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.
This case involved periodontal supportive care after non-surgical management of localized, severe chronic
periodontitis (possibly with a history of aggressive periodontitis) and periodontal abscess. This included
maintaining the current periodontal health, and rehabilitation of patient’s oral function and aesthetic concern
using simple, economical and reversible direct restorations without further damaging the patient’s dentition
for example composite resin as splint. Besides that, to address the patient’s complaint of unsightly gaps in
between the teeth, an acrylic gingival prosthesis with denture tooth incorporated was constructed.
Amalgam has been widely used in dentistry and its components may cause some oral mucosal changes (OMC), commonly presenting as oral lichenoid lesions (OLLs), acute or generalized sensitivity reaction or amalgam tattoo. Our objective was to determine the demographic and clinical profile of patients with and without OMC adjacent to their amalgam restorations (AR) and to evaluate the prevalence and types of AR-related OMC and associated clinical parameters. Materials and methods: In this retrospective crosssectional study, 83 outpatients attending the Primary Dental Care Unit at the Faculty of Dentistry, University Malaya were examined for the presence of AR-related OMC. The study period was from early to mid July 2016. Firstly, patients’ personal details (age, gender, medical status, social habits) were analyzed and history of AR (the age, condition and number of restorations) was determined. Clinical examination of patient’s oral cavity was carried out to detect any AR-related OMC. The data collected was analyzed using SPSS 12.0.1 Result: Approximately 14.6 % patients had OMC. OLLs and amalgam tattoo made up 1.2% and 13.4% respectively. Females (8.4%) had higher predilection and Chinese were more commonly affected (8.4%). Social habits were not associated with OMC. Certain systemic diseases, age (p=0.005) and duration of amalgam (p=0.007) in the oral cavity were significant risk factors for OMC. Conclusions: Present findings suggest that AR-related OMC is uncommon. Three key parameters namely systemic diseases, patient’s age and duration of AR were identified as significant risk factors predisposing to the development of OMCs.
This study aims to determine which age assessment data using the third molar development values
(local or international) is suitable for estimating the age of Malays or Chinese in Malaysia. A sample of 60
panoramic images of Malays and Chinese aged between 13.58 to 21.25 years were selected. Different
assessment surveys which included the studies by Yusof et al. (2015), Wilson (2005), Johan et al. (2012),
Mincer et al. (1993), AlQahtani et al. (2010) and Gunst et al. (2003) were employed to estimate the age
from the developing third molar on the panoramic images studied. The estimated ages were compared
to the chronological age of the selected Malaysians. All the datas were then recorded on Microsoft Excel
sheet. The two observers were then subjected to the Intraclass Correlation Coeffecient (ICC) inter-observer
reliability test.The highest number of correspondence (65%) between the chronological and estimated age
(within one year) was for the survey conducted by Wilson. With regards to ethnicities, 70% of Chinese
matched the mean estimated age by Wilson while Malays showed a high correspondence for the study
by Mincer et al. (63.3%). Furthermore the ICC reliability test showed strong agreement between the two
observers. There were similarities between the Malay and Chinese population in the correspondence of
the estimated age to the chronological age employing the different dental estimation surveys; in addition
the study by Wilson and Mincer et al. yielded best matching for these Malaysians.
The objectives of the study were to determine the normal dental arch width of Malays, their correlation with
the facial framework and the ideal size of orthodontic impression trays that fit the dental arch. Eighteen adult
Malays with normal Class I occlusion were evaluated. Arch width was measured on each subject’s dental
cast. Direct anthropometric measurements were taken for 8 facial landmarks. Orthodontic impression trays
were tried on each subject’s dental cast to determine the best fitting tray. Correlations analysis was made
between the arch widths and the best fitting impression trays used and also with various craniofacial
anthropometric measurements. The eight measurements from the craniofacial region were compared
with the maxillary and mandibular intercanine, interpremolar and intermolar widths. In the maxillary arch,
there were significant correlation between the face width and the interpremolar and intermolar widths
respectively, while in the mandibular arch, significant correlations were noted between the mandible depth
and the interpremolar and intermolar widths respectively. The most common fitting impression tray was size
6 for the upper jaw and size 5 for the lower jaw. There was a significant correlation between the maxillary
intercanine width and the size of the impression trays. The significant correlation between upper and lower
interpremolar and intermolar widths and the anthropometric measurements of this Malay population may
assist in predicting arch expansion to achieve Class 1 occlusion during orthodontic or maxillofacial surgical
treatment. The significant correlation between the upper intercanine width and the size of impression tray
can be a useful parameter when determining the size of impression tray.
This study aimed to determine the incidence, aetiology, types of injury, management and the outcomes of
the treatment of maxillofacial trauma among paediatric patients treated in Faculty of Dentistry, University of
Malaya. A retrospective study (2005-2015) was carried out which involved retrieving past records (manual/
electronic form) of paediatric patients (under 16 years old) who presented with maxillofacial trauma. Data
collected was organized using descriptive statistics with SPSS version 12.0.1. The total number of patients
was 120 but only 93 had complete records. The ratio of boys to girls was 2:1. The main cause of injury
was falling (54%) followed by motor-vehicle accident (MVA) (42%), assault (3%), and sport (1%). The total
count of soft tissue injury only was about 41% while 59% presented with maxillofacial fracture. Midface
were the most common fracture occurred followed by mandibular fractures. Both fractures were mostly
managed by open reduction and internal fixation (ORIF) using non-resorbable plates except for condylar
fractures which were mostly managed conservatively. In conclusion, the incidence of maxillofacial trauma
in children increased within the time frame of this study. The most common aetiology was fall. Hard tissue
injury accounting for most of the cases whereby midface was the most common site involved. ORIF was the
treatment of choice for most of the fracture cases except for condylar fractures (conservative management).
All patients had achieved reasonable outcomes postoperatively in terms of form and functions.
Patient satisfaction can be used as one of the indicator for measuring quality of dental care provided. The
objective of this study was to assess patient experiences with dental service provided by undergraduate
dental students in Faculty of Dentistry, University of Malaya. A cross sectional study was done by
distributing a self-answered questionnaire to patients treated by undergraduate dental students. Patient
level of satisfaction was assessed by using five point Likert-like scale (strongly disagree, disagree, neutral,
agree and strongly agree), with a list of items divided into three domains, consist of interpersonal skills,
dental treatment and services. The response rate was 71.3%. The mean satisfaction scores were 83.09%,
78.62 and 74.16 for interpersonal skills, dental treatment and services domains respectively and the overall
mean satisfaction score was highly satisfactory (78.62%). The percentage of satisfied patients was 82.4%,
66.2% and 55.4% for interpersonal skills, dental treatment and services domains respectively. There
was significant association between satisfaction score with age (p-value=
In response to the introduction of an integrated dental education program at University of Malaya (UM) in 2011, a study was conducted to develop a caries risk assessment model (CRA) for use in non-surgical caries management for Year 3 and 4 students of the new integrated program. Methods: The CRA model was based on risk indicators used by dental students in the Preventive Dental Clinic (PDC). Patients aged 15 years and above who attended the PDC for the first time in year 2009 and 2010 were used as study sample. Four hundred and fourteen patient names were identified from the student PDC logbook. Of the 414, 359 dental records had complete data and included in the analysis. Data were analysed using SPSS version 17.0. Chi-square test was used for group comparison and associated factors for coronal caries were analysed using Multiple Logistic Regression (MLR). Results: The final model showed that adults, brushing teeth once daily, and not having dental prosthesis/appliance were 3.31 (CI=1.64-6.69), 2.53 (CI=1.19-5.40), and 2.25 (CI=1.25-4.10) more likely to develop coronal caries, respectively, than adolescents, brushing teeth at least twice a day, and having dental prosthesis/appliance. Conclusions: The results indicate that age group, toothbrushing frequency and dental prosthesis status are significant indicators for coronal caries among patients. Outcomes of the study contributed towards bridging the gap between cariology
and preventive modules in the new integrated dental program.
To assess the oral health related quality of life
(OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.
The purpose of this study was to assess the tissue
response of Type 2 diabetic subjects towards non surgical
periodontal therapy as compared with matched, nondiabetic
subjects. This was a retrospective, comparative
study using periodontal case notes of 40 subjects attending
undergraduates’ periodontal clinics (20 diabetics, 20 nondiabetics),
who were selected based on the inclusion
and exclusion criteria. Response towards non surgical
periodontal therapy was assessed through three clinical
periodontal parameters, namely plaque score, gingivitis
score and number of periodontal pocket ≥5mm at the
baseline and after initial non surgical periodontal therapy.
Data obtained was then analyzed by SPSS Version 12.
Both diabetic and non-diabetic subjects showed significant
improvements (p-value = 0.021; 0.000; 0.001 and 0.010;
0.014; 0.001) in all three parameters after the therapy.
However, when comparison was made between the two
groups, there was no significant difference (p-value = 0.913;
0.892 and 0.903) in any of the parameters. Periodontal
conditions improved clinically in both diabetic and nondiabetic
subjects after non-surgical periodontal therapy.
Therefore, both groups responded similarly towards the
therapy and thus it can be postulated that well-controlled
diabetic status does not have a significant effect on the
outcome of periodontal therapy.
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
Background: In Malaysia, preschool teachers have long been utilised as oral health educators. However their level of oral health knowledge and effectiveness of the training they received are seldom investigated. This study aims to evaluate the of oral health education seminar (OHE) held for public preschool teachers (KEMAS) in terms of the improvement of their knowledge, practices and attitudes.
Methods: This was a one arm interventional study (before and after survey following OHE seminar intervention). All KEMAS preschool teachers (n=107) in Hulu Terengganu were invited to attend OHE seminar which consisted of 1 hour lecture and 40 minutes OHE demonstration. Pretest questionnaire was collected before the seminar started and post-test questionnaire was collected two weeks later. A self-administered questionnaire used in this study was adapted from “preschool teachers’ knowledge, practices and attitudes towards oral health”, National Oral Health Survey of Preschool Children, 2005. Data were analysed using descriptive and McNemar test, SPSS version 15.0.
Results: Of 107 subjects, only 61 teachers responded yielding to 57% response rate. All subjects were female with mean age of 46 years (SD: 6.03). Overall, there was an improvement of teachers’ oral health knowledge, practices and attitudes after the seminar. Several items seem to have be improved significantly after the seminar, for example knowledge item on factors causing periodontal disease (p=0.03). In terms of practice, all teachers reported they brushed teeth at least twice daily using fluoridated toothpaste and use of dental floss was increased significantly after the seminar (p<0.001). Majority of teachers have positive perceptions on their roles in oral health education.
Conclusion: Oral health education seminar appeared to be effective at influencing certain aspects of teachers’ oral health knowledge, practices and attitudes.
Keywords: attitudes, knowledge, oral health promotion, practice, preschool teachers
Conventional oral squamous cell carcinomas are readily
recognized histopathologically but the presence of
additional atypical features may be challenging from
a diagnostic point of view. We present a case of a welldifferentiated
oral squamous cell carcinoma with pseudoglandular
differentiation and discuss the possible differential
diagnoses on a histopathological basis. Accurate diagnosis
is imperative for timely and appropriate intervention and
denotes distinctive prognostic implications. The presence
of perivascular and perineural infiltrations as observed in
this case would indicate the need for further post-operative
therapeutic decision-making aimed at controlling local
spread as well as distant metastases
Tooth transposition is a rare developmental anomaly
affecting less than 1% of the population. The
permanent maxillary canine and 1st premolar are the
most commonly affected teeth. Bilateral maxillary
canine-1st premolar transpositions are extremely rare
with only a handful of cases being reported in the
literature. We report one such case of bilateral
maxillary canine-1st premolar transposition in a 28
year old Malaysian female which was associated with
other dental anomalies.
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
The purpose of this study was to determine the
DNA yield and quality from different non-invasive
sampling methods and to identify the method which
gave the highest DNA yield. Method: Thirty-eight
volunteers had been recruited in this study where
blood, buccal cells and saliva were collected using
various collection techniques. Buccal cells were
collected by 1) cytobrush and 2) saline mouth rinsing
or “swish”. Meanwhile saliva was collected by passive
drooling method. Upon processing the white blood
cell (WBC), buccal cells and saliva samples, DNA
extraction was performed according to the
manufacturer’s protocol. Quantification and quality
(DNA ratio at A260/A280) of the extracted DNA were
determined using NanoDropND-1000®. T-test was
performed to compare means between DNA obtained
from various collection methods. Results: DNA yields
from buccal cells collected with cytobrush, “swish”,
saliva and WBC (mean ± SD) were (8.2 ± 5.9)ng/μl,
(28.2 ± 14.9)ng/μl, (5.9 ± 9.5)ng/μl and (105.3 ±
75.0)ng/μl respectively. Meanwhile the mean DNA
ratio at A260/A280 for cytobrush, “swish”, saliva and
WBC were 2.3, 2.0, 1.7 and 1.8 respectively. Post hoc
test with Bonferroni correction suggested that DNA
yield from “swish” technique exhibited the least mean
different as compared to the DNA extracted from WBC
Diagnosis and management of orofacial pain of non-odontogenic origin has always been a challenge to dentists. Inaccurate diagnosis would result in delay of treatment and in cases of orofacial pain, affects patient’s quality of life. Temporomandibular pain dysfunction syndrome is the most common temporomandibular disorder that presents to dental clinics. Trigeminal neuralgia, also known as ticdouloureux is a relatively rare condition that causes electric shock-like pain when the trigger zone is stimulated by triggering factor. Case report: A case of temporomandibular pain dysfunction syndrome in a 52 years old Indian lady that was managed as trigeminal neuralgia for 7 years is presented. Conclusion: The aim of this case report is to make dentists aware of the signs and symptoms of different orofacial pain, so that early and accurate diagnosis can be made and appropriate treatment instituted.
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
In Malaysia, training to enter dental
nursing profession is only open to women. Ironically,
there are no such gender restrictions on training for
any other health related professions in Malaysia.
Aim: Therefore this study aims to assess the
perceptions of Malaysian Senior Dental Officers
(SDOs) towards the employability of male workers in
the dental nursing profession and to compare findings
from male and female SDOs. Methods: This cross
sectional study was carried out on all SDOs in
Ministry of Health, Malaysia, using a self-administered
questionnaire. Descriptive statistics and a chi square
test were used to address the study objectives. Results:
Of the 112 participants, 78 SDOs returned the
questionnaire, yielding a response rate of 70%. The
majority of SDOs had positive perceptions of the
employment of male dental nurses. It was indicated that
gender is an important indicator for workforce
development, and that the employment of both male
and female dental nurses would enhance productivity.
Almost 70% of SDOs perceived that the productivity
of oral health service would be enhanced by having
male and female dental nurses but 84.6% disagreed
that male dental nurses would be more productive than
female. Two thirds of SDOs disagreed that male dental
nurses would increase satisfaction among male
patients. About 64% of male SDOs disagreed that
dental nursing profession is associated with female
traits. There was no significant difference between
perceptions by male and female SDOs for any
statements. Conclusion: The majority of Malaysian
SDOs have positive perceptions towards the
employability of male dental nurses, and perceived
dental nursing as a suitable profession for both
genders. Training for the dental nursing profession
should therefore be made available for men.
To explore the association between social
support and stress levels in preclinical and clinical dental
students in Malaysia. Method: A cross sectional survey
of dental undergraduate students was conducted at the
Faculty of Dentistry, University of Malaya, Universiti
Kebangsaan Malaysia and Universiti Sains Malaysia.
Stress was measured using the Dental Environment Stress
(DES) questionnaire. A DES-32 item was used to measure
stress for the clinical students and DES-16 item for the
preclinical students. Four questions were used to measure
social support. The total stress scores were standardized
for comparison purposes. Results: A total of 357 (79.7%)
preclinical and 417 (71.8%) clinical undergraduate dental
students responded to the questionnaires. The clinical
students experienced higher stress [mean standardized
DES score = 72.63, SD = 10.64] than preclinical students
[mean standardized DES score = 70.19, SD=12.01]. The
two most stressful items reported by preclinical students
were “fear of failing” and “examination and grades”.
Among clinical students, the two most stressful items related
to academic were “completing course requirement” and
“fear of failing course” and items related to clinical session
were “fear of being barred due to the clinical schedule”
and “patients late or absent”. Multiple regression analyses
revealed that low stress levels among preclinical students
were significantly associated to a lot of contact with
students of the same course. Conclusion: To some extent,
social support does play a role in explaining differences in
perceived stress, in particular among preclinical students.