The ability of a pathologist to accurately interpret a lesion is largely dependent on a good biopsy performed by the surgeon. This article describes the common pittfalls in biopsy techniques and offers ways to minimize them. It also discusses the difficulties encountered by the pathologist in attempting to interpret artefactually damaged tissues.
The mangement of vascular lesions such as haemangiomas frequently present difficult choices between various treatment modalities. Circumstances may limit the,number of options available for the surgeon. This article describes the circumstances, investigations, difficult choices, and eventual treatment of a case of a mandibular haemangioma. It is concluded that for a medium sized haemangioma such as in this case,in the absence of facilities to embolize it, surgical excision may be safely carned out provided that proper investigations and precautions have been conducted. An angiogram is of utmost important in determining the feeding vessels and is very important before any surgical procedure is attempted.
The diagnosis of oral cancer have been variously reported as being due to delay by clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer on more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.
In Malaysia the School Dental Service (SDS) provides comprehensive dental treatment with the aim of rendering the child dentally fit before leaving primary school at 12 years. Hence the purpose of this study was to investigate I) the prevalence and treatment needs of traumatised permanent incisors and 2) to assess their relationship to the degree of incisor overjet amongst 12-13 year-old schoolchildren. The sample comprised of 1519 schoolchildren attending 20 secondary government and government-aided schools in Klang district. There were 772 boys and 747 girls. The sampling procedure involved a multistage, clustered and stratified random sampling. The prevalence of traumatic injuries in permanent incisors was 2.6% which confirmed the results of a previous local study. Boys suffered more trauma than girls with a ratio of about 1.5:I. A majority (77.5% ) of the children had one tooth affected. The most commonly affected teeth were the upper central incisors (91.8%) followed by the lower central incisors (4.1%). A high percentage (57.5%) of children with traumatised anterior teeth had increased overjet (>3mm). Almost all cases (93.9%) required two or more surface fillings. However the majority of affected children (56%) were satisfied with their appearance. It is concluded that traumatic dental injuries should be incorporated as part of the treatment plan for the SDS and appropriately managed soon after occurrence or not later than 12 years after which they leave the SDS. Future epidemiological studies should also give due emphasis to the relative importance of traumatised teeth in children.
The effect of filler content and storage conditions such as drying, storing in water and thermal cycling on linear dimensional changes were investigated and evaluated. The dimensional accuracy studies were performed using a specific designed mould and a coordinate measuring machine. The findings gave support to the view that tiller content is an important factor influencing the physical and mechanical properties of the composite inlay material. The higher tiller content gave less polymerization shrinkage. The greatest linear shrinkage recorded was 0.79 %. The average linear shrinkage (in air, water and thermal cycling) for 79 % filler Prisma AP.H was 0.33 %, for 65 % tiller Prisma AP.H was 0.35 % and for 50 % filler Prisma AP.H was 0.42 %. Generally, dimensional changes was greatest when stored dry. This was followed by materials which were thermal cycled. The least dimensional change recorded was when the materials were stored in water.
Side effects such as abrasion of the dental hard tissue have been frequently observed following the extensive use of mechanical cleansing. As promising antiseptics like chlorhexidine produces extrinsic dental staining on long term usage, there has been increasing interest and research generated towards chemically based stain removing agents. This invitro studyexamined whether some commercial oral hygiene products could inhibit chlorhexidine derived stain independent of any mechanical cleansing action. Perspex blocks were soaked in triplicate in chlorhexidine solution for 2 minutesand stain inhibition by these products was determined by further soaking the blocks in productl water slurries for 2 minutes and finally in tea solution for I hourly periods. The optical density (OD) of each specimen was determined at each hourly interval by spectrophotometry at 395 nm and the mean values obtained. At the end of the study, most of the products inhibited stain compared to water control and there was a variation in the stain inhibitingefficacyof the products. It is thus concluded that oral hygiene products like dentifricesand mouthrinses can inhibit chlorhexidine derived extrinsic dental stain to a variable degree through a chemical action by contained ingredients.
The Combined Cleft Clinic at the University Hospital, Kuala Lumpur was organised in 1992. The team consists of Plastic Surgeon, Orthodontists, Speech therapist, Ear, Nose and Throat Surgeon, Audiologist, medical officers and the nurses. We attend the clinic on a regular basis. Specialists from other medical and dental disciplines as well as the members of the Cleft Lip and Palate Association of Malaysia (CLAPAM) do occasionally participate in this set-up.The team members formulate treatment plans for each cleft patient, monitor the patient's growth and development and manage the patient at different stages according to the individual needs. To date, the idea of team approach and an establishment of a centre towards management of cleft patients seem to be the most ideal as the patients are benefiting total treatment and care from various specialists from only one place. The experience of University Hospital as a centre for cleft patients is discussed.
The canine teeth of the mature ferret have closed apices. They are easily accessible for operating purposes and are sufficiently large, allowing conventional cavity preparation techniques to be prepared using ordinary dental instruments. Handling of the ferret is relatively easy since it becomes quite tame after a period of time. The body weight in male is greater and the teeth larger than those of the female. The cost of purchase and maintenance of the ferret is also inexpensive. For all these reasons, the ferret male is animal of choice in dental experiments.
In recent years, dental evidence has played an important role in the positive identification of unknown deceased victims of catastrophies. To improve further dental identification techniques, there is an urgent need to adopt a national policy on denture marking as a compulsory procedure in the fabrication of dentures. The favoured scheme of marking which provides the most information for the identity of the denture wearer is proposed here.
Supernumerarypremolars have been reported to occur in 0.29% of the general populationand to represent about 9.1% of all supernumerary teeth. Most of the supernumerary teeth reported in the literature were detected by radiographsas most of them were unerupted or impacted.Asearch of the literature revealed not many cases of fully erupted and well aligned supernumerary premolars being reported. A case of a unilateral transposed supernumery premolarthat had erupted into alignment is presented here. The remarkable featureof this case is that the supernumery premolar is transposed between the first and second permanent maxillary molars. The etiology of supernumeraryteeth is also reviewed.
Severe gingival recession caused by dehiscence usually present a challenging task to the clinician as any mucogingival surgery without bony regeneration will not 'prevent the condition from recurring. The procedures of guided tissue regeneration ( GTR ) which allow regeneration of the lost periodontium may offer some solution to the condition. This paper reports on the use of a non-resorbable GTR membrane to treat an isolated lower incisor gingival recession associated with dehiscence.
A case of mucosal burn during the placement of fissure sealant on the first permanent molars of a 9-year-old Malay boy is presented. The erythematous lesion with accompanying burning sensation appeared a few minutes after the etching liquid, containing 37% by weight phosphoric acid, had accidentally come into contact with the buccal mucosa on the right side of the angle of the mouth. The mucosa showed complete healing after one week. The use of rubber dam for tooth isolation while doing fissure sealant is essential to avoid accidental contact of potentially caustic chemicals, such as the phosphoric acid etchant, with the oral mucosa as it can result in mucosal burns.
The current standard of managing facial bone fractures is the use of rigid internal fixation. This method provides good stabilization and repair for mid-face fractures such as the zygomatico-orbitalfracture. Nowadays, for the young and old, patients want not only rapid bone healing, but also good facial aesthetics after surgical treatment following maxillofacial trauma. Therefore, osteosynthesis of fractures and inconspicuous post-operative scars are considered essential. The lower eyelid approach or modified blepharoplasty provides rapid access to the infraorbital rim as well as the orbital floor, while the lateral eyebrow incision gives direct access for fixation at the fronto-zygomatic suture. Combining the Gillies' approach and a single form of rigid internal fixation, good cosmetic results and function can be achieved. Cases using the micro-plate-system for thin infraorbital bones and the miniplate- system for thicker facial bones involving zygomatico-orbital fractures are described.
Fixed-removable appliance is frequently used to extrude a tooth but the idea of incorporating an acrylic capping or stop has not been documented in the literature. This article reports on a case treated with this new approach and describes the technique used.
Human saliva contains a large number of proteins which can be separated using polyacrylamide gel electrophoresis (PAGE). In this study the protein profiles of whole saliva of diabetic and non-diabetic were compared. Considerable variations between individuals in the protein profiles were observed. The saliva from diabetic patients appeared to have more of proline-rich protein bands in the molecular weight region below 56 KOa. Further investigations using individual gland saliva should be carried out.
A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of orofacial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the preceding four weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of orofacial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states is planned.
The palatal root of the first permanent molar is the most commonly deflected root into the maxillary sinus during extraction. A rational approach to the surgical removal of a root from the antrum is important. Some surgeons prefer the alveolar approach while others prefer the Caldwell-Luc operation. A case is presented where the palatal root tip of the left upper first molar was removed from the maxillary sinus by the Caldwell-Luc approach with simultaneous closure of the oro-antral fistula resulting from dental extraction. A fibreoptic light probe was used. The advantages and disadvantages as well as how to avoid the common complications of this surgical technique are discussed. A good result was achieved with successful removal of the root and no loss of sensibility of the teeth and/or gum for this case.
Surgery done around gingival margin may eventually result in loss of attachment and recession of the gingiva. Root hypersensitivity is another possible complication when coupled with overzealous tooth brushing by the patients. This paper presents an alternative method to remove a lesion located at the lateral cervical third of a root. Its advantage is that the gingival margin is kept intact.
Endoseous Implant insertion for the replacement of missing teeth is the state of the art at present times. An understanding of the biology of the perimplant tissues is imperative for the overall success in the dental rehabilitation of a patient with fixture supported prosthesis. The dental implant tissue interface comprises bone, both cortical and cancellous bone; supracrestal connective tissue and the epithelial attachment. A comprehensive review of the response of bone during the postoperative or healing phase, the loading or remodelling phase and during the steady phase is described.
The calcifying epithelial odontogenic tumour (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955. It accounts for less than 1% of all odontogenic lesions. A case of CEOT which presented together with cardiac abnomlalities is presented here and the literature of CEOT is reviewed.