This retrospective study aimed to determine the prevalence of temporomandibular disorder (TMD)
secondary to orthognathic surgery (OGS) in various types of dentofacial deformities, to access the
relationship of new onset of TMD in different types of OGS to pain-related TMD and intraarticular TMD,
and to evaluate the chronic facial pain, temporomandibular joint (TMJ) function, and masticatory efficiency
after OGS.
A total of 26 patients who were previously treated with OGS in University Malaya Medical Centre,
Kuala Lumpur from January 2005 to June 2015 agreed to participate. The subjects had either undergone
bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy (BIMAX). All subjects were
assessed using Diagnostic Criteria for Temporomandibular Disorder (DC/TMD). Data collected from
patients’ records showed absence of TMD at presurgical stage. The present study showed 42.3% of 26
patients experienced TMD after OGS in various types of dentofacial deformities, 19.2 % of them presented
with post-operative facial pain, 30.8 % had limitation in mastication, 19.2 % experienced limitation in
mobility of the jaw, and 11.5% of them experienced limitation in verbal and emotional commences. In
conclusion, there was no association between prevalence of TMD secondary to OGS in either type
of dentofacial deformities or type of surgery involved. We also noted that the minority of the patients
suffered chronic facial pain and jaw function limitation after OGS.
Objective: This study aimed to assess the awareness of periodontal disease and level of knowledge of the relationship between smoking and periodontal disease amongst subjects who were smokers verses non-smokers.
Methods: A questionnaire looking at knowledge of respondents regarding gum disease and knowledge and awareness about oral impacts of smoking on periodontal disease was developed and pretested in Dental Faculty University of Malaya. Basic Periodontal Examination (BPE) index was used to assess periodontal status.
Results: The questionnaire was answered by 130 subjects. Prevalence of smoking was 14.6%. A total of 58.6% non-smokers and 57.9% smokers knew about periodontal disease. However, only 26.1% non-smokers and 10.5% smokers knew that the cause for periodontal disease was plaque. More non-smokers than smokers knew that smoking affected periodontal health (80.2% and 68.4% respectively) (p>0.05) and tooth mobility was an effect of smoking on periodontal health (27.0% and 0%) (p<0.05). Regarding source of information on effect of smoking on periodontal health, 63.2% smokers and 63.1% non-smokers reported obtaining information through the mass media. However, only 31.6% smokers and 28.8% non-smokers were informed by their dentist.
Conclusion: The awareness of periodontal disease and knowledge of the relationship between smoking and periodontal disease was low in this selected population of smokers and non-smokers.
Keywords: Awareness, knowledge, periodontitis, smoking
Study site: Primary Care Unit, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
The aim of study was to evaluate the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 of University of Malaya. The subjects were patients treated in the Year 4 periodontology clinic (Polyclinic B) (n=38) and Year 5 periodontology clinic (Polyclinic C) (n=30). Data was gathered using a questionnaire which consisted of 4 components namely appointment facilities, infrastructure and basic facilities, behaviour of students dental clinician, and quality and efficiency of treatment provided. The results showed that for appointment facilities the level of satisfaction was almost 80%; for infrastructure and basic facilities the satisfaction was more than 85%; for behavior of students dental clinician the level of satisfaction was more than 90% and for quality and efficiency of treatment provided the level of satisfaction was more than 60%. When all the components were compared between patients treated in Polyclinic B to patients treated in Polyclinic C, there was no statistically significant difference (p>0.05). In conclusion, the level of satisfaction of patients treated in the undergraduate Year 4 and Year 5 periodontology clinic of University of Malaya is the same
Aim: Self-assessment based on benchmarked professional standards is an excellent tool to assist in improving the dental curriculum. Areas of strength and weaknesses can be identified. It can also act as a baseline standard when significant changes are introduced to the dental curriculum. The aims of this prospective cross-sectional study was to investigate self-assessed confidence of final year dental undergraduates in paediatric dentistry enrolled at University of Malaya in 2013. Methods: 65 undergraduates completed anonymised questionnaires which were formulated based on expected professional competencies in three domains namely clinical skills, patient management, and professional development and clinical governance. Visual analogue score (VAS) represented by a 10cm line with score ‘0’ no confidence at all and ‘10’ complete confidence was used to measure the level of confidence. Results: The overall analysis of self-assessed confidence was very positive with median VAS ≥ 5cm in; clinical skills, 7.66±1.31cm (range=2.41–9.97cm: n=62; 95.4%), patient management 7.73±1.27cm (range=5.09–9.95cm: n=64; 100.0%), and professional development and clinical governance, 8.13±1.21cm (range=5.22–10.00cm: n=64; 100.0%). High confidence was reported for routine dental care (fillings and preventive care) while lower confidence reported for basic life support (median VAS=5.65cm) and pulp therapy for immature permanent teeth (median VAS=5.95cm). Conclusions: The final year dental undergraduate students of the University of Malaya appear to have good overall self-assessed confidence in core areas in paediatric dentistry.
Objective: This study examined the influence of visual art therapy techniques in reducing anxiety level
among 4 to 6 years old paediatric dental patients.
Methods: Eleven subjects were selected among 4 to 6 years old paediatric dental patients. The initial
reaction towards dental procedure/treatment was evaluated using Frankl Behavior Rating Scale. The
anxiety level was assessed by using Malay-Modified Child Dental Anxiety Scale (MCDASf
) to measure
a child situational anxiety of pre- and post-treatment. Visual art making activities included free drawing,
clay moulding and collage technique. The participant reaction to dental treatment was assessed by using
Frankl Behavioural Rating Scale for two subsequent independent visits in two weeks interval. Median
and Ordinal Test ranked the variables score of behavioural reaction towards dental treatment and anxiety
level.
Results: Play-doh (PD) subjects could accept dental procedures more if compared to free drawing (FD)
and storytelling by collage (ST) subjects, which has lower post treatment-median scores in Visit 1 and
Visit 2, FD and ST subjects need more time to show positive attitude towards dental treatment.
Conclusion: These findings suggest dental anxiety level of children aged 4 to 6 years old reduced after
the art therapy and play-doh(clay-moulding technique) is the art making activity of choice among 4 to 6
years old paediatric dental patients.
According to the 3rd edition of the international
classification of headache disorders (ICHD3 2013),
Trigeminal Neuralgia (TN) is classified into two types:
1. Classical TN, purely paroxysmal 2. Classical TN
with concomitant persistent facial pain. In this article,
the authors describe a 47 year-old, male with unilateral,
severe, recurring, electric shock-like pain involving left
lower jaw, teeth and gingiva. Diagnosis of classical TN
of the left 3rd division of the trigeminal nerve was made.
The patient was treated with pharmacotherapeutic agents
but without relief. Magnetic resonance imaging (MRI)
of the brain showed medial vascular compression of left
trigeminal pontine root entry zone caused by superior
cerebellar artery. A microvascular decompression (MVD)
surgery was done at the left trigeminal pontine root entry
zone resulting in good relief of pain. This article highlights
the differential diagnoses to be considered with TN and
also emphasize the difference between the two types of
the TN according to ICDH3 (2013). It also highlights the
difference between classical TN purely paroxysmal with
and without vascular compression by imaging techniques
and their differing treatment modalities, which therefore
should be reflected in future ICDH classification.
There is significant amount of research done
on Oral Squamous cell carcinoma (OSCC). One research
technique is immunohistochemical (IHC) analysis using
whole sections. With little availability of OSCC tissues
high throughput analysis such as Tissue Microarray
(TMA) are capable of efficient analysis of small samples.
However, the results become questionable if the tumor
exhibits high degree of heterogeneity as TMA cores might
not accurately represent the whole section. Aim: The aim
of this study is to determine the optimal number of TMA
cores required to provide an accurate representation of
the whole section with IHC analysis in OSCC. Materials
and Methods: Twenty tissue samples stained with
anti-p53 antibody were scanned at 40x magnification.
Three to six virtual cores of size 0.6 mm, 1.0 mm and
1.5 mm were drawn on the scanned slides. H-scores
were obtained for both whole sections and cores using
NuclearQuant (3DHistech, Budapest, Hungary) software
after eliminating non-tumour cells and artifacts manually.
The correspondence between the cores and whole sections
were calculated using intra-class correlation and one
sample t-test. Results: Good correlation was obtained
with just a single core of 0.6mm (0.826). Subsequent
increase in core number and size resulted in improved
correlation coefficient and smaller confidence interval.
Conclusion: Three TMA cores of 0.6 mm would be the
most optimal, as not only was there very strong correlation
with the whole tissue section, the extra core will also be
able to act as confirmation if the results of the first 2 cores
are in doubt.
The study aimed to evaluate the quality of the hybrid
layer form by three different adhesive systems. Class V
cavities were prepared on the buccal surface of fourty
extracted human premolars. The prepared teeth were
randomly assigned into four groups according to the
adhesive system and application mode. The systems
were: Optibond S (OS, total-etch); Optibond Versa (OV,
two-bottles, self-etch); Single Bond Universal (SBU,
one-bottle, self-etch) and Single Bond Universal with
etchant (SBU + etchant). All cavities were restored with
composite (Filtek Z350XT). The samples were sectioned,
polished and pretreated to remove minerals, protein
and water prior to SEM evaluation. From the images,
thickness of the hybrid layers was measured. Present of
resin tags and adaptation failure were also recorded. The
data obtained were analyzed using ANOVA, Dunnett’s
T3, Kruskal-Wallis and Mann-Whitney tests. OS group
showed the highest average hybrid layer thickness (4.34
µm), followed by SBU + etchant (3.06 µm), OV (1.91 µm)
and SBU (0.95 µm). Both adhesive and cohesive failures
were observed in SBU group. Present of prominent resin
tags were seen in both OS and OV groups. In conclusion,
all the investigated adhesive systems were able to perform
distinguishable actions as shown in micro-morphological
alteration and hybrid layer thickness. Two-bottles, selfetch
adhesive (OV) was proven to produce negligible
adaptation failure compared to other adhesive systems in
the present study. Combined all-in-one adhesive (SBU)
was found to render a superior bonding performance in
total-etch mode comparing to self-etch mode.
The audit aimed to investigate the availability of
orthodontic instruments and materials at Faculty of
Dentistry, University of Malaya. The standard was set as
100% of instruments and materials should be available
when required for orthodontic treatment. The form
comprised of six sections, which listed the commonly
used instruments and materials involved in the procedures
of impression taking, fitting and removal of molar bands,
bonding and debonding of orthodontic brackets and
activation of orthodontic appliances. The fifth section listed
the less commonly used instruments and materials and a
part for the clinician to list down instruments that were
used but not listed in the form. Whilst the last section is for
the clinician to list down the instruments or materials that
were not available when requested. A total of 567 forms
were completed and it was found that 97.6% instruments
and 98.6% materials were available. Overall, 22 types of
instruments were temporary not available with frequency
mean of 2.1 (Minimum: 1; Maximum: 7) whilst 6 types of
materials were temporary not available with a frequency
mean of 2.3 (Minimum: 1; Maximum: 8). In conclusion,
majority of the instruments and materials required during
orthodontic clinical sessions were available. The check list
of frequently used orthodontic instruments and materials
from this audit could aid inventory and help future
management of the material and instruments.
The prevalence of oral mucosal lesions in elderly
population is 22.8% to 61.6%. Conventional oral
examination (COE) is usually carried out to detect oral
mucosal lesions (OML). However, new diagnostic aids
have been introduced to improve OML detection. This
study aimed to determine the utility of autofluorescence
(AF) imaging in detecting OML from normal oral mucosa
and its anatomic variation among institutionalised elderly
Malaysian when compared with COE. Fifty subjects
randomly selected from 9 nursing homes and COE and AF
imaging using VELscope Vx, (LED Dental, Vancouver,
British Columbia, Canada) were carried out. Sensitivity,
specificity, positive (PPV) and negative predictive value
(NPV) and accuracy of AF imaging were calculated.
From the study, fifteen subjects had normal oral mucosa,
15 anatomic variations and 36 lesions were identified.
The sensitivity and specificity of AF imaging were 100%
and 70% whereas the PPV and NPV were 80% and 100%
respectively. The accuracy of AF imaging was 86.37%
when compared to COE. In conclusion AF imaging was
able to detect OML and differentiate them from normal
oral mucosa. However it has limited usefulness in
differentiating between these lesions. This study however,
was able to detail the AF imaging profile of normal oral
mucosa, its normal variants and some common reactive or
infective lesions which can be used in future OML studies
as comparison to oral potentially malignant lesions.
This review intends to provide a highlight on the potential application of salivary proteomics in
periodontal diagnosis and attempts to throw light on the emerging salivary diagnostic tools for periodontal disease detection. Background: Clinical parameters for detection of periodontitis such as probing depth, attachment level, bleeding on probing, plaque index, and radiographic assessment of alveolar bone loss provide information on the severity of periodontitis, but they do not measure disease activity. Ideally, development and application of rapid and simple diagnostic tests based on host salivary or immune factors may facilitate early detection of patients at risk for periodontal diseases, allow appropriate intervention, decrease the need for more aggressive treatment and improve the response to periodontal therapy. Results: Studies have shown that saliva could be used as a diagnostic fluid as it is one of the inexpensive, noninvasive and easy-to-use diagnostic methods. Salivary constituents that have been studied as potential diagnostic biomarkers for periodontal disease includes locally produced proteins of host and bacterial origin, genetic/genomic biomarkers such as DNA and mRNA of host origin, bacteria and bacterial products, ions, steroid hormones and volatile compounds. Conclusion: Periodontal oral diagnostic devices will enable screening of large populations, more quickly and effectively. Use of salivary biomarkers to sample large populations will help to identify at-risk groups more effectively and increase access to treatment for those most at need, thereby, improving public health.
The gram-positive, mesophilic and non-motile coccus Streptococcus gordonii is an important causative agent of infective endocarditis (IE). This pioneer species of dental plaque also causes bacteraemia in immune-supressed patients. In this study, we analysed the genome of a representative strain, Streptococcus gordonii SK12 that was originally isolated from the oral cavity. To gain a better understanding of the biology, virulence and phylogeny, of this potentially pathogenic organism, high-throughput Illumina HiSeq technology and different bioinformatics approaches were performed. Genome assembly of SK12 was performed using CLC Genomic Workbench 5.1.5 while RAST annotation revealed the key genomic features. The assembled draft genome of Streptococcus gordonii SK12 consists of 27 contigs, with a genome size of 2,145,851 bp and a G+C content of 40.63%. Phylogenetic inferences have confirmed that SK12 is closely related to the widely studied strain Streptococcus gordonii Challis. Interestingly, we predicted 118 potential virulence genes in SK12 genome which may contribute to bacterial pathogenicity in infective endocarditis. We also discovered an intact prophage which might be recently integrated into the SK12 genome. Examination of genes present in genomic islands revealed that this oral strain
might has potential to acquire new phenotypes/traits including strong defence system, bacitracin
resistance and collateral detergent sensitivity. This detailed analysis of S. gordonii SK12 further improves our understanding of the genetic make-up of S. gordonii as a whole and may help to elucidate how this species is able to transition between living as an oral commensal and potentially causing the lifethreatening condition infective endocarditis.
This study was undertaken to explore the perception of Year IV and Year V University of Malaya dental
students on different domains related to the competency based test (CBT). Methodology: A questionnaire
was constructed and a survey conducted to explore the students’ perception on four domains related to
the competency test: 1) benefits, 2) readiness to take, 3) timing and 4) lecturers’ supervision. Results: In
general, majority of the students agreed that they benefited from the competency test and felt adequately
prepared for each test. Students’ agreeing on feeling confident to sit for each test ranged from 70.0%-
81.4% for Year IV and 45.1%-70.4% for Year V. Majority of Year IV and Year V students perceived that
the timing of each competency test was ‘just right’. There was a high response of ‘Strongly agree/agree’
to availability of patients for practice and assessment, self-confidence and amount and distribution of
clinical session as factors affecting when they take the CBT. Majority of Year IV students agreed that the
assessment of lecturers was consistent for each tests while Year V had a high percentage of ‘Neutral’
response. Students’ agreeing that there was feedback after the test was 52.9%-71.4% for Year IV and
31.0%-56.5% for Year V. ‘Strongly agree/agree’ response of 68.6%-75.0% for Year IV and 36.6%-52.1%
for Year V was recorded for the level of supervision being the same after passing the test. Conclusion:
Overall, majority of students gave positive perception towards CBT in relation to four main domains
explored in this reseThis study was undertaken to explore the perception of Year IV and Year V University of Malaya dental
students on different domains related to the competency based test (CBT). Methodology: A questionnaire
was constructed and a survey conducted to explore the students’ perception on four domains related to
the competency test: 1) benefits, 2) readiness to take, 3) timing and 4) lecturers’ supervision. Results: In
general, majority of the students agreed that they benefited from the competency test and felt adequately
prepared for each test. Students’ agreeing on feeling confident to sit for each test ranged from 70.0%-
81.4% for Year IV and 45.1%-70.4% for Year V. Majority of Year IV and Year V students perceived that
the timing of each competency test was ‘just right’. There was a high response of ‘Strongly agree/agree’
to availability of patients for practice and assessment, self-confidence and amount and distribution of
clinical session as factors affecting when they take the CBT. Majority of Year IV students agreed that the
assessment of lecturers was consistent for each tests while Year V had a high percentage of ‘Neutral’
response. Students’ agreeing that there was feedback after the test was 52.9%-71.4% for Year IV and
31.0%-56.5% for Year V. ‘Strongly agree/agree’ response of 68.6%-75.0% for Year IV and 36.6%-52.1%
for Year V was recorded for the level of supervision being the same after passing the test. Conclusion:
Overall, majority of students gave positive perception towards CBT in relation to four main domains
explored in this resarch.
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.
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
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.
Long term evaluations of impacts of community
based health promotion programmes are not an easy or
straightforward task to do due to lack of validated and
reliable indices. Objective: To develop and test an index
to measure schoolchildren’s oral health knowledge,
attitudes, and behaviour as a result of a school-based health
promotion programme in Malaysia called the Doktor
Muda (Junior Doctor) Programme (DMP). Materials and
Methods: The index was developed in English based on
the DMP module and translated into Malay. The Malay
version was tested on 174, 11-12 year old schoolchildren.
Psychometric analysis of the index involved content and
face validity tests as well as factor analysis, internal and
test-retest reliability. Results: Factor analysis yielded 3
factors with groups of items viz. oral health knowledge
(OHK), oral health attitudes (OHA) and oral health
behaviour (OHB). The Cronbach’s alpha coefficients of the
three factors were 0.61, 0.73, and 0.64, respectively. The
Kappa coefficients were 0.70, 0.77 and 0.73, respectively
(intraclass correlation coefficients = 0.72, 0.70 and 0.78).
The final questionnaire comprised 33 items, namely; OHK
11 items, OHA 15 items, and OHB 7 items. Conclusion:
The Health Promotion Questionnaire Index (HPQI) to
measure the DMP impact on schoolchildren’s oral health
knowledge, attitudes, and behaviours was empirically
verified to be valid and reliable for use among 11-12 year
old Malaysian schoolchildren.
Water delivered through dental unit waterline system
(DUWS) is often reported contaminated with microbes
dislodged from biofilm that forms within the tubing
of a dental chair unit (DCU). ADM: The study aimed
at evaluating the sanitary level of DCU water from
a teaching dental clinic. Materials: The presence of
pathogenic bacteria which include total coliforms, faecal
coliforms, E. coli, faecal streptococci and P. aeruginosa
were determined using conventional microbiological
methods while PCR technique was used to identify other
microbial contaminants. Result: pH of DCU water was
found slightly acidic at pH 5.4-5.5 and the temperature
was 23°C. Pathogenic contaminants were absent but
the DCU water was highly loaded with Sphingomonas
rhizogenes (17.9%), Sphingomonas dokdonesis
(79.5%), Sphingomonas mucosissima (1.1%) and
Methylobacterium radiotolerans (1.5%). The high load of
microbes that exceeded 200 cfu/ml was of great concern
as it failed to meet recommendation set by the American
Dental Association.