Stjepan Spalj

Aim: To evaluate the psychometric properties of the Croatian version of the Child Perceptions Questionnaire 8–10 (CPQ8–10) and to explore the relationship between oral health, malocclusion, and quality of life in children. Methods: A convenience sample of 278 Croatian children aged 8–10 years completed the CPQ8–10, including items on oral symptoms (OS), functional limitations (FL), emotional well-being (EW), and social well-being (SW). Clinical examinations recorded dental caries and malocclusion. Internal consistency, test–retest reliability, convergent and discriminant validity, and responsiveness to early orthodontic treatment were assessed. Confirmatory factor analysis tested the original four-factor structure. Results: The four-factor structure was confirmed, explaining 49.6% of the total variance, with acceptable model fit. Cronbach’s α ranged from 0.56 (OS) to 0.84 (EW). Strong test–retest reliability was present for OS (r=0.84) and moderate reliability for FL, EW, SW, and total score. CPQ8–10 scores correlated with global self-ratings of oral health and well-being, and children with active caries showed higher OS, EW, and total scores (p < 0.05). Responsiveness analyses in 27 children undergoing early orthodontic treatment showed significant improvement in total CPQ score (p = 0.047). Conclusion: The Croatian CPQ8–10 is a valid, reliable, and responsive measure of oral health–related quality of life in children. Emotional and social dimensions are particularly sensitive, supporting the instrument’s use in clinical and epidemiological contexts to evaluate the impact of dental conditions and interventions from the child’s perspective.

Objectives: To evaluate patients' perceptions of colour change induced by tooth whitening over 1 year. Material and Methods: This study included 50 participants aged 19–28. In 24 patients, teeth were whitened with photoactivated gel, whereas in 26 patients, a placebo gel with peppermint oil was applied to simulate burning. Colour changes were monitored spectrophotometrically. Patients reported procedural pain and psychosocial impact using the Orofacial Esthetic Scale (OES) and Oral Health Impact Profile (OHIP). Personality characteristics were assessed. Results: Short‐term (one week) colour change was significantly greater in the active group than in the placebo group (effect estimate 1.9; 95% confidence interval [CI] 1.1–2.8; p < 0.001), but this difference decreased in the long term (one year) due to relapse in the active group. Higher pain was reported in the active group than in the placebo group ( p = 0.013). Teeth whitening significantly increased satisfaction with orofacial aesthetics (OES) in both groups in the short term ( p < 0.001). Long‐term satisfaction decreased in the active group, but not in the placebo group. Satisfaction in both groups was higher in the long term than before the intervention. The intervention reduced the OHIP domain scores in both groups in the short term; however, no major changes were observed in the long term. The intensity of short term colour changes in the correlated with the intensity of the change in psychosocial impact ( r = −0.304; p = 0.032). A greater long‐term colour change was associated with reduced psychosocial impact among introverted participants ( p = 0.043). Conclusion: Both tooth whitening and placebo appeared to confer psychosocial benefits, possibly due to colour changes, expectancy effects, and temporary satisfaction. Trial Registration: This clinical trial was retrospectively registered at ClinicalTrials.gov (Identifier NCT03380702) on 21 December 2017. The trial protocol and statistical analysis plan are available through the ClinicalTrials.gov registry. Individual de‐identified participant data (including the data dictionary), statistical code and other study materials are available from the institutional repository https://repository.fdmri.uniri.hr/

Introduction: Malocclusion and altered dentofacial esthetics significantly influence adolescents' psychosocial well‐being during a sensitive developmental period. Understanding these impacts is important for esthetic and orthodontic treatment planning. Methods: A total of 254 adolescents from orthodontic clinics in Osijek, Rijeka, and Split completed the Malocclusion Impact Questionnaire (MIQ), the Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ), the Jaw Functional Limitation Scale (JFLS), along with Likert‐type scales assessing satisfaction with dental and facial appearance and perceived need for orthodontic treatment. Results: The Croatian MIQ showed a unidimensional structure with excellent internal consistency ( α = 0.92). MIQ correlated strongly with PIDAQ domains ( r = −0.58–0.76, p < 0.001) and the esthetic component of the IOTN as rated by both patients and orthodontists ( r = 0.27 and 0.32; p < 0.001), but not with JFLS or objective malocclusion indices. Malocclusion impacts were influenced by the increased esthetic component of IOTN (6% of variance; p < 0.001), female gender (13%; p < 0.001), and increased age (3%; p = 0.011). Conclusion: Older female adolescents experienced a greater psychosocial impact of malocclusion. The Croatian MIQ is a valid and reliable instrument for assessing the psychosocial impact of malocclusion.

The aim was to analyze current orthodontic retention protocols in Croatia and their trend over a 10-year period. In a repeated cross-sectional survey, questionnaires were distributed to 150 orthodontists in Croatia in 2013 and 185 of them in 2023 (representing 69% and 85% of practicing orthodontists with response rates of 61% and 75%). Significant changes in retainer types across different malocclusions and treatment protocols were observed over a 10-year period. There was an increase in the use of VFR and a decrease in acrylic retention plates in both jaws (p≤0.001). Over the decade, the use of only fixed retention in the mandible declined from 20% to 7% (p=0.007), and the combination of fixed and removable retention in the maxilla dropped from 29% to 17% (p≤0.033). Increased use of removable retainers was noted in cases involving rotations, open bites, and extractions. Conversely, fixed-removable retainers were more frequently used in spacing cases (p≤0.001). There was a trend toward fewer check-ups (p=0.001) and toward increased patient self-monitoring (p=0.021). Personal experience as the primary reason for choosing a retention protocol increased from 39% to 62% (p<0.001). Additionally, the use of written information on retention rose from 39% to 69% (p<0.001). Retention practices in Croatia have evolved over the past decade, characterized by increased use of VFRs, more frequent implementation of dual retention in the mandible, and greater provision of written retention information. Additionally, follow-up protocols have shifted toward fewer scheduled visits, with increased emphasis on patient self-monitoring.

Objective: To evaluate whether tobacco smoking modifies the clinical outcomes of non‐surgical periodontal therapy (NSPT) in adults with periodontitis and what are the added benefits of a chlorhexidine‐based antiseptic. Methods: Sample included 60 subjects aged 24 to 75 years (median 49; 67% females) diagnosed with periodontitis; 50% of them were regular smokers. All subjects underwent clinical periodontal examination that included measuring Full Mouth Plaque Score (FMPS), Full Mouth Bleeding Score (FMBS), Pocket Depth (PD), Clinical Attachment Level (CAL), Gingival Recession (GR) and Tooth Mobility (TM). All subjects underwent NSPT. Half of the subjects in each group used a 0.12% CHX‐based mouth‐rinse twice a day for 15 days. Clinical examination was repeated 8 weeks after NSPT. Results: FMPS significantly decreased after NSPT in all groups ( p ≤ 0.013). FMBS was reduced in non‐smokers (with and without CHX) ( p ≤ 0.038) with a greater effect when using CHX. No major differences in FMBS in smokers were noted. NSPT reduced PD in all non‐smokers ( p ≤ 0.016) with a greater effect with CHX use; and in smokers with CHX ( p ≤ 0.016). The same findings were in gain of CAL ( p ≤ 0.028). The effect of NSPT on GR and TM was small. In multiple regression analysis, the use of CHX and male sex were significant predictors of a reduction in the proportion of deep pockets (≥ 5 mm), when age and exposure to tobacco smoke were controlled for (R ² = 0.170; p = 0.033). Conclusion: Smoking reduces the success of NSPT but the addition of antiseptic proved to be an additional benefit.

Objectives The study compared the bacterial composition of supragingival dental biofilm (SDB) among smokers and non-smokers (NS). Materials and methods This cross-sectional study included 60 subjects allocated into three groups: tobacco heating system smokers (THSS), cigarette smokers (CS) and NS. SDB samples were collected, and bacterial DNA was extracted and prepared for next generation sequencing of the 16s rRNA gene hypervariable regions. Bioinformatic pipelines were applied to assess microbial diversity and taxonomic composition. Results No significant differences were observed in alpha diversity (Observed taxa and Shannon index) or beta diversity (Bray-Curtis index) among groups. In contrast, significant differences in microbiome bacterial composition were identified across multiple taxonomic levels. At the genus level, Alysiella (p = 0.016) and Propionibacterium (p = 0.025) were most abundant in THSS, whereas Actinobaculum (p = 0.004), Avibacterium (p = 0.015) and Haemophilus (p = 0.030) predominated in NS. At the species level: Alysiella filiformis (p = 0.006) and Streptococcus thermophilus (p = 0.025) were most abundant in THSS, Streptococcus lactarius (p = 0.05) in CS, and Prevotella multiformis (p = 0.016) and Lactobacillus salivarius (p = 0.018) in NS group. Conclusions Distinct differences in bacterial composition of SDB were observed among THSS, CS and NS. The increased abundance of anaerobic bacteria with cariogenic potential in THSS and CS suggests a more dysbiotic profile and increased pathogenic potential compared to NS. Clinical relevance Variations in SDB bacterial composition may influence the pathological potential of dental biofilms in smokers and non-smokers.

Objective: The oral cavity is the beginning of the digestive tract and the composition of saliva could indicate immune events in the gut and joints. The objective of this research was to evaluate the diagnostic accuracy of salivary interleukin (IL)-17A for temporomandibular joint (TMJ) internal derangements (IDs) in patients with spondyloarthritis (SpA). Methods: SpA disease activity was assessed using the Bath Ankylosing Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and Disease Activity Index for Psoriatic Arthritis (DAPSA). Salivary cytokines were analyzed using enzyme-linked immunosorbent assay. TMJ conditions were evaluated using The Diagnostic Criteria for Temporomandibular Disorder (DC/TMD) protocol. A symptomatic TMJ-ID group with intracapsular arthralgia (n = 64) and asymptomatic TMJ-ID group without intracapsular arthralgia (n = 50), regardless of joint sounds, were compared with controls (healthy TMJs, n = 86). Results: Women were more prevalent and salivary IL-17A concentration was higher in both ID groups than in controls. Salivary IL-17A levels positively correlated with erythrocyte sedimentation rate, anti-streptolysin-O titer, salivary IL-12/23 p40 and matrix metalloproteinase-3 levels, sore and swollen joint counts, BASDAI, chronic TMJ pain and anxiety. IL-17A demonstrated diagnostic accuracy for currently symptomatic (cutoff, 11 pg/mL) and asymptomatic (cutoff, 11.6 pg/mL) TMJ-ID vs. controls. Patients with IL-17A levels above these cutoffs more frequently exhibited disc displacement with reduction and degenerative TMJ disease, higher self-reported spinal pain and higher SpA activity, as assessed by ASDAS, than patients with IL-17A levels ≤ cutoffs. TMJ-related headache and somatization contributed to greater TMJ pain in those with IL-17A > cutoffs, when compared with dichotomous controls. Conclusions: Salivary IL-17A concentration provides an accurate laboratory marker of SpA activity and enables the diagnosis of both currently symptomatic and asymptomatic TMJ-IDs in patients with SpA.

To investigate quality of life changes, family impacts, and predictors of successful overjet (OJ) reduction in patients treated with removable functional appliances for prominent upper front teeth. A total of 86 cases were analyzed, whose ages ranged from 11 to 13 years (median 12; 43% female). They were randomly allocated to treatment by twin block (TB) and Sander bite-jumping appliance (SBJ). OJ was measured before and after 1 year, and the Child Perceptions Questionnaire, Parental-Caregivers Perceptions Questionnaire, and Family Impact Scale were self-administered. Treatment was unsuccessful in 33% of patients (discontinued regular check-ups or OJ reduction ≤ 40%). In successfully treated individuals, there was a reduction in problems related to child emotional well-being (EW) and oral symptoms, parental EW, and family impacts (p ≤ 0.010). In unsuccessfully treated individuals, there was a reduction in problems related to child EW and social well-being (p ≤ 0.036). In the multiple logistic regression model, sex, type of appliance, and parental perception of the child's functional limitations before treatment were predictors of successful OJ reduction (p < 0.001). Success odds were 8.1 times increased with TB compared to SBJ appliance (95% confidence interval [CI] 2.4-27.6; p = 0.001), 5 times in males (95% CI 1.6-15.5; p = 0.006) and 5 times when parents observed lowered functional limitations (≤ 4) in their child (95% CI 1.5-16.4; p = 0.008). Appliance type, sex, and parental perceptions of a child's functional limitations predicted treatment success. Both successfully and unsuccessfully treated young adolescents reported improvement in oral health-related quality of life, implying that unsuccessfully treated patients convinced themselves that it was worth being treated.

Objective: To explore how age and gender shape the relationship between personality traits, quality of life (QoL), and a patient’s decision to undergo surgery for correction of dentofacial deformity. Methods: In a cross-sectional study, 108 individuals aged 14–53 years (median age 18 years; interquartile range 17–26) with a moderate to very great need for surgery according to the Index of Orthognathic Functional Treatment Need were assessed. There were 43% adolescents (≤17 years) and 68% females. Participants completed validated questionnaires measuring personality characteristics (Big Five Inventory, Multidimensional Perfectionism Scale, and Self-Esteem Scale), along with the Orthognathic Quality of Life Questionnaire. The decision to accept or refuse surgery was recorded. Results: Overall, 51% of patients accepted surgery (48% of females and 57% of males). Adults were more likely to accept surgery than adolescents (61% vs. 37%; p = 0.019, V = 0.241; odds ratio 2.7; 95% confidence interval 1.2–5.9). In adults, lower self-esteem (SE) (p = 0.034, r = 0.270) and higher perfectionism (p = 0.012; r = 0.320), particularly concern over mistakes (CM) (p < 0.001; r = 0.469) and personal standards (p = 0.004; r = 0.370), were associated with acceptance. Among adolescents, personality traits showed no significant effect. However, in both age groups, impaired oral function (OF) (p = 0.013; r = 0.368 for adolescents and p = 0.006; r = 0.348 for adults) and greater facial esthetics concern (FE) (p = 0.018; r = 0.350 and p = 0.015; r = 0.310) influenced surgery acceptance. Males who accepted surgery had higher awareness of deformity than those who refused (p = 0.006; r = 0.463), while females who accepted surgery had lower SE (p = 0.044; r = 0.235). In both males and females FE was higher in those who accepted surgery (p = 0.009; r = 0.439 for males and p = 0.006; r = 0.320 for females), OF (p < 0.001; r = 0.597 and p = 0.003; r = 0.342), and CM (p = 0.030; r = 0.367 and p = 0.006; r = 0.325). Conclusions: The relationship between personality traits, QoL, and the decision to undergo orthognathic surgery was more strongly influenced by age than by gender. OF and FE influenced acceptance across all age and gender groups, while personality-related factors were particularly relevant among adults.