Satisfaction of Parents and Caregivers with Dental Treatment of Children Under General Anesthesia in a Day Care Surgery Setting

Objective

The aim of this study was to examine the satisfaction of parents and caregivers of patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting.

Material and Methods

Anonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA. The survey consisted of 4 parts: general data, data about procedure, satisfaction with various aspects of care and the perception of parents/caregivers about the condition of their child in relation to the time before dental treatment in GA.

Results

66 parents/caregivers (30.5%) responded to the questionnaire. Overall satisfaction with the treatment was high (4.69). Respondents expressed the highest degree of satisfaction with communication with nurses (4.92), and the lowest with the waiting time for the procedure (3.89). Parents/caregivers of patients who reported difficulty eating expressed significantly lower overall satisfaction than the subjects whose children did not report difficulty eating. Also, the more treatments the patients underwent, the lower was the overall satisfaction than of those subjects whose children were never treated in such a manner before.

Conclusions

Since patient satisfaction has a beneficial impact on treatment outcome and adherence to preventive recommendations, all health care providers should strive to achieve it.

Oral Cavity Colonization with Multidrug-Resistant Gram-Negative Bacteria after Preoperative Prophylactic Use of Antibiotics as a Risk Factor for Ventilator-Associated Pneumonia

BACKGROUND

Although it was previously shown that prolonged prophylactic antibiotic exposure and multiple inadequate antibiotic therapies are independent risk factors for multidrug-resistant ventilator associated pneumonia there were no studies investigating whether pre-operative prophylactic dose of antibiotics changes oral microbiome and increases the risk of ventilator associated pneumonia. The aim of the study was to determine if pre-operative prophylactic dose of antibiotics affects the oral microbiome, increases the colonization with Gram-negative bacteria and subsequent risk of ventilator associated pneumonia.

SUBJECTS AND METHODS

Mechanically ventilated adult patients receiving surgical antibiotic prophylaxis were included in the study. The presence of Gram negative microorganisms in the pre-prophylactic and post-prophylactic oral swabs and tracheal aspirates, as well as the occurrence of ventilator associated pneumonia, were analyzed.

RESULTS

Number of patients colonized with Gram negative bacteria in post- prophylactic oral swab was significantly higher compared to oral swab taken before prophylactic antibiotic. On the other hand, the number of patients with Gram- negative bacteria in tracheal aspirates remained similar as in post- prophylactic oral swabs. Moreover, we found that presence of Gram- negative bacteria in both pre- and post- prophylactic oral swabs was in the positive correlation with the presence of Gram- negative bacteria in tracheal aspirates.

CONCLUSIONS

This study showed increased colonization of oral cavity with Gram- negative bacteria after preoperative prophylactic antibiotics. Furthermore, receiving two prophylactic antibiotics from WHO Watch list increased the incidence of Gram- negative bacteria in oral swabs and tracheal aspirates, and the risk of ventilator associated pneumonia development.

Self-Massage and Low-Level Laser in Treatment of Masseter Myalgia: Short-Term Effect

INTRODUCTION

The aim of this study was to explore the efficiency of massage in the treatment of masseter myalgia compared with biostimulatory laser.

MATERIALS AND METHODS

The instrument Diagnostic Criteria for Temporomandibular Disorders was used to select subjects and monitor treatment outcome. 54 subjects with masseter myalgia of more than 3 months in duration were invited to participated and 42 cases were available at the end and analyzed. Age range was 16-67 years (median 33, interquartile range 25-53), 36% subjects was ≥40 years and there were 62% females in both groups. Both treatment groups (self-massage and laser) had 21 participants and were monitored one months after the start of treatment. Age, gender, distress, somatization, catastrophizing, hypervigilance, health competence and oral parafunctions were also assessed as factors that could influence effectiveness of treatment.

RESULTS

Laser and massage are effective in reducing symptoms of chronic myalgia of the masseter in self-reported limitation of jaw function and reducing pain intensities (p<0.001). Increase of mouth opening was present in both groups, but mainly significant in laser group. The differences in the amount of change between groups were not significant. Psychological characteristics and parafunctions, present before the treatment, age and gender did not have major affect the effectiveness of treatment.

CONCLUSION

Both treatment modalities are effective in treatment of chronic myalgia in short-term.

Post-Discharge Complications of Dental Treatment in General Anesthesia Performed in a Day-Care Service

Objective

To review the frequency and management of post-discharge complications in patients who underwent dental treatment in general anesthesia (GA) in a day-care surgery setting and identify the factors that increase the risk for these complications.

Material and methods

Anonymous questionnaire was sent to parents/caregivers of patients who underwent full mouth restoration in GA at our institution between 1^st January 2017 and 31^st July 2019. Demographic and clinical data of patients as well as the data about the occurrence and management of complications were collected.

Results

Sixty-six parents/caregivers (30.5%) responded to the questionnaire. Most frequent complications were drowsiness and pain in 40(60.6%) patients. Complications were managed by parents or caregivers with conservative measures at home in 57(91.9%) cases. Phone consultation with dentist was required in 5(8.1%) cases. One patient (1.6%) was readmitted. Younger age and diagnosis were associated with increased risk for drowsiness.

Conclusion

Post discharge complications of dental treatment in GA in a day-care service are common and they can be managed by parent/caregiver with conservative measures at home. The rate of readmission is low. Dental treatment in GA in a day-care service is a safe procedure that can be performed with acceptable risk in carefully selected patients.

Prophylactic application of antibiotics selects extended-spectrum β-lactamase and carbapenemases producing Gram-negative bacteria in the oral cavity

Prophylactic administration of broad-spectrum antibiotics in surgery can change the oral microbiome and induce colonization of oral cavity with Gram-negative bacteria including multidrug (MDR) or extensively drug resistant (XDR) organisms which can lead to lower respiratory tract infections. The aim of the study was to analyse the Gram-negative isolates obtained from oral cavity of the mechanically ventilated patients in ICUs, after prophylactic application of antibiotics and their resistance mechanisms and to compare them with the isolates obtained from tracheal aspirates from the same patients. The antibiotic susceptibility was determined by broth dilution method. PCR was applied to detect genes encoding β-lactamases. Marked diversity of Gram-negative bacteria and resistance mechanisms was found. High resistance rates and high rate of bla_CTX-M and carbapenemase encoding genes (bla_VIM-1 , bla_OXA-48 ) were found among Klebsiella pneumoniae. Pseudomonas aeruginosa was found to harbour bla_VIM and in one strain bla_PER-1 gene, whereas Acinetobacter baumannii produced OXA-23-like and OXA-24/40-like oxacillinases and was XDR in all except one case. All XDR isolates belong to international clonal lineage II (IC II). The main finding of the study is that the prophlylactic application of antibiotics in surgery intensive care units (ICUs) is associated with the colonization of oral cavity and lower respiratory tract with Gram-negative bacteria. The identity of Gram-negative bacteria in oral cavity reflected those found in endotracheal aspirates leading to conclusion that oral swab as non-invasive specimen can predict the colonization of lower respiratory tract with resistant Gram-negative organisms and the risk for development of ventilator-associated pneumonia.

Development of a valid and reliable instrument for the assessment of quality of life in parents of children with clefts

PURPOSE

Orofacial clefts are the most common congenital malformations that affect craniofacial structures. Studies show that they have a major influence on psychological development of the patient, and on their families. A review of the literature showed a lack of specific questionnaires for children and their parents. This study investigated the impact of orofacial clefts in children on the quality of life of their parents. In addition, the results of the treatment and the quality of work of the health team members involved in this process were evaluated.

MATERIALS AND METHODS

For the purpose of this study, an original questionnaire was made to analyse the effect of orofacial clefts in children who had undergone surgery on the quality of life of 73 of their parents. The questionnaire consisted of 28 simple statements, which were evaluated with a 5-degree Likert scale (from 1-fully disagree to 5-fully agree), did not require any specific additional clarification, and were easy to complete.

RESULTS

Analysis of areas of the questionnaire that applied to the parents, resulted in two subscales, parental social health and child social health, which had satisfactory Cronbach's coefficients (0.907 and 0.897, respectively). However, some issues had a relatively poor coefficient of internal consistency, which justified their expulsion from the final model of the parent questionnaire.

CONCLUSION

The questionnaire developed for this study comprised two subscales concerned with the social health of parents/respondents and the social health of adolescents, as perceived by the parents. It was a valid and reliable instrument, and it showed satisfactory quality of life for parents of adolescents with clefts.

Mechanical Properties of High Viscosity Glass Ionomer and Glass Hybrid Restorative Materials

Objectives

to determine the mechanical properties of hybrid and high-viscosity glass ionomer cements. Compressive strength and hardness of three glass ionomer cements (GIC) were measured: Ketac ™ Universal Aplicap ™, EQUIA Fil® and EQUIA FORTE Fil®, and the SEM sample analysis were performed.

Materials and Methods

The samples for measuring the compressive strength were prepared using silicone molds with standard dimensions of 6 mm x 4 mm and stored in deionized water for five days, while the samples for hardness measurement were prepared using Teflon molds with a cylindrical opening in the middle, dimensions 2 mm in height and 5 mm in width. For each material, one sample was made (n = 1) and stored in deionized water at 37ºC for 25 days. A representative sample of each material was analyzed using SEM. For the comparison of obtained values, the ANOVA test was used, while Tukey test was used for the multiple comparison.

Results

There were no significant differences between the compressive strength of the three tested materials (p <0.05). The hardness values were: 157 HV0,2 for Ketac ™ Universal Aplicap ™, 47 HV0,2 for EQUIA Fil® and 39 HV0,2 for EQUIA FORTE Fil®, respectively, and were significantly different, implying that Ketac ™ Universal Aplicap ™ has much higher hardness values than the other materials tested. SEM sample analysis revealed similar fracture modes of the tested materials.

Conclusion

It was concluded that there were no statistically significant differences in compressive strength and fracture modes between the tested materials, while Ketac ™ Universal Aplicap ™ hardness results were significantly higher than the ones measured for EQUIA Fil® and EQUIA FORTE Fil®.

Dental Treatment Under General Anesthesia in a Day Care Surgery Setting

Objective

To analyze data on full-mouth rehabilitation under general anesthesia (GA) performed at the University Clinical Hospital Zagreb with emphasis on patient characteristics, type of procedure and postoperative complications.

Materials and methods

Retrospective chart review of 100 patients treated under GA at the Dental clinic’s day care surgery. Patient’s demographic (sex, age) and clinical data (diagnosis, GA technique, intubation type, procedure duration, number of carious teeth, presence of visible calculus, number of sealed teeth, fillings, extractions and endodontic treatments, discharge time, postoperative complications) were registered.

Results

Eighty patients were treated under GA because of noncompliance due to different reasons and twenty patients because of either their poor physical condition or extensive dental procedure. Median DMFT per patient was 9(0-21). Eighty nine patients underwent full-mouth dental restoration and 11 patients underwent other types of procedures. Ninety-six patients were safely discharged the same day. Four patients experienced postoperative complications and three of them were hospitalized for another 24-48 hours for postoperative follow-up.

Conclusion

Patients with physical and/or intellectual disabilities have higher caries activity and increased dental treatment needs compared to the general population. Dental treatment under GA in day care service is a safe and effective way of providing dental care for noncompliant patients.

Fluoride Release from Glass Ionomer with Nano Filled Coat and Varnish

Objective

This in vitro study compares the fluoride release from microlaminated glass ionomer based on glass hybrid technology coated with two different surface coating agents.

Materials and Methods

A total of 18 samples were divided into three groups of six samples each: (1) glass ionomer Equia Forte Fil coated with Equia Forte Coat (Equia+EC), (2) glass ionomer Equia Forte Fil coated with GC Fuji Varnish (Equia+VC) and (3) uncoated glass ionomer Equia Forte (EQUIA cont). Fluoride release was measured using an ion-selective electrode (ORION EA 940) after 24 hours, 4 days, 30 days and 64 days. Repeated measures ANOVA, multiple comparisons, Tukey's test and paired t-test were used to test the differences between the groups.

Results

The differences between the groups and four time points were statistically significant (ANOVA, p<0.0001). Cumulative fluoride ion release after 64 days was 66.01 mg/l, 123.54mg/l and 203.22 mg/l for EQUIA+EC, EQUIA+VC and EQUIA cont, respectively. All the differences were statistically significant except the difference between EQUIA+VC and EQUIA cont after 24 hours.

Conclusions

The amount of released fluoride was significantly lower in the samples coated with nanofilled surface coating agent compared to the samples coated with varnish and uncoated samples.

INFLUENCE OF THE SEROTONERGIC SYSTEM POLYMORPHISM ON THE EXPRESSION OF DENTAL ANXIETY

- The aim of the study was to test the correlation between 5-HTTLPR polymorphism and dental anxiety. Research hypothesis was that positive relation between the expression of dental anxiety and the S allele exists in the population of healthy Caucasians. We conducted a prospective study on 159 subjects, volunteers made up of medical and non-medical staff of the Sestre milosrdnice University Hospital Centre. Both genders were included, age range 19 to 59, mentally and physically healthy (according to DSM-5 classification of mental disorders). For the purpose of this research, we used a sociodemographic questionnaire containing the following information: age, gender, education level, work status, marital status and residence. Corah's Dental Anxiety Scale-Revised (DAS-R) was used to measure dental anxiety. Data distribution was tested by Kolmogorov-Smirnov test, difference between the groups by ?χ2-test and one-way analysis of variance, and correlation of variables by logistic regression. In the study population, we found positive correlation between S-allele and total result in DAS-R questionnaire. The presence of S allele suggests that the person will have a higher result in DAS-R questionnaire, i.e. higher expression of dental anxiety.

Impact of Smoking on Oral Health: Knowledge and Attitudes of Croatian Dentists and Dental Students

Objective

The aim of this study was to evaluate smoking habits, the level of knowledge and attitudes towards smoking, as well as the role of dental professionals in prevention of smoking among students of the School of Dental Medicine, University of Zagreb and compare them to attitudes of practicing Croatian dentists.

Materials and methods

The study was carried out among 1^st and 6^th year dental students at the School of Dental Medicine, University of Zagreb and dentists employed in primary practice throughout Croatia. A total of 159 subjects (51 1^st and 53 6^th year dental students and 55 dentists) participated in the study.

Results

The prevalence of smoking was highest among 6^th year dental students (39, 6%). It slightly decreased among dentists (34, 5%), while least smokers were found among first year dental students (7, 8%). The majority of dental student smokers expressed a desire to stop smoking (66, 7% of 1^st year dental student smokers and 76% of 6^th year dental student smokers), while less than half of dentist smokers had the desire to stop - only 45, 8% of them. Dental students of the 1^st and 6^th year of the study showed a statistically significantly higher level of desire for education about harmful smoking effects and patients counselling to quit smoking compared to dentists. The data gathered in this study indicate that it is necessary to increase awareness among dental professionals about harmful effects of smoking on oral and general health. Also, their awareness about the central role of healthcare workers as promoters of a healthy lifestyle among patients should be raised.

Cytotoxicity and Genotoxicity of Resin Based Dental Materials in Human Lymphocytes In Vitro

SUMMARY – The aim of this in vitro study was to evaluate cytotoxicity and genotoxicity of six different dental nanocomposite materials, three conventional ones and three flowable composite resin materials, in human lymphocytes. The following materials were tested: Tetric EvoCeram, Tetric EvoFlow, Filtek Ultimate, Filtek Ultimate Flow, G-aenial and G-aenial Flo. Cytotoxicity was evaluated for two mass concentrations (0.007 g/mL and 0.013 g/mL) of each material, non-cured and cured, after 4 hours and 24 hours. Genotoxicity was evaluated using micronucleus assay under the same conditions as applied during the investigation of cytotoxicity. Uncured forms of Tetric EvoCeram, Tetric EvoFlow and Filtek Ultimate Flow in higher mass concentration caused genotoxic effect. Uncured G-aenial Flo in higher mass concentration induced apoptosis and necrosis. Uncured Tetric EvoFlow and uncured Filtek Ultimate Flow in higher mass concentration induced early apoptosis after both test periods. None of the conventional composite resin materials tested showed cytotoxicity except for uncured G-aenial, which induced apoptosis in higher mass concentration in both test periods. In conclusion, under the conditions of this in vitro study, cured conventional composites did not show cytotoxic or genotoxic effect, which is important for clinical application of these materials, whereas uncured forms exhibited certain level of cytotoxicity and genotoxicity, mainly because of monomers in their composition.

Salivary Electrolytes in Patients with Metallic and Ceramic Orthodontic Brackets

Objectives

It is known from the existing literature that metal ions within orthodontic appliances are prone to corrosion due to the salivary and bacterial interplay in the oral cavity. The results from the most studies show that levels of salivary nickel and chromium do not increase after the installment of orthodontic appliances.

Material and methods

However, there are no studies on salivary levels of titanium, cobalt, copper and zinc in these patients. Salivary levels of nickel (Ni), titanium (Ti), chromium (Cr), cobalt (Co), copper (Cu) and zinc (Zn) were measured in 42 patients with ceramic brackets and in 42 patients with metal conventional brackets prior to insertion of orthodontic appliances and six months after insertion of orthodontic appliances by means of inductive coupled plasma/mass spectrometry. Statistical analysis was performed by use of Wilcoxon signed rank test and Mann Whitney test with level of significance set at 0.05.

Results

The results showed that salivary level of titanium increased significantly six months after installment of orthodontic appliances. Salivary level of chromium and zinc significantly decreased after installment of orthodontic appliances. There were no significant differences in salivary levels of nickel, titanium, chromium, copper, cobalt and zinc between the patients with metallic and those with ceramic brackets.

Conclusion

We might conclude that the salivary level of titanium increased significantly six months after installment of orthodontic appliances unlike salivary levels of chromium and zinc which significantly decreased after installment of orthodontic appliances, regardless of bracket type which was used.

Efficacy of removal of cariogenic bacteria and carious dentin by ablation using different modes of Er:YAG lasers

The primary objective of this in vitro study was to evaluate the efficiency of removal of cariogenic bacteria and carious dentin by ablation using two lasers: fluorescence-feedback controlled (FFC) Er:YAG laser and different pulses of Er:YAG laser based on variable square pulse technology (VSPt). The secondary objective was to measure the temperature during laser ablation of carious tissue. Seventy-two extracted human molars were used in this study. Sixty teeth with carious dentin were randomly divided into four experimental groups according to the treatment for caries removal: group 1: 400 µs (FFC group); group 2: super short pulse (SSP group, 50 µs pulse); group 3: medium short pulse (MSP group, 100 µs pulse); group 4: short pulse (SP group, 300 µs pulse) and one positive control group with no treatment. Twelve teeth without carious lesion were used as a negative control group. After caries removal, swabs were taken with cotton pellets and real-time PCR analysis was performed. During caries ablation, a thermal infrared camera was used to measure the temperature changes. In all experimental groups, specimens were free of bacterial contamination after the treatment. In the SSP, MSP and SP groups, temperatures measured during caries ablation were significantly higher compared to temperatures in the FFC group (P<0.001). In this in vitro study, laser treatment for removal of carious dentin and cariogenic bacteria was an efficient treatment modality without causing excessive temperatures that might adversely affect pulp vitality.

The influence of different types of brackets and efficacy of two chlorhexidine mouthwashes on oral hygiene and the incidence of white spot lesions in adolescents during the orthodontic therapy

BACKGROUND

To detect the effect of two different types of brackets (ceramic and stainless steel) and investigate the effectiveness of two chlorhexidine mouthwashes 0.2% (CHX) on oral hygiene status and incidence of white spot lesions (WSLs) in adolescents wearing fixed orthodontic appliance.

SUBJECTS AND METHODS

One hundred and twenty subjects (aged 11 to 18 years, mean age 14.5 years) were divided into six equal groups according to brackets type and to different mouthwashes: Group 1: metal brackets and conventional CHX, Group 2: metal brackets and CHX with anti-discoloration system (CHX-ADS), Group 3: ceramic brackets and conventional CHX, Group 4: ceramic brackets and CHX-ADS, Group 5: metal brackets and water correction flavors mouthwash (placebo), Group 6: ceramic brackets and placebo. Four weeks after the placement of fixed orthodontic appliance the subjects were provided with three different mouthwashes for use during the next two weeks. Assessment was carried out according to oral hygiene index-simplified (OHI-S) and WSL index performed: prior to placement of the appliance (baseline), four weeks, six weeks, eighteen weeks, and thirty weeks after the placement. The data were then subjected to statistical analysis.

RESULTS

Group 4 showed reduction in the OHI-S scores when compared to the Group 5 (in the 6^th week), and Group 6 (in the 6^th and 18^th week), which was statistically significant, P<0.05. Group 4 showed decrease in the WSLs scores when compared to the Group 1 (in the 4^th, 6^th, 18^th and 30^th week), Group 5 (in the 18^th and 30^th week) and Group 6 (in the 6^th, 18^th and 30^th week), which was statistically significant, P<0.05.

CONCLUSION

The ceramic brackets and the usage of CHX-ADS resulted in better oral hygiene status and lower incidence of WSLs.

Psychosocial and Economic Status of the Parents with Children with and without Tooth Trauma

BACKGROUND

The main goal of this research is to try and understand influence of psychological and social factors in children with tendencies to repeat tooth trauma.

SUBJECTS AND METHODS

Research included 147 patients, children of preschool and school age (88 boys and 59 girls). In the research patients were divided in two age groups: 5-8 and 9-12 years. In both groups there were 49 patients with no experience of dental trauma and 69 patients with experience of one dental trauma and 29 patients with repeated dental trauma. All patients that were involved in the study had previous experience with dental and medical treatment. Study included evaluation of dental anxiety and also factors that caused dental phobia previous their visit to the office in the children with no dental trauma compared to repeat dental trauma patients. On the whole study group differences considering sex, age and psychosocial status in the level of dental anxiety and dental fear were also measured.

RESULTS

Categories of children without trauma and with one or multiple trauma showed that it is a similar sex division in the categories. In the no trauma group participation of the boys is lower (46.9%) while in the group with repeated trauma their participation is significantly higher (79.3%). Based on that the risk of repeated dental trauma is characteristic of boys.

CONCLUSIONS

Results of this study show that tested psychosocial variables do not differentiate participants according to the tested groups or in other words there is no difference between tested groups in their psychosocial standing.

Developmental Defects of Enamel in Children with Intellectual Disability

OBJECTIVES

To investigate the frequency of developmental defects of enamel (DDE) in children with intellectual disability.

SUBJECTS AND METHODS

Children aged 5-18 years (72 children with intellectual disabilities and 72 controls) were included in the study. All the teeth were screened for developmental defects of enamel using the modified Developmental defects of enamel (mDDE) index.

RESULTS

Out of the 72 children with intellectual disabilities in this study, 20 (27.78%) presented dental defects of enamel, compared with 8 (11.11%) of those in the control group, which was considered statistically significant (p = 0.021). The majority of children in both groups had white demarcated opacities. Children in both groups were more likely to have maxillary teeth affected than the mandibular teeth and the asymmetrical demarcated enamel defects were more common than the symmetric ones. Majority of opacities in children in both groups were on the maxillary incisors.

CONCLUSIONS

Children with intellectual disabilities have more developmental defects of enamel than children in the control group. Enamel defects increase caries risk and cause reduction in enamel mechanical properties leading to restoration failures.

Measuring the Influence of Galilean Loupe System on Near Visual Acuity of Dentists under Simulated Clinical Conditions

AIM

The purpose of this study was to compare near visual acuity of dentists without optical aids (VSC) with near visual acuity of those using the Galilean telescope system (VGA2) with magnification of x 2.5, and the distance of 350 mm in simulated clinical conditions.

METHODS

The study included 46 dentists (visual acuity 1.0 without correction). A visual acuity testing was carried out using a miniaturized Snellen visual acuity chart which was placed in the cavity of molar teeth mounted in a phantom head in simulated clinical conditions. Near visual acuity for the vicinity was examined: 1) without correction at a distance of 300-400 mm (VSC); 2) with Galilean loupes with magnification of x2.5, focal length of 350mm.

RESULTS

The distributions of near visual acuity recorded using VSC and VGA2, 5 systems were compared by the Wilcoxon Signed Rank test. The results obtained by Wilcoxon Signed Rank test pointed to a statistically significant difference in the distribution of recorded visual acuity between the VSC and VGA2 optical systems (W = - 403.5; p <0.001).

CONCLUSION

If using the VGA2, 5 systems, higher values of the near visual acuity were recorded and subsequently compared to near visual acuity without magnifying aids (VSC).

Dental Fear in Children with Repeated Tooth Injuries

Tooth injuries are serious clinical conditions. Some children experience dental trauma only once, while others are more prone to repeated tooth injuries. Repeated dental trauma occurs in 19.4% to 30% of patients. Pain and dental trauma are the most common reasons for fear and anxiety. The main objective of this study was to investigate how dental trauma, as well as repeated dental trauma affects the occurrence and development of dental fear in children. The study was conducted on a random sample of 147 subjects (88 boys and 59 girls) aged 5-8 and 9-12 years. Subjects in both age groups were divided into subroups without dental trauma, with one dental trauma and with repeated dental trauma. The validated Children’s Fear Survey Schedule – Dental Subscale was used on fear assessment. Results showed that only 12.2% of children without trauma, 33.3% with one trauma and 51.7% with repeated trauma were not afraid of injection. Older children had a significantly lower fear of injections, touch of an unknown person, choking, going to the hospital and people in white uniforms. Dentist was not the cause of fear in 65.5% of patients with repeated trauma. With each repeated injury of teeth, the degree of their fear of dental treatment was lower.