The position of the mental foramen of the local Malays and Indians in Singapore was determined from a series of orthopantomograms. The most frequent location does not conform to the position cited in many anatomy, surgery, and dental anesthesia texts as being below and between the apices of the lower premolars. This data has implications in the teaching and practice of dental anesthesia. In both these races, the median location is just below the second premolar.
Knowledge of the position of the mental foramen is important both when administering regional anesthesia and performing periapical surgery in the mental region of the mandible. This study determines the position of the mental foramen in a selected Malay population. One hundred and sixty nine panoramic radiographs of Malay patients retrieved from a minor oral surgery waiting list were selected to identify the normal range for the position of the mental foramen. The foramen was not included in the study if there was any mandibular tooth missing between the lower left and right first molars (36-46). The findings indicated the most common position for the mental foramen was in line with the longitudinal axis of the second premolar (69.2%) followed by a location between the first and second premolar (19.6%). The right and left foramina were bilaterally symmetrical in three of six recorded positions in 67.7% patients. The mental foramen was most often in line with the second premolar.
This study was conducted to determine the prevalence of pre-eruptive intracoronal dentin defects from panoramic radiographs from a group of children and young adults aged 20 years and below. The radiolucent lesions were noted with regard to which teeth were affected, the location of the defects and the size of the defects relative to the width of dentin. Out of 1007 radiographs examined, 275 (27.3%) have pre-eruptive dentin defects. The prevalence of anomaly among males was 28.4% as compared to 26.2% among females. However, the difference between genders was not significant, thus subsequent results have been combined. Of 275 subjects with dentin radiolucencies, 243 subjects (88.7%) had only one affected tooth, 30 subjects (10.9%) had two teeth affected and 2 subjects (0.7%) had three affected teeth. The tooth prevalence of the anomaly was 2.1% and most of the lesions occurred as a single occurrence on the affected tooth. Within each tooth type, the highest tooth prevalence of intracoronal dentin defect was found in the upper first premolar (5.1%). More than half of the lesions extended less than 1/3 of the width of the dentin thickness. The high prevalence of the condition indicates the need for increased awareness and recognition of this during radiographic examination of teeth in the pediatric age group in early pre-eruptive stages so that early detection and diagnosis can be made and treatment can be done at the most appropriate time.
Tonsilloliths are very rare concretions found in the tonsillar crypt. They are usually single and unilateral, but occasionally may be multiple or bilateral. Small concretions in the tonsils are common, but well formed giant unilateral or bilateral tonsilloliths are extremely uncommon. Only two cases of bilateral tonsilloliths have so far been reported in the literature. A case of unilateral tonsillolith, mimicking bilateral tonsilloliths taken with the orthopantogram (OPT) in a 57-year-old Malaysian Indian female with squamous cell carcinoma of the oral cavity is described. Although the OPT is a reliable and standard panoramic X-ray unit used in dentistry, superimposition of a lesion involving one side of the jaw creates a pseudo or ghost image on the contralateral side leading to a misdiagnosis of bilateral lesions. This report highlights that tonsilloliths, though rare, should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and that investigations such as CT scan or MRI may be required to differentiate pseudo or ghost images from true bilateral pathologies.
Susuk, or charm needles, are inserted and worn subcutaneously in the face and other parts of the body, as they are believed to enhance beauty and youth, and for many other reasons such as treatment of headache, aches and pains in the joints, back or abdomen. The practice of inserting susuk is a traditional belief, genuinely cultural and superstitious, and common in the south-east Asian region. We present 13 cases of susuk, which was found incidentally on the radiographs as the patients came for various types of treatment at our centre.
A 50-year-old friendly and attractive Chinese lady was examined by the Primary Care Unit, Faculty of Dentistry, University of Malaya. Her requests for treatment included implants and crowns. Two periapical radiographs of teeth 16 and 48 were taken to aid diagnosis. Interestingly, pin-like radio-opaque objects were found over the crown of the impacted tooth 15 and also tooth 17. These objects were initially interpreted as silver points or radiographic artifacts but further investigation employing panoramic radiography revealed the distribution of more radio-opaque objects in the orofacial region. Based on a review of the literature and the opinion of experienced radiology and oral surgery lecturers, these foreign radio-opaque objects were diagnosed as susuks or charm needles.
BACKGROUND: Numerous methods of age estimation have been proposed. The Demirjian method is the most frequently used, which was first applied in a French Canadian population in 1973. The Willems method is a modification of the above and was applied in a Belgian population in 2002.
OBJECTIVES: The objectives of this study were to test the applicability of the two methods, namely Demirjian and Willems, for age estimation in a Malay population, and to find the correlation between body mass index and the difference between the dental age and the chronological age.
MATERIALS AND METHODS: A cross-sectional study involving 214 boys and 214 girls, selected by a simple stratified random sampling method was carried out. The orthopantomograph was used to score the seven left mandibular teeth, and the calculated maturity score was used to obtain the Demirjian dental age. Willems dental age was estimated using the tables proposed in the Willems method. Results. The Demirjian method overestimated the age by 0.75 and 0.61 years, while the Willems method overestimated the age by 0.55 and 0.41 years among boys and girls, respectively. In boys, the body mass index was significantly correlated to the difference in age using the Willems method.
CONCLUSION: Further modification of either method is indicated for dental age estimation among the Malay population.
The anterior loop is defined as where the mental neurovascular bundle crosses anterior to the mental foramen then doubles back to exit the mental foramen. It cannot be seen clinically but can be detected in 11-60% of panoramic radiographs. As this anatomical structure is important in determining the placement position of endosseous implants in the mandibular premolar region, a pilot study was undertaken to determine its visibility on dental panoramic radiographs in dentate subjects of various age groups. One or more anterior loops were visible in 39 (40.2%) radiographs encompassing 66 sites (34.4%). Interestingly, anterior loops were most commonly observed bilaterally, followed by on the right side of the mandible only. An anterior loop on the left side only was observed in just 1 radiograph. Visibility of anterior loops reduced as the age of subjects increased. More than half (58.1%) of subjects aged 20-29 years exhibited at least one anterior loop; this gradually reduced to only 15 percent of subjects aged 50 and older. There was no association between visualization of the anterior loop and subject gender.
The aim of this study was to identify the position of impacted mandibular third molars based on the classifications of Pell & Gregory and Winter, the indications for extraction, and the relation of post-operative complications and position. Records of patients who attended Hospital Universiti Sains Malaysia between January and December 2007 for surgical removal of mandibular third molars were reviewed. The angulation type, width and depth of impaction were determined by reviewing the orthopantomograms. The indications of extraction and occurrence of any post- operative complications were recorded. A total of 238 impacted teeth were surgically extracted from 194 patients (97 males, 97 females). The reasons for extraction include recurrent pericoronitis (43.1%) followed by prophylactic purposes (33.5%). Mesioangular impactions accounted for 52.3% and Class IIA position of impaction accounted for 45.7% of extractions. The most common post-operative complication was persistent pain and swelling (14.7%) followed by trismus (4.1%) and dry socket (3.0%). There was no significant relationship between the angulation, width and depth of impaction and the occurrence of complication. Mesioangular type and Class IIA position of impaction were the most common impaction. Although the association was not significant, high frequency of post-operative complications was observed in mesioangular, horizontal, IIA and IIC positions.
Mental foramen is an opening of the mental canal onto the lateral surface of the mandible. In this pilot radiographical study, in Malay population the effects of ageing towards the location and visibility of the mental foramen were determined. Most of the mental foramina were found to be located inferior to the apex of the second premolar. Non-visibility of the foramen was greatly increased in patients aged 50 years and above (Pearson Chi-square; p = 0.00). This finding may provide a guide to dental surgeries in Malay patients of different age groups.
Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological assessment diagnosed her complaint as trigeminal neuralgia but pain remained poorly controlled even with high doses of carbamazepine and gabapentin. A dental referral and orthopantomographic examination revealed multifocal sclerotic masses in her jaws, suggestive of florid cemento-osseous dysplasia (FCOD). Right mandibular incisional biopsy confirmed the diagnosis. A decision was made to curette the right mandibular masses and lateralised the right inferior dental nerve. Follow-up disclosed considerable pain reduction. This case raises the issue as to whether the sclerotic bone masses in FCOD may have caused nerve compression which
aggravated her neuralgic pain.
BACKGROUND: One of the most commonly used method for dental age assessment is the method reported by Demirjian and coworkers in 1973. It was later modified by Willems and coworkers whereby they “performed a weighted ANOVA” in order to adapt the scoring system.
AIM: To evaluate the applicability of Demirjian and Willems methods for dental age estimation for Malaysian children and to correlate the accuracy of the findings with the chronology of tooth development of premolars and second molars.
MATERIALS AND METHODS: A total of 991 dental panoramic radiographs of 5-15-year-old Malaysian children were included in the study. The mean Demirjian and Willems estimated ages were compared to the mean chronological age.
RESULTS: The mean chronological age of the sample was 10.1±2.8 and 9.9±3.0 years for males and females respectively. Using the Demirjian method, the mean estimated dental age was 10.8±2.9 years for males and 10.5±2.9 years for females. For Willems method, the mean estimated age was 10.3±2.8 years males and 10.0±3.0 years respectively.
CONCLUSIONS: Willems method was more applicable for estimating dental age for Malaysian children. Overestimation in Demirjian method could be due to advanced development of second bicuspids and molars.
This study is aimed to evaluate the accuracy of Demirjian method in estimating the chronological age of male and female Kelantanese Malay children between 6 and 16 years of age and to establish a new dental age (DA) curve if the Demirjian method was not found to be accurate. About 905 panoramic radiographs of healthy Malay children between 6 and 16 years of age were collected from the radiographic unit in the Hospital Universiti Sains Malaysia (HUSM) and the orthodontic clinic in Hospital Kota Bharu (HKB). Children who had any disease affecting the dental development, or have agenesis in the lower arch and poor quality radiographic images were excluded. The results showed that Demirjian method overestimated the chronological age (CA) by 1.23 years for boys and 1.20 years for girls and it was less accurate for the Kelantanese Malay children. Thus new standard curve were produced and tested on external samples. Results showed that the mean difference between the chronological age and DA is about 0.17 years for boys and 0.11 years for girls. DA was more advanced in the Kelantanese Malay boys and girls as compared to French-Canadian children in all age groups. It is concluded that the Demirjian method tends to be less accurate in estimating the chronological age in Malay children. The new curve that was produced is more applicable to the Kelantanese Malay children.
The objectives of this study were to determine the normal mean value of the root-crown (R/C ratios) in Malay patients and their variations by gender and dental arch from orthopantomogram radiographs (OPGs). Two thousand nine hundred and twenty teeth with fully developed roots were measured from 112 OPGs. Subjects with history of maxillofacial trauma or orthodontic therapy were excluded. The mean age of the subjects was 19.1 (SD 2.08) years old for males while females 18.9 (SD 2.19) years old in the range from 15 to 22 years old. The intra-examiner reproducibility of the assessment method was good (Intraclass correlation coefficient 0.81). Results of this study showed that there was no significant difference between R/C ratios of males and females groups. However, the ratios of the antagonist teeth for both males and females were significantly greater in the mandible than in the maxilla (p
Study site: Dental clinic, Hospital Universiti Sains Malaysia
This study aimed to establish a safety zone for the placement of mini-implants in the buccal surface between the second maxillary premolar (PM2) and first maxillary molar (M1) of Mongoloids.
This study aimed to assess the variability of the lower third molar (tooth 38 and 48) development in Northeast Malaysian population with respect to the side of dentition, to generate age prediction models and to compare the outcome with other studies. A total of 1080 orthopantomograms of Northeast Malaysian population aged between 14 and 25 years (540 males and 540 females) from the Hospital Universiti Sains Malaysia's archive which met the inclusion and exclusion criteria were selected and the maturity stages of tooth 38 and 48 were scored using Demirjian's stages (A-H). The findings showed a wide variation of the development of lower third molars in the Northeast Malaysian population. The roots developed earlier in males than in females. The development of the dentition on opposite sides of the mandible was synchronously in females and males. A multiple regression analysis shows that 71.1% of variance in age was explained by sex and developmental stage of tooth 48. An age prediction model was generated from the regression analysis: [Age = 7.117 + 1.907*(stage of tooth 48) - 0.432*(sex)] with mean prediction errors between -0.17 to 3.14 years. The obtained data in the current study are useful for references and determining age of unidentified human remains for identification investigation.
This study is designed to compare and evaluate the diagnostic image quality of dental panoramic radiography between conventional and digital systems. Fifty-four panoramic images were collected and divided into three groups consisting of conventional, digital with and without post processing image. Each image was printed out and scored subjectively by two experienced dentists who were blinded to the exposure parameters and system protocols. The evaluation covers of anatomical coverage and structures, density and image contrast. The overall image quality score revealed that digital panoramic with post-processing scored the highest of 3.45±0.19, followed by digital panoramic system without post-processing and conventional panoramic system with corresponding scores of 3.33±0.33 and 2.06±0.40. In conclusion, images produced by digital panoramic system are better in diagnostic image quality than that from conventional panoramic system. Digital post-processing visualization can improve diagnostic quality significantly in terms of radiographic density and contrast.
The objective of this study was to determine whether dental calcification can be used as a first-level diagnostic tool for assessment of skeletal maturity.