An important relationship should exist between the periodontist and restorative dentist. Periodontics and restorative dentistry should not be divisible and all forms of restorations, from a simple filling to a complex precision-retained bridge, should be performed with the health and biology of the periodontium in mind. A very crucial concept which should be borne in the mind of every restorative dentist is the concept of biologic width.
Like dental caries, epidemiological assessment of periodontal disease is important for purposes of recognizing the extent of the disease in the population as well as a basis for planning and evaluating preventive and treatment programmes. while present day measurement methods for dental caries are excellent such is not true for periodontal diseases. This paper reviews the development and usefulness of different indices for the assessment of periodontal disease and treatment needs in epidemiological investigations.
Mucoepidermoid tumours of the minor salivary glands of the tongue are rarely encountered. A case of a high-grade malignant type is reported here. Merits of subdivision of the mucoepidermoid tumour on the basis of its malignant potential are outlined, and variations of histological presentation of the present tumour at its primary and nodal sites are discussed.
Granular cell ameloblastomas are uncommon lesions accounting for about 3-5% of all histologic subtypes of ameloblastoma. The plexiform granular cell odontogenic tumour, on the other hand, is a newly described lesion characterised by a monophasic plexiform pattern of granular cells. This article reports a tumour found occurring in the left mandible of a 67-year-old Indian male which histologically showed features of both the aforementioned lesions.
A case of talon cusp in the primary maxillary left central incisor is reported. This dental anomaly was not associated with any other somatic or dental abnormality. Though pulpal extension into the cusp was detected radiographically, clinical examination after the cusp was ground failed to reveal any pulpal extension. The tooth was badly carious and was restored with a polycarbonate crown.
Transposition of teeth is a rare and special type of ectopic eruption where two contiguous teeth are found occupying each other's respective normal positions. Nine patients with transposed maxillary teeth are reported. The literature on transpositions, especially on the theories regarding the aetiology, is reviewed.
The disinfective and fixative properties of glutaraldehyde are now widely investigated. Glutaraldehyde is effective against micro-organisms and their spores. Recently, studies have shown the effectiveness of glutaraldehyde against the HIV virus. 2% glutaraldehyde is now recommended for the sterilisation of surgical instruments, operating areas, dental impressions and root canals during endodontic therapy. Studies have also shown that glutaraldehyde is an effective fixative with minimum side effects, limited penetration and quick acting. Pulpotomy studies using glutaraldehyde as the fixative agent produce high success rates. The important feature is the vital pulpal tissue at the apical third suggesting its limited penetration. The small amounts that get distributed systemically are quickly metabolised and excreted in the urine or exhaled as carbon dioxide.
To obtain the profile of periodontal conditions in West Malaysian adults, five small scale surveys were carried out on selected occupational adult groups, 20-54 years old, between 1987 to 1990. Periodontal assessment was made using the CPITN index. In all, 779 subjects were examined. Results indicated that only 16% of the adults examined had healthy gingivae. Bleeding of the gingivae was limited to the younger (20-24 years) age group. Calculus is highly prevalent in at least 65.5% of all the subjects examined. Periodontal pockets were limited to mostly shallow pockets and the risk of developing pockets increased with increasing age. Both navy personnel and factory workers showed a higher number of healthy sextants across all ages as compared to the other three occupational groups; viz., rubber tappers, villagers and government workers. The rubber tappers were the only group with deep pockets, with the prevalence ranging between 8 to 25%. Implications of the findings to the Malaysian dental delivery system are discussed.
A case report of sequestra formation in the oral cavity most probably as a sequelae of periodontal abscess in a diabetic patient is presented. The sequestra probably formed as a complication of uncontrolled diabetes mellitus rather than erythroleukemia. The lesion was located at the bifurcation area of the lower left second molar. Removal of the sequestra, scaling and a course of antibiotics managed to control the lesion.
A case of bullous pemphigoid with extra-oral and intraoral lesions in a 60-year-old female is reported. Diagnosis is based on histopathology and direct immunofluorescence, and the treatment regime described included oral prescription of prednisolone and topical application of a mixture of fluocinonide ointment and triamcinolone acetonide in Orabase on the oral lesions.
A clinical analysis of 304 cases of pyogenic granuloma (excluding pregnancy tumour) were obtained from the clinical evaluations submitted by clinicians while sending specimens for biopsy. The average age of the patients with pyogenic granuloma was 28.9 years with a peak age incidence in the second decade. More female patients were affected and the lesions present mainly in the Chinese. The majority of the lesions were ulcerated and pedunculated. The lesions had a mean diameter of 10.8 mm with a mean lesion duration of 6.0 months. The gingiva was the prevalent site for these lesions with a greater number being located in the maxilla. The recurrence rate was found to be 14.1%.
Samples of stimulated whole saliva were obtained from ninety-four 12-14-year-old school children living in inner London to evaluate if there was a correlation between Streptococcus mutans counts in saliva with plaque amount, gingival inflammation and caries experience. S. mutans counts were obtained by a dip-slide method (Dentocult 'Strip Mutans') in which the count was expressed as 0, 1, 2, 3, or 4 based on visual estimation of the colony density. There was no association between counts' of S. mutans in saliva with plaque amount and gingival inflammation. However, there was a significant trend of increased decayed, missing, filled surfaces (DMFS) with increasing S. mutans counts.
A questionnaire survey on cross-infection control was conducted among 1371 professionally trained dentists whose names appeared in the Malaysian Government Gazette of 1990. A 73.1 percent response rate was obtained. About 13 percent of the dentists routinely did not wear gloves during treatment of patients as opposed to 54 percent who routinely did. About 83 percent and 52 percent of dentists wore a mask and eyewear or glasses respectively when carrying out dental procedures. About 93 percent of dentists would use a new sterile needle for each patient and about 40 percent would wipe working surfaces with disinfectant after each patient. The practice of sterilizing handpieces was found to be uncommon as opposed to the sterilization of hand instruments. Variations were observed in some of the infection control measures by gender, seniority in service and employment status. More than one-third of the respondents had experienced puncture wounds during the last month prior to the survey.
A case of unicystic ameloblastoma which recurred after 15 years showing unusual histological features is reported. The prominent pseudo-glandular features present are described. This case highlights the importance of extensive histological examination for more characteristic features of ameloblastoma to reach a correct diagnosis.
Records of 302 root-filled teeth treated by dental undergraduates were reviewed by four lecturers in the Department of Conservative Dentistry, University of Malaya. Preoperative and operative factors were evaluated for their association with postoperative pain experience of patients during the visit immediately after completion of biomechanical preparation. Eighty four percent of patients did not experience any pain after biomechanical preparation whilst the remaining 16 percent only complained of slight or moderate pain. The incidence of pain after biomechanical preparation is not high even when performed by inexperienced undergraduates. Teeth with a pre-existing painful condition had a higher chances of postoperative of pain. The incidence of postoperative pain was halved when teeth were associated with a sinus tract.
Two hundred and twenty-nine children aged 12-15 years who were continuous residents of Penang island, in the north of Peninsular Malaysia were examined for caries and enamel defects. Caries prevalence was 82.2% with a DMFT score of 3.4 and DMFS score of 4.9; there were very few missing teeth and very little untreated caries in the population examined. Majority of DF (decayed/filled) lesions were pits and fissures with approximal and smooth surfaces relatively caries free. The prevalence of enamel defects was 76.4% with 19.1% of all teeth examined being affected. More posterior than anterior teeth were affected by enamel defects just as there were more maxillary than mandibular teeth affected by enamel defects. Diffuse patchy opacities were the most common defect diagnosed and this was found in 60.2% of the population examined. A bilateral distribution of diffuse patchy opacities was seen in 41.5% of the population examined. Tooth surfaces with enamel defects were no more susceptible to caries than defect-free surfaces.
Adenomatoid odontogenic tumours (AOT) are benign, hamartomatous odontogenic lesions that not uncommonly mimic a dentigerous cyst radiographically. Such a case as found involving an unerupted left maxillary canine in a 19-year-old Chinese female is described. The differential diagnosis of some common odontogenic cysts and neoplasms occurring in Malaysians, that may present in a dentigerous relationship to an unerupted tooth is discussed. A brief review of the radiographic literature on AOT is also included.
Fractures of the mandible and their management are discussed in detail in textbooks and articles dealing with facial trauma. This paper presents the management and treatment of a case of a unilateral comminuted and complicated fracture of the mandible due to dog attack on a geriatric patient. The attack also severed the patient's right arm. Due to the severity of the trauma, an emergency surgery was performed on the mandible and arm.
The aim of this retrospective study is to report on the prevalence of post-extraction complications among patients attending the Oral Surgery outpatient clinic of the Faculty of Dentistry, University of Malaya over a 12-month period from January to December, 1992. The prevalence of post-extraction complications which required further treatment was only 3.4% (n = 100), out of a total of 2968 patients who had extraction of one or more permanent teeth. Analysis based on complete clinical reports (n = 79) showed that dry socket accounted for nine out of ten cases of post-extraction complications. However the aetiology was largely unknown. No obvious association with medical history could be made. Lower teeth were more likely to have complications. The most common teeth associated with dry socket were the molars (76%) and premolars (19%). The most common molars to be affected are the first, followed by the third and lastly the second molars. A brief review of current aetiological factors of dry socket was discussed.
The aim of the present study was to determine the oral health status of 16-year-old Malaysian school children. The prevalence of caries was 75.5%. More than 60% of subjects had caries experience by teeth (DMFT) scores of 0-3. The largest component of the DMFT and caries experience by surface index was the filled component. Females had higher caries prevalence and caries scores than males. The mouth and tooth prevalences of enamel defects were 56% and 21.8%, respectively. The most common type of enamel defects observed were diffuse opacities, affecting 95.5% of affected subjects and 92.1% of affected teeth. One-third of subjects had healthy gingival conditions, 8.6% had bleeding gingivae, 55.1% had calculus and 3% had pockets. Less than 1% of subjects wore or required dentures. Cleft lip and/or palate was uncommon. This study shows that the prevalence of caries and DMFT scores have declined over the last 30 years.