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n
t
iv
e
e
x
a
m
i
n
a
t
i
o
n
.
R
e
p
o
r
t
s
t
h
e
p
r
e
s
e
n
c
e
o
f
h
a
r
m
f
u
l
h
a
b
i
t
s
-
g
r
i
n
d
i
n
g
a
n
d
c
l
e
n
c
h
i
n
g
o
f
t
h
e
t
e
et
h
d
u
r
i
n
g
s
l
e
e
p
.
At
ab
o
u
t
6
-
7
y
e
a
r
s
o
f
a
g
e
,
d
i
f
f
ic
u
l
ty
b
r
e
a
t
h
i
n
g
t
h
r
o
u
g
h
t
h
e
n
o
s
e
w
a
s
d
e
t
e
ct
e
d
,
a
n
d
a
f
t
e
r
c
o
n
s
u
l
t
a
t
i
o
n
w
i
t
h
a
n
o
t
o
r
h
i
n
o
l
a
r
y
n
g
o
l
o
g
i
s
t
,
t
h
e
p
a
t
i
e
n
t
u
n
d
e
r
w
e
n
t
a
n
o
p
e
r
a
t
i
o
n
,
f
o
l
l
o
w
i
n
g
t
h
e
c
o
n
c
l
u
s
i
o
n
t
h
a
t
t
h
e
d
i
a
g
n
o
s
i
s
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as
t
h
e
c
a
u
s
e
o
f
t
h
e
h
a
r
m
f
u
l
h
a
b
i
t
.
R
e
p
o
r
t
e
d
a
p
a
s
t
h
e
a
d
t
r
a
u
m
a
a
b
o
u
t
5
y
e
a
r
s
a
g
o
.
T
h
e
r
e
w
e
r
e
n
o
m
i
s
s
i
n
g
te
e
t
h
.
O
r
a
l
h
y
g
i
e
n
e
c
o
n
s
i
s
ts
o
f
c
l
e
a
n
i
n
g
t
h
e
t
e
e
t
h
i
n
t
h
e
m
o
r
n
i
n
g
a
n
d
i
n
t
h
e
e
v
e
n
i
n
g
w
i
t
h
a
m
a
n
u
a
l
b
r
u
s
h
,
w
i
t
h
m
e
d
i
u
m
h
a
r
d
n
e
s
s
o
f
t
h
e
f
i
l
a
m
e
n
ts
a
n
d
u
s
i
n
g
a
t
o
o
t
h
p
as
te
-
S
e
n
s
o
d
y
n
e
o
r
C
o
l
g
at
e
.
N
o
m
o
u
t
h
w
a
s
h
is
u
s
e
d
.
I
n
t
a
k
e
o
f
f
l
u
o
r
i
d
e
c
a
m
e
o
n
l
y
w
i
t
h
t
h
e
t
o
o
t
h
p
a
s
t
e
.
R
e
p
o
r
t
ed
f
r
e
q
u
e
n
t
c
o
n
s
u
m
p
t
i
o
n
o
f
c
a
r
b
o
n
a
t
e
d
b
e
v
e
r
a
g
e
s
b
e
t
w
e
e
n
m
ai
n
m
e
a
ls
a
n
d
le
s
s
f
r
e
q
u
e
n
t
c
o
n
s
u
m
p
t
i
o
n
o
f
s
w
e
et
s
a
n
d
o
t
h
e
r
s
i
m
p
l
e
c
a
r
b
o
h
y
d
r
a
t
es
.
G
e
n
e
r
al
m
e
d
i
ca
l
h
i
s
t
o
r
y
.
T
h
e
p
a
t
i
e
n
t
h
a
d
a
h
o
s
p
i
t
a
l
s
ta
y
a
t
t
h
e
a
g
e
o
f
8
d
u
e
t
o
a
n
o
p
e
r
a
t
i
o
n
-
a
d
e
n
o
i
d
ec
t
o
m
y
.
T
h
e
m
o
t
h
e
r
d
i
d
n
o
t
r
e
p
o
r
t
a
n
y
d
i
f
f
i
c
u
l
t
ie
s
w
i
t
h
t
h
e
p
r
e
g
n
a
n
c
y
a
n
d
t
h
e
c
h
i
l
d
b
i
r
t
h
,
as
w
el
l
as
t
a
k
i
n
g
m
e
d
i
c
a
ti
o
n
d
u
r
i
n
g
p
r
e
g
n
a
n
c
y
.
T
h
e
c
h
i
l
d
d
o
e
s
n
o
t
t
a
k
e
a
n
y
m
e
d
i
c
at
i
o
n
a
n
d
h
a
s
n
o
p
r
o
v
e
n
a
l
l
e
r
g
i
es
.
N
o
g
e
n
e
r
a
l
m
e
d
ic
a
l
il
l
n
es
s
es.
E
x
a
m
i
n
a
t
i
o
n
:
e
x
t
r
a
o
r
al
:
n
o
f
a
ci
a
l
as
y
m
m
e
t
r
y
,
n
o
c
i
c
a
t
r
i
c
es
,
th
e
s
k
i
n
o
f
t
h
e
f
a
c
e
h
as
p
r
e
s
e
r
v
e
d
t
u
r
g
o
r
,
v
i
s
i
b
l
e
m
u
c
o
u
s
m
e
m
b
r
a
n
es
-
n
o
c
h
a
n
g
e
s
,
r
a
s
h
u
n
i
t
s
a
n
d
s
w
e
l
l
i
n
g
s
a
r
e
n
o
t
o
b
s
e
r
v
e
d
.
N
o
p
a
t
h
o
l
o
g
y
i
n
t
h
e
m
o
v
e
m
e
n
t
o
f
t
h
e
t
e
m
p
o
r
o
-
m
a
n
d
i
b
u
l
a
r
j
o
i
n
t
a
n
d
t
r
is
m
u
s
w
as
d
et
e
c
t
e
d
.
I
n
t
r
a
o
r
a
l
e
x
a
m
i
n
a
t
i
o
n
:
m
u
c
o
u
s
m
e
m
b
r
a
n
e
:
n
o
p
a
t
h
o
l
o
g
i
ca
l
ch
a
n
g
e
s
;
g
i
n
g
i
v
a
:
c
o
l
o
r
:
l
o
c
al
iz
e
d
r
e
d
n
e
s
s
;
t
e
x
t
u
r
e
:
s
m
o
o
t
h
;
p
a
p
i
l
l
ae
:
s
w
o
ll
e
n
;
g
i
n
g
i
v
a
l
m
a
r
g
i
n
:
s
w
o
l
l
e
n
,
r
e
d
,
t
h
i
c
k
e
n
e
d
.
B
it
e
-
d
is
t
al
b
it
e
(
cla
s
s
I
I
,
1
s
u
b
c
l
as
s
)
,
d
e
e
p
b
it
e
.
S
t
r
o
n
g
l
y
p
r
o
t
r
u
d
i
n
g
u
p
p
e
r
i
n
c
i
s
o
r
s
a
n
d
s
a
g
i
tt
a
l
d
is
t
a
n
c
e
b
e
t
w
e
e
n
t
h
e
tw
o
d
e
n
t
a
l
a
r
c
h
e
s
(
o
v
e
r
j
e
t
)
.
P
a
la
t
a
ll
y
i
n
c
l
i
n
e
d
u
p
p
e
r
l
a
t
e
r
a
l
i
n
c
i
s
o
r
s
a
n
d
r
o
t
a
t
e
d
p
r
e
m
o
l
a
r
s
.
T
o
n
g
u
e
:
u
n
c
o
a
t
e
d
,
n
o
r
m
a
l
c
o
l
o
r
,
r
a
s
h
e
l
e
m
e
n
ts
n
o
t
o
b
s
e
r
v
e
d
.
A
l
l
o
f
t
h
e
p
a
t
i
e
n
ts
’
s
p
e
r
m
a
n
e
n
t
t
e
e
t
h
h
a
d
e
r
u
p
t
e
d
(
e
x
c
e
p
t
t
h
e
t
h
i
r
d
m
o
l
a
r
s
)
,
a
n
d
i
t
i
s
e
x
p
e
ct
e
d
t
h
a
t
t
h
e
y
h
a
v
e
c
o
m
p
l
e
t
e
d
t
h
e
i
r
r
o
o
t
d
e
v
e
l
o
p
m
e
n
t
.
W
e
p
e
r
f
o
r
m
e
d
a
n
d
a
n
a
l
y
z
e
d
a
n
o
r
a
l
h
y
g
i
e
n
e
i
n
d
e
x
:
P
L
I
-
P
l
a
q
u
e
i
n
d
e
x
b
y
S
i
l
n
e
s
s
a
n
d
L
ö
e
[
2
0
]
.
T
h
i
s
i
n
d
e
x
r
e
f
l
e
ct
s
p
l
a
q
u
e
t
h
i
c
k
n
es
s
o
n
l
y
n
e
a
r
t
h
e
c
o
r
o
n
a
l
e
d
g
e
.
A
s
s
e
s
s
m
e
n
t
is
b
y
s
c
r
a
p
i
n
g
w
i
t
h
a
p
r
o
b
e
,
w
i
t
h
o
u
t
s
ta
i
n
i
n
g
.
T
h
e
p
la
q
u
e
i
n
d
e
x
o
f
a
n
i
n
d
i
v
i
d
u
a
l
w
as
d
e
t
e
r
m
i
n
e
d
b
y
s
u
m
m
i
n
g
t
h
e
v
a
l
u
e
s
o
b
t
a
i
n
e
d
f
o
r
e
a
c
h
t
o
o
t
h
a
n
d
ca
l
c
u
l
at
i
n
g
t
h
e
a
v
e
r
a
g
e
s
.
T
o
d
et
e
r
m
i
n
e
t
h
e
p
l
aq
u
e
i
n
d
e
x
,
S
il
n
e
s
s
a
n
d
L
ö
e
r
e
f
e
r
e
n
c
e
v
a
l
u
es
w
e
r
e
t
a
k
e
n
a
s
a
b
as
is
:
p
l
a
q
u
e
i
n
d
e
x
0
:
N
o
p
l
a
q
u
e
i
s
i
n
t
h
e
a
r
e
a
a
d
j
ac
e
n
t
t
o
t
h
e
g
i
n
g
i
v
a
.
T
h
e
Sil
n
ess
an
d
L
o
e
P
laq
u
e
i
n
d
ex
h
as
a
f
o
u
r
-
p
o
in
t
s
ca
le
:
i)
S
co
r
e
0
:
T
h
e
to
o
th
s
u
r
f
ac
e
is
clea
n
;
ii)
Sco
r
e
1
:
T
h
e
to
o
th
s
u
r
f
ac
e
ap
p
ea
r
s
clea
n
,
b
u
t
d
en
tal
p
laq
u
e
ca
n
b
e
r
em
o
v
e
d
f
r
o
m
th
e
g
in
g
iv
al
th
ir
d
with
a
s
h
ar
p
ex
p
lo
r
er
)
;
an
d
iii)
Sco
r
e
2
:
P
laq
u
e
is
v
is
ib
le
alo
n
g
t
h
e
g
in
g
iv
al
m
a
r
g
in
(
s
ee
Fig
u
r
e
1
a
n
d
T
ab
le
1
).
B
ased
o
n
th
e
s
co
r
in
g
s
y
s
tem
,
p
laq
u
e
i
n
d
ex
=
(
2
+1
+1
+
2
)
/4
=
1
.
5
.
Acc
o
r
d
in
g
to
th
e
p
laq
u
e
in
d
ex
s
y
s
tem
,
th
is
m
ea
n
s
th
e
p
laq
u
e
in
d
ex
f
o
r
t
h
e
to
o
th
is
m
o
d
er
ate
ac
c
u
m
u
lat
io
n
o
f
s
o
f
t
d
e
p
o
s
it
with
in
th
e
g
in
g
iv
al
p
o
ck
et,
o
r
th
e
to
o
th
a
n
d
g
i
n
g
iv
al
m
ar
g
in
wh
ich
ca
n
b
e
s
ee
n
with
th
e
n
a
k
ed
ey
e
(
s
ee
Fig
u
r
e
1
a
n
d
T
a
b
le
1
)
.
I
ts
v
alu
e
is
eq
u
al
to
1
.
5
8
,
wh
ich
d
ef
in
es
o
r
al
h
y
g
ien
e
as
s
atis
f
ac
to
r
y
to
p
o
o
r
.
W
e
ap
p
lied
m
o
d
er
n
to
o
ls
f
o
r
ea
r
ly
d
ia
g
n
o
s
is
-
th
e
I
C
DAS
s
y
s
tem
[
2
1
]
.
I
C
DAS
an
d
th
e
I
n
ter
n
atio
n
al
C
ar
ies
C
las
s
if
icatio
n
an
d
Ma
n
ag
em
en
t
Sy
s
tem
™
(
I
C
C
MS™
)
,
an
in
ter
n
atio
n
al
s
y
s
tem
f
o
r
th
e
d
iag
n
o
s
is
,
d
etec
tio
n
,
an
d
ev
alu
ati
o
n
o
f
ca
r
ies lesi
o
n
s
as sh
o
wn
in
T
ab
le
2
.
Den
tal
ca
r
ies
d
iag
n
o
s
is
D3
a
was
f
o
u
n
d
o
n
teeth
3
6
,
1
7
,
2
7
,
3
7
,
4
6
,
an
d
4
7
to
o
th
with
d
iag
n
o
s
is
d
en
tal
ca
r
ies
D2
.
Den
tal
ca
r
ies
D1
b
was
d
ia
g
n
o
s
ed
o
n
teet
h
1
6
,
1
2
,
2
2
,
2
4
,
2
5
.
T
o
d
ate,
th
e
p
atien
t
h
as
n
o
t
h
ad
f
illi
n
g
p
lace
d
.
C
o
n
s
u
ltati
o
n
an
d
tr
ea
tm
en
t
b
y
a
n
o
r
th
o
d
o
n
tis
t
ar
e
n
ec
ess
ar
y
.
C
o
n
s
u
l
tatio
n
with
an
o
r
al
s
u
r
g
eo
n
is
also
n
ec
ess
ar
y
;
if
n
ec
ess
ar
y
,
tr
ea
tm
en
t
ca
n
b
e
c
ar
r
ied
o
u
t
b
y
g
e
r
m
ec
to
m
y
-
b
y
ex
tr
ac
tio
n
o
f
th
e
im
p
ac
ted
3
r
d
m
o
lar
s
(
3
8
a
n
d
4
8
)
.
T
ab
le
1
.
Scale
an
d
cr
iter
ia
f
o
r
s
co
r
in
g
th
e
p
laq
u
e
in
d
ex
-
PLI
-
P
laq
u
e
in
d
e
x
b
y
Sil
n
ess
an
d
L
ö
e
P
LI
-
P
l
a
q
u
e
i
n
d
e
x
b
y
S
i
l
n
e
ss
a
n
d
L
ö
e
C
r
i
t
e
r
i
a
0
A
b
se
n
c
e
o
f
mi
c
r
o
b
i
a
l
p
l
a
q
u
e
1
Th
i
n
f
i
l
m
o
f
mi
c
r
o
b
i
a
l
p
l
a
q
u
e
a
l
o
n
g
t
h
e
f
r
e
e
g
i
n
g
i
v
a
l
m
a
r
g
i
n
2
M
o
d
e
r
a
t
e
a
c
c
u
m
u
l
a
t
i
o
n
w
i
t
h
p
l
a
q
u
e
i
n
t
h
e
s
u
l
c
u
s
3
La
r
g
e
a
m
o
u
n
t
o
f
p
l
a
q
u
e
i
n
s
u
l
c
u
s
o
r
p
o
c
k
e
t
a
l
o
n
g
t
h
e
f
r
e
e
g
i
n
g
i
v
a
l
mar
g
i
n
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
7
6
-
1
2
8
3
1278
Fig
u
r
e
1
.
R
ep
r
esen
tativ
e
teeth
o
n
wh
ich
th
e
p
atien
t'
s
d
en
tal
p
laq
u
e
ac
cu
m
u
latio
n
was a
s
s
es
s
ed
T
ab
le
2
.
I
C
DAS
I
I
1
5
/0
6
/2
0
1
2
C
o
d
e
D
e
scri
p
t
i
o
n
0
N
o
e
n
a
m
e
l
d
e
mi
n
e
r
a
l
i
z
a
t
i
o
n
1
E
n
a
m
e
l
d
e
mi
n
e
r
a
l
i
z
a
t
i
o
n
l
i
m
i
t
e
d
t
o
5
0
%
o
f
t
h
e
e
n
a
me
l
t
h
i
c
k
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e
ss
a
n
d
i
t
s
o
u
t
e
r
s
u
r
f
a
c
e
2
D
e
mi
n
e
r
a
l
i
z
a
t
i
o
n
(
b
r
o
w
n
d
i
sc
o
l
o
r
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t
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o
n
)
b
e
t
w
e
e
n
5
0
%
o
f
e
n
a
mel
a
n
d
1
/
3
o
f
d
e
n
t
i
n
3
D
e
mi
n
e
r
a
l
i
z
a
t
i
o
n
(
b
r
o
w
n
c
o
l
o
r
a
t
i
o
n
)
i
n
v
o
l
v
i
n
g
t
h
e
m
i
d
d
l
e
t
h
i
r
d
o
f
t
h
e
d
e
n
t
i
n
4
D
e
mi
n
e
r
a
l
i
z
a
t
i
o
n
(
b
r
o
w
n
c
o
l
o
r
a
t
i
o
n
)
i
n
v
o
l
v
i
n
g
t
h
e
i
n
n
e
r
t
h
i
r
d
o
f
t
h
e
d
e
n
t
i
n
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
Ma
lo
cc
lu
s
io
n
is
a
wo
r
ld
wid
e
d
en
tal
p
r
o
b
lem
.
Ma
n
y
r
is
k
f
a
cto
r
s
co
n
tr
ib
u
te
to
d
en
tal
ab
n
o
r
m
alities
,
in
clu
d
in
g
h
e
r
ed
itar
y
o
n
es.
Den
tal
ca
r
ies,
p
u
lp
itis
an
d
p
er
iap
ical
in
f
lam
m
atio
n
s
,
tr
au
m
atic
in
ju
r
ies,
d
ev
elo
p
m
e
n
tal
ab
n
o
r
m
alities
,
an
d
o
r
al
h
ab
its
ar
e
th
e
m
o
s
t
c
o
m
m
o
n
o
r
al
d
is
ea
s
es
in
c
h
ild
r
en
th
at
ar
e
s
tr
o
n
g
ly
ass
o
ciate
d
with
m
alo
cc
lu
s
io
n
[
2
2
]
.
T
h
e
p
atien
t
is
at
h
ig
h
ca
r
ies
r
is
k
-
p
r
esen
ce
o
f
ac
tiv
e
wh
ite
ca
r
ies
lesi
o
n
s
,
p
r
esen
ce
o
f
p
laq
u
e
o
n
th
e
teeth
,
p
o
o
r
o
r
al
h
y
g
ien
e
,
a
n
d
n
o
t r
eg
u
lar
ly
v
is
itin
g
as sh
o
wn
i
n
Fig
u
r
e
2
.
Sá
-
Pin
to
et
a
l.
[
2
3
]
ev
alu
ate
th
e
s
cien
tific
r
esu
lts
r
eg
ar
d
in
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
m
alo
cc
lu
s
io
n
an
d
d
en
tal
ca
r
ies
in
ad
o
lescen
ts
.
Or
th
o
d
o
n
tic
tr
ea
tm
e
n
t
is
th
o
u
g
h
t
t
o
in
cr
ea
s
e
th
e
r
is
k
o
f
d
en
tal
ca
r
ies.
T
h
e
g
o
als
o
f
o
r
th
o
d
o
n
tic
tr
ea
tm
en
t
in
p
atien
ts
with
m
alo
cc
lu
s
io
n
ar
e
to
im
p
r
o
v
e
t
h
e
esth
etics
o
f
th
e
m
ax
illo
f
ac
ia
l
r
eg
io
n
a
n
d
to
o
p
tim
ize
m
asti
ca
to
r
y
f
u
n
ctio
n
b
y
c
h
an
g
i
n
g
th
e
p
o
s
itio
n
o
f
th
e
teeth
[
2
4
]
,
[
2
5
]
.
Or
th
o
d
o
n
tic
tr
ea
tm
en
t
is
ass
o
ciate
d
with
a
r
ed
u
ce
d
lik
elih
o
o
d
o
f
a
d
e
n
tal
ca
r
ies.
Fu
r
th
er
m
o
r
e,
th
e
r
e
is
n
o
ev
id
e
n
ce
s
h
o
win
g
a
r
elatio
n
s
h
ip
b
etwe
e
n
th
e
o
u
tco
m
e
o
f
ca
r
i
o
u
s
teeth
an
d
o
r
th
o
d
o
n
tic
tr
ea
tm
e
n
t
[
2
6
]
.
Au
th
o
r
s
s
u
ch
as
Seif
f
er
t
et
a
l.
[
2
7
]
,
c
o
n
d
u
cted
a
s
cien
tific
s
tu
d
y
ev
alu
atin
g
th
e
q
u
al
ity
o
f
clin
ical
p
r
ac
tice
g
u
id
elin
es
f
o
r
th
e
p
r
ev
en
tio
n
o
f
d
en
tal
ca
r
ies in
ch
ild
r
en
an
d
ad
o
lescen
ts
.
T
h
e
to
o
th
g
er
m
o
f
th
e
f
o
u
r
p
er
m
an
en
t th
ir
d
m
o
la
r
s
,
in
th
e
s
tag
e
o
f
f
o
r
m
atio
n
o
f
th
e
d
e
n
tal
cr
o
wn
,
ar
e
laid
,
an
d
th
o
s
e
o
f
th
e
lo
wer
ja
w
h
av
e
a
p
r
o
b
ab
le
p
r
o
g
n
o
s
is
o
f
s
tay
in
g
r
etain
e
d
o
r
d
if
f
icu
lt
er
u
p
tio
n
.
T
h
e
to
o
th
g
er
m
o
f
th
e
f
o
u
r
th
ir
d
m
o
lar
s
,
in
th
e
s
tag
e
o
f
f
o
r
m
atio
n
o
f
t
h
e
d
en
tal
cr
o
wn
,
ar
e
laid
,
an
d
th
o
s
e
o
f
th
e
lo
wer
jaw
h
av
e
a
p
r
o
b
a
b
le
p
r
o
g
n
o
s
i
s
o
f
s
tay
in
g
r
etain
ed
o
r
d
if
f
icu
lt
er
u
p
tio
n
.
X
-
r
a
y
s
tatu
s
:
Or
th
o
p
an
to
m
o
g
r
a
p
h
y
(
OPG)
was
p
er
f
o
r
m
ed
f
o
r
d
iag
n
o
s
tic
p
u
r
p
o
s
es
an
d
its
q
u
ality
was
s
atis
f
ac
to
r
y
.
R
o
o
t
d
e
v
el
o
p
m
en
t
o
f
th
e
teeth
is
co
m
p
lete,
with
o
u
t th
e
th
i
r
d
m
o
lar
s
as sh
o
wn
in
Fig
u
r
e
3
.
T
r
ea
tm
en
t
p
lan
:
Mo
tiv
atio
n
a
n
d
ed
u
ca
ti
o
n
to
im
p
r
o
v
e
th
e
o
r
al
h
y
g
ien
e
is
p
r
o
v
id
ed
.
T
r
e
atm
en
t
f
o
r
r
ed
u
cin
g
th
e
p
la
q
u
e
o
n
th
e
te
eth
-
th
e
in
d
u
ce
d
g
in
g
iv
al
in
f
la
m
m
atio
n
-
p
r
o
f
ess
io
n
al
o
r
al
h
y
g
ien
e
ap
p
licatio
n
o
f
f
lu
o
r
id
e
v
ar
n
is
h
ev
er
y
3
m
o
n
th
s
.
T
r
ea
tm
en
t
o
f
th
e
r
ev
e
r
s
ib
le
lesi
o
n
s
with
to
o
th
m
o
u
s
s
e
f
o
r
a
p
er
io
d
o
f
7
m
o
n
th
s
ev
er
y
n
i
g
h
t
af
ter
o
r
al
h
y
g
ien
e
with
t
h
e
ap
p
licatio
n
o
f
th
e
cr
ea
m
o
n
t
h
e
d
r
y
en
am
el
s
u
r
f
ac
es.
T
h
e
ch
ild
d
o
es
n
o
t
wash
o
f
f
th
e
c
r
ea
m
af
ter
war
d
s
.
A
ca
r
io
u
s
p
r
o
ce
s
s
was
estab
li
s
h
ed
-
p
r
esen
ce
o
f
ca
r
io
u
s
p
r
o
ce
s
s
in
d
icato
r
s
-
ac
tiv
e
en
am
el
les
io
n
s
,
p
r
esen
ce
o
f
d
en
tin
c
av
ita
ted
lesi
o
n
s
.
T
r
ea
tm
en
t
b
eg
in
s
with
th
e
d
eter
m
in
atio
n
o
f
th
e
ac
tiv
e,
t
h
e
s
tatio
n
ar
y
lesi
o
n
s
,
th
e
r
ev
er
s
ib
le
,
an
d
th
e
ir
r
ev
er
s
ib
le
l
esio
n
s
.
T
h
e
ac
tiv
e
lesi
o
n
s
ar
e
lo
ca
ted
u
n
d
e
r
th
e
p
laq
u
e,
in
ar
ea
s
f
o
r
t
h
e
d
ev
elo
p
m
en
t
o
f
ca
r
ies,
th
e
le
s
io
n
h
as
n
o
clea
r
b
o
u
n
d
ar
ies,
it
is
r
o
u
g
h
,
with
o
u
t
tr
an
s
p
ar
e
n
cy
an
d
with
o
u
t
a
s
h
in
e,
a
n
d
th
e
co
lo
r
is
wh
ite.
I
n
ac
tiv
e
lesi
o
n
-
in
aty
p
ical
ar
ea
s
,
lack
o
f
a
p
laq
u
e,
with
clea
r
b
o
u
n
d
ar
ies
o
f
t
h
e
lesi
o
n
,
h
as
a
s
h
in
e,
tr
an
s
p
ar
e
n
cy
,
s
m
o
o
th
,
c
o
lo
r
-
wh
ite
to
b
r
o
wn
.
Activ
e
ca
r
i
o
u
s
lesi
o
n
s
r
eq
u
ir
e
n
o
n
-
o
p
er
at
iv
e
o
r
o
p
e
r
ativ
e
p
r
ev
en
tiv
e
t
r
ea
tm
en
t.
I
n
ac
tiv
e
lesi
o
n
s
d
o
n
o
t
r
eq
u
ir
e
tr
ea
t
m
en
t.
R
ev
er
s
ib
le
lesi
o
n
s
ar
e
D1
a,
D1
b
,
an
d
D2
.
T
h
ey
r
eq
u
ir
e
n
o
n
-
o
p
er
ativ
e
p
r
ev
en
tiv
e
tr
ea
tm
e
n
t.
I
n
ca
s
e
o
f
ir
r
ev
er
s
ib
le
lesi
o
n
s
,
it
is
n
ec
ess
ar
y
to
ca
r
r
y
o
u
t
o
p
er
ativ
e
tr
ea
tm
en
t,
p
r
ec
ed
e
d
b
y
n
o
n
-
o
p
er
ativ
e
o
n
es.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
n
terd
is
cip
lin
a
r
y
d
ia
g
n
o
s
tics
a
n
d
d
en
t
a
l trea
tmen
t
:
c
lin
ica
l c
a
s
e
…
(
Do
b
r
in
ka
Mit
ko
va
Da
mya
n
o
va
)
1279
Fig
u
r
e
2
.
Ph
o
to
d
o
cu
m
en
tatio
n
o
f
th
e
p
atien
t'
s
p
r
im
ar
y
ex
a
m
in
atio
n
,
d
eter
m
in
atio
n
o
f
th
e
d
en
tal
s
tatu
s
Fig
u
r
e
3
.
Or
th
o
p
an
t
o
m
o
g
r
ap
h
y
(
OPG)
o
f
th
e
p
atien
t'
s
p
er
m
an
en
t d
en
titi
o
n
,
p
er
f
o
r
m
e
d
p
ar
a
-
clin
ic
al
ex
am
in
atio
n
A
d
if
f
er
en
tial
d
iag
n
o
s
is
b
etw
ee
n
a
d
ee
p
f
is
s
u
r
e
a
n
d
o
cc
lu
s
al
ca
r
ies
is
n
ec
ess
ar
y
.
All
o
f
th
e
m
o
lar
s
er
u
p
t
with
d
ee
p
f
is
s
u
r
es.
Fis
s
u
r
es
ar
e
m
atu
r
in
g
last
an
d
th
eir
m
in
er
aliza
tio
n
is
th
e
wea
k
est
(
p
o
s
t
-
er
u
p
tio
n
m
atu
r
atio
n
last
s
u
p
t
o
1
0
y
ea
r
s
af
ter
er
u
p
tio
n
)
.
T
h
e
e
n
am
el
in
th
e
ar
ea
o
f
th
e
d
ee
p
f
is
s
u
r
e
s
is
ex
tr
em
ely
th
in
.
Plaq
u
e
f
o
r
m
atio
n
is
en
h
a
n
ce
d
an
d
u
n
o
b
s
tr
u
cted
-
ea
s
y
e
n
tr
y
o
f
f
o
o
d
r
esid
u
es
an
d
m
icr
o
o
r
g
an
is
m
s
.
Plaq
u
e
in
th
e
f
is
s
u
r
e
ca
n
n
o
t
b
e
af
f
ec
te
d
b
y
th
e
s
elf
-
clea
n
in
g
m
ec
h
an
is
m
s
in
th
e
m
o
u
th
.
A
p
e
r
m
an
en
t
ca
r
i
o
g
en
ic
s
itu
atio
n
is
cr
ea
ted
,
wh
ich
d
o
es
n
o
t
allo
w
p
o
s
t
-
er
u
p
tio
n
r
e
m
in
er
aliza
tio
n
.
Fis
s
u
r
e
ca
r
ies
d
ev
elo
p
s
in
m
an
y
o
cc
lu
s
al
ar
ea
s
b
ec
a
u
s
e
th
e
f
is
s
u
r
es
an
d
p
its
o
n
t
h
e
o
cc
l
u
s
al
s
u
r
f
ac
e
o
f
th
e
n
ewly
er
u
p
ted
to
o
th
ar
e
m
u
c
h
m
o
r
e
th
an
th
o
s
e
in
th
e
a
d
u
lt
i
n
d
iv
id
u
als
(
h
ig
h
l
y
d
etailed
tex
tu
r
e)
.
T
h
e
en
tr
a
n
ce
o
f
th
e
d
ee
p
f
is
s
u
r
e
is
n
ar
r
o
wed
,
an
d
an
ex
ten
s
io
n
ex
is
ts
b
elo
w
it.
A
to
o
th
b
r
u
s
h
is
u
n
ab
le
to
p
e
n
etr
ate
d
ee
p
in
to
th
ese
tig
h
t
s
p
ac
es.
E
v
en
th
e
s
in
g
le
b
r
is
tle
o
f
th
e
to
o
th
b
r
u
s
h
is
to
o
lar
g
e
to
e
n
ter
an
d
clea
n
th
e
f
i
s
s
u
r
e.
Pro
tectio
n
o
f
th
ese
f
is
s
u
r
es
is
ac
h
iev
ed
b
y
ap
p
licatio
n
o
f
s
ea
lan
ts
.
I
n
o
r
d
er
to
m
ak
e
a
s
u
cc
ess
f
u
l d
if
f
er
e
n
tial d
iag
n
o
s
is
,
it is
n
ec
ess
ar
y
: d
ir
ec
t o
b
s
er
v
atio
n
,
ad
d
itio
n
al
s
tu
d
ies,
in
d
ir
ec
t
d
at
a,
an
d
estab
lis
h
in
g
th
e
p
r
esen
c
e
o
f
ca
r
ies r
is
k
f
ac
to
r
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
7
6
-
1
2
8
3
1280
T
h
e
f
o
llo
win
g
was
p
er
f
o
r
m
ed
:
o
p
er
ativ
e
tr
ea
tm
e
n
t
o
f
d
en
tal
ca
r
ies:
T
o
o
th
2
7
-
with
o
cc
lu
s
al
ca
r
ies,
lesi
o
n
D3
b
-
in
th
e
d
is
tal
f
o
s
s
a.
Op
er
ativ
e
tr
ea
tm
en
t
with
a
m
in
im
ally
in
v
asiv
e
tech
n
iq
u
e
an
d
a
ca
lciu
m
d
ih
y
d
r
o
x
id
e
d
r
ess
in
g
,
a
g
lass
-
lin
er
p
ad
(
GI
C
)
,
a
n
d
d
ef
i
n
itiv
e
f
illi
n
g
with
p
h
o
to
-
co
m
p
o
s
ite
wer
e
ap
p
lied
.
T
o
o
th
3
7
-
ca
r
ies
o
cl
u
s
alis
D2
,
p
e
r
f
o
r
m
ed
m
in
im
ally
i
n
v
a
s
iv
e
o
p
er
ativ
e
tr
ea
tm
en
t
an
d
f
illi
n
g
with
p
h
o
to
-
co
m
p
o
s
ite.
Su
b
s
eq
u
en
t
a
p
p
li
ca
tio
n
o
f
s
ea
lan
ts
o
f
h
ea
lth
y
f
o
s
s
ae
,
f
i
s
s
u
r
es
,
an
d
p
its
.
W
e
s
et
th
e
en
d
o
f
tr
ea
tm
en
t:
d
ef
in
itiv
e
f
illi
n
g
with
p
h
o
to
co
m
p
o
s
ite
m
ater
ia
ls
:
T
o
o
th
3
6
with
D3
a
o
cc
l
u
s
al
ca
r
ies,
af
ter
a
m
in
im
ally
in
v
asiv
e
o
p
er
ativ
e
tr
ea
tm
en
t,
a
g
lass
-
lin
er
s
u
p
p
o
r
t
was
p
lace
d
an
d
o
b
t
u
r
atio
n
with
p
h
o
to
-
co
m
p
o
s
ite
an
d
ap
p
licatio
n
o
f
s
ea
lan
ts
o
f
th
e
h
ea
lth
y
o
cc
l
u
s
al
p
its
an
d
f
o
s
s
ae
o
n
th
e
o
cc
l
u
s
al
s
u
r
f
ac
e
o
f
th
e
f
is
s
u
r
e
(
d
ef
in
itiv
e
o
b
tu
r
atio
n
class
1
)
;
t
o
o
th
4
7
o
cl
u
s
alis
ca
r
ies
D2
–
af
te
r
m
in
im
ally
in
v
asiv
e
o
p
e
r
ativ
e
tr
ea
tm
en
t
an
d
f
illi
n
g
was
m
ad
e
with
p
h
o
t
o
-
co
m
p
o
s
ite
an
d
a
p
p
licatio
n
o
f
s
ea
lan
ts
o
f
th
e
h
ea
lth
y
p
its
an
d
f
o
s
s
ae
o
f
th
e
o
cc
lu
s
al
f
is
s
u
r
e
(
d
ef
in
itiv
e
f
illi
n
g
class
1
)
.
Ap
p
licatio
n
o
f
a
s
ea
lan
t
o
n
th
e
h
ea
lth
y
p
its
an
d
f
is
s
u
r
es;
t
o
o
th
3
6
with
a
ca
r
io
u
s
lesi
o
n
D3
a
o
n
th
e
o
cc
lu
s
al
s
u
r
f
ac
e
–
a
s
u
p
p
o
r
t
was
m
ad
e
o
f
g
lass
lin
er
(
GI
C
)
an
d
f
illi
n
g
with
p
h
o
t
o
-
co
m
p
o
s
ite,
af
ter
wh
ich
a
s
ea
lan
t
was
ap
p
lied
to
th
e
h
ea
lth
y
p
its
an
d
f
is
s
u
r
es
as sh
o
wn
in
Fig
u
r
e
4
.
Fig
u
r
e
4
.
T
o
o
th
3
7
with
a
D2
ca
r
io
u
s
lesi
o
n
o
n
t
h
e
o
cc
lu
s
al
s
u
r
f
ac
e,
af
ter
m
ic
r
o
-
in
v
asiv
e
o
p
er
ativ
e
p
r
ep
ar
atio
n
o
f
a
ca
v
ity
,
a
d
ef
in
itiv
e
f
illi
n
g
with
p
h
o
t
o
-
co
m
p
o
s
ite
was m
ad
e
Dir
ec
t o
b
s
er
v
atio
n
in
clu
d
es: V
is
u
al
o
b
s
er
v
atio
n
-
r
eq
u
ir
es g
o
o
d
lig
h
tin
g
,
d
r
y
in
g
an
d
clea
n
t
ee
th
.
An
y
ca
lcu
lu
s
d
ep
o
s
itio
n
o
r
p
r
esen
ce
o
f
a
p
laq
u
e
s
h
o
u
ld
b
e
clea
n
ed
b
ef
o
r
e
ex
am
in
a
tio
n
,
a
n
d
th
e
f
is
s
u
r
e
m
ay
b
e
s
tain
ed
with
f
o
o
d
p
ig
m
e
n
ts
.
T
ac
tile
in
s
p
ec
tio
n
u
s
in
g
an
at
r
a
u
m
atic
p
r
o
b
e.
Ag
g
r
ess
iv
e
p
r
o
b
in
g
s
h
o
u
ld
n
o
t
b
e
u
s
ed
b
ec
au
s
e
it
m
ay
d
am
a
g
e
t
h
e
s
u
p
er
f
icial
en
am
el
lay
er
an
d
in
itiate
an
in
cip
ien
t
ca
r
io
u
s
lesi
o
n
.
R
eten
tio
n
o
f
th
e
p
r
o
b
e
in
th
e
f
is
s
u
r
e
m
a
y
r
esu
lt
in
a
f
alse
p
o
s
itiv
e
o
r
n
e
g
ativ
e
r
esu
lt.
E
a
r
ly
c
h
ild
h
o
o
d
o
r
al
h
ea
lt
h
m
an
ag
em
en
t
is
p
e
r
f
o
r
m
ed
in
th
e
p
ed
iatr
ic
d
e
n
tal
clin
ics
[
2
8
]
–
[
3
0
]
to
m
in
im
ize
th
e
ad
v
e
r
s
e
im
p
ac
t
o
f
t
h
ese
d
is
ea
s
es
o
n
th
e
teeth
[
3
1
]
–
[
3
3
]
.
I
n
r
ec
e
n
t y
ea
r
s
,
th
e
r
e
h
as
b
e
en
a
s
ig
n
if
ican
t
i
n
cr
ea
s
e
in
th
e
n
u
m
b
er
o
f
p
atien
ts
an
d
/o
r
p
ar
e
n
ts
s
ee
k
in
g
o
r
th
o
d
o
n
tic
tr
ea
tm
en
t
d
u
e
to
a
n
u
m
b
er
o
f
p
s
y
c
h
o
s
o
cial
a
n
d
esth
etic
im
p
r
o
v
em
en
ts
,
n
o
t
o
n
ly
d
u
e
t
o
f
u
n
ctio
n
al
ab
n
o
r
m
alities
[
3
4
]
–
[
4
1
]
.
Hea
lth
in
d
icate
s
th
e
d
eg
r
ee
o
f
f
u
n
ctio
n
a
l
an
d
p
s
y
ch
o
l
o
g
ical
in
teg
r
ity
o
f
th
e
o
r
g
an
is
m
.
M
an
y
au
t
h
o
r
s
in
th
is
f
ield
h
av
e
f
o
u
n
d
t
h
at
o
r
al
h
ea
lth
is
d
i
r
ec
tly
r
elate
d
t
o
th
e
p
atien
t'
s
s
y
s
tem
ic
co
n
d
itio
n
in
ch
ild
h
o
o
d
u
p
t
o
1
8
y
ea
r
s
o
f
ag
e
[
4
2
]
,
[
4
3
]
.
Fro
m
o
u
r
av
a
ilab
le
liter
atu
r
e,
we
f
o
u
n
d
th
at
t
h
er
e
is
an
in
cr
ea
s
e
in
th
e
n
ee
d
f
o
r
o
r
th
o
d
o
n
tic
tr
ea
tm
en
t
in
a
lar
g
e
n
u
m
b
er
o
f
d
if
f
e
r
en
t
ca
s
es
o
f
p
atien
ts
v
is
itin
g
d
en
tal
clin
ics
[
4
4
]
–
[
4
7
]
.
T
h
er
e
is
also
a
n
ee
d
f
o
r
p
r
o
p
er
p
lan
n
in
g
in
o
r
d
er
to
p
r
o
v
id
e
tim
ely
,
o
r
th
o
d
o
n
ti
c
s
er
v
ices
b
o
th
at
th
e
in
d
iv
id
u
al
lev
el
in
th
e
d
en
tal
clin
ic
an
d
at
th
e
lev
el
o
f
g
r
o
u
p
s
o
f
ch
ild
r
en
an
d
to
ass
ess
th
e
n
ee
d
f
o
r
r
eso
u
r
ce
s
an
d
m
eth
o
d
s
o
f
p
r
o
v
id
i
n
g
tr
e
atm
en
t te
ch
n
iq
u
es
[
4
8
]
.
4.
CO
NCLU
SI
O
N
Patien
ts
an
d
th
eir
p
ar
en
ts
s
h
o
u
ld
b
e
tr
ain
ed
to
p
r
ac
tice
e
x
ce
llen
t
o
r
al
h
y
g
ien
e
d
u
r
in
g
o
r
th
o
d
o
n
tic
tr
ea
tm
en
t.
Or
al
h
ea
lth
ca
r
e
is
also
im
p
o
r
tan
t
to
r
ed
u
ce
t
h
e
r
i
s
k
o
f
d
ev
el
o
p
in
g
d
en
tal
ca
r
ies.
Fu
r
th
er
s
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1
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3
]
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.
K
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4
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[
5
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N
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,
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,
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J.
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Re
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6
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U
.
S
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7
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D
.
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[
8
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U
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[
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i
n
i
c
a
l
Pe
d
i
a
t
ri
c
D
e
n
t
i
s
t
ry
,
v
o
l
.
1
1
,
n
o
.
4
,
p
p
.
3
0
7
–
3
1
6
,
2
0
1
8
,
d
o
i
:
1
0
.
5
0
0
5
/
j
p
-
j
o
u
r
n
a
l
s
-
1
0
0
0
5
-
1
5
3
1
.
[
4
7
]
B
.
A
v
i
n
a
sh
,
B
.
S
.
,
R
.
M
.
,
S
.
S
h
e
k
a
r
,
a
n
d
A
.
B
.
S
.
,
“
A
sse
ssm
e
n
t
o
f
d
i
f
f
e
r
e
n
t
t
y
p
e
s
o
f
m
a
l
o
c
c
l
u
si
o
n
u
si
n
g
i
o
t
n
i
n
d
e
x
a
n
d
g
e
o
g
r
a
p
h
i
c
i
n
f
o
r
mat
i
o
n
s
y
s
t
e
m
:
A
c
r
o
ss
-
s
e
c
t
i
o
n
a
l
o
b
ser
v
a
t
i
o
n
a
l
s
t
u
d
y
,
”
I
n
d
i
a
n
J
o
u
r
n
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
Re
se
a
r
c
h
&
D
e
v
e
l
o
p
m
e
n
t
,
v
o
l
.
1
1
,
n
o
.
1
,
p
.
2
9
3
,
J
a
n
.
2
0
2
0
,
d
o
i
:
1
0
.
3
7
5
0
6
/
v
1
1
/
i
1
/
2
0
2
0
/
i
j
p
h
r
d
/
1
9
3
8
3
2
.
[
4
8
]
A
.
L
o
G
i
u
d
i
c
e
,
“
A
d
v
a
n
c
e
d
a
p
p
l
i
c
a
t
i
o
n
s
i
n
p
e
d
i
a
t
r
i
c
d
e
n
t
i
st
r
y
:
A
w
o
r
l
d
w
i
d
e
p
e
r
s
p
e
c
t
i
v
e
o
f
t
h
e
l
a
st
1
3
y
e
a
r
s,”
C
h
i
l
d
r
e
n
,
v
o
l
.
1
0
,
n
o
.
1
0
,
p
.
1
6
7
8
,
O
c
t
.
2
0
2
3
,
d
o
i
:
1
0
.
3
3
9
0
/
c
h
i
l
d
r
e
n
1
0
1
0
1
6
7
8
.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Do
b
r
in
k
a
Mi
t
k
o
v
a
D
a
m
y
a
n
o
v
a
h
o
ld
s
a
s
p
e
c
ializa
ti
o
n
i
n
d
e
n
ti
stry
a
n
d
p
e
d
iatric
d
e
n
ti
str
y
.
S
in
c
e
2
0
1
3
,
sh
e
is
w
o
rk
in
g
i
n
t
h
e
De
p
a
rtme
n
t
o
f
P
e
d
i
a
tri
c
De
n
ti
stry
,
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
o
f
M
e
d
ica
l
Un
iv
e
rsity
o
f
Va
rn
a
.
S
h
e
h
a
s
4
1
p
u
b
l
ica
ti
o
n
s
a
n
d
1
6
p
a
rti
c
ip
a
ti
o
n
s
i
n
sc
ien
ti
fic
c
o
n
g
r
e
s
se
s.
S
h
e
is
th
e
m
e
m
b
e
r
o
f
Bu
lg
a
rian
De
n
tal
As
so
c
iatio
n
(BDA
),
Bu
l
g
a
rian
S
c
ien
ti
fic
De
n
t
a
l
As
so
c
iatio
n
(BS
DA
),
t
h
e
Na
ti
o
n
a
l
As
so
c
iatio
n
o
f
P
e
d
iatric
De
n
ti
stry
D
o
c
to
rs,
Eu
r
o
p
e
a
n
Org
a
n
iza
ti
o
n
f
o
r
Ca
ries
Re
se
a
rc
h
(ORCA
),
a
n
d
Un
io
n
o
f
S
c
ien
ti
sts
in
Bu
l
g
a
ria.
He
r
re
se
a
r
c
h
in
tere
sts
in
c
lu
d
e
p
e
d
iatric
d
e
n
ti
stry
,
re
sto
ra
ti
v
e
d
e
n
ti
str
y
,
a
n
d
o
p
e
ra
ti
v
e
d
e
n
ti
stry
.
S
in
c
e
2
0
1
8
,
sh
e
is
a
C
h
ief
As
sista
n
t
P
ro
fe
ss
o
r
i
n
t
h
e
M
e
d
ica
l
Un
iv
e
rsity
o
f
Va
rn
a
,
B
u
lg
a
ria,
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
ici
n
e
,
De
p
a
rtme
n
t
o
f
P
e
d
iatric
De
n
tal
M
e
d
ici
n
e
.
F
r
o
m
Ap
ril
2
0
2
1
,
sh
e
h
o
l
d
s
th
e
p
o
siti
o
n
o
f
As
so
c
iate
P
ro
fe
ss
o
r
a
t
th
e
Un
iv
e
rsit
y
o
f
M
e
d
icin
e
in
Va
rn
a
,
a
t
t
h
e
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
d
r_
d
a
m
y
a
n
o
v
a
@a
b
v
.
b
g
o
r
d
o
b
rin
k
a
.
d
a
m
y
a
n
o
v
a
@m
u
-
v
a
r
n
a
.
b
g
.
S
irm
a
To
d
o
r
o
v
a
An
g
e
lo
v
a
g
a
in
e
d
a
m
a
ste
r’s
d
e
g
re
e
a
t
th
e
Un
iv
e
rsity
o
f
Eco
n
o
m
ics
in
Va
rn
a
,
B
u
l
g
a
ria
,
i
n
2
0
0
5
a
n
d
i
n
2
0
1
1
,
a
M
a
ste
r'
s
d
e
g
re
e
in
De
n
tal
M
e
d
icin
e
a
t
th
e
M
e
d
ica
l
Un
iv
e
rsit
y
o
f
Va
rn
a
.
F
ro
m
2
0
1
1
t
o
2
0
1
8
,
sh
e
wo
r
k
e
d
a
s
a
n
a
ss
istan
t
p
ro
fe
ss
o
r
a
n
d
sin
c
e
2
0
1
8
a
s
a
Ch
ief
As
sista
n
t
-
P
ro
fe
ss
o
r
a
t
M
e
d
ica
l
Un
iv
e
rsit
y
-
Va
rn
a
.
In
2
0
1
5
,
s
h
e
g
a
in
e
d
a
Ce
rti
fica
te
o
f
S
p
e
c
ializa
ti
o
n
o
f
P
e
d
iatric
De
n
ti
str
y
.
I
n
2
0
1
7
,
s
h
e
g
a
in
e
d
a
p
o
stg
ra
d
u
a
te
d
e
g
re
e
with
th
e
i
n
d
e
p
e
n
d
e
n
t
re
se
a
rc
h
:
“
Ca
ries
Risk
As
se
s
sm
e
n
t
a
n
d
P
re
v
e
n
ti
o
n
in
C
h
il
d
re
n
S
u
ffe
ri
n
g
fro
m
S
o
m
e
Re
n
a
l
Diso
rd
e
rs”
.
In
2
0
1
9
wa
s
issu
e
d
h
e
r
m
o
n
o
g
ra
p
h
“
Ep
ig
e
n
e
ti
c
a
n
d
G
e
n
e
ti
c
As
p
e
c
ts
o
f
Ora
l
He
a
lt
h
i
n
Ch
i
l
d
re
n
wit
h
P
y
e
lo
n
e
p
h
ri
ti
s”
.
In
2
0
2
4
,
sh
e
h
o
l
d
s
a
n
a
c
a
d
e
m
ic
d
e
g
re
e
o
f
As
so
c
iate
P
ro
fe
ss
o
r
a
t
P
e
d
iatric
De
n
t
istry
a
t
th
e
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
,
M
e
d
ica
l
Un
iv
e
rsit
y
o
f
Va
rn
a
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
d
rsirm
a
a
n
g
e
lo
v
a
@g
m
a
il
.
c
o
m
.
Yo
a
n
a
Ru
m
e
n
o
v
a
Ruse
v
a
is
b
o
rn
i
n
t
h
e
c
it
y
o
f
Va
rn
a
,
Bu
l
g
a
ria.
In
2
0
1
6
,
sh
e
g
ra
d
u
a
ted
fro
m
se
c
o
n
d
a
ry
e
d
u
c
a
t
io
n
a
t
IV
EG
"
F
re
d
e
ric
J
o
li
o
t
C
u
rie"
in
th
e
c
it
y
o
f
Va
rn
a
,
a
fo
re
ig
n
lan
g
u
a
g
e
p
ro
fil
e
(S
p
a
n
ish
,
E
n
g
li
s
h
).
S
h
e
g
a
i
n
e
d
h
e
r
M
a
ste
r
d
e
g
re
e
o
f
De
n
tal
M
e
d
ici
n
e
in
2
0
2
2
i
n
M
e
d
ica
l
U
n
iv
e
rsit
y
,
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
o
f
Va
rn
a
,
Bu
lg
a
ria.
S
in
c
e
2
0
2
2
,
s
h
e
h
a
s
b
e
e
n
a
fu
ll
-
ti
m
e
a
ss
istan
t
i
n
th
e
De
p
a
rtme
n
t
o
f
“
P
e
d
iatric
De
n
ti
stry
”
a
t
th
e
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
o
f
t
h
e
M
e
d
ica
l
Un
iv
e
rsity
o
f
Va
rn
a
.
F
r
o
m
2
0
2
2
,
sh
e
h
a
s
sta
rted
h
e
r
re
sid
e
n
c
y
in
p
e
d
iatric
d
e
n
ti
stry
i
n
th
e
De
p
a
rtme
n
t
o
f
P
e
d
iatric
De
n
ti
stry
a
t
th
e
Un
iv
e
rsity
o
f
M
e
d
icin
e
i
n
th
e
c
it
y
o
f
Va
rn
a
a
n
d
th
e
F
a
c
u
lt
y
o
f
De
n
tal
M
e
d
icin
e
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
d
r.
jo
a
n
a
.
ru
se
v
a
@g
m
a
il
.
c
o
m
or
y
o
a
n
a
.
ru
se
v
a
@m
u
-
v
a
rn
a
.
b
g
.
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