A 48 years old Malay lady with a case of painless soft fluctuant swelling of left parotid gland is reported. The lesion was found to be a cystic lesion through the pre operative examinations and investigations. The cyst was completely excised, taking care not to injure the lower division of the facial nerve. Post recovery was uneventful with no defect of the facial nerve functions. The histologic picture confirmed that the cyst was lymphoepithelial cyst which is so called “branchial cyst”. Through the literature reviews of parotid lymphoepitelial cyst the discussions on prevalence, origin, diagnosis, histological finding, investigation and the modes of treatment are made. The ultra sound was found to be valuable in the pre operative evaluation of the parotid swelling furthermore it is non-invasive, harmless, painless and relatively quick.
Tooth wear is the loss of tooth tissue and structures not due to caries. It can occur in various forms either attrition, abrasion, erosion, noncaries cervical lesion (NCCL) or a combination of two or more forms. The objective of this study was to determine the patterns and associated aetiologies of tooth wear among adults in Kelantan, Malaysia. This crosssectional study involved 81 adults with tooth wear which was visually assessed using the Smith and Knight Tooth Wear Index (TWI). A questionnaire was used to seek putative aetiologies of the wear. Data were analyzed and the results were expressed as frequencies and percentages. Six thousand three hundred and eighty four tooth surfaces were examined in 1596 teeth. 17.4% surfaces had tooth wear; 80% scored 1, 18% scored 2 and 2% scored 3. Among the 81 cases of tooth wear, 29 (35.8%) had abrasion; 25 (30.9%) had attrition; 1(1.2%) had erosion while 26 (32.1%) had the combined type. Among those with abrasion, majority had the habit of eating freshwater clams (Corbicula fluminea) as local delicacy where most of the times people use their teeth to pry open the clam shells. Erosion was related to the pooling of carbonated drinks or beverages in the mouth before swallowing. In conclusion, most adults experienced abrasion and the most common possible associated aetiology is the way of eating clams.
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.
Tracheostomy is a life saving surgical procedure performed to maintain upper airway ventilation. The
indications include providing relief of upper airway obstruction, to replace endotracheal intubation in patients needing prolonged assisted ventilation, protection of tracheobronchial tree and facilitates tracheobronchial toilet.More importantly, post operative tracheostomy care is very crucial for the success of the treatment and avoiding complications. We report a rare case of an obligate parasite which had infested the tracheal stoma due to poorhygiene.
Dental caries is an important community dental health problem with limited studies in the mixed dentition stage. The aim of this study was to determine the caries prevalence and treatment needs among 7- 9 year old school children in Kelantan which is situated in North East Malaysia. A retrospective dental record review of fully documented dental records belonging to primary school children attending a paediatric dental clinic was conducted. Dental caries was recorded using dmft index and DMFT index for deciduous teeth and permanent teeth respectively. Three hundred and nineteen dental records of 175 (54.9%) boys’ and 144 (45.1%) girls’ were selected and subjected to a ‘dental record study’. The prevalence of dental caries was 93% (95% CI : 89,97) in primary dentition and 50.5% (95% CI : 42.2, 58.8) in permanent teeth. Mean dmft and DMFT was 6.2(SD 3.39) and 1.04(SD 1.34) respectively. Regarding treatment needs in the primary dentition, 35.4% of teeth needed one surface filling, 34.7% needed extraction, 24.5% needed two or more surfaces filling and 5.6% needed pulp care. In the permanent dentition, 54.7% required sealants and 21.9% required one surface restoration. The caries prevalence and treatment needs were high among this study population in the mixed dentition stage, particularly showing the early involvement of newly erupted permanent teeth. It appears that high caries prevalence in the primary dentition is a risk factor for caries in newly erupted permanent teeth. Oral health promotions programmes are required in the mixed dentition stage and may reduce the risk of caries in permanent dentition.
Renal cancer is a rare occurrence in all adult malignancies, and renal cell carcinoma (RCC) is the most common type. Due to its aggressive behaviour and high tendency for metastasis, manifestation of RCC varies, often with non-urologic features or symptoms from metastatic sites. Metastatic RCC to the head and neck region is rare particularly to the tongue are extremely rare. We report an elderly lady who presented with recurrent tongue mass metastasis from RCC, a rare cancer with even rarer metastatic site.
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.
The aim was to study the prevalence and sociodemographic features of odontogenic, non-odontogenic and salivary glands lesions among patients seen in Hospital Universiti Sains Malaysia. This information is essential to assist clinician in formulating reliable differential diagnosis of such lesion. Data on patient demographics, lesion location, tissue of origin and microscopic diagnosis were extracted from the Laboratory and Diagnosis record registries for biopsy specimen accessioned from year 2000 to 2012. This data was subsequently analyzed based on World Health Organization Classification of Head and Neck Tumours (2005). A total of 748 cases were included in the study. Out of the total number of cases, 367 cases were males and 377 cases were females. Ninety seven cases (13%) were of odontogenic origin, while 90 cases (12%) and 197 cases (26%) were of non-odontogenic and salivary gland origin respectively. Forty five percent of cases involved oral mucosal lesions. The most prevalent odontogenic lesion reported within the twelve years period was radicular cyst and ameloblastoma. Non-odontogenic bone lesion was rarely encountered with it making up less than two percent of total cases reported. Pleomorphic adenoma was the most prevalent benign salivary glands neoplasm reported within similar time period.
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)
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
Oligodontia, although rare, may have significant impact on the quality of life of those affected with it. Provision of restorative treatment for these patients can be very challenging and demanding for clinicians, especially during the active growth phase. Nevertheless, the dental needs of these patients are real and should be addressed appropriately. The present case report described a restorative rehabilitative plan and execution of different restorative treatment modalities in a 14-year-old patient with oligodontia. The challenges faced in the provision of dental care were highlighted. The treatment outcome showed a positive psychological impact on the well-being of the patient based on parental observations.
This study was designed to obtain and compare the nasalance scores produced by normal Malay
children and those with repaired palatal cleft. Data from 103 noncleft children and 27 children with repaired clefts were included. All children were of Malay origin with the Malay language (Kelantan dialect) as their first language.Two short and simple test stimuli were constructed in the Malay language;one resembled the Nasal Sentences and the other resembled the Zoo Passage (oral passage) used in nasometer testing. Nasalance scores were obtained with the Nasometer II model 6400 by Kay Elemetrics. Calibration of the nasometer and collection of data followed the recommended protocol outlined in the manual. Nasalance scores for the Oral Passage was significantly higher (p< 0.001) for the children with repaired palatal clefts when compared to scores for children without clefts. However, no differences in nasalance scores were detected between both groups for the Nasal Passage. The normative nasalance scores for Malay children with Kelantan dialect was established, which can be used as an objective reference in the management of Malay patients with resonance disorders.
Dental caries is the main oral health problem in hearing-impaired (HI) children and remains the most neglected need. The present study aimed to determine caries prevalence and treatment needs in HI children and the association with salivary parameters. A cross-sectional study was conducted on 63 HI children aged between 7-14 years who attended a special school for the deaf. Clinical oral examination was done and salivary parameters (resting flow rate and resting pH) were measured. Caries experience was charted using the index of decay-filled teeth (dft) and Decay-Missing-Filled Teeth (DMFT) for primary and permanent dentition respectively. Data were analysed using SPSS version 12.0. The mean age was 11.5 (SD 2.39) years and 53.8% were female. Dental caries prevalence was 88.0% (95% Cl: 73.0, 100.0) in primary dentition and 85.0% (95% Cl: 73.0, 96.0) in permanent dentition. The mean dft was 6.1 (SD 4.14) and the mean DMFT was 4.9 (SD 3.28). The mean resting flow rate was 0.14 (SD 0.08) ml/min while mean pH was 6.8 (SD 0.79). Both pit and fissure sealants and restorations were the highest (83.1%) treatment needs. Only 3.1% of the children did not require any treatment. There were no significant association between both salivary flow rate and salivary pH with caries experience in the primary (p=0.342, p=0.610 respectively) and permanent (p= 0.99, p=0.70 respectively) teeth. In conclusion, children with HI have high caries prevalence and unmet need for dental treatments. Salivary pH and resting flow rate of the children were not associated with their caries experience.
The objectives of this study were to determine the normal mean value of the root-crown (R/C ratios) in Malay patients and their variations by gender and dental arch from orthopantomogram radiographs (OPGs). Two thousand nine hundred and twenty teeth with fully developed roots were measured from 112 OPGs. Subjects with history of maxillofacial trauma or orthodontic therapy were excluded. The mean age of the subjects was 19.1 (SD 2.08) years old for males while females 18.9 (SD 2.19) years old in the range from 15 to 22 years old. The intra-examiner reproducibility of the assessment method was good (Intraclass correlation coefficient 0.81). Results of this study showed that there was no significant difference between R/C ratios of males and females groups. However, the ratios of the antagonist teeth for both males and females were significantly greater in the mandible than in the maxilla (p
Study site: Dental clinic, Hospital Universiti Sains Malaysia
Dental caries and gingivitis are common oral health problems affecting schoolchildren worldwide. Effective tooth brushing in children is fundamental in preventing dental caries and gingivitis and maintaining good oral health. Children routinely present with unsatisfactory oral hygiene due to poor compliance and poor dexterity in tooth brushing. The purpose of the present study was to evaluate the effectiveness of a novel T-shaped toothbrush in plaque removal and gingival health among children and to obtain feedback regarding its use. Nineteen participants aged 8-10 years who fulfilled the criteria enrolled in this study. The children were taught the proper technique of using the new toothbrush and instructed to use it for a period of 2 weeks. The plaque scores and gingival scores were measured at baseline and after 2 weeks. They were asked to complete a questionnaire regarding the use of the toothbrush after 2 weeks. Statistical analysis was performed using t-test. There was a statistically significant (p
Oral cancer is one of the common cancer cases identified in the developing countries. Genetic mutation and overexpression of certain genes and proteins have been associated in the development of this cancer. Notch signalling pathway is normally involved in controlling the development process of vertebrates and invertebrates; however, deregulation of this pathway was found to be responsible in the formation of certain cancers including oral cancers. Activation of this pathway requires binding of the ligands to its receptors. Four NOTCH receptors (NOTCH 1, 2, 3 and 4) have been identified in mammals. Disruptions within these molecules might interfere with the normal functions of Notch signalling pathway. Hence, this study was conducted to detect mutations of NOTCH1 and NOTCH2 receptor genes which might be occurring in the oral cancer cases obtained from the local population. DNA extracted from fresh-frozen tissue biopsy of the tongue and buccal mucosa from 10 confirmed cases of oral cancer were subjected for polymerase chain reaction (PCR) amplification using the specific sets of primers. The PCR products were sent for sequencing before final results were analysed.
Due to time and cost limitation, only two out of four NOTCH receptor genes; NOTCH1 and NOTCH2, were used in this analysis. The results revealed absence of nucleotide changes for both NOTCH receptor genes amplified from these oral cancer samples. More samples and further analysis looking into other regions in these genes are required to conclude the involvement of NOTCH receptor genes mutation in causing oral cancer.
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.
The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to reestablish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.
Staphylococcus aureus (S. aureus) is an important bacterium with significant pathological implications
in the field of medicine. Attempting to cure bacterial infections at an advanced stage results in considerable waste
of time, effort and expenditure. Thus, the prevention of such illnesses is paramount. Besides using chemical
drugs to treat infections, several non-organic extracts have been tested in trials and been shown to impede the
bacteria’s growth. This paper proposes that the modified hydrothermal nanotitania extract has great potential to
combat this lethal organism. The viability of S. aureus was shown to be markedly reduced following the addition
of nanotitania extract with 0.01%, 0.03% and 0.05% silver after 24, 48, and 72 hours. The ability of the
nanotitania extract to inhibit the growth of S. aureus indicates its antimicrobial characteristics.
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.