Dr. Maria Kukleva Ph.D.



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1.	PREVENTION AND TREATMENT OF CARIES INCIPIENT IN CHILDHOOD WITH FLUORIDE GEL M. Kukleva, [Dissertation] 1999, Plovdiv
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2.	INCIDENCE AND PREVALENCE OF DENTAL CARIES IN 12- YEAR OLDS IN PLOVDIV, BULGARIA M. Kukleva, V. Kondeva, M. Dimitrova, S. Petrova BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 167 (Abstract 89) The 12- year- olds group is specified as a target group for studying dental caries. The clinicostatistical studies of dental caries in 12- year- olds in Plovdiv according to the requirements of WHO date back to 1981 /1981; 1989; 1992; 1997/. The need of refreshing the data determines the purpose of the present study: - to study the incidence /DMFT/ and prevalence /Ep %/ of dental caries in 12 year- olds children from Plovdiv in 1999. - to compare the present results with the results of previous studies. The study includes 300 12- year old children. The sample selection is random. DMFT in 12- year olds in 1999 is 2.73 and Ep is 77.00 %. Comparing the results with previous studies shows a trend of steadily decreasing values from 1981 (DMFT 3.66; Ep 87.57 %) with 1992 exhibiting the lower levels of these indicators (DMFT 2.47; Ep 70.85 %). A trend of increasing DMFT and Ep between 1992 and 1997 is observed (DMFT 3.03; Ep 80.00 %). The results in 1999 show a light decrease of the level of DMFT and increase of free of caries individuals from 1997 to 1999 without statistically significant differences. The trends of caries incidence and caries prevalence in 12-year- old children in Plovdiv show the favorable effect of the preventive programs till 1992 and the necessity of undertaking urgent measures for overcoming the unfavorable trends in the last years.
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3.	COMBINED APPLICATION OF GLASIONOMER CEMENT AND FLUORIDE GEL IN CARIES TREATMENT - A CASE REPORT M. Kukleva BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 169 (Abstract 95) The treatment of acute dental caries is a serious problem. Presence of white spots with mat and rough surfaces, which can be easily destroyed even with a probe, is clinically detected. It is often that in the middle of the spots cavitation is observed due to enamel loss. Treatment includes limitation of spot's size, thickening of their surfaces and restoration of tissue loss. Composite application is not the best solution in this case. In the present paper of acute caries incipient treatment with combined application of glasionomer cement and 0.42 % fluoride gel is described. Subjects of treatment are 8 teeth of a 13- year- old girl with white spots on the vestibular surfaces. Tissue loss is observed in some of the spots. Oral hygiene motivation is carried out. For the purpose of spots` size limitation and thickening of their structure 4 applications of fluoride gel are made at 1- week- intervals. Tissue deficiencies are filled with glasionomer cement and after that 4 applications with fluoride gel are made under the same conditions. Reapplication and control are carried out every 6 months. 18 months later no secondary caries is detected. Spots have smaller size. Their surface is smooth and shiny. These results demonstrate that the applied treatment can be used as a method for treatment of acute caries in children.
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4.	CARIES INCIDENCE AND TREATMENT NEED IN 7-, 12- AND 14 -YEAR OLDS IN PLOVDIV, BULGARIA M. Kukleva, V. Kondeva BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 167 (Abstract 90) The research comprises 600 7-, 12- and 14year - old randomly selected children, which are equally distributed in each age group. Dental caries is detected by means of a probe and an explorer at cavitation level according to WHO requirements. The aim of the present study is to estimate: 1. Caries incidence ( DMF / P ), incidence of active caries ( D / P ), incidence of field caries ( F / P ) and incidence of caries treated with extraction ( M / P ) 2. Caries incidence and incidence of active caries with respect to sex 3. Relative number of surfaces with active caries from the total number of surfaces with caries Results show that caries incidence increases when age go es up - 0.37 in 7- year- olds, 3.03 in 12- year- olds and 3.23 in 14- year olds. No statistically significant differences are found when comparing the data of caries incidence and incidence of active caries with respect to sex (P > 0.05). The highest values of active caries are in 7- year- olds - 61.36 %, followed by 14- year- olds - 44.00 % and 12 year olds - 36.20 %. These values determine treatment need in studied populations.
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5.	STUDY OF CARIES POLARIZATION AMONG 1 - 3 YEAR OLDS POPULATION M. Dimitrova, M. Kukleva, V. Kondeva BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 168 (Abstract 91) The plaque-retentive properties of brackets result in a severe challenge to surfaces generally not susceptible to caries. The clinical studies have shown that as many as 50 - 75 % of patients develop demineralization on the labial surfaces during orthodontic treatment. These so-called white-spot lesions appear to be very resistant to remineralization after debonding. These lesions most often discolor and represent an unaesthetic side effect of orthodontic treatment that is of great clinical concern. Lower caries resistance due to the continuing process of mineralization and maturation of permanent teeth characterizes the age of-11 - 15. This presupposes a higher demineralization risk compared to patients, in which these processes are already over. The purpose of the study is to compare the relative number of demineralized surfaces after debonding in patients at different age. The study comprises 22 patients, aged 11 - 15 (248 surfaces with brackets) and 21 patients aged 19 -24 (260 surfaces with brackets). Orthodontic treatment continues for 24 months in all patients. White spots are found in 128 (51.61 %) of the surfaces in the group of 11 - 15- year olds and in 18 (6.92 %) of the surfaces in the group of 19 - 24- year- olds. Comparing of the data shows that the risk of demineralization in the age of 11 - 15 years is higher. That's why orthodontic treatment has to be combined with a prevention program.
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6.	RISK OF DEMINERALIZATION IN PATIENTS DURING ORTHODONTIC TREATMENT WITH BRACKETS-COMPARATIVE STUDY M. Kukleva, D. Shetkova, V. Beev BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 168 (Abstract 92) The plaque-retentive properties of brackets result in a severe challenge to surfaces generally not susceptible to caries. The clinical studies have shown that as many as 50 - 75 % of patients develop demineralization on the labial surfaces during orthodontic treatment. These so-called white-spot lesions appear to be very resistant to remineralization after debonding. These lesions most often discolor and represent an unaesthetic side effect of orthodontic treatment that is of great clinical concern. Lower caries resistance due to the continuing process of mineralization and maturation of permanent teeth characterizes the age of-11 - 15. This presupposes a higher demineralization risk compared to patients, in which these processes are already over. The purpose of the study is to compare the relative number of demineralized surfaces after debonding in patients at different age. The study comprises 22 patients, aged 11 - 15 (248 surfaces with brackets) and 21 patients aged 19 -24 (260 surfaces with brackets). Orthodontic treatment continues for 24 months in all patients. White spots are found in 128 (51.61 %) of the surfaces in the group of 11 - 15- year olds and in 18 (6.92 %) of the surfaces in the group of 19 - 24- year- olds. Comparing of the data shows that the risk of demineralization in the age of 11 - 15 years is higher. That's why orthodontic treatment has to be combined with a prevention program.
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7.	EARLY CHILDHOOD CARIES INCIDENCE AND TREATMENT NEED M. Dimitrova, M. Kukleva, V. Kondeva BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 168 (Abstract 94) Early Childhood Caries /ECC/ is serious public health problem. A specific apprach when treating caries is needed at the age of its appearance. The aim of this paper is to study the caries incidence and treatment need in 1-, 2- and 3- year- old children. The research is carried out on 370 randomly selected children equally distributed in each age group. Data are obtained using a probe and mirror at cavitation level according WHO requirements. It is estimated: 1. caries incidence, incidence of active caries and incidence of field caries 2. relative number of surfaces with active and field caries from total number of surfaces with caries It is found that caries incidence in 1- year- olds is 0.54, followed by 2- year- olds - 1.46 and 3- year- olds - 1.85. Caries incidence of field caries is very low in all age groups. Percentage of active caries is 100.00 % in 1- year- olds, 99.45 % in 2- year- olds and 86.54 % in 3- year- olds. As age goes up the percentage of treated caries only slightly increases. This finding demonstrates that caries in the studied population is not treated. The results of the study prove the necessity of developing of effective methods for dental caries treatment that can be easily applied in early childhood.
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8.	DYNAMICS OF SOME PARAMETERS OF MACULA CARIOSA ALBA TREATED WITH FLUORIDE GEL M. Kukleva BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 169 (Abstract 93) The purpose of the research is to follow up the changes of the level of demineralization and the area of the spots during treatment with 0.42 % fluoride gel. 182 white spots in 27 children /aged 7 to 16/ are observed. All spots included in the research are limited only within the vestibular surfaces of permanent teeth. 2 groups are formed - a control group /70 spots/ and an experimental group /112 spots/. In both groups a program for oral hygiene motivation is carried out. The level of demineralization is measured by color test with 2 % methylen blau. Measurement is made in four stages. The changes in the area are measured in mm2. The initial area is equal to 100 %. Spots are treated with fluoride gel applied with a brush, installed on a drill, for 1 minute. 4 applications at 1- week- intervals are made. Changes are checked at the end of 1st, 2nd, 6th, and 12th months. The color test shows a decrease in the respective values during the research. The decrease is higher in the experimental group with a statistically significant difference after the 1st month. There is a slight decrease in the average area of the spots in the control group. At the end of the research the area is 92.01 % of the initial area. The average area in the experimental group is 28.16 % of the initial one at the end of the study. These results show a high effectiveness of the treatment with 0.42 % fluoride gel.
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9.	SPECIFICITY OF CARIES ATTACK IN EARLY CHILDHOOD M. Dimitrova, M. Kukleva, V. Kondeva BaSS 2000 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY THESSALONIKI - GREECE - APRIL 13 - 16, 2000, 169 (Abstract 96) For the effectiveness of prevention and treatment of caries it is necessary to know the specificity of caries attack of particular teeth at particular age. The aim of this study is to estimate: 1. caries incidence of types of teeth 2. caries incidence of types of teeth surfaces generally and with respect to jaws in 1-, 2-, and 3- year olds. The research included 370 randomly selected children, equally distributed in all age groups. Caries is detected with a probe and a mirror at cavitation level according to WHO requirements. Data analysis demonstrates that in 1- year- olds caries on central incisors in the upper jaw shows highest incidence, followed by caries on first molars in both jaws. In 2- year- olds caries incidence on central incisors in the upper jaw again takes highest values. Caries incidence on first and second molars is higher in the lower jaw compared to the upper jaw. These trend changes in the 3- year- olds, in which group most affected by dental caries are molars in the lower jaw, followed by central incisors in the upper jaw. Highest values takes caries incidence on vestibular surfaces of central incisors in the upper jaw in 1- and 2- year olds and on the occlusal surfaces of molars in the lower jaw in 3- year- olds. These results are most probably predetermined not only by anatomical and morphological characteristics of the teeth, but by the specific risk factors in early childhood, as well.
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10.	STATES OF FIRST (I1) AND SECONDARY (I2) PERMANENT INCISOR ERUPTION IN 7- YEAR- OLD CHILDREN IN PLOVDIV, BULGARIA M. Kukleva, V. Kondeva 3rd BALKAN CONGRESS OF MEDICINE AND DENTISTRY FOR STUDENTS AND YOUNG DOCTORS BURSA - TURKEY, November 5 - 7, 1999, 88 (Abstract 2) For the planning and formulating of strategies for local prophylaxis, it is necessary to know the eruption of particular teeth at particular age. The aim of the research is to estimate the states of first (I1) and secondary (I2) permanent incisor eruption in 7- year- olds in Plovdiv. The research is carried out on 200 7-year- olds children (100 boys and 100 girls). Subjects are selected at random. Data are obtained after a singular check. It is found that 81.50 % of I1 and 37.25 % of I2 in 7-year - old children are in a process of eruption or are fully erupted. Statistically significant differences are found when comparing the data according to types of jaws (P < 0.001). The analysis of the results of the investigation showed that: - In the lower jaw 97.75 % of I1 and 59.50 % of I2 are erupted. - In the upper jaw 65.23 % of I1 and 15.00 % of I2 are erupted. No statistically significant differences are found when comparing the data according to sex (P > 0.05).
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11.	EPIDEMIOLOGY OF EARLY CHILDHOOD CARIES IN 1- TO 3-YEAR OLD CHILDREN IN PLOVDIV, BULGARIA M.Dimitrova, M. Kukleva, V. Kondeva 3rd BALKAN CONGRESS OF MEDICINE AND DENTISTRY FOR STUDENTS AND YOUNG DOCTORS BURSA - TURKEY, November 5 - 7, 1999, 88 (Abstract 1) Early Childhood Caries /ECC/ is a serious public health problem in both developing and industrialized countries. The purpose of this study is to evaluate the epidemiology of Early Childhood Caries according to persons in 1- to 3-year- old children in Plovdiv. The research is carried out on 237 children. The average age of children included in this survey is 2.5 year. Subjects are selected at random. Data are obtained for ECC with a probe a and mirror. Results indicated that 37.55 % of children are affected from ECC. The analysis of the results showed that relative number of children with ECC increases as age goes up: - 12.50 % in 1-year olds. - 25.80 % in 2-year olds. - 46.35 % in 3-year olds.
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12.	EPIDEMIOLOGY OF EARLY CHILDHOOD CARIES AND RISK FACTORS IN CHILDREN FROM PLOVDIV, BULGARIA M. Dimitrova, M. Kukleva, V. Kondeva 3rd BALKAN CONGRESS OF MEDICINE AND DENTISTRY FOR STUDENTS AND YOUNG DOCTORS BURSA - TURKEY, November 5 - 7, 1999, 91 (Abstract 7) The aim of this research is to study epidemiology of Early Childhood Caries and risk factors in children from Plovdiv. The research is carried out on 237 1- to 3-year- old children selected at random. Early Childhood Caries is detected in 89 of them. In order for the risk factors to be found out parents have been asked details about pregnancy, early childhood, nutrition of the mother and the child, oral hygiene, diseases etc. The analysis of the results shows that the most significant risk factors are: - Often consumption of sugar-containing food between the main meals - 73.00 %. - Use of a nipple with honey/jam - 29.21 %. - Use of a feeding-bottle in the evenings - 28.09 %. - Often consumption of antibiotics in the form of syrup - 12.36 %. - Pathological pregnancy - 11.23 %. Results prove the necessity of motivating parents about the proper nutrition of their children in early childhood.
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13.	GROUP CARIES PROPHYLAXIS WITH FLUORIDE GEL M. Kukleva 3rd BALKAN CONGRESS OF MEDICINE AND DENTISTRY FOR STUDENTS AND YOUNG DOCTORS BURSA - TURKEY, November 5 - 7, 1999, 3 (Lectures Abstract 2) The first permanent molars (M1) are especially sensitive to caries attack immediately after eruption. The effect of preventive methods during this period in groups at low risk of caries is insufficiently studied. The aim of the research is to study the effect of caries prevention of M1 after eruption by means of fluoride gel application in groups with low risk of caries. A clinical study including 213 seven-year-old children from Plovdiv has been conducted within two years. The children were assigned to two groups - experimental and control. In both groups children without clinical caries on M1 were included (DMFT = 0; DMFS = 0). The sampling procedures excluded subjects with multiple and diffuse obturations of the deciduous teeth, inadequate oral hygiene or undergoing orthodontics treatment. In the experimental group eight applications with 0.42 % fluoride gel were performed at three months intervals. At the end of the study period the prevalence rate of caries on teeth (DMFT) and dental surfaces (DMFS) was higher in the control group (P < 0.001). Caries reduction in the experimental group was 73.81 % on the teeth and 72.31 % on the dental surfaces. The results of our study show that immediately after eruption the first permanent molars are susceptible to caries in individuals at low risk of caries too. This necessitates prevention activity during this period irrespective of the presumed risk. The fluoride gel shows high anticaries activity on M1 after eruption.
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14.	STATES OF PREMOLAR (P1, P2) AND SECONDARY PERMANENT MOLAR (M2) ERUPTION IN 12- YEAR- OLD CHILDREN M. Kukleva BaSS 1999 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY ISTANBUL - March 22 - 25, 1999, 332 (Abstract PP 351) It is known that teeth show lowest resistance immediately after their eruption. For the planning and formulating of strategies for local prophylaxis knowledge of the eruption of particular teeth at particular age is needed. The research is carried out on 200 12- year- old children from Plovdiv (100 boys and 100 girls). Subjects are selected at random. Data are obtained after a singular check. The relative number of erupted premolars (P1, P2) and secondary permanent molar (M2) are determined. It is found that 84.38 % of P1, 67.88 % of P2 at 36.75 % of M2 in the 12- year- olds are in a process of eruption, or are fully erupted. No statistically significant differences are found when comparing the data according to sex and types of jaws (P > 0.05).
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15.	SPECIFICITY OF CARIES ATTACK ON PRIMARY PERMANENT MOLARS IN 7-, 12- AND 14- YEAR - OLDS FROM PLOVDIV M. Kukleva, V. Kondeva BaSS 1999 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY ISTANBUL - March 22 - 25, 1999, 331 (Abstract PP 350) The aim of the research is to determine the specificity of caries attack on primary permanent molars /M1/ in 7-, 12- and 14- year - old children. The research is carried out on 600 7-, 12- and 14- year - old children from Plovdiv according to the WHO requirements. Caries incidence /Is/ in general and on types of surfaces of M1 in both jaws is determined. Results are compared by means of variation analysis at level of significance P < 0.05. As age goes up Is of M1 increases sharply. Data analysis regarding caries incidence on types of surfaces shows that Is takes highest values for the occlusal surfaces in all age groups (P < 0.01). Is of the occlusal surfaces of M1 is higher in the lower jaw compared to the upper jaw (P < 0.05). These results support the idea that the morphologic characteristics of fissures are important for the appearance of dental caries during the first few years after the eruption.
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16.	FLUORIDE ION CONCENTRATION IN THE SALIVA TWO HOURS AFTER FLUORIDE GEL APPLICATION M. Kukleva BaSS 1999 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY ISTANBUL - March 22 - 25, 1999, 330 (Abstract PP 346) The research is carried out on 10 healthy 14- year- olds. 5 ml. of non-stimulated saliva are gathered in the mornings before eating and after mouth - rinsing. Fluoride gel is applied by means of a cotton pack for 5 minutes. 2.5 ml. of saliva are gathered each half an hour for 2 hours after application. Saliva gathering begins 15 minutes after application and continues for 15 minutes. Fluoride ion concentration in the probes is determined with an ion - selective electrode. Half an hour after application a sharp increase in fluoride ion concentration is observed (P < 0.001). After that, fluoride ion concentration decreases reaching the initial level after the first hour. The research shows that fluoride gel is active after application as well. The observed concentrations are low and there is no danger of unfavorable local and peroral effects.
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17.	MORPHOLOGICAL STUDY OF ENAMEL AFTER FLUORIDE GEL APPLICATION IN VITRO M. Kukleva BaSS 1999 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY ISTANBUL - March 22 - 25, 1999, 330 (Abstract PP 347) The research is carried out on 20 premolars extracted by orthodontic reasons. 6 x 6 mm. large fields are marked on the vestibular surfaces. 10 teeth are being demineralized by means of an acid gel with pH 3.0 for 7 days at 37 0C. All teeth, out in the middle of the field, are divided into 4 groups: 1st group: samples of normal enamel 2nd group: samples of demineralized enamel 3rd group: symmetrical samples of normal enamel treated with fluoride gel 4th group: symmetrical samples of demineralized enamel treated with fluoride gel Fluoride gel is applied with the help of a brush installed on a drill at 400 - 500 r. p. m. for 3 min. and cotton packs, equally soaked with fluoride gel for 5 min. Each application is carried out 7 days after previous one. In the time between the applications the samples are kept in artificial saliva. After routine treatment of the samples an electromicroscopical study with a SEM - Philips at 30 KV and increasing capacity of 2500 to 3000 times is carried out. Forming of spherolytes and crystallites at an initial stage as a result of fluoride gel application in vitro is detected.
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18.	COMPARATIVE STUDY OF CARIES INCIDENCE (Is) ON TYPES OF SURFACES IN 14- YEAR- OLDS FROM PLOVDIV M. Kukleva, V. Kondeva BaSS 1999 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY ISTANBUL - March 22 - 25, 1999, 331 (Abstract PP 349) The research is carried out on 200 14- year- olds (100 boys and 100 girls) according to the WHO requirements. Subjects are selected at random. Data are obtained after a singular check. It is studied 24447 teeth surfaces. Caries incidence (Is) on types of surfaces is determined. Results are compared by means of variation analysis at level significant P < 0.05. Data analysis shows that most affected by caries in the 14- year- olds are the occlusal dental surfaces followed by the aproximal and smooth surfaces.
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19.	MEASURING THE QUANTITY OF PHOSPHOR IN THE SALIVA AFTER APPLICATION OF FLUORIDE GEL M. Kukleva, T. Bozukova, M. Karakasidu Folia Medica XXXXI, 1,1999; 136 - 137 The transition of active ingredients from the prophylactic agents into the saliva leads to an increase of its mineralising potential. The aim of the research is to measure the quantity of phosphor in the saliva after application of a gel containing both fluoride and phosphate ions. The quantity of phosphor is measured photometrically according to the Chen method. Results show a sharp increase in the quantity of phosphor in the saliva after application. As time passes it gradually decreases, and after 2 hours it reaches the initial level.
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20.	COMPARATIVE STUDY OF THE POLARIZATION OF DENTAL CARIES IN 7-, 12- AND 14- YEAR- OLD CHILDREN FROM PLOVDIV, BULGARIA M. Kukleva, V. Kondeva Folia Medica XLI, 3.1999; 65-70 As a result of the anticaries prevention programs the percentage of persons with high level of DMFT decreases and the percentage of persons free of caries increases. This demands the formulation of a new approach in determining the strategies and priorities of the preventive programs and the amount of the needed dental services. A clinico-statistical study of dental caries comprising 600 children of 7, 12 and 14 years of age (300 boys and 300 girls) from Plovdiv was carried out in 1997. The diagnosis of dental caries was visual-tactile. In every age group the percentages of persons with different levels of DMFT were determined. The findings were compared with the results gathered in 1992. It was found that with age the percentage of persons free of caries decreased and the percentage of the persons with high level of DMFT increased. In 1992 15.07 % of 12-year-old children were carriers of 59.26 % of the total number of DMFT, while in 1997 10.00 % were carriers of 25.75 % of the total number DMFT. The most pronounced polarization of dental caries was found in the 7-year-old children group. In Plovdiv the polarization of dental caries in the 12-year-old children group was less pronounced in 1997 than in 1992.
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21.	COMPARATIVE STUDY OF THE INCIDENCE AND PREVALENCE OF DENTAL CARIES IN 12- YEAR OLD CHILDREN FROM PLOVDIV M. Kukleva, V. Kondeva Folia Medica XXXXI, 2.1999; 44-48 The necessity of refreshing the data determines the purpose of present study - to study the incidence and prevalence of dental caries in 1997 and compare the results with the results of previous studies. The study of dental caries is clinico - statistical and comprises 200 12-year-old children from Plovdiv. The sample selection is random. The diagnosis of dental caries is visual-tactile. The incidence (DMFT) and prevalence of dental caries is determined by person (Ep). The results are compared with the results of studies of children of the same age group carried out in 1981, 1989, 1992. The incidence of caries in 12-year old children from Plovdiv is 303 and the prevalence rate by persons is 80.00 %. Comparing the results with previous studies shows a trend of steadily decreasing values with 1992 exhibiting the lowest levels of these indicators. A trend of increasing DMFT and Ep between 1992 and 1997 is observed. The trends of incidence and Ep in 12-year old children in Plovdiv show the favorable effect of the prevalence programs till 1992 and necessity of undertaking urgent measures for overcoming the unfavorable trends set in the last years.
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22.	CARIES INCIDENCE ON TYPES OF SURFACES OF PREMOLARS IN 12- AND 14- YEAR - OLDS FROM PLOVDIV M. Kukleva, V. Kondeva Folia Medica XXXX, 3A,1998; 184 - 185 (Abstract) *Introduction:* During the first years after the break teeth are sensitive towards caries attack because of the uncompleted mineralisation of the hard dental tissue and the morphologic characteristics of the fissures. The knowledge of the specificity of caries attack makes it possible to forecast the effect of different prevention programmes. Aim: To determine caries incidence generally and on types of surfaces of premolars in 12- and 14- year - olds. Material and Methods: The research is carried on 400 12- and 14- year - olds from Plovdiv in 1997 according to the WHO requirements. Dental caries is detected by means of a probe and a mirror at cavitation level. Caries incipient is not included in the study. Caries incidence (Is) in general and on types of surfaces in both jaws is determined. Results are compared by means of variation analysis at level of significance P < 0.05. Results: Results show that in both age groups caries incidence is higher for P2. When compared to P1 a statistically significant difference is found for the 12- year- olds (P < 0.05). Data analysis regarding caries incidence on types of surfaces shows that vestibular and lingual surfaces of premolars are not affected by caries. Caries incidence of the occlusal surfaces takes highest values. This is for P1 as well as for P2 in both jaws. When compared to the other surfaces statistically significant differences are found for P1 and P2 in the 12- and 14- year- olds (P < 0.05; P < 0.01) with the exception of the distal surfaces of P2 in the upper jaw the 14- year- olds (P > 0.05). The authors argue that this is due to the lower self - cleaning of these surfaces as well as to the insufficient oral hygiene. The fact that the occlusal surfaces are affected by caries to a higher degree supports the idea that mineralisation of the hard dental tissue and the morphologic characteristics of the fissures are important for the beginning of the cariesogenic process at that age. Conclusion: Results show that: - At the age of 12 and 14 caries incidence (Is) is higher for the secondary premolars compared to the primary premolars. - Is takes highest values for the occlusal surfaces compared to the other ones. - The lower resistant of the occlusal surfaces of P1 and P2 in both jaws and the distal surfaces of P2 in the upper jaw has to be taken into account when developing prevention programs
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23.	CARIES INCIDENCE ON TYPES OF SURFACES OF CENTRAL AND LATERAL INCISORS IN 7-, 12- AND 14- YEAR - OLDS FROM PLOVDIV M. Kukleva, V. Kondeva Folia Medica XXXX, 3A,1998; 184(Abstract) *Introduction:* As a results of the anticaries prevention and especially of the better oral hygiene caries incidence of the front teeth strongly decreases. Research evidence for the last few years show that dental caries is a disease that affects mostly the chewing teeth. The knowledge of the extent to which teeth are affected by dental caries is essential for the implementation of a goal - oriented and adequate prevention. Aim: To determine caries incidence /Is/ in generally and on types of surfaces of the front and side incisors in 7-, 12- and 14- year - olds. Material and Methods: The research is carried out in 1997 in Plovdiv. It comprises 600 7-, 12- and 14- year- old randomly selected children, which are equally distributed in each age group. Dental caries is detected by means of a probe and a mirror at cavitation level. DMFS is determined generally and on types of surfaces of the central and lateral incisors in both jaws. Results are statistically compared by means of variation analysis at level of significance P < 0.05. Results and discussion: Results show that central and lateral incisors in the 7- year olds are not affected by caries /DMFS = 0/. The level of DMFS is low in the 12- and 14- year - olds. Central incisors are affected by caries to a greater degree compared to the lateral ones. The difference is statistically significant at the age of 14 (P < 0.05). This is due to the earlier break of the central incisors and the longer presence of local cariesogenic factors. These results are consistent with the results of the research carried out with the same age groups in 1992 in Plovdiv. Data analysis regarding caries incidence on types or surfaces show that in I1 in both jaws most affected are the medial surfaces. When compared to the distal surfaces no statistically significant differences are found. The vestibular and lingual surfaces are not affected by caries except for the 14- year- olds but at that age the level of DMFS is very low. Results for I2 show that the medial surfaces are affected to a higher degree than the distal ones but the differences are not statistically significant (P > 0.05). There is an exception in the lower jaw the 12- year- olds where the level of DMFS is the same in the medial and the distal surfaces. The other surfaces are not affected by caries except for the vestibular ones where the level of DMFS is higher than that of the medial ones. The difference however is not statistically significant(P > 0.05). Conclusion: - I1 and I2 are weakly affected by caries and this is true in general as well as for types of surfaces. - I1 are affected by caries to a higher degree compared to I2.
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24.	EPIDEMIOLOGICAL RESEARCH OF CARIES ON PERMANENT TEETH IN 7-, 12- AND 14- YEAR - OLDS IN PLOVDIV M. Kukleva, V. Kondeva Folia Medica XXXX, 3A,1998; 149 (Abstract) *Introduction:* Epidemiological investigations of dental caries are important for planning of prevention programmes and forecasting the effect of their implementation. WHO recommends that data should be updated every 5 years. Aim: To determine caries epidemiology with respect to persons /Ep/, teeth /Eò/ and dental surfaces /Es/, as well as caries incidence on teeth /Iò/ and dental surfaces /Is/ in 7-, 12- and 14- year - olds from Plovdiv in 1997. To compare the results with the data obtained from the research carried out in 1992. Material and Methods: The research is carried out on 600 7-, 12- and 14- year - olds from Plovdiv in 1997 according to the WHO requirements. Dental caries is detected by means of a probe and a mirror at cavitation level. Caries incipient is not included in the study. Ep, Et, Es, It, Is are determined. Results are compared by means of variation analysis at level of significance P < 0.05. Results: The results of the investigation clearly show that as age goes up caries epidemiology on persons /Ep/ increases. Data analysis show statistically significant increase between 7 and 12 years of age /P < 0.001/ and a slight decline between 12 and 14, but with no significant difference /P > 0.05/. It was found that Ep in the 12- year olds sharply increased from 70.85 % in 1992 to 80.00 % in 1997. The difference is statistically significant /P < 0.05/. The juxtaposition of Eò and Ep shows increase in 12 years old group and a statistical significance of this difference /P < 0.001/, and just the opposite situation in 7 and 14 years old group /P > 0.05/. The growth in children increases the caries incidence on teeth /Iò/ and on teeth surfaces /Is/. The difference between 7 and 12 years is statistically significant /P < 0.001/. So comparing the data for caries incidence, we should declare a define increase in this indexes in 1997, in 12 and 14 years of age and a slight decrease in 7 years of age, but with no statistically differences /P > 0.05/. Conclusion: The increase of caries epidemiology and caries incidence in 12 - year - olds suggests an unfavorable change in oral prevention between the two studies.
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25.	SPECIFICITY OF CARIES ATTACK ON PERMANENT MOLARS IN 14- YEAR - OLDS M. Kukleva, V. Kondeva Folia Medica XXXX, 3A,1998; 187 (Abstract) *Introduction:* Immediately after the break of teeth occlusal surfaces are most susceptible to caries attack. This is due to the morphological characteristics of the fissures and the uncompleted mineralisation. Aim: To determine the specificity of caries attack on permanent molars /M1, M2/ in 14- year - old children. Material and Methods: The research is carried out in 1997 on 200 14- year - old children from Plovdiv according to the WHO requirements. Caries incidence /Is/ in general and on types of surfaces of M1 and M2 in both jaws is determined. Results are compared by means of variation analysis at level of significance P < 0.05. Results: The data analysis shows that at the age of 14 the first permanent molars are to a much greater degree affected by the caries (P < 0.01). This is due to the longer presence of local cariesogenic factors because of the molars` earlier break. In the upper jaw caries incidence of M1 and M2 is highest on the occlusal surfaces. When compared to the other surfaces the difference is statistically significant (P < 0.05). The occlusal surfaces of M1 are followed /in a descending order/ by the medial, lingual, distal and vestibular surfaces. The data for M2 shows that after the occlusal surfaces come the lingual ones and the rest are not affected by caries. The situation in the lower jaw is similar to that upper jaw. Caries incidence takes highest values for the occlusal surfaces. When compared to other surfaces P < 0.01 is found. Conclusion: - In 14 - year - olds the first permanent molars are to a greater degree affected by caries than the second molars (P < 0.01) - The occlusal surfaces of the primary and secondary molars are most affected by caries. When compared to the other surfaces statistically significant differences are found (P < 0.01), this is for both jaws
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26.	CARIES POLARIZATION ON PERMANENT TEETH IN 7-, 12-, 14- YEAR - OLD CHILDREN M. Kukleva, V. Kondeva BaSS 1998 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY SOFIA - BULGARIA - March, 1998, 114 (Abstract 10 P) It is known that as a result of caries prevention the number of people with high caries incidence decreases. The aim of the research is to determine the relative number of people with zero and different caries incidence. Results show that the number of people with zero caries incidence decreases and the number of people with high caries incidence increases as age goes up. The relative number of children with zero, with low and high caries incidence decreases among 12- year- old children and the number of children with moderate caries incidence increases compared to other researches.
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27.	EPIDEMIOLOGICAL STUDY ON CARIES INCIPIENS IN 7- , 12-, 14- YEAR - OLD CHILDREN M. Kukleva, V. Kondeva BaSS 1998 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY SOFIA - BULGARIA - March, 1998, 115, (Abstract 13 P) The aim of the authors is to study the epidemiology of initial caries on subjects /Ep/, teeth /Eò/ and surfaces /Es/. The research is carried on permanent teeth in 600 children in Plovdiv. The results are compared to the data about active caries in the same age groups. The results show high values of Ep, Eò and Es in the 7- year - olds. The authors stress on the need of early caries prevention.
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28.	CARIES PREVENTIVE EFFECT OF FLUORIDE GEL ON CARIES INCIPIENS M. Kukleva, V. Kondeva, Hr. Mateeva BaSS 1998 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY SOFIA - BULGARIA - March, 1998, 115 (Abstract 12 P) The research was carried out on 211 7- year- old children with no earlier history of active dental caries on permanent teeth. Two groups - a test and a control group are formed. The concentration of free fluoride ions in the gel is 0.42 %. The application was repeated 4 times annually, once each 3 months. After 12 months the results of the research on the test group were compared to those of the control group. Results show that in the test group only 25.53 % of the cases with macula cariosa fusca develop into active caries, and in the control group the percentage is 86.05 %. The difference is statistically significant /p < 0.001/. The results indicate considerable caries preventive effect of fluoride gel on caries incipiens.
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29.	CARIES ACTIVITY /A/ AND CARIES REDUCTION AFTER GROUP CARIES PREVENTION WITH FLUORIDE GEL M. Kukleva, V. Kondeva, Hr. Mateeva BaSS 1998 5th CONGRESS OF THE BALKAN STOMATOLOGICAL SOCIETY SOFIA - BULGARIA - March, 1998, 115 (Abstract 11 P) A group prevention with fluoride gel is carried out on 107 7 - year - old children. The concentration of free fluoride ions in the gel is 0.42 %. The fluoride gel is applied four times a year. 104 7- year- old children participated in the control group. Children in both groups have no earlier history of active dental caries. Caries incidence /I/ and caries activity /A/ on teeth and dental surfaces are tested. The results after 12 months show that caries activity on teeth /As/ in the control group is 0.84, and in the test group is 0.22. Caries activity on dental surfaces /As/ in the test group is 0.25, and in the control group is 0.93 /p < 0.001/. Caries reduction of active dental caries on teeth / Rs / is 73.81 % and caries reduction on dental surfaces /Rs/ is 73.12 %.
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30.	A STUDY ON THE PREVALENCE OF CARIES INCIPIENS IN 7-, 12- AND 14- YEAR- OLD CHILDREN FROM PLOVDIV M. Kukleva, V. Kondeva Folia Medica XXXX, 4.1998; 54-59 The decline in dental caries prevalence I many countries of the world in the last decades requires the adoption of new approaches towards determination of prevention strategies. The individuals and groups at high risk of developing caries should be differentiated from the rest of the population with the aim of carrying out selective prevention. Of particular interest is the determination of the risk of developing caries before adequate prevention. The aim of the present study was to determine the prevalence of caries incipiens on the teeth and on the dental surfaces in 7-, 12- and 14-year-old children and to compare it with the prevalence of clinical caries in the same population groups. The study is representative by design and compares 600 children aged 7, 12 and 14 years from Plovdiv. The study is designed and carried out in compliance with the guidelines of WHO for conducting clinico-statistical study of dental caries. The diagnostic procedure of caries incipiens is visual-tactile. The test of vital staining with 2 % water solution of Methilen Blau was also used. Caries incipiens prevalence was found to be higher than that of clinical caries in 7-year-old children (P<0.001). In 12- and 14- year-old children the ratio of caries incipiens to clinical caries shifts in favour of clinical caries (P<0.001). The higher prevalence of caries incipiens compared to clinical caries in 7-year-old children (P<0.001) justifies its more extensive investigation as a predictive factor for developing caries in the 7 - 12 years age groups.
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31.	PREVENTION OF DENTAL CARIES ON THE FIRST PERMANENT MOLARS WITH FLUORIDE GEL IN THE FIRST YEAR AFTER ERUPTION M. Kukleva Folia Medica XXXX, 4.1998; 60-64 The first permanent molars (M1) are especially sensitive to caries attack immediately after eruption. The questions concerning the effect of preventive methods during this period in groups at low risk of caries are insufficiently studied. The aim of the study was to examine the effect of caries prevention of M1 in the first year after eruption by means of fluoride gel in groups with low risk of caries. A clinical study including 213 seven-year-old children from Plovdiv was conducted in the course of one year. The children were assigned to two groups - experimental and control. In both groups children without clinical caries on M1 were included. The sampling procedure excluded subject with multiple and diffuse obturations of the deciduous teeth, inadequate oral hygiene or undergoing orthodontics treatment. In the experimental groups four applications with 0.42 % fluoride gel were performed at three months intervals. At the end of the study period the prevalence rate of caries on teeth and dental surfaces was higher in the control group (P<0.001). Caries reduction in the experimental group was 73.81 % on the teeth and 73.12 % on the dental surfaces. The results of our study show that immediately after eruption the first permanent molars are susceptible to caries in individuals at low risk of caries. This necessitates prevention activity during this period irrespective of the presumed risk. The fluoride gel applied by the author shows high anticaries activity on M1 in the first year after the eruption.
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	*Key words:* Bracket, Caries activity, Caries incidence, Caries incipiens, Caries incipient, Demineralization, Dental caries, DMFT, Early Childhood Caries, ECC, Eruption, Fluoride gel, Incisor, Kukleva, Level of DMFT, Orthodontic, Permanent teeth, Polarization, Prevalence, Prevention, Preventive programs, Saliva, Treatment, White spot