The impact strength of a newly developed experimental polyurethane-based polymer which is derived from palm oil (Experimental PU) was compared with denture polymers; heat-cured and self cured polymethyl methacrylate (PMMA) and ® Eclipse , light-activated urethane dimethacrylate prosthetic resin system. Ten specimens were ® prepared using heat-cured PMMA (Meliodent Heat Cure, Heraeus Kulzer, Germany), self cured PMMA ® (Meliodent Rapid Repair, Heraeus Kulzer, ® Germany), Eclipse baseplate resin (Dentsply, USA) and Experimental PU material. Specimens were prepared following manu- facturer’s instructions except for the Experimental PU material where it was prepared in bulk and sectioned to the desired dimension, 64 x 6 x 4 mm. A ‘V’ notch of approximately 0.8mm in depth was machine cut across the 6mm width. Prior to the Charpy type impact test, specimens were soaked in a water bath for 50 hours at 37ºC. ® Eclipse baseplate resin showed the highest 2 impact strength (2.73 kJ/m ±0.54) followed by ® 2 Meliodent Rapid Repair (2.50kJ/m ±0.65), ® 2 Meliodent Heat Cure (1.96kJ/m ±0.42) and 2 Experimental PU (1.04kJ/m ±0.29). One-way ANOVA showed significant interaction between materials (p
The most prevalent oral mucosal lesions are aphthous ulcerations commonly referred to as canker sores. The clinical characteristic of oral recurrent aphthous ulceration/stomatitis(ORAS) is well defined and can be partly described as an oval or rounded ulcer covered by a grey-white or yellowish fibrinous exudate and surrounded by an erythematous halo. There is intense or moderate pain and the ulcers heal in about 10 - 14 days for the more common type and more than 2 weeks for the severe type. Recurrence of the ulcers occurs at intervals within a year or over several years. Variations of ORAS described above have made studies on aetiology and treatment difficult to interpret due to differing descriptions of differing diseases with similar clinical signs and symptoms and possibly differing aetiologies. A classification that was considered useful as a working model for ORAS was formulated in 1978. While the classification of ORAS had been widely accepted since 1978, the cause for ORAS is still unknown and its aetiology in general remains unclear. However, its immunopathogenesis is now becoming more clearly defined.
This paper attempts to review epidemiological studies of oral cancer and precancer in Malaysia. The defmitions of prevalence, incidence, risk habits and oral cancer and precancers were discussed to better understand' the different types of studies conducted, which would be important in making comparisons between studies. Currently, epidemiological data on oral cancer in Malaysia are sketchy. The only incidence data for oral cancer in Malaysia was reported by Hirayama in 1966, 35 years ago. He estimated that 3.1 new cases per 100,000 population were diagnosed for the year 1963. A number of histopathological data of oral and maxillofacial biopsies were reported. Oral cancer accounted for one-fifth of all oral biopsies. A national study on oral mucosal lesions in Malaysia carried out in 1993/4 reported that there was a variation seen in the occurrence of oral premalignancy among the ethnic groups. The Indians and the indigenous people of Sabah and Sarawak were identified as high risk groups for oral cancer and precancer. It was also observed that both of the ethnic groups chewed betel quid. In conclusion, the epidemiological studies have provided useful data, which may be used in planning for future oral health programmes and research towards enhancing Malaysia's on-going effort in preventing the occurrence of these diseases.
Verruco-papillary lesions (VPLs) of the oral cavity
described in the literature involve a spectrum of conditions
including squamous papilloma, verruca vulgaris, focal
epithelial hyperplasia, condyloma, proliferative verrucous
leukoplakia and verrucous carcinoma. The majority of the
VPLs are slow growing, benign in nature and have a viral
aetiology (1). Mucosal HPV types (HPV 6, 11, 13, 30,
32, 45, 52, 55, 59, 69, 72 and 73) have been implicated
as possible etiological causes for these benign lesions (2)
while virus associated benign mucosal outgrowths are not
too difficult to diagnose either clinically or by microscopy.
Apart from virus-associated lesions, VPLs harboring
malignant potential such as verrucous carcinoma,
proliferative verrucous leukoplakia and oral verrucous
hyperplasia (OVH) need to be further clarified for better
understanding of their predictable biologic behavior and
appropriate treatment. In particular, the condition referred
to as oral verrucous hyperplasia (OVH) poses a major
diagnostic challenge. OVH represents a histopathological
entity whose clinical features are not well recognised and
is usually clinically indistinguishable from a verrucous
In 1980, Shear and Pindborg classified OVHs into
two clinical variants, a sharp variety comprising of long,
narrow, heavily keratinized verrucous processes which
appears white as a result of heavy keratinization and a
second variant referred to as the blunt variety consisting
of verrucous processes that are broader, flatter and not
heavily keratinized (3). A new pathological entity distinct
from what Shear and Pindborg earlier described has been
found in recent years among betel-quid chewers mainly
from Taiwan. In 2005, Chung et al., in a field survey of
1075 adults noted 9 verrucous lesions which they described
as exophytic outgrowths, which the authors hinted had
hitherto not been reported in the scientific literature (4).
Their Figure: 1 illustrated this newly described “verrucous
lesion”. Subsequently in 2009 Wang et al described a case
series of 60 cases from Taipei and classified these lesions as
plaque-type and mass-type lesions primarily based on their
histopathological features. It was also documented that the
mass-type verrucous hyperplasia may manifest as single
or multiple verrucous whitish pink lesions clinically while
the plaque-type lesions may appear as whitish verrucous
plaques. They also concluded that the terminology OVH
should be reserved to denote only the mass-type lesions
both clinically and histologically and suggested that the
plaque-type lesions should be clinically classified as oral
verruciform leukoplakia and histologically as verruciform
In an effort to bring uniformity in reporting
these lesions both clinically and histopathologically a
consensus meeting was held in Kuala lumpur, Malaysia
during December 15-18, 2013. A working committee
that included specialists working on oral malignant andpotentially malignant disorders attempted to formulate the
clinical and histopathological criteria of OVH based on
the discussion among the participants in the meeting. The
meeting was attended by 46 participants from 7 countries
and included specialists and trainees in the disciplines
of Oral Medicine and Oral and Maxillofacial Pathology.
Consensus guidelines arising from this meeting is as
Long term evaluations of impacts of community
based health promotion programmes are not an easy or
straightforward task to do due to lack of validated and
reliable indices. Objective: To develop and test an index
to measure schoolchildren’s oral health knowledge,
attitudes, and behaviour as a result of a school-based health
promotion programme in Malaysia called the Doktor
Muda (Junior Doctor) Programme (DMP). Materials and
Methods: The index was developed in English based on
the DMP module and translated into Malay. The Malay
version was tested on 174, 11-12 year old schoolchildren.
Psychometric analysis of the index involved content and
face validity tests as well as factor analysis, internal and
test-retest reliability. Results: Factor analysis yielded 3
factors with groups of items viz. oral health knowledge
(OHK), oral health attitudes (OHA) and oral health
behaviour (OHB). The Cronbach’s alpha coefficients of the
three factors were 0.61, 0.73, and 0.64, respectively. The
Kappa coefficients were 0.70, 0.77 and 0.73, respectively
(intraclass correlation coefficients = 0.72, 0.70 and 0.78).
The final questionnaire comprised 33 items, namely; OHK
11 items, OHA 15 items, and OHB 7 items. Conclusion:
The Health Promotion Questionnaire Index (HPQI) to
measure the DMP impact on schoolchildren’s oral health
knowledge, attitudes, and behaviours was empirically
verified to be valid and reliable for use among 11-12 year
old Malaysian schoolchildren.
Background: In an academic setting due to financial constrain, it is not uncommon during non-surgical procedures dental students and clinical supervisors wash their gloved hands with disinfectants in between patients or when touching on non-contaminated objects. Whether this practice could cause any deterioration of the glove and expose clinicians and patients to infectious micro-organisms was a concern.
Aim: The aim of this study was to investigate the effect of multiple washes of gloved hands with a disinfectant on the integrity of the gloves. Methods: Three brands of commonly used gloves in a dental school were tested for leaks after multiple washes with a disinfectant. Thirty pairs of each type of gloves were subjected to 0, 1, 5, 10, 20 and 30 washes with a disinfectant solution at a 5-minute interval between each wash. After each washing cycle, the gloves were filled with 1L of water and hanged for 2 minutes to observe any signs of water leaks.
Results: The results showed that the type of gloves and number of washes were significantly associated with the leakage rates (p<0.001). Washing of gloves for more than 5 times were at least 6 times higher to suffer from leakage (OR=6.23, 95% CI=2.14–18.08). Powdered gloves were almost 13 times higher to leak in all washes (OR=12.78, 95% CI= 4.40–37.14) and were almost 25 times more likely to leak when washed for more than 5 times (OR = 24.92, 95% CI = 5.79 – 107.21) when compared to the non-powdered gloves.
Conclusion: The practice of washing gloved hands with a disinfectant deteriorates the integrity of the gloves.
Key words: Cross infection, disinfectant, glove, leakage, micropores
The application of PCR technique in genetic screening was demonstrated using the genetic materials from buccal cells of the students in the class. Two factors were taken into consideration when designing the experiments. The DNA region to be amplified should not be associated with any disease state. This is to eliminate any emotional and ethical problems associated with the experiments. In this practical, the presence and absence of a 38 bp sequence in the intron of COLIA2 gene were studied. The students were also shown on how to analyse the presence of homozygous and heterozygous alleles and the genetic variations that might be observed in the different ethnic groups of students. Another factor was the time taken to complete the experiment. Our experience showed that this experiment would take at least six hours to obtain and analyse the results. It is therefore suitable to be used in class teaching.
Background: The high prevalence and impacts of orofacial pain (OFP) have caused major sufferings to individuals and society. The purpose of the study was to investigate the problems and impacts of OFP among a group of Malaysian aborigines. The objectives were to determine (i) the prevalence, aetiology, duration, severity, types and persistence of OFP during the past 3 months preceding the study; (ii) its associated impact on daily performance; and (iii) the measures taken for pain relief.
Methods: This is a cross sectional study carried out in Kuala Lipis, Pahang involving 6 villages of Orang Asli Bateq and Semai. Study sample was chosen using convenient sampling including adults aged 16 years and above. Participants were invited for an interview using structured questionnaire followed by clinical examination. Data analysis was carried out using SPSS ver12.
Results: Response rate was low at 20% (n = 140). Over one-quarter (26.4%) of the sample experienced OFP in the previous 3 months. Toothache was found to be the main aetiology (83.3%) followed by gingival pain (18.9%), temporomandibular joint (10.8%) and facial pain (8.1%). Mean duration of pain was 9.8 days for toothache, 162.4 days for gingival pain, 7.3 days for TMJ and 5.7 days for facial pain. Of those who had OFP, over half rated the pain as moderate (37.8%) and severe (29.7%) and most of the pain was ‘intermittent’ in nature (81.1%). Over half (62.2%) admitted the pain had disappeared during the interview. In terms of pain relief, 56.8% of the sample used traditional medicine. The pain had impacted on the chewing ability (70.3%, p=0.01), ability to sleep at night (73.0%, p<0.001), levels of anxiety (70.3%), ability to perform daily chores (33.3%) and social life (35.1%) of the Orang Asli sample.
Conclusion: This study suggests the prevalence of OFP was high among the Orang Asli sample, which imposed considerable physical and psychological impacts on daily life.
Key words: orofacial pain; impacts; quality of life; Malaysian aborigines
Tissue-integrated oral implants have opened-up a new perspective in oral rehabilitation of tumour patients who had undergone surgery. The present case demonstrated a simple approach to rehabilitate a patient who had subtotal maxillectomy using dental implant. The use of an implant in combination with a natural abutment tooth was shown to improve the retention and stability of the obturator. Magnetic attachment and telescopic restoration were the retainers of choice and they provided good aesthetic result.
The purpose of this study were to compare the emergence profiles of crowns with their contralateral tooth, in vitro, and to determine if there is any association between the design of tooth preparations and the resultant emergence profile. 50 working models used for single crown construction were examined. Measurements of the faciolingual width of the crowns and contralateral teeth were taken using digital calipers. Internal line angles and the margin width of dies and the emergence profile of the corresponding crowns were measured from longitudinally sectioned polyvinylsiloxane indices mounted on a flat-bed scanner using image analysis software. Using Students t tests, no statistically significant differences (p>0.05) were found for shoulder width (mean 0.94 ± 0.23mm), internal line angle (mean 105.83 ± 13.57°) or emergence profiles (28.56 ± 12.95°) in the different (anterior, premolar or molar) preparations or crowns. The mean emergence profiles for all crowns was statistically significantly greater (p
Direct composite veneers can be used to mask tooth discolorations and/or to correct unaesthetic tooth forms and/or positions. However, these type of restorations are often regarded as one of the most challenging in aesthetic dentistry presumably due to the extent of natural tooth structure that must be recreated. This paper discusses easy application techniques and tips for Ceram.X Duo™, a nano ceramic composite restorative material. Its natural shading system allows the restoration of tooth with both dentine and enamel shade and transforms it into a final direct veneer restoration that mimics a natural tooth.
The objective of this study was to investigate the effect of various luting cement systems on bond strength of fibre-reinforced posts to root canal dentine. 40 extracted single rooted sound premolar teeth were root filled, decoronated and randomly divided into four groups. Fibre posts, Aestheti- Plus™ (Bisco,Inc. Schaumburg, IL, USA) were cemented using four luting cements: Group A (control): Elite 100® Zinc phosphate (GC Corp, Japan), Group B: Calibra ™ Esthetic Resin Cement (Dentsply Caulk, USA), Group C: RelyX ARC Adhesive Resin (3M ESPE), Group D: RelyX Unicem Aplicap (3M ESPE). Each root was sliced into 2 discs representing the coronal and middle portions of the root canal giving rise to 20 specimens per group. Bond strength was determined using push-out tests and data was analyzed using SPSS version 14.0. The mean bond strength of Group A to Aestheti-Plus™ post was 7.71 MPa (±2.51) and Group B was 5.69 MPa (±3.23). Group C exhibited the lowest mean bond strength, 4.29 MPa (±3.53) while the highest bond strength was obtained from Group D, 7.98 MPa (±2.61). One way ANOVA showed significant interaction between all groups (p=.OOI). Post-hoc Bonferroni test reve;iled that bond strength of Group C was significantly lower compared to Group A (p=.008) and D (p=.004). In conclusion, the mean bond strength of Aestheti- Plus™ post to root canal dentine was highest when cemented with RelyX Unicem resin cement followed by Elite 100® zinc phosphate cement, Calibra and RelyX ARC resin cements. However, the bond strengths of Cali bra and RelyX Unicem resin cements were not significantly different from Elite 100® zinc phosphate cement.
The controversy on malignant transformation of oral lichen planus has always intrigued researchers. We present a case of lichenoid lesion and squamous cell carcinoma of the tongue, occurring in a middle aged Indian lady. The diagnosis and timing of these lesions is discussed.
Aim: Self-assessment based on benchmarked professional standards is an excellent tool to assist in improving the dental curriculum. Areas of strength and weaknesses can be identified. It can also act as a baseline standard when significant changes are introduced to the dental curriculum. The aims of this prospective cross-sectional study was to investigate self-assessed confidence of final year dental undergraduates in paediatric dentistry enrolled at University of Malaya in 2013. Methods: 65 undergraduates completed anonymised questionnaires which were formulated based on expected professional competencies in three domains namely clinical skills, patient management, and professional development and clinical governance. Visual analogue score (VAS) represented by a 10cm line with score ‘0’ no confidence at all and ‘10’ complete confidence was used to measure the level of confidence. Results: The overall analysis of self-assessed confidence was very positive with median VAS ≥ 5cm in; clinical skills, 7.66±1.31cm (range=2.41–9.97cm: n=62; 95.4%), patient management 7.73±1.27cm (range=5.09–9.95cm: n=64; 100.0%), and professional development and clinical governance, 8.13±1.21cm (range=5.22–10.00cm: n=64; 100.0%). High confidence was reported for routine dental care (fillings and preventive care) while lower confidence reported for basic life support (median VAS=5.65cm) and pulp therapy for immature permanent teeth (median VAS=5.95cm). Conclusions: The final year dental undergraduate students of the University of Malaya appear to have good overall self-assessed confidence in core areas in paediatric dentistry.
To determine the number of cases that are at risk of poor stability in terms of arch width changes following fixed appliances treatment at the Orthodontic Unit, Klinik Pergigian Cahaya Suria, Kuala Lumpur. In a retrospective audit, 101 pre- and post-treatment lower study casts were selected from cases completed in the year 2015 at the Orthodontic Unit, Klinik Pergigian Cahaya Suria, Kuala Lumpur. Samples were measured using a universal caliper by a single calibrated operator. Samples was categorised as extraction or non-extraction types. Arch width changes was determined using paired T-test. The recommended limit was 0mm for inter-canine width, 2 mm for inter-first premolar width and 3mm for inter-second premolar and inter-molar width. Differences were considered “within limits”, if the changes were within the recommended limit ±0.25mm (for possible marginal measurement error) and “expanded”, if above the range for within limits. 42.6% were non-extraction while 57.4% were extraction cases. In the non-extraction group, 52.2% cases had expanded inter-canine widths, followed by inter-first and second premolars (27.9%) and interfirst molar (20.9%) widths. Arch width changes for the inter-first and second premolars and inter-molars widths were statistically significantly different (p<0.05) but bot clinically significant. In the extraction group, 67.2% had expanded inter-canine widths, followed by inter-first premolar (64.3%), inter-second premolar (9.1%) and inter-first molar (5.2%) widths. The inter-canine (M=1.43; SD=2.71, p<0.05) and inter-first premolar (M=2.87; SD=2.61, p<0.05) widths statistically and clinically significant expansion but the inter-second premolar and molar were significantly contracted (p<0.05). The number of cases with expanded arch widths was high regardless of the extraction type.
Keywords: Arch width expansion, stability
A late adolescent patient presented with a Class III malocclusion on a skeletal Class III base, complicated by severe upper arch and moderate lower arch crowding, reverse overjet, anterior and bilateral posterior crossbites with displacement, proclined upper incisors, retroclined lower incisors, distally tipped lower canines and non-coincident centrelines. Treatment was undertaken on an extraction basis by employing the use of an upper removable appliance with Z-springs and posterior bite blocks to correct the anterior crossbite, quad helix and jockey arch for arch expansion, and pre-adjusted edgewise fixed appliance to level and align, space closure and achieve a mutually protective functional occlusion. This paper discussed the rational and evidences behind the treatment employed.
Supernumerary teeth have a genetic predisposition
with a predilection for males. This article reports an
uncommon radiological finding in a non-syndromic
sibling pair who presented with supernumerary teeth
of different morphologies on opposite and different
regions of the dental arches. A 14-year-old Chinese
male presented with a conical supernumerary palatally
placed between the upper right central and lateral
incisors. His older brother had unerupted bilateral
supplemental supernumerary teeth between the roots
of the lower second premolars and first permanent
molars. Trends of the phenotypic presentation of
familial non-syndromic supernumerary cases are
discussed. Familial supernumerary teeth have been
suggested to be due to autosomal dominance or
recessive traits. Variation in the numeral, spatial and
morphological phenotypic expressions suggests a
multifactorial model of multiple genetic, epigenetic
and environmental influences. Clinicians need to be
mindful of the possible phenotypic variations that may
present when treating cases with family history of
Sjörgren’s syndrome is an uncommon chronic autoimmune disorder that affects exocrine glands.
Sialolithiasis is an obstructive salivary gland disease which is also uncommon in the parotid salivary gland.
The existing literature has documented the occurrence of multiple calcifications within the parenchyma of
the parotid glands in patients with Sjörgren’s syndrome. This report describes the first case of right parotid
duct solitary sialolith formation in a 64 year old female patient with Sjörgren’s syndrome. Whether the
salivary stone encountered in this case represents an oral manifestation of Sjörgren’s syndrome or is just
a co-incidental finding was discussed.
The presence of macroglossia, a tendency towards poor cooperation and the inability to adapt to compl~te dental prostheses due to motor and mental deficiencies makes the oral rehabilitation of Down Syndrome patients difficult. This article reports on the use of mini implant supported overdenture to rehabilitate a Down Syndrome patient who had difficulty adapting to his new mandibular complete denture. The patient's ability to cooperate during treatment as well as the maintenance of an optimal oral hygiene practice enabled mini-implants to be inserted and maintained 20 months post insertion as evidenced by clinical and radiological findings. To the author's knowledge, this is the first reporting of a successful mini implant supported overdenture in a Down Syndrome patient.
This cross-sectional study was carried out to identify A. actinomycetemcomitans and P. intermedia in the subgingival plaque of three ethnic groups (Malays, Chinese and Indians) in a selected group of adult Malaysians with advanced Chronic Periodontitis and to correlate these findings with their periodontal status. Thirty periodontally diseased adults were age, gender and ethnically matched with 30 healthy individuals. Clinical parameters were assessed for all. Subgingival plaque samples were collected for identification of A. actinomycetemcomitans and P. intermedia using polymerase chain reaction. Prevalence for P. intermedia (83.3%) was high and A. actinomycetemcomitans
(6.7%) low in the total subject population. P. intermedia and A. actinomycetemcomitans were more
prevalent in diseased (86.7%, 10% respectively) than in healthy (80%, 3.33% respectively) subjects. A. actinomycetemcomitans was detected in 15% Indians, 5% Malays but none of the Chinese subjects whereas P. intermedia was detected in 90% Malays, 85% Indians and 75% Chinese subjects. No significant association between presence of A. actinomycetemcomitans
and P. intermedia with race and periodontal disease status was found. Only A. actinomycetemcomitans had a significant association with clinical attachment level (CAL) (p < 0.05). In conclusion, in this small subject group, none of the pathogens were associated with race and periodontal disease status and only A. actinomycetemcomitans had a significant association with CAL.