Tobacco use is linked with many serious illnesses, such as cancer, cardiopulmonary diseases, as well as with many health problems. Every year, the use of tobacco products causes a heavy toll of deaths and severe human disease worldwide. One of the many health problems linked to tobacco use is its detrimental impact on oral health. Tobacco causes a whole series of oral health problems, ranging from life-threatening (precancerous changes leading to oral cancer) and serious (periodontal disease, teeth decay) to social (bad breath). Tobacco is consumed through the mouth in a variety of forms, varied from smoked tobacco to smokeless tobacco chewing on itself or combined with areca nut. All these forms of tobacco have damaging effects on the oral health. The most significant preventive measure to prevent the oral health problems caused by tobacco use is to stop using tobacco products. The risk of developing oral cancer drops rapidly when a smoker ceases tobacco use. After ten years of not using tobacco, an ex-smoker/user's risk of oral cancers is about the same as that for someone who has never smoked. To stop using tobacco products is not an easy task. Fortunately, there are a number of therapies available to assist in quitting of tobacco. It is important to remember that, while it will be difficult, ceasing to use tobacco has immediate health benefits, including increased life expectancy and reduced risk of tobacco related diseases and conditions.
The widespread use of aesthetic fillings has highlighted their advantages and disadvantages. One
of the most troublesome features of earlier aesthetic materials was the difficulty of finishing the restoration surface to decrease adherence of food debris. The rougher the finished surface, the greater the possibility of bacterial accumulation and discolouration of restoration along the restoration margin with secondary caries formation. Aside from these clinical implications, patients are highly discerning and could detect roughness of 0.30 μm with their tongue. The aesthetic restoration should mimic the appearance of natural dentition and should have an enamel-like appearance. An increased demand for superior aesthetics from composite resin has increased the
demand for more eff icient and simple polishing techniques. The development of nanocomposites has given a new perspective to the polishing of composite resins. Nanocomposites claim the advantage of improved gloss, optical characteristics and reduced wear. To date, results of in vitro studies have been equivocal regarding the most efficient and effective polishing system. There is variation in the effects of different finishing and polishing instruments on the surface roughness due to great diversity in size, shape, composition and distribution of the filler particles of composite resins, type of resin and a wide variety of finishing and polishing instruments. This paper will
review the different factors that affect polishing techniques used in achieving the desired polish on
composite resin restorations.
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.
A late adolescent patient presented with a Class III malocclusion on a skeletal Class III base, complicated by severe upper arch and moderate lower arch crowding, reverse overjet, anterior and bilateral posterior crossbites with displacement, proclined upper incisors, retroclined lower incisors, distally tipped lower canines and non-coincident centrelines. Treatment was undertaken on an extraction basis by employing the use of an upper removable appliance with Z-springs and posterior bite blocks to correct the anterior crossbite, quad helix and jockey arch for arch expansion, and pre-adjusted edgewise fixed appliance to level and align, space closure and achieve a mutually protective functional occlusion. This paper discussed the rational and evidences behind the treatment employed.
The aim of this study was to assess the wear of tungsten carbide burs and round rotary diamond instruments through measurements of rake angle and visual observations respectively under a field emission scanning electron microscope. Sixty short and long head pear-shaped tungsten carbide burs and 18 round rotary diamond instruments that had been used to complete < 5, > 5 and > 10 cavity preparations (n=10/group) were selected from the 3rd and 4th year dental students, Faculty of Dentistry, University of Malaya. There were two control groups consisting of long and short tungsten carbide burs of ten each. Two-way ANOVA was used to analyse the rake angle data. The data from the two control groups were collectively analysed following multiple paired t-test (p>.05) which showed no significant difference between the two types of tungsten carbide bur (short and long head). The mean rake angle of the control group was significantly higher (p < .05) compared to the < 5, > 5 and > 10 cavity preparation groups. The rake angle of the > 10 cavity preparation group was significantly lower than the other two test groups (p < .05). Round rotary diamond instruments in the < 5 cavity preparation group showed intact diamond particles with distinct cutting facets comparable to the control group. However, diamonds instruments in the > 5 and > 10 cavity preparation groups showed blunt diamond particles. In conclusion, wear of tungsten carbide burs and round rotary diamond instruments were evident after repeated use. Wear was more pronounced when instruments were used to prepare more than ten cavities.
The objectives of this study were to assess the practice of molar root canal treatment (RCT) among general dental practitioners (GDPs), confidence level of GDPs in performing molar RCT and to identify factors that influence their confidence in managing molar RCI. One hundred questionnaires were distributed to GDPs in Kuala Lumpur and Selangor. Fifty questionnaires were delivered by mail and the remaining fifty were hand-delivered. All data was coded and verified. Fiftysix OOPs rcsponded to the questionnaires. Only fortyfive questionnaires were accepted (n=45) as eleven OOPs had never performed molar RCI. Most of the OOPs followed the standard quality guidelines while performing molar RCT except for vitality testing (36.4%) and rubber dam usage (27.3%). In this study, 100% of the GDPs were confident in making diagnosis of perinidicular diseases and 95.4% were confident in performing molar RCT from history taking until obturation. Patients' tolerance and availability of instruments and materials (97.7%) were two factors that most influence the GDPs' confidence level. The. least influcncing factor was undergraduate training (78.1 %). Attending seminars and lectures on endodontic, large number of molar teeth treated for ReT, patLents' affordability to pay for RCT and postgraduate training also influencc GDPs' confidence to a certain degree. From this study, it can be concluded that majority of OOPs complied standard quality guidelines except for vitality testing and rubber dam usage. Most of them were confident in performing molar RCT and were greatly influenced by the availability or"instruments and materials in their clinic and patients' tolerance in receiving molar RCI.
This systematic review focuses on the management of two types of osseous defects, i.e. dehiscence and fenestration that arise during the placement of dental implant in the edentulous area (delayed implant placement). A systematic online search of main database from 1975 to 2009 was made. Five randomised controlled trials have been identified based on the inclusion criteria. Different management procedures were identified, in which guided bone regeneration procedure was most commonly advocated. Resorbable and non-resorbable m'embranes were compared, in which resorbable membrane was preferred as it caused less complicatiQn of membrane exposure or risk of infection. The benefit of using bone substitute along with membrane in rypairing bony defects cannot be concluded.
Purpose of the study: The objective of this study was to investigate the existence of the golden proportion between the width of the maxillary anterior teeth of undergraduate dental students at University of Malaya. Materials and method: Standardised photographs of 100 dental students’ smiles displaying only the lips and the teeth were captured. The images were transferred to a personal computer and the width of the maxillary anterior teeth was measured using an Image
Analyzer (Leiqa QWin). Calculations were made according to the Theory of Golden Proportion. The
data were statistically analysed using paired student T-test (α
This cross-sectional study was carried out to identify A. actinomycetemcomitans and P. intermedia in the subgingival plaque of three ethnic groups (Malays, Chinese and Indians) in a selected group of adult Malaysians with advanced Chronic Periodontitis and to correlate these findings with their periodontal status. Thirty periodontally diseased adults were age, gender and ethnically matched with 30 healthy individuals. Clinical parameters were assessed for all. Subgingival plaque samples were collected for identification of A. actinomycetemcomitans and P. intermedia using polymerase chain reaction. Prevalence for P. intermedia (83.3%) was high and A. actinomycetemcomitans
(6.7%) low in the total subject population. P. intermedia and A. actinomycetemcomitans were more
prevalent in diseased (86.7%, 10% respectively) than in healthy (80%, 3.33% respectively) subjects. A. actinomycetemcomitans was detected in 15% Indians, 5% Malays but none of the Chinese subjects whereas P. intermedia was detected in 90% Malays, 85% Indians and 75% Chinese subjects. No significant association between presence of A. actinomycetemcomitans
and P. intermedia with race and periodontal disease status was found. Only A. actinomycetemcomitans had a significant association with clinical attachment level (CAL) (p < 0.05). In conclusion, in this small subject group, none of the pathogens were associated with race and periodontal disease status and only A. actinomycetemcomitans had a significant association with CAL.
This article reviews the concept of Combination Syndrome and presents a clinical case of a patient with a modern variation to this clinical scenario': The clinical procedures involved in the provision of a maxillary complete denture against a mandibular implant-supported complete fixed prosthesis is described with some suggestions on how to optimise the treatment outcome for the patient.
This study aimed to detect the presence of enterococci in the root canals of untreated and treated teeth with periapical disease and to compare this to their presence in the saliva and in the immediate surgical environment during root canal treatment. Using an aseptic technique, 33 samples were obtained from 27 untreated and 6 previously treated teeth associated with apical periodontitis. Reduced Transport Fluid (RTF) was used as transport medium. Saliva samples and areas in the surgical environment were also sampled. These were performed prior to chemo-mechanical debrjdement and obturation for every case. The saliva was diluted to 10- J and was plated on Bile Aesculin Azide (BEA) agar whereas the rest of the samples were plated on Bile Aesculin (BE) agar. These plates were then incubated aerobically at 37°C for 48 hours. All the colony types that blackened the agar were sub-cultured to obtain pure isolates and tested on 6.5% sodium chloride (NaCI). Growth on this medium was Gram stained for further confirmation of cell morphology. Gram positive cocci isolated from previous positive test were identified as enterococci. Enterococci were recovered from untreated cases only; from 2 teeth (in 2 patients) prior to chemo-mechanical debridement, from 3 teeth (in 3 patients) prior to obturation and I from saliva sample. A 'total of 5 samples from 5 different patients were positive for enteroco•cci. Sampling in the immediate surgical environment revealed a low occurence in the range of3.0% (1/33) to 15_2% (5/33). In conclusion, the occurence of enterococci in patients and the immediate surgical environment was low number.
Osteosarcoma is a primary malignant neoplasm of the bone. Osteosarcoma of the jaws especially those of maxilla is rare. The diagnosis of osteosarcomas is difficult and challenging. In this case report we highlight a rare case of osteosarcoma of the maxilla in a 29 year old male patient which was highly aggressive and was initially diagnosed as rhabdomyosarcoma. This case highlights the difficulty in diagnosing osteosarcoma merely from incisional biopsy specimens which may not be representative of the whole tumour. Limited clinical information at incisional biopsy also adds to the difficulty in arriving at the definitive diagnosis. We further discuss the treatment modalities followed in this case.
Tumours that occur in the oral cavity may contain granular cells as a component of their pathology. A more common granular cell lesion occurring in the head and neck region is the granular cell tumour (GCT) that usually arises in the tongue or the buccal mucosa. Granular cell tumours are very rare in the parotid gland with only 11 cases previously reported in the English literature. We report a case of a benign tumour involving the parotid gland of a young female patient. The case was diagnostically challenging due to the large proportion of granular cells masking the underlying pathology. Histopathological features and immunohistochemical analysis favoured a diagnosis of a benign GCT. The present report provides an insight into the differential diagnosis and attempts to characterise the granular cells with the use of the wellestablished immunohistochemical markers and conventional histopathological techniques.
Oral cancer is the sixth most common malignancy in the world. Despite recent advances in cancer diagnoses and therapies, the five-year survival rate of oral cancer patients has remained at a dismal 50% in the last few decades. Oral cancer is of major concern in Southeast Asia primarily because of the prevalent oral habits namely betel quid chewing, smoking and alcohol consumption. This paper provides a brief overview on the various aetiological agents and risk factors implicated in the development of oral cancer.
The objective of this study was to determine the effect of chewing commercially available meswak may have on levels of calcium, chloride, phosphate and thiocyanate in stimulated whole saliva. A total of 20 subjects participated in the investigation. They were distributed into two groups. Those in group A (10 individuals) were asked to first chew on a cotton roll (sized #1) followed by the chewing of an equivalent sized 5mm piece of commercially available meswak. Subjects in group B (10 individuals) did the same but, chewed on cotton roll (sized #2) followed by the chewing of an equivalent sized 10mm piece of commercially available meswak. After following a specified chewing protocol, samples of stimulated whole saliva were collected into a graduated tube at the end of every chewing regime. Calcium, chloride, phosphate and thiocyanate analysis were carried out using colour titration and spectrophotometer. Results from this investigation indicated that commercially available meswak chewing sticks apart from containing high amounts of calcium and chloride may possibly release phosphate and thiocyanate into whole saliva. These findings suggest that the commercially available meswak used as chewing sticks may have the potential of releasing substances into saliva that could influence the state of oral health. Further studies have to be carried out to ascertain the therapeutic benefits of chewing commercially available meswak.
Missing teeth can be due to hypodontia, trauma or extraction. In general, the options for treatment depend on the severity of the hypodontia and the severity of the malocclusion. Occasionally, the space from missing teeth has to be maintained for prosthetic replacement and require an orthodontic/restorative approach. It is very important to ensure the space maintained is adequate for aesthetic reason so that it can be replaced with a prosthesis after the orthodontic treatment is completed. This article discusses a new innovation and clinical technique for maintaining this space during orthodontic treatment by using an acrylic tooth with several modifications. This innovation will be illustrated using two cases.
A retrospective study was carried out to review the records of 47 patients who had had in total 80 supernumerary teeth (ST) removed under general anaesthesia between 1975 and 2002. Malays made up 38.30%, Chinese 51.06%, and Indians 10.64% of the patients. The predominant age group was 6-10 year-old. The mean age was 12.96 ± 9.49 years. The male and female ratio was 1.35:1. Most of the patients had either one ST (n=31; 65.96%) or two ST (n=11; 23.40%). Five cases of multiple supernumeraries were recorded. Two patients experienced late formation of subsequent ST after the first surgery, thus requiring a second surgery. The majority of ST were conical in shape (n=35; 43.75%). Most of the ST were located in the premaxilla (n=55; 68.8%). Almost a quarter (23.75%) of ST were inclined towards the oral cavity. Some of the effects on the dentition were diastema, cystic changes, rotation, displacement, and retention of the permanent teeth and these were the indications for removal of ST. The most common surgical approach for maxillary ST was from the labial, buccal or labio-buccal approach.
Choosing the right light-curing unit can be a very difficult task for some orthodontists. Currently, there are various types of light curing units available in the market with various trade names and specifications. Most of the time information regarding light curing units is obtained from advertisements, websites or manufacturers’ catalogues. Sometimes such information can be misleading. This article attempts to provide several tips for orthodontists in selecting light curing units.
The aim was to examine the protein profiles of whole and parotid saliva using Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE) and MALDI-TOF mass spectrometry. The banding patterns of proteins exhibited by the unstimulated whole saliva samples on the gel remained quite constant but the intensity of the protein bands were slightly different from one sample to another. Comparison of the protein profiles of unstimulated whole saliva and stimulated parotid saliva showed almost similar banding pattern. The exception is the presence of a pink protein band in the 65-67 kD region in the stimulated parotid saliva samples which was also observed in the unstimulated whole saliva sample contributed by a cerebral palsy patient. Analysis of the saliva samples using MALDI-TOF mass spectrometry also revealed that the stimulated parotid saliva samples exhibited some peaks that were in the same region as those for the unstimulated whole saliva sample of the cerebral palsy subject. This may imply that there is ineffective control of the parotid secretion in cerebral palsy subject under unstimulated condition. The SDS-PAGE and MALDI-TOF analyses may provide more information on the profiles of the salivary proteins which could be beneficial in the diagnosis of salivary gland dysfunction.
The aim of the study was to assess the association between past fluoride exposures from ingested toothpaste and current fluorosis manifestations in 10- 11 year old index subjects. Fluorosis was assessed with the Dean’s Index in 1343 10-11 year old index subjects. Two hundred index subjects who had younger 4-5 year old siblings were sub sampled and fluoride exposures from ingested toothpaste in their younger siblings (proxy subjects) were determined. The values for the fluoride ingested per brushing of the proxy subjects were utilised together with past frequency of toothbrushing of index subjects to extrapolate on the past exposure of index subjects. The mean extrapolated past fluoride exposure from ingestion of toothpaste was highly variable; 671.7 ug ± 739.3 ug (sem= 56.9). It was higher in the subjects with fluorosis (697.3 ug) than in those without fluorosis (646.89 ug) but differences were not of statistical significance. This approach of extrapolation has not been reported elsewhere and need to be validated. The implications of the present methodology to estimate past fluoride exposure is discussed.