There is significant amount of research done
on Oral Squamous cell carcinoma (OSCC). One research
technique is immunohistochemical (IHC) analysis using
whole sections. With little availability of OSCC tissues
high throughput analysis such as Tissue Microarray
(TMA) are capable of efficient analysis of small samples.
However, the results become questionable if the tumor
exhibits high degree of heterogeneity as TMA cores might
not accurately represent the whole section. Aim: The aim
of this study is to determine the optimal number of TMA
cores required to provide an accurate representation of
the whole section with IHC analysis in OSCC. Materials
and Methods: Twenty tissue samples stained with
anti-p53 antibody were scanned at 40x magnification.
Three to six virtual cores of size 0.6 mm, 1.0 mm and
1.5 mm were drawn on the scanned slides. H-scores
were obtained for both whole sections and cores using
NuclearQuant (3DHistech, Budapest, Hungary) software
after eliminating non-tumour cells and artifacts manually.
The correspondence between the cores and whole sections
were calculated using intra-class correlation and one
sample t-test. Results: Good correlation was obtained
with just a single core of 0.6mm (0.826). Subsequent
increase in core number and size resulted in improved
correlation coefficient and smaller confidence interval.
Conclusion: Three TMA cores of 0.6 mm would be the
most optimal, as not only was there very strong correlation
with the whole tissue section, the extra core will also be
able to act as confirmation if the results of the first 2 cores
are in doubt.
The prevalence of oral mucosal lesions in elderly
population is 22.8% to 61.6%. Conventional oral
examination (COE) is usually carried out to detect oral
mucosal lesions (OML). However, new diagnostic aids
have been introduced to improve OML detection. This
study aimed to determine the utility of autofluorescence
(AF) imaging in detecting OML from normal oral mucosa
and its anatomic variation among institutionalised elderly
Malaysian when compared with COE. Fifty subjects
randomly selected from 9 nursing homes and COE and AF
imaging using VELscope Vx, (LED Dental, Vancouver,
British Columbia, Canada) were carried out. Sensitivity,
specificity, positive (PPV) and negative predictive value
(NPV) and accuracy of AF imaging were calculated.
From the study, fifteen subjects had normal oral mucosa,
15 anatomic variations and 36 lesions were identified.
The sensitivity and specificity of AF imaging were 100%
and 70% whereas the PPV and NPV were 80% and 100%
respectively. The accuracy of AF imaging was 86.37%
when compared to COE. In conclusion AF imaging was
able to detect OML and differentiate them from normal
oral mucosa. However it has limited usefulness in
differentiating between these lesions. This study however,
was able to detail the AF imaging profile of normal oral
mucosa, its normal variants and some common reactive or
infective lesions which can be used in future OML studies
as comparison to oral potentially malignant lesions.
The main aim of this study is to get the Malaysian chief dentists’ perceptions of the oral health promotion activities currently taking place in their respective states in terms of the strengths and weaknesses of these activities. A qualitative method using an open-ended questionnaire was used to obtain this information. The study samples consist of all the chief dentists in Malaysia who represented a majority of population in their states. The results showed that the main current oral health promotion activities is dental health education talks which aims to disseminate oral health information through health education talks, toothbrushing drills, dental exhibition, pamphlets, brochures and publications. Half of the respondents felt that the commitment of the staff, the support of the public sectors and collaboration with other agencies are the main strengths while the lack of staff and fund has been said as the weaknesses. A range of opportunities however exist to strengthen oral health promotion in Malaysia.
Teaching is a complex activity which consists not only of giving instructions but also promotion of learning. Different students have different preference for learning styles. Dental educators must therefore attempt to mix and match their methods of teaching to accommodate students with differing learning styles to provide an opportunity to maximize their learning. This paper aims to share the writer's experience and students' perceptions towards a different mode of teaching/learning method. The Jigsaw Classroom method was employed on University of Malaya's third-year dental students during their Water Fluoridation lecture. At the end of the session, students were asked to reflect upon the learning experience and to inscribe their feelings. Initially, students showed their resentment towards the new learning style but their resistance changed once they got into a group and started to learn from each other. In the reflective essay, most students expressed that learning through teaching and discussing as required in the Jigsaw method enhanced their understanding of the topic and they claimed that they were able to retain the information better. In this study, the Jigsaw method proved that learning in the lecture hall can be fun, educational and enriching.
The audit aimed to investigate the availability of
orthodontic instruments and materials at Faculty of
Dentistry, University of Malaya. The standard was set as
100% of instruments and materials should be available
when required for orthodontic treatment. The form
comprised of six sections, which listed the commonly
used instruments and materials involved in the procedures
of impression taking, fitting and removal of molar bands,
bonding and debonding of orthodontic brackets and
activation of orthodontic appliances. The fifth section listed
the less commonly used instruments and materials and a
part for the clinician to list down instruments that were
used but not listed in the form. Whilst the last section is for
the clinician to list down the instruments or materials that
were not available when requested. A total of 567 forms
were completed and it was found that 97.6% instruments
and 98.6% materials were available. Overall, 22 types of
instruments were temporary not available with frequency
mean of 2.1 (Minimum: 1; Maximum: 7) whilst 6 types of
materials were temporary not available with a frequency
mean of 2.3 (Minimum: 1; Maximum: 8). In conclusion,
majority of the instruments and materials required during
orthodontic clinical sessions were available. The check list
of frequently used orthodontic instruments and materials
from this audit could aid inventory and help future
management of the material and instruments.
This clinical case report details the clinical sequence of a 78-year-old male receiving prosthetic rehabilitation using an implant-supported screwretained fixed partial denture. Despite the limitations imposed, the aesthetic and functional demands of the patient were fulfilled by this prosthetic rehabilitation. The importance of detailed prosthetic planning and evaluation prior to implant surgery is essential, therefore ideally, it should be done by the same operator or a team of operators working together. Problems can arise when the construction of the prosthesis is performed by other people who are not involved in the planning stage.
The aim of this study was to assess the wear of tungsten carbide burs and round rotary diamond instruments through measurements of rake angle and visual observations respectively under a field emission scanning electron microscope. Sixty short and long head pear-shaped tungsten carbide burs and 18 round rotary diamond instruments that had been used to complete < 5, > 5 and > 10 cavity preparations (n=10/group) were selected from the 3rd and 4th year dental students, Faculty of Dentistry, University of Malaya. There were two control groups consisting of long and short tungsten carbide burs of ten each. Two-way ANOVA was used to analyse the rake angle data. The data from the two control groups were collectively analysed following multiple paired t-test (p>.05) which showed no significant difference between the two types of tungsten carbide bur (short and long head). The mean rake angle of the control group was significantly higher (p < .05) compared to the < 5, > 5 and > 10 cavity preparation groups. The rake angle of the > 10 cavity preparation group was significantly lower than the other two test groups (p < .05). Round rotary diamond instruments in the < 5 cavity preparation group showed intact diamond particles with distinct cutting facets comparable to the control group. However, diamonds instruments in the > 5 and > 10 cavity preparation groups showed blunt diamond particles. In conclusion, wear of tungsten carbide burs and round rotary diamond instruments were evident after repeated use. Wear was more pronounced when instruments were used to prepare more than ten cavities.
The aim of study was to evaluate the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 of University of Malaya. The subjects were patients treated in the Year 4 periodontology clinic (Polyclinic B) (n=38) and Year 5 periodontology clinic (Polyclinic C) (n=30). Data was gathered using a questionnaire which consisted of 4 components namely appointment facilities, infrastructure and basic facilities, behaviour of students dental clinician, and quality and efficiency of treatment provided. The results showed that for appointment facilities the level of satisfaction was almost 80%; for infrastructure and basic facilities the satisfaction was more than 85%; for behavior of students dental clinician the level of satisfaction was more than 90% and for quality and efficiency of treatment provided the level of satisfaction was more than 60%. When all the components were compared between patients treated in Polyclinic B to patients treated in Polyclinic C, there was no statistically significant difference (p>0.05). In conclusion, the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 periodontology clinic of University of Malaya is the same
To date, fluorides has remained to be the best means of controlling dental caries. Fluoride is given either systematically via fluoridated water or topically through other supplements including toothpastes. In recent years increasing prevalence of enamel defects or fluorosis is observed in both populations receiving or not receiving water fluoridation. It is suspected that excessive ingestion of a "standard" 1000 to 1500 ppm fluoride from toothpastes might be a contributing factor to the presence of such defects. In Malaysia, reports of enamel defects occurring amongst 12 to 16 year-old schoolchildren ranged between 67 to 88 percent. Where water fluoridation is available, the amount of fluorides received from the home is between 0.3 to 0.5 ppm F. However, almost all toothpastes sold locally contains fluoride, the content of which is unknown to the consumers. This study reports on the analysis of fluoride levels carried out on 20 toothpaste samples sold locally. Results showed that fluoride levels in all 20 samples ranged between 20 to 1970 ppm F. Only two of the 20 samples analyzed, however, indicated having a level anywhere near the "standard" level. In addition, only two type~ of children's toothpaste with a fluoride concentration of 20 and 450 ppm F were commonly available as compared to adult toothpastes in all the samples studied.
Osteosarcoma is a primary malignant neoplasm of the bone. Osteosarcoma of the jaws especially those of maxilla is rare. The diagnosis of osteosarcomas is difficult and challenging. In this case report we highlight a rare case of osteosarcoma of the maxilla in a 29 year old male patient which was highly aggressive and was initially diagnosed as rhabdomyosarcoma. This case highlights the difficulty in diagnosing osteosarcoma merely from incisional biopsy specimens which may not be representative of the whole tumour. Limited clinical information at incisional biopsy also adds to the difficulty in arriving at the definitive diagnosis. We further discuss the treatment modalities followed in this case.
Chronic idiopathic facial pain is the diagnosis given to a group of orofacial pain of psychogenic origin which includes atypical facial pain, facial-arthromyalgia, atypical odontalgia and oral dysaesthesia. Despite various biochemical findings, the condition remains poorly understood, but we have begun to understand the nature of these patients. This review discusses the possible aetiology of the disease through various biochemical and clinical findings. The contribution of behavioural and psychological factors to the clinical course of the disease are described. The type of adverse life events that predispose people to the disease and their potency are briefly mentioned. The current diagnostic approach for the disease is also mentioned. Treatment includes antidepressant medication, physiotherapy, bite-guards and analgesics. The problems encountered in the long-term management and outcome studies of these patients include drop-outs, non-compliance and denial.
Aneurysmal bone cyst is a rare non-epithelialized pseudocyst of the jaws. Jaffe and Lichtenstein in 1942 were the first to recognize aneurysmal bone cyst as a distinct clinical and pathological entity while Bernier and Bhaskar in 1958 were the first to describe the presence of this lesion in the jaws. A case of aneursymal bone cyst in the maxilla is presented and the literature reviewed.
The standard procedure for alveolar cleft closure in cleft lip and palate patients is by alveolar bone grafting (ABG) where the residual opening of oronasal fistula in the palate is also closed simultaneously. Occasionally there is a situation of soft tissue inadequacy and attempt to close the fistula at the same procedure as ABG may compromise the result of the bone graft itself. An unforeseen leakage at the closure may cause graft infection leading to failure. This article reports on a technique where alveolar bone grafting was done without closure of residual palatal fistula to provide adequate soft tissue coverage for the grafted bone. This may reduce the risk of leakage at the oral mucosal coverage of the graft . The residual palatal fistula will be closed at later stage by muco-palatal flap or tongue flap. We reported on a case of a failed ABG which was reconstructed using this technique. Various other techniques to ensure success of ABG were also discussed. Conclusion: The alveolar bone grafting without closure of oro-nasal fistula reduced the risk of failure of ABG in a wide alveolar cleft.
Much interest has been generated in tooth-co loured inlays/onlays especially with patient's concern for esthetic appearance and the dentist's appreciation for additional strength of the restored tooth, together with bonding. Many types of tooth-coloured inlay/onlay restorations are available but none have undergone extensive and long term research. The different types of inlay/onlay restorations together with steps in their preparation are presented in this paper.
This pilot survey was conducted to determine the main reason and the motivating factors which, influence patients in seeking orthodontic treatment. 115 patients aged 11-30 years old were taken from the orthodontic waiting list at the Dental Faculty, University Malaya dated December 1999 - May 2000. A structured questionnaire was designed and the survey of patients was carried out using the telephone. The desire to have a better dental appearance was the main reason (65 %) given by patients who were seeking orthodontic treatment. The most important motivating factor that influences patients in seeking orthodontic treatment was to attain straight teeth (48 %). In conclusion, patients seek orthodontic treatment mainly due to psychological reason, which is to improve dental appearance and aesthetic. Perceived needs of an orthodontic patient should also be taken into consideration before commencing orthodontic treatment to increase chances of mutually satisfying result for both the orthoqontist and patient.
The objectives of this study were to assess the practice of molar root canal treatment (RCT) among general dental practitioners (GDPs), confidence level of GDPs in performing molar RCT and to identify factors that influence their confidence in managing molar RCI. One hundred questionnaires were distributed to GDPs in Kuala Lumpur and Selangor. Fifty questionnaires were delivered by mail and the remaining fifty were hand-delivered. All data was coded and verified. Fiftysix OOPs rcsponded to the questionnaires. Only fortyfive questionnaires were accepted (n=45) as eleven OOPs had never performed molar RCI. Most of the OOPs followed the standard quality guidelines while performing molar RCT except for vitality testing (36.4%) and rubber dam usage (27.3%). In this study, 100% of the GDPs were confident in making diagnosis of perinidicular diseases and 95.4% were confident in performing molar RCT from history taking until obturation. Patients' tolerance and availability of instruments and materials (97.7%) were two factors that most influence the GDPs' confidence level. The. least influcncing factor was undergraduate training (78.1 %). Attending seminars and lectures on endodontic, large number of molar teeth treated for ReT, patLents' affordability to pay for RCT and postgraduate training also influencc GDPs' confidence to a certain degree. From this study, it can be concluded that majority of OOPs complied standard quality guidelines except for vitality testing and rubber dam usage. Most of them were confident in performing molar RCT and were greatly influenced by the availability or"instruments and materials in their clinic and patients' tolerance in receiving molar RCI.
To assess the oral health related quality of life
(OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.
Langerhans Cell Histiocytosis (LCH) refers to a group of lesions presenting with a spectrum of clinical. features but sharing similar histology. These lesions are rare and treatment has been quite variable with current treatment protocol recommended being dependent on whether it is a unifocal or multi focal bone disease or a multi focal multisystem disease. However, the clinical presentations of LCH are variable and the decision to place into the appropriate clinical types may sometimes be masked by the non-discovery of all the lesions. In the oral maxillofacial area, the clinical features of these lesions may further pose a problem by nondescript manifestations as dental/periodontal/oral mucosal disorders. These oral findings may sometimes lead to inappropriate choice of treatment and delay in the diagnosis of all the lesions involved. This paper describes one such case where LCH manifest itself as a periodontal disease thus leading to delay in identifying all the sites involved and consequently a delay in id~ntifying the appropriate clinical type.
This article reviews the concept of Combination Syndrome and presents a clinical case of a patient with a modern variation to this clinical scenario': The clinical procedures involved in the provision of a maxillary complete denture against a mandibular implant-supported complete fixed prosthesis is described with some suggestions on how to optimise the treatment outcome for the patient.
The main objective of this study was to assess knowledge on tooth bleaching among patients visiting dental health care centres in Klang Valley. A total of 200 patients were conveniently selected and interviewed using structured questionnaires. Among the 200 respondents, 75.5% knew about bleaching. There was no statistically significant difference in knowledge of bleaching in relation to age, gender, ethnic group and income level of the patients interviewed (p>0.05) but the education level had a significant influence (p=0.049). Respondents with tertiary education had better knowledge about tooth bleaching as compared to those respondents without tertiary education. The sources of information about bleaching came from advertisements on electronic media (65.5%), articles in newspapers and magazines (14.7%), dentists (10.9%) and family and friends (8.8%). Out of the 75.5% of respondents who knew about bleaching, 18.2% had tried bleaching their teeth using either over-the-counter products or had undergone professional bleaching treatment. The commonest reasons cited for bleaching treatment were to remove coffee and tea stains (70%) and cigarette stains (16.7%). 73.3% of these patients were satisfied with the results achieved after bleaching. However, the majority of these patients (59.6%) were unsure of the safety of these bleaching products/procedures. In conclusion, 75.5% of patients interviewed in this study knew that bleaching is one of the treatment options available to improve dental aesthetics but only 18.2% have tried bleaching their teeth. Their main source of knowledge about bleaching came from advertisements on electronic media.