Branchial apparatus anomalies usually manifest in teenage or early adult life. Infection complicates
second branchial pouch anomalies usually presented as a neck lump or discharging sinus. It is the most common
form of anomalies compared to another branchial pouch aberrant. However, it is extremely rare to find a
complete branchial fistula with both internal and external openings. Misdiagnosis usually occurs leading to
inappropriate and suboptimal treatment. Here, we report of a case of complete second branchial pouch fistula
and discuss the clinical presentation and surgical management of such lesion.
Many studies have indicated that hearing-impaired (HI) children have poor oral hygiene mainly
contributed by difficulties in communication. The objectives of the study were to assess the difficulties
experienced by HI children during dental visit and the effectiveness of “Oral Health Care for the HearingImpaired”
(OCHI) programme in improving the oral health knowledge and practice, and reducing the dental
plaque maturity scores among HI children. A community intervention study was conducted and training of trainers
(TOT) was done to train the teachers in delivering oral health education (OHE) and practices by using developed
booklet and video. The difficulties faced by the HI children during dental visit, and the oral health knowledge and
practice (OHKP) were assessed by face-to-face interview with HI children whilst the dental plaque maturity was
assessed using GC Tri Plaque ID Gel™ (TPID) during pre-intervention, post-intervention-1 and postintervention-2.
Data were analysed using SPSS version 22. Among the teachers, there was an increase in the
mean (SD) total knowledge and attitude score during post-TOT compared to pre-TOT, 46.1 (2.44) and 43.7
(4.01); (p
Given that the germline mutations of BRCA1 and BRCA2 confer genetic susceptibility to cancer, the
genetic variations, polymorphisms or mutations are widely analyzed in Western countries. However, in Asian
population, the prevalence of BRCA1 and BRCA2 polymorphisms is very limited. In Asia, breast cancer occurs in
women early with an age of onset under 50 years. This review comprises the incidence of BRCA1 and BRCA2
polymorphisms in the Japanese, Korean and Malaysian population. Founder mutations of BRCA1 and BRCA2
were also compared to mark the genetic difference in these populations. The mutational analysis performed to
analyze the entire coding region of BRCA1 and BRCA2 include the next generation sequencing and full
sequencing of all exons and intron-exon junctions. From the diagnosis of triple negative breast cancer (TNBC)
patients, TNBC is associated with the lack of tailored therapies and the treatment option available for TNBC
patients is mainly chemotherapy. The poor prognosis of TNBC leads to determine the predictive biomarkers in
order to develop treatment efficacy. This review will address the current clinical therapies available to treat TNBC
patients.
Prosthodontic rehabilitation and management of microstomia patient presents challenges at all stages
during prosthesis fabrication; from making primary impressions to the prostheses insertion. These patients have
reduced mouth opening, and hence it can be extremely challenging to make impressions and to fabricate
dentures using the conventional methods. The present case report describes prosthodontic management of a
partially dentate patient with microstomia that developed secondary to surgical resection and radiation therapy of
head and neck cancer. A simplified novel approach has been advocated using the patient’s existing metal
removable partial denture as a key in master cast preparation.
Foreign bodies (FB) are most often lodged in the upper digestive tract and amongst the common encounter in outpatient clinic. In most instances, the ingested FB passes uneventfully through the gastrointestinal tract without any harm but in certain cases, it can migrate extraluminally and lead to serious complication. Long standing migrated FB can cause devastating complications like neck abscess and injuries to the major blood vessels. In the present case, a wooden toothpick had migrated to the soft tissue of the neck. A careful and detailed history with clinical-radiographic investigation helped to locate the ingested FB and aided in its successful removal.
Study site: Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Taiping, Perak, Malaysia
Fluorosis is important to measure because it is a condition that can be used as biomarker for the level
of fluoride exposure during enamel formation. Increased and decreased in fluorosis prevalence may also reflect
to the different ways of measuring the disease. The choice of measuring fluorosis is depends on the objective of
the assessment such as assessing public health significant of fluorosis in the population or assessing the detailed
of biological effects of fluoride. These differences in requirement have led to the adoption of many indices and
assessment methods of enamel fluorosis, which subsequently led to evaluation of examiner agreement between
them. Several indices were developed to measure dental fluorosis in the 20th century. These include fluorosis
specific indices such as Dean’s Index; the Thylstrup and Fejerskov Index; the Total Tooth Surface Index; and the
Fluorosis Risk Index. Non-specific descriptive indices such as the Developmental Defects of Enamel index have
also been used to record fluorosis. Fluorosis has most commonly been recorded using clinical examinations and
photographs. Recent developments have seen the use of a Visual Analog Scale and automated grading systems
such as Quantitative Light Fluorescence emerge as possible enhancements to fluorosis scoring. This article aims
to review existing indices and new methods in measuring dental fluorosis, together with examiner reliability
across different methods and indices.
The present study compared and evaluated the shear bond strength (SBS) of two types of glass
ionomer cement (GIC), Riva Self Cure HVTM (SDI Ltd., Victoria, Australia) and GC Fuji IX GP EXTRATM (GC
America Inc., Alsip, USA) with and without the use of Riva Bond LCTM (SDI Ltd., Victoria, Australia), a lighted
cured resin-modified glass ionomer cement (RMGIC) universal adhesive. Sixty extracted sound premolars with
prepared exposure of the dentine on the occlusal surface were randomly assigned into four groups according to
the tested restorative materials. Shear bond strength (SBS) tests were performed by using the Shimadzu
Universal Testing Machine at a crosshead speed of 0.5 mm/minute, and the values obtained were statistically
analysed using one-way ANOVA and Tukey tests. The inter-group comparison showed statistically significant
differences in the SBS values between all the test groups (p < 0.001). A stereomicroscope was used to assess
the modes of failure. Adhesive failures were predominant in adhesive groups (>80%) compared to higher
cohesive failures found in the non-adhesive groups (>86%). A Spearman's rho correlation test performed to
determine the association between SBS values and mode of failures had indicated positive correlations between
the adhesive failure and SBS values in the adhesive groups (rs=0.86, p
Surgical ciliated cyst of the maxilla is a rare complication following surgical procedures or trauma
involving the maxillary sinus. It can occur at any time after any procedures or trauma involving the maxillary
sinus even though many years have lapsed. Clinically it may mimic other cysts of the maxillary sinus
therefore a thorough history taking is necessary for diagnosis. Treatment is usually by enucleation or
marsupialisation. This report highlighted a case of surgical ciliated cyst involving the right maxillary sinus
probably secondary to maxillary sinus procedures, which were performed 30 years prior to presentation.
A study was done to assess and compare the levels of infection control practices amongst Year
3, 4 and 5 undergraduate dental students at the Faculty of Dentistry, University of Malaya, Malaysia. This
study also compared the levels of infection control practices between the operators and the assistants
performing a similar task. A checklist was designed based on the Infection Control Guidelines published by
the Faculty of Dentistry. The audit checklist criteria were specific to the operators and assistants or common
to both. 10 pairs of students (operators and assistants) were randomly selected from Polyclinics A, B and C,
representing Year 3, 4 and 5 students respectively (n=60). The subjects were audited as soon as they
entered the clinic, during treatment and up until they exited the polyclinic. The data collected were analysed
using SPSS and Rasch model. Year 3 students performed better infection control practices (1.43 logit)
followed by Year 5 (0.96 logit) and Year 4 (0.94 logit) students. The operators in Year 5 and the assistants
in Year 3 and 4 were more compliant to infection control practices. 100% of students complied with removal
of gown before leaving the clinic. However, only 1.7% of dental students wore protective goggles or face
shield during treatment and disinfected prostheses before and after inserting into patient’s mouth.
Introduction and reinforcement of infection control practices should be incorporated at the beginning of each
academic year for all students to allow for better practice and delivery of treatment to patients.
Euphorbia tirucalli Linn. is traditionally used as medicine especially in the treatment of diseases
caused by bacterial pathogens. The objectives of the present study were to identify the bioactive
compounds in the stem of Euphorbia tirucalli Linn. using the gas chromatography-mass spectrometry (GCMS)
analysis, and to investigate their potentials as an alternative for antimicrobial activity. Two-microliters
of dried powdered of Euphorbia tirucalli Linn. stem were mixed with methanol followed by injection into
splitless mode of GC-MS. Separation was achieved by Elite-5MS fused capillary column. The mass spectra
were compared with the spectra of known components stored in the NIST and WILEY databases for
compound identification. Forty-six chemical constituents were identified. The major constituents were
lanosta-8,24-dien-3-ol, (3β)- (13.60%), (23S)-ethylcholest-5-en-(3β)-ol (7.02%), linoleic acid (2.96%) and
viminalol (2.57%). Most of the active compounds present in the stem of Euphorbia tirucalli Linn. have
previously been shown to exhibit antimicrobial properties.
Intraclass correlation coefficient (ICC) measures the extent of agreement and consistency among
raters for two or more numerical or quantitative variables. This review paper aimed to present several tables that
could illustrate the minimum sample sizes required for estimating the desired effect size of ICC, which is a
measurement of the magnitude of an agreement. Determination of the minimum sample size under such
circumstances is based on the two fundamentally important parameters, namely the actual value of the ICC and
the number of observations made by each subject. The sample size calculations are derived from Power Analysis
and Sample Size (PASS) software where the alpha and minimum required power is fixed at 0.05 and higher than
0.80 respectively. A discussion on how to use these tables for determining sample sizes required for each of the
various scenarios and the limitations associated with their use in each of these scenarios is provided.
This in-vitro study aimed to evaluate and compare the marginal leakage and penetration ability of
a moisture-tolerant (Embrace WetBondTM) and a conventional (ClinproTM) resin-based sealants under three
different enamel surface preparations (acid etched, acid etched and saliva contaminated and bur
preparation and acid etched). One hundred and twenty extracted caries free human premolars teeth were
cleaned and randomly divided into six groups of equal numbers, according to the type of sealants used and
surface preparations. All the sealed teeth were subjected to thermocycling and immersed in a methylene
blue dye. Each tooth was then embedded into acrylic resin before it was sectioned into four sections per
tooth. Marginal leakage and unfilled surface area (indicating penetration depth of resin) were then
measured using an optical 3D measurement device (Alicona Infinite Focus®). Both sealants exhibited
comparable proportion of marginal leakage on acid etched only surfaces. Moisture-tolerant sealant showed
the least proportion of marginal leakage on bur prepared and etched surfaces. Presence of saliva has
detrimental effect on adhesion of both sealants. Nevertheless, depth of penetration of sealant into the
fissures is comparable with both sealant types irrespective of the surface preparations.
Primary intra-osseous squamous cell carcinoma (PIOSCC) is a rare tumour which occurs centrally
within the jaws. It is believed to arise from odontogenic epithelial remnants or from pre-existing odontogenic
cysts/tumours. A case of PIOSCC arising from an odontogenic cyst in a 57-year-old female is discussed.
Initial clinical and radiographic examination was suggestive of an odontogenic cyst / cystic tumour. The
lesion was enucleated and sent for diagnostic histopathology which revealed the presence of an invasive
carcinoma arising from the walls of the odontogenic cyst. The patient then underwent right mandibular
resection and reconstruction as well as right supra-omohyoid neck dissection. Long standing odontogenic
cysts have the potential to undergo malignant transformation though this may not always be the case.
Relying only on radiographic findings for the management of cyst-like lesions without obtaining
histopathological diagnosis is extremely ill-advised.
Sialolithiasis is one of the commonest disease of salivary glands. Submandibular salivary gland
or its duct is a major site of sialolithiasis and it is always leads to sialadenitis. However large sialolith
formation and self-extrusion is a rare condition. A case of submandibular sialolithiasis is reported where
patient presents with recurrent submandibular swelling and subsequently end up with a spontaneous
extrusion. The mechanisms and management of the salivary gland calculi are also discussed.
The present study aimed to determine the best polymerase chain reaction (PCR) conditions for
amplification of odontoblast markers; alkaline phosphatase (ALP), dentin matrix protein 1 (DMP1), dentin
sialophosphoprotein (DSPP) and osteopontin (OPN). Informed consent was obtained from the individuals
prior to tooth extraction. RNA was extracted from odontoblasts obtained from extracted teeth using
innuPREP RNA Mini kit (Analytik Jena, Germany). Five selected target factors in enhancing PCR: primer
concentration, extension time, number of cycles, annealing time, and annealing temperature were
manipulated to yield the correct size of amplicons. One step reverse transcriptase PCR reactions were
performed using MyTaq One-Step RT-PCR kit (Bioline, USA) with a C1000 Thermal Cycler (Bio-Rad, USA)
in a 25 µL reaction, keeping the amount of 2 ng/µL RNA, 0.25 µL reverse transcriptase, 0.5 µL RiboSafe
Rnase inhibitor and 1X MyTaq One-Step Mix, constant. The optimal conditions were determined to be
400nM of primers for DMP1 and DSPP, 200 nM for ALP and OPN; 30 seconds of extension time and 35
PCR cycles for all genes; 10 seconds of annealing time for ALP, DMP1 and DSPP, 7 seconds for OPN. The
annealing temperature were 56.4°C for ALP, 58.6°C for DMP1, 52.7°C for DSPP, and 56.3°C for OPN,
respectively. The optimized PCR protocols produced the correct size of odontoblast markers.
Surgical removal of impacted lower wisdom tooth has become increasingly costly to patient while still remains as the most common dental surgical procedure that is performed on outpatient basis. In the present study, a total of 23 patients with impacted lower wisdom tooth were surgically removed under local anaesthesia by using different irrigating solution namely, normal saline, distilled water and chlorhexidine. The samples underwent standard operating procedures and medication. Post operative complications in terms of pain, swelling, infection and delayed wound healing were assessed and compared on Day 1 and Day 7 after surgery. The result of this study showed that there is no significant difference between the three irrigating solution used in surgical removal of impacted lower wisdom tooth in terms of postoperative complication. A bigger scale of research with more samples is recommended to evaluate the most efficacy irrigating solution during surgical removal of impacted lower wisdom tooth.
Study site: Oral surgery clinic, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia
Perivitelline fluid (PVF) of the horseshoe crab embryo has been reported to possess an important role
during embryogenesis by promoting cell proliferation. This study aims to evaluate the effect of PVF on the
expression of cell cycle regulatory genes from human dental pulp stem cells (DPSCs) between different cell
passages viz. 4, 5, 6. The cells were treated with a single dose of PVF (26.89 mg/ml) PVF. Gene expression was
quantified for CDKNA2A, PTEN, MDM2 and TP53 genes using reverse transcriptase PCR. CDKN2A and MDM2
expression for treated and untreated DPSCs, expressed a similar pattern of expression. The higher expression of
CDKN2A showed that the treatment increased cell proliferation and prevented cell senescence. DPSCs with PVF
treatment showed increased expression of MDM2 at passage 4 and drastically declined expression at passage 5
and slightly increased at passage 6. TP53 expression of DPSCs treated group showed a higher expression
compared to untreated group. On the other hand, the expression of PTEN in DPSCs treated group started to
increase from passage 5 to 6. However, on the whole, the PTEN expression was higher than the untreated group
in all the passages studied here. The results showed that PVF could enhance cell cycle regulatory gene
expression in DPSCs as indicated by the higher expression of all the genes considered in this study at different
cell passages in the treated group compared to the untreated group. Mann Whitney test was utilized to determine
the significance of cell cycle regulatory genes expression between treated and untreated group. Significant
difference in expression of genes between the treated and untreated groups were found at all passages except
for CDKN2A gene whereby, its expression was not significantly different at passage 5 though it did express
slightly higher in PVF treated DPSCs.
The unilateral nasal symptom should trigger a treating physician to a certain diagnosis. The differential
diagnosis includes foreign body, rhinolith and tumour. The chronicity of symptom helps a lot with the diagnosis.
Foreign body for example, tends to present with positive history of insertion, mainly by children or the acute
symptom of local infection. In the presence of prolonged symptom, rhinolith should be suspected especially when
the patient presents with pathognomonic nasal obstruction with foul smelly discharge. A referral should be made
for a nasoendoscopy evaluation whenever a rhinitis-like symptoms remain after a period of medical treatment for
allergy. We share a case of a missed diagnosis of a rhinolith after six years of symptoms.
Prolonged work with highly repetitious flexion and extension of the wrist and forceful grip task were shown to increase the risk of developing carpal tunnel syndrome (CTS) among dental personnel. The present study was carried out to determine the prevalence, risk factors and coping strategies of probable CTS among clinical dental support staff in Hospital Universiti Sains Malaysia (HUSM). A cross-sectional study was conducted and a set of questionnaire consisting of socio-demographic status, work-related and psychosocial risk factors and coping strategies was distributed. Ninety-five clinical dental support staff completed and returned the questionnaire with a response rate of 80.5%. The prevalence of probable CTS was 38.9%, with the highest prevalence was found among dental surgery assistants (40.5%) followed by dental technologists (29.7%). There was no significant association between work-related or psychosocial risk factors with probable CTS (p>0.05). Most of the respondents with symptoms of CTS chose religion as the coping mechanism; mean 7.11 (SD 1.13). Awareness training should be emphasized among clinical dental support staff on the prevention of CTS.
Study site: Hospital Universiti Sains Malaysia (HUSM)
Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is relatively a rare tumour of head and
neck region. Without histopathological confirmation, it appears and behaved as like malignant epithelial tumor of
the head and neck region as will be illustrated in the present case. Cutaneous involvement of the tumor with
distant metastasis has made the prognosis unfavorable. This isolated case of head and neck PC-ALCL was
highlighted as it has a tendency to behave aggressively and early diagnosis and treatment is crucial to avoid poor
survival outcome.