of various kinds of PPE, at the beginning of the pandemics and now, 2.5 years later, including dentists’ current vaccination status, and their opinions and attitudes toward the national COVID-19 economic impact on dental practice. Methodology: Study research was in a form of a cross-sectional longitudinally designed online survey and was conducted in two parts. Results and conclusions: Dental professionals in B&H had a high frequency of COVID-19 symptoms in the second pandemic year. The vaccination status of dentists in B&H was in line with the global average values of vaccinated professionals. Dentists used patient management preventive measures and PPE recommended by WHO, but some preventive measures have been changed and prioritized recently. The economic impact of pandemics on dentistry was predominantly negative.

Objectives Oral health in children is additionally burdened with the presence of dental fear and anxiety (DFA). These clinical psychologic entities in their progressive stages inevitably lead to avoidance of dental appointments, which makes prevention and therapy of oral diseases more difficult. Upon the onset of DFA in general, as one of the emotional outcomes of stress in a dental office, most children patients could define the specific stressors that were most intense for them, which could predict the presence of DFA. Aim To examine the predictors of DFA presence in 9-12-year-old children, and investigate how they could explain the DFA occurrence in study participants. Material and Methods The sample consisted of 200 children aged from 9 to 12 years. The DFA presence was determined by the modified version of the CFSS-DS scale. The child's behavior in the dental office during the treatment was evaluated by the trained observer using Venham anxiety and behavior rating scales. Socioeconomic status, characteristics of dental office visits, and previous caries experience were also analyzed. Results The main DFA predictors were related to invasive dental treatments, where the behavior during dental treatment was the most accurate expression of the DFA appearance. Conclusions Invasive dental procedures are the main stressful factor for DFA occurrence. Predisposing factors could strengthen the DFA occurrence.

Background: The most commonly used diagnostic tests for evaluation of the dental fear and anxiety (DFA) presence in children were psychometric scales, where interpretation in determining and using of their cut-off scores sometimes was not completely exact. Also, several studies have been conducted where the results were conflicting in terms of who better assessed the DFA presence - the children, their parents, or dentists. Objective: To determine the normative values in the child and parental versions of the Modified version of the CFSS-DS scale (CFSS-DS-mod scale) and to compare the ways in which children, their parents, and the dentist assessed the DFA presence in the dental office. Methods: Survey sample consisted of 200 children aged from 9 to 12 years, whose DFA presence was determined by the CFSS-DS-mod scale. Child parents answered to their version of this scale, and the dentist observed the child behavior in the dental office during the treatment using Venham Anxiety and Behaviour Rating Scales. Results: Parental version of the CFSS-DS-mod scale found to be reliable (Cronbach alpha = 0.955) and valid (67.87% of variance explained) instrument for assessment of the DFA presence in children. Two cut-off scores were determined in a child (37 and 43), as well as in a parental version of CFSS-DS-mod scale (36 and 44), respectively. Dentists assessed the DFA presence in child patients most accurately. Conclusion: The normative values of psychometric instruments should be considered prior to their use. The borderline area of DFA presence should also be taken into account in the future studies. Children could underestimate DFA existence by themselves while interviewing.

Introduction: Having in mind the importance of providing continuous pediatric dental services during the COVID-19 pandemic and the fact that children have similar viral loads to adults, the potential to spread the virus to others, and with variable clinical presentation of COVID-19 infection, this study aimed to analyze the impact of COVID-19 outbreak on pediatric dentistry service provision, risks, and preventive measures before and during dental treatment. Method: Structured and closed epidemiological cross-sectional survey involved seven Southeastern European countries. The questionnaire was developed using the modified Delphi method, pretested, and tested in North Italy during April 2020. The sample consisted of licensed dental professionals reached via national dental chambers and social media using the best strategies according to the national setting. Results: A total of 3227 dentists participated in the survey, and we included 643 specialists in this study—among them, 164 were pediatric dentists. Most pediatric dentists worked in the public sector (61.0%) and provided emergency (64.6%) and routine dental treatment (18.3%) during the outbreak. One-third of pediatric dentists were COVID-19 tested, statistically significantly more than other specialties, and 3.0% tested COVID-19 positive. In addition, significantly more pediatric dentists (13.4%) reported the presence of at least one symptom related to COVID-19 compared to other specialists (6.1%). None of the pediatric dentists reported PPE shortage. However, 26.2% of all specialists stated that they lacked clear step by step professional guidance in a national language. Similarly, in both groups, around 10% of specialists attended education on coronavirus. Conclusions: Considering that most pediatric dentists provided dental treatment during lockdown in their countries in public health centers and that they will continue to work during pandemic, our results suggest that pediatric dentists might be at higher risk of COVID-19 infection. Further research should focus on finding better ways to promote and adapt preventive, protective measures and PPE in the pediatric dental setting to be behaviorally acceptable. Moreover, additional efforts should be invested in dental education regarding COVID-19 in the mother tongue.

Uvod/cilj: Cilj je ovog istraživanja ispitati stupanj znanja i stavove o oralnom zdravlju medicinskih sestara, prvostupnica/prvostupnika i magistri/magistara sestrinstva, zaposlenih u KBC-u Rijeka, te vidjeti postoje li razlike u znanju i stavovima u odnosu na stupanj stručne spreme. Ispitanici i metode: Istraživanje je provedeno na uzorku od 100 ispitanika muškog i ženskog spola, u dobi od 22 do 62 godine. Ispitanici su medicinske sestre sa završenom srednjom školom (49 %) i prvostupnici ili magistri sestrinstva (51 %). Istraživanje je provedeno putem upitnika Hiroshima University-Dental Behavioral Inventory (HU-DBI). Rezultati: Medicinske sestre / medicinski tehničari koji su prvostupnici ili magistri sestrinstva imaju statistički značajno viši ukupan HU-DBI (p = 0,033). Statistički značajne razlike nađene su u pitanjima o pažljivom četkanju svakog zuba (p = 0,026), o odgađanju odlaska stomatologu sve dok ne zaboli zub (p = 0,008) i o tome da im se dogodilo da im stomatolog kaže da dobro četkaju svoje zube (p = 0,016). Zaključak: Dobiveni rezultati pokazuju da medicinske sestre sa završenim studijem sestrinstva imaju više znanja o oralnom zdravlju i da ta znanja primjenjuju u svom svakodnevnom održavanju oralne higijene

Background/Aim : The aim of this study was to investigate oral health knowledge, attitudes and habits regarding oral health among nurses and to evaluate if there is a difference in self-reported oral health behavior in relation to the degree of professional education. Methods : The study was conducted on a sample of 100 subjects, both gender, aged 22 to 62. The respondents were nurses with completed secondary school (49%) and nurses with bachelor’s or master’s degrees in nursing (51%). The study was conducted via the Croatian version of the Hiroshima University-Dental Behavioral Inventory (HU-DBI) questionnaire. Results : Nurses with a bachelor’s or master’s degree had a significantly higher HU-DBI score than nurses with completed secondary school (p=0.033). Statistically significant difference was found in the following questions: I brush each of my teeth carefully (p=0.026), I put off going to the dentist until I have a toothache (p=0.008) and I have had my dentist tell me that I brush very well (p=0.016). Conclusion : The obtained results show that healthcare professionals with higher education (bachelor’s or master’s degree in nursing) have more knowledge on oral health and that they apply this knowledge in their daily oral hygiene routine.