There is a major concern about the increased use of antibiotics in dental practice and the emergence of resistant bacterial strains. In recent years, dentists have reported a shift from narrow-spectrum to broad-spectrum antibiotic prescriptions due to increasing antibiotic resistance. The aims of this study are to investigate the prescribing patterns of the therapeutic and prophylactic use for antibiotics in various dental situations by dental practitioners. The study also specifically investigates the prescribing habits of dental practitioners regarding certain cardiac conditions and related dental procedures in patients predisposed to infective endocarditis. This study utilized a questionnaire which was designed to investigate the antibiotic prescribing patterns by dental practitioners in the Klang Valley region. The returned questionnaires were analyzed using SPSS, to identify compliance to antibiotic guidelines by Malaysia National Clinical Guidelines (MNCG) (2003) and American Heart Association Guidelines (AHAG) (2008). 217 dentists responded to the questionnaire and the responses show that there is a wide variety of antibiotic prescriptions among dentists and there is also misuse of antibiotics in some clinical dental conditions. The results also show that there is a large variation in the antibiotic prescriptions patterns for prophylaxis against infective endocarditis. Furthermore, there is uncertainty as to which cardiac conditions required prophylaxis and for which particular dental procedures. This study concludes that there is a clear need for the development of prescribing guidelines, regular monitoring of antibiotic prescriptions by dental practitioners and educational initiatives to encourage the rational and appropriate use of the antibiotics.
The cleft lip and palate patients often have constricted maxillary arch, congenitally missing teeth, impacted teeth, and many kinds of malocclusion problems. Secondary bone grafting in cleft lip and palate patients is performed preferably before the eruption of permanent canine in order to provide adequate periodontal support for eruption and preservation of the teeth adjacent to the cleft. Secondary grafting with iliac marrow consistently produces trabecular bone to unify the maxilla and provide odontogenic support. Presented here is a case of unilateral cleft lip and palate, which was treated by expansion by quad helix and straight wire appliance for correction of dental malocclusion. Also discussed in detail the entire range of treatment procedures the boy underwent from 14 years of age, especially the role of secondary bone grafting with iliac marrow to facilitate the eruption of permanent impacted canine.
It is the aim of all clinicians to accomplish biological tooth movement, which implies the use of low, continuous force. Constant unrelented search for a better wire, which can deliver optimal orthodontic force, has led to the invention of a lot of orthodontic wires such as Stainless steel, Beta Titanium, Nickel Titanium and multi stranded wires. In this study, the loading and unloading properties of 0.016 inch, 0.016x0.022 inch and 0.017x0.025 inch dimensions of stainless steel, conventional NiTi, Super elastic NiTi, and TMA arch wires were determined by means of a modified three point bending test for two inter bracket widths of 5 mm and 6.5 mm for deflection of 1 to 3 mm. The applied forces dependence on cross-sectional size differs from the linear-elastic prediction in super elastic NiTi wires. The stainless steel wires had the highest force values on all the three dimensions and cross section. On loading and unloading, TMA wires had force values in-between stainless steel, conventional NiTi and super elastic NiTi. The conventional NiTi had much lower force values compared to stainless steel and TMA and were linearly progressing compared to Super elastic NiTi. On loading and unloading the super elastic NiTi had force values in the range of conventional NiTi and had constant forces on higher deflection. The studies showed that the force value was comparatively higher in 5 mm inter bracket width than the 6.5 mm inter bracket width for all the cross section and dimension of wires.
Perceived and normatic needs for dental treatment is increasing globally, as patients in various parts of the world demonstrate different patterns of oral diseases (1). Some regions showed an increasing demand for aesthetic dentistry (2), while some demonstrated a rise in procedures relating to tooth preservation and functional restoration (3). In spite of the variable market demands, it is evident that utilisation of oral health care services has improved worldwide, regardless of patients’ socioeconomic status and other personal or environmental circumstances (1). (Copied from article)
In 2013, the Malaysian Education Blueprint (Higher Education) was developed by the Ministry of Education to guide the transformation process of the education system in this country for the next decade, starting from 2015 (1). The blueprint highlighted core aspirations for Malaysian higher education, which includes rapid expansion of research output and quality (1). This effort is in line with the nation's aspiration to uplift the standard of service provision among healthcare professionals, whose practice should advance on the essence of high quality scientific evidence.(Copied from article)
Collaborative teaching is an educational approach that seeks to involve participation of teachers and learners in achieving learning goals and outcomes in an interactive manner (1). Such approach has been effective in equipping students with knowledge and/or skills via high levels of learning, while allowing interpersonal development such as teamwork, time management, as well as communication and written competencies (2, 3). (Copied from article)
Squamous cell carcinoma (SCC) is the commonest cancer in the mouth. Multiple risk factors, such as smoking, alcohol consumption, irradiation, viruses infection and chronic irritation are thought to be responsible for the formation of oral squamous cell carcinoma. Although SCC can develop through a series of precancerous stages manifested as various degrees of epithelial dysplasia, this is not always the case. p53 is the commonest mutated gene in human cancers. Mis-sense mutation of the gene or complexing of the protein with viral or cellular proteins prolongs its half-life and leads to its detection by immunohistochemistry. This study was designed with the aim of demonstrating any possible relationship between p53 and oral squamous cell carcinoma by immunohistochemical staining techniques. A total of 66 specimens from the oral cavity (10 normal mucosa, 11 hyperkeratosis without dysplasia, 11 mild dysplasia, 11 moderate dysplasia, 10 severe dysplasia and 13 SCC) were examined for the presence of p53. The results show p53 was not expressed in normal mucosa, but was found with increasing frequency in increasingly severe dysplasia and SCC. In conclusion, this study shows p53 mutation is common in oral squamous cell carcinoma and probably occurs early in the multisteps of oral carcinogenesis.
Introduction: The peer assessment rating (PAR) index was used to self-audit 4 years of completed pre-adjusted edgewise appliance cases treated by a single orthodontist in a government clinic. The objectives of this study were to evaluate orthodontic treatment standards and factors which may influence treatment outcomes and treatment time.
Methodology: Pre and post-treatment study models were scored using the PAR index by the author. 17 models were re-examined for intra-examiner reliability using intra-class correlation coefficient (ICC). ICC was excellent for pretreatment (0.96), post-treatment (0.98) and reduction in PAR (0.96) scores.
Results: There were 173 cases (51 males; 122 females) with mean age 17.6 (SD 5.75) years. Mean treatment time was 18.6 (SD 6.47) months with range between 5-40 months. There was no statistically significant difference between one-arch and two-arch cases and between routine and compromised cases. Treatment time in extraction cases (mean 19.5, SD 6.17) was significantly different (p=0.000) compared with non-extraction cases (mean 11.6, SD 4.10) although this accounted for 15% of the variation only (r=0.388). 76.3% cases were ‘greatly improved’, 22.0% ‘improved’ and 1.7% ‘worst/ no different’. Mean pretreatment, post-treatment and reduction in PAR score was 34.1(SD 9.68), 6.4 (SD 6.84) and 27.9 (SD 9.69) respectively. Mean percentage PAR score reduction was 82.0% (SD 1.96). Pretreatment (p=0.000), post-treatment (p=0.000) and reduction (p=0.489) in PAR scores was significantly different between routine and compromised cases. There was significant difference (p=0.000) between category of improvement and pretreatment scores but not with treatment time.
Conclusion: Severe malocclusions had larger reduction in PAR scores and required longer treatment time. Extraction cases took longer to complete and routine cases had better outcomes than compromised cases with severe skeletal discrepancy.
Aim: Orthodontic treatment duration is variable and associated with many factors Very few studies looks at operator changes influencing treatment duration and outcome. This study aims to evaluate the influence of operator changes on treatment time and quality.
Methodology: This is a 4-year cross-sectional retrospective study of preadjusted Edgewise two-arch appliance cases treated by single/ multiple operators and finished/debonded by the author. 60 singleoperator (Group 1) and 82 multiple-operator (Group 2) cases were selected and the Peer Assessment Rating (PAR) Index was used to measure treatment outcome.
Results: Group 1 (2.31 years, SD.86) had statistically significantly shorter treatment time than Group 2 (3.25 years, SD1.23). Mean % reduction in PAR scores was high (88.7%), although single operators (92%) showed a slightly higher (p=.04) reduction than multiple-operator cases (86.2%). Post-treatment PAR score was slightly higher in Group 2 (4.6, SD5.4) compared with Group 1 (2.6, SD2.9). There was no significant difference in post-treatment PAR scores with operator changes from within and outside the clinic although there was difference in treatment duration (p=.0001). Possible predictors of treatment duration included number of failed/changed appointments, extractions and pre-treatment PAR. Multiple linear regression model showed significant association of treatment time with failed/changed appointments (p=.0001) and number of operators (p=.0001) although this contributed to 57.5% of possible factors (r=.762) .
Conclusion: Change of operator contributes to increased treatment time by 11.3 months. Although standard of treatment was high in both groups there was slightly better outcomes in single operators. The reduction in PAR score can be predicted more accurately in single operators.
Introduction: There is generally inconsistent appropriate orthodontic referral among local dentists. Orthodontic indices are not routinely used to assess the need for treatment. The aim of this pilot study is to evaluate the efficacy of the Index of Orthodontic Treatment Need (IOTN) as an educational tool to improve their ability to assess orthodontic treatment need.
Methodology: Local dental officers assessed 30 study models on two occasions (before and after IOTN training) and their findings compared with an expert group for agreement in IOTN scores and referral decisions. Training comprised oral/visual presentation, instruction manuals, ‘hands-on’ and self-study. Kappa statistic (?) was used to assess agreement.
Results: As a group there was no significant improvement in referral decisions after training with only ‘moderate’ agreement (?=0.47), although half of the subjects improved. Agreement was better with aesthetic (?=0.51) than functional (?=0.41) assessment. ‘Sensitivity’ was 82.4% and ‘Specificity’ was 58.2% but both were not statistically significant before and after training.
Conclusion: The IOTN has potential as an educational tool for improving the diagnostic skills of dental officers. More accurate assessment of the Dental Health Component with the IOTN ruler and familiarity with the Aesthetic Component has to be emphasized in future training.
Oral granular cell tumour is a fairly rare lesion with a predilection for the tongue. Seven cases (6 females, 1 male) of oral granular cell tumour were seen during the 40 year period (1967-2006) in Stomatology Unit, Institute for Medical Research (IMR) in which 5 cases were located at the tongue. All the cases presented as a single swelling and excisional biopsies were carried out in all cases.
Abscess of the periodontium is a localized purulent inflammation of the periodontal tissues1. It has been classified into three categories which are gingival abscess, periodontal abscess and pericoronal abscess. A periodontal abscess can be defined as a localized purulent infection affecting the tissues surrounding a periodontal pocket that can lead to the destruction of supporting structures4 including tortuous periodontal pockets, furcation involvement, and intrabony defects. The lesion may be acute or chronic abscess. A localized acute abscess may progress to a chronic abscess if the pus drains through a fistula into the outer gingival surface or into the periodontal pocket. (Copied from article).
Aim of the study: To compare the weight of retrieved food accumulated under the dentures base with and without adhesive treatment.
Materials and Method: Each subject was given 32 g of non-salted dry roasted peanuts to chew and swallow. After finishing all the peanuts, the subject was asked to brush their denture using toothbrush and toothpaste without removing the denture from the mouth and rinsed their mouth vigorously with water. The weight of the retrieved peanuts accumulated under the denture base collected, dried, and weighted. All procedures were repeated with denture adhesive.
Results: On average, the mean weight of peanuts particles recovered beneath upper dentures without application of denture adhesive was 51.21 mg which is higher than the mean weight of upper denture with adhesive treatment (35.36 mg). The similar pattern was detected for the lower dentures but at higher mean weight.
Conclusion: Application of denture adhesive significantly reduced the amount of retrieved peanut particles collected under the denture base compared to no-adhesive treatment (p< 0.005).
This study aims to determine the prevalence of hand-held ProTaper® files system among UKM final year dental undergraduates and to assess their perception in performing endodontic treatments.
Methods: 85 final year dental students from 2006/2007 academic session participated in the questionnaire survey. All students underwent didactic endodontic teaching of conventional stainless steel files throughout a 2-year course and a 2-day ProTaper® hand files seminar on canal preparation. Each student had a total of 6 months clinical period before the survey was distributed to the subjects and returned for data analysis.
Results: A 100% response rate was received. About 58.8% (n=50) used hand ProTaper routinely while 41.2% claimed themselves as non-users. Amongst the users, 52.5% were moderate users and about 33.6% were frequent users. Tooth type and size of canals were the selected criteria for file use. Majority of users used ProTaper® hand for posterior teeth and regarded it as user friendly. Although almost all users expressed concern of instrument fracture during use, very few did break. Procedural errors were not experienced by 51.3% users.
Conclusion: About 2/3rd majority of UKM undergraduate dental students use ProTaper® hand-held system as an alternative for canal preparation. Procedural errors were perceived to occur much less when using the NiTi files. The system can be initiated to novice users and can be taught as part of endodontic curricula.
Background: Mothers play an important role in preventing fluorosis due to inadvertent swallowing of fluoridated toothpaste and enhancing the effectiveness of toothbrushing amongst preschool children through proper supervision.
Aim: To investigate the knowledge of mothers with regards to the benefits and risks of fluoride toothpaste usage among preschool children and to assess the level of parental supervision during toothbrushing. In additional, we wish to investigate the toothpaste purchasing behaviour of mothers in relation to brand, price, flavour, fluoride content and the influence of advertisement.
Methodology: Cross-sectional study of a representative random sample of 373 mothers of 5-6 year old preschool children through self-administered questionnaires.
Result: The response rate was 90.3% (337). The majority (61.7%) of the mothers reported that the amount of toothpaste their children used was half-length. Most mothers (70.6%) claimed they usually apply toothpaste for their child. About one-half (50.4%) reported the children applied the toothpaste themselves. Only 41.2% of the respondents supervised their children every time during toothbrushing. The mean age at which the child started brushing and using toothpaste was about 34 months (S.D. 14.9) and 37 months (S.D.14.8) respectively. Almost all (95.8%) reported that their children rinsed their mouth after toothbrushing. The mothers’ choice of toothpaste for their child was influence by brand (91.4%), flavour (91.4%) and fluoride content (84.6%) with price being the least of the factors. The majority of the respondents (82.7%) had average to good overall knowledge scores. There was significant association (P=0.034) between the level of education of the mothers and their level of knowledge on fluoride toothpaste usage.
Conclusion: Future oral health messages for preschool children and mothers in Perlis should target areas found lacking in terms of knowledge and practices with regards to fluoride toothpaste usage. This includes regular supervision of preschool children during toothbrushing by parents and using only a small amount of toothpaste for young children.
The aim of the study was to assess the potential role of dentists as smoking cessation counsellors in their practice. The target group comprised of all public and private sector dentists in the Federal Territory of Kuala Lumpur (FTKL) and Selangor. Data were collected via a twenty-six item questionnaire which was mailed to 831 dentists. A response rate of 67.1% was obtained. Results revealed that the majority of the respondents (97.8%) perceived that in addition to providing oral care, dentists should also be interested in their patients’ general health. Generally, about two-thirds of dentists (69.1%) and especially those from the public sector (76.4%) considered that they have an important role to play as smoking cessation counsellors. However, less than half of the respondents (40.3%) perceived that patients do not expect smoking cessation advice from their dentists. Yet, more than half of the respondents (55.1%) provided advice or helpful hints in order to motivate their patients to quit smoking. About 65% of the overall respondents did explain to their patients regarding the health risk due to smoking and its detrimental effects. Perceived obstacles to smoking cessation include lack of information between dentistry and smoking cessation (86.1%) followed by lack of training and lack of time.
A case report of a 16 year old male oligodontia patient who presented with a Class I malocclusion on a skeletal I base. He had multiple missing teeth of upper lateral incisors and all premolars except for lower right first premolar. Treatment involved fixed appliance with the aid of mini-implants to mesialize posterior teeth in order to reduce the number of prosthodontic replacement of the remaining missing teeth planned for the future. The application of the mini-implants in the sequence of treatment is presented
People with hearing and/or speech impairments (HSI) reported having difficulty communicating with the dental team, indicating the need for the profession to develop an effective communication strategy when dealing with these patients. This paper discusses the development of a toolkit designed to guide delivery of oral hygiene instruction, oral health education and dental consultation for patients with HSI, and how its use had resulted in an improved oral health outcome in a patient with such disabilities.
The aim of this literature review is to review the current care setting for conscious sedation for dentistry in the primary and secondary care sectors in the United Kingdom (UK) and to recommend a plan for setting up a service for the provision of conscious sedation in Malaysia based on the UK models. An electronic search using various databases and web-based search engines were conducted during the period from January to March 2016. Various combinations of keywords were used to help the literature search including dental care settings, conscious sedation, equipment for conscious sedation, referral pathway for sedation and training in sedation. The findings have shown that, although there are specific requirements for the facilities practising sedation, the majority of the requirements are common to all dental practices, such as health and safety, infection control, emergency drugs etc. The good integration between primary and secondary care in providing conscious sedation relies on the compliance with the referral pathway. It is recommended that the practice of conscious sedation in the dental setting in Malaysia begins at the Special Needs Dentistry (SND) Unit, Kajang Hospital because the unit has been partly equipped for conscious sedation and the specialist in charge has received appropriate training in Conscious Sedation for Dentistry at King’s College London Dental Institute. Ensuring safety, effectiveness and appropriateness of the sedation techniques used are the major aims when delivering care to fit individual needs. It is highly recommended to look into the country in which the service has been well established such as United Kingdom as a reference for future development of the conscious sedation service in Malaysia.
Aim: To assess the prevalence and clinical features of aggressive periodontitis in newly referred patients to the Periodontal Clinic in Seremban.
Methodology: Sample size calculation was done using Epi Info software with minimum sample estimated at 279. 583 new patients who were referred to this clinic from year 2013 to July 2015 were examined clinically and radiographically. Patients were diagnosed using American Academy of Periodontology workshop 1999 definition.
Results: Thirty-one (5.3%) patients were identified as having aggressive periodontitis with 28 (90%) of these patients exhibiting generalized form of aggressive periodontitis. Mean age of these patients was 34.9 years. In terms of gender and ethnicity, 21 females and 18 Malays were diagnosed with Aggressive periodontitis. First molars had the highest amount of clinical attachment loss (CAL=5.4mm). The number of missing teeth at the first visit was at median 2 (Interquartile range=4). The number of prognostically hopeless teeth at first visit was at median 1 (Interquartile range=2). Canines were preserved in most of the patients.
Conclusion: Aggressive periodontitis was found in 5.3% of our samples. It was diagnosed at mean age of 34.9 years old.