To explore the association between social
support and stress levels in preclinical and clinical dental
students in Malaysia. Method: A cross sectional survey
of dental undergraduate students was conducted at the
Faculty of Dentistry, University of Malaya, Universiti
Kebangsaan Malaysia and Universiti Sains Malaysia.
Stress was measured using the Dental Environment Stress
(DES) questionnaire. A DES-32 item was used to measure
stress for the clinical students and DES-16 item for the
preclinical students. Four questions were used to measure
social support. The total stress scores were standardized
for comparison purposes. Results: A total of 357 (79.7%)
preclinical and 417 (71.8%) clinical undergraduate dental
students responded to the questionnaires. The clinical
students experienced higher stress [mean standardized
DES score = 72.63, SD = 10.64] than preclinical students
[mean standardized DES score = 70.19, SD=12.01]. The
two most stressful items reported by preclinical students
were “fear of failing” and “examination and grades”.
Among clinical students, the two most stressful items related
to academic were “completing course requirement” and
“fear of failing course” and items related to clinical session
were “fear of being barred due to the clinical schedule”
and “patients late or absent”. Multiple regression analyses
revealed that low stress levels among preclinical students
were significantly associated to a lot of contact with
students of the same course. Conclusion: To some extent,
social support does play a role in explaining differences in
perceived stress, in particular among preclinical students.
The aim of this study was to determine the effectiveness of demineralized freeze-dried bone xenograft (DFDBBX) in minimizing post-surgical recession in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were matched for the tooth type, location of defects and periodontal pocket depth (5 to 7mm). Following an initial nonsurgical treatment, recession at defects indicated for surgery was measured pre-operatively. Surgical treatment was carried out by split mouth design, where the test sites were assigned DFDBBX and the control sites were subjected to debridement without the use of DFDBBX. Recessions were measured at 3 months, 6 months and 9 months post-operatively. The results showed no statistically significant difference in mean recession at 3, 6 and 9 months post-operatively compared to baseline for both test and control groups. Thus, DFDBBX was ineffective in minimizing recession on patients with moderate to severe periodontitis, as compared to surgical debridement alone.
This study evaluated the effectiveness of demineralized freeze-dried bone xenograft in reducing post-surgical pocket depth in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were selected for this study. The bony defects were matched for tooth type, location and pocket depth. Following an initial non-surgical treatment, only pockets of 5 to 7 mm deep were indicated for surgery. Periodontal pockets were measured pre-operatively and at 3, 6 and 9 months post-surgically. The study protocol included a split mouth design, where surgical treatment was carried out at both test and control sites. The test sites were assigned demineralized freeze-dried bone xenograft and the control sites were subjected to debridement alone without the use of demineralized freeze-dried bone xenograft. The results from this study showed a statistically significant difference in the mean pocket depth at 6 and 9 months post-operatively for both test and control groups, but there was no statistically significant difference at 3 months. In conclusion, demineralized freeze-dried bone xenograft was ineffective in reducing periodontal pocket depth in patients with moderate to severe periodontitis, as compared to surgical debridement alone.
The root canal walls of twenty -five deciduous molar teeth with exposed and necrotic pulps were examined using thescanning electronmicroscope. Immediately after extraction, all teeth were fixed in Kamosky's solution. The coronal portion of the tooth was sectioned at about 2mm above the enamel cemental junction.The mesial and distal roots were separat~d and either split in the mesio-distal or bucco-lingual direction. All specimens were prepared for SEM. Obsevations showed that all roots were infected with organisms consisting of cocciand short rods. Some of the coccihad penetrated the dentine layer. However, the distribution of organisms is. not uniform throughout thecanals. Bacterialinvasion ismostinthecoronal region and reduces towards the apical region: Accompanying bacterial invasion is root canal walls deterioration. The odontoblastic processes are the first to deteriorate followed by the predentine layer.
The CO2 laser has been actively used clinically for soft tissue surgery. The advantages have been widely acknowledged. In implant related tissue surgery, the use .6f CO2 laser has been debated on whether the heat generated during the procedure would be detrimental to the bone thus losing the implants through disosseointegration. In this preliminary work, CO2 laser was used to perform a simulated gingivectomy of tissue surrounding plasma coated titanium implants. The purpose was to observe the pattern of heat generated at different levels of the implant body. The safe power range and standard precaution was also identified. The results suggested that power output between 6 Watt to 8 Watt in repeated pulsed mode with duration of 5 seconds is considered safe. With this mode the operator
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.
In Malaysia the School Dental Service (SDS) provides comprehensive dental treatment with the aim of rendering the child dentally fit before leaving primary school at 12 years. Hence the purpose of this study was to investigate I) the prevalence and treatment needs of traumatised permanent incisors and 2) to assess their relationship to the degree of incisor overjet amongst 12-13 year-old schoolchildren. The sample comprised of 1519 schoolchildren attending 20 secondary government and government-aided schools in Klang district. There were 772 boys and 747 girls. The sampling procedure involved a multistage, clustered and stratified random sampling. The prevalence of traumatic injuries in permanent incisors was 2.6% which confirmed the results of a previous local study. Boys suffered more trauma than girls with a ratio of about 1.5:I. A majority (77.5% ) of the children had one tooth affected. The most commonly affected teeth were the upper central incisors (91.8%) followed by the lower central incisors (4.1%). A high percentage (57.5%) of children with traumatised anterior teeth had increased overjet (>3mm). Almost all cases (93.9%) required two or more surface fillings. However the majority of affected children (56%) were satisfied with their appearance. It is concluded that traumatic dental injuries should be incorporated as part of the treatment plan for the SDS and appropriately managed soon after occurrence or not later than 12 years after which they leave the SDS. Future epidemiological studies should also give due emphasis to the relative importance of traumatised teeth in children.
A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of orofacial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the preceding four weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of orofacial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states is planned.
The prevalence of tooth loss amongst the elderly is generally very high. Hence mastication and subsequently nutrition is greatly affected leading to the impairment of their general health. Therefore denture construction is an important aspect in the rehabilitation of the oral and general health in most elderlies. However, poorly constructed dentures and lack of maintenance coupled with various other health and healthrelated problems of the elderly, for instance poor general health especially with immunocompromised states, multiple medication intake, xerostomia, reduced mobility, economic status, mental state and ignorance may all lead to discomfort and denture associated lesions in these elderly patients. No regional studies or data on denture-related lesions in the general population have been reported. Previous epidemiological studies of adults in Malaysia (1,2) and other local studies have not investigated lesions of the oral tissues associated with geriatric denture wearers although studies in developed countries, where prevalence of denture usage is high, have noted that denture-related lesions to be the most common group of oral mucosal lesions in the elderly (3-7). As has been reported in most developing countries, the proportion of elderly in Malaysia is also increasing. It has also been noted that the mean number of teeth present decreases as age increases; in those between 15 to 19 years, all 28 teeth are present, 35 to 44 years-old have 23 teeth whereas those above 65 years retain only 12 teeth. Edentulousness increases from 0% to 7.3% to 56.6% in these age groups respectively (2). It is anticipated that with the increasing population of the elderly in Malaysia and the improving economy, the proportion of denture wearers in the population will increase. In view of the lack of investigations in Malaysia focusing exclusively on this group of lesions, it is therefore the aim of this pilot investigation to highlight the prevalence of denture- related lesions in a representative population of the elderly living in the community, both in the urban and rural areas. It may also form a basis against which future studies can be compared.
A postal questionnaire concerning the Malaysian dentists' attitudes towards their patients yielded a 73.1% response rate. The results of this study indicated that a majority of dentists felt that patients had more negative than positive attributes. Private practitioners attributed more negative traits to their patients than their public sector colleaques. About 88% of dentists indicated that the most negative patient attribute was fear of pain. Fear of pain was perceived to be stronger than fear of the dentist (62.2%). likewise the patients' inability to seek treatment soon enough (78.4%), to come for regular check-up (72.7%) and to follow advice on personal oral hygiene(70.1%) were worrisome.
A 73.1 percent response rate was obtained in a postal questionnaire survey conducted among Malaysian dentists to assess their attitudes and needs for continuing dental education. It appeared that on an average the Malaysian dentist spent very little time on continuing education,reading journals and participation in professional dental meetings.The need for continuing education was strongly evident as almost all dentists indicated that such activities be further developed in Malaysia. Crown and Bridgework, Oral Surgery and Orthodontic appeared to be areas in which more continuing education were required.
Several national studies have been undertaken to assess the prevalence of fluorosis utilizing the Dean's Index. However, the latest national study undertaken in 1997 (1) had utilized the DDE Index and hence does not allow comparisons to be made with the earlier set of national data. This cross-sectional study was undertaken to evaluate the prevalence of dental fluorosis using the Dean's Index in a sample of 12-13 year-old schoolchildren and to assess the relationship between fluorosis and their caries status. The sampling procedure involved a multistage, clustered and stratified random sampling. The sample comprised of 1519 schoolchildren attending 20 secondary government and governmentaided schools in fluoridated urban and rural areas of Klang District in Peninsular Malaysia. There were 772 males and 747 females. Each subject was administered a questionnaire to elicit the demographic information. Intra-oral examination for dental fluorosis and caries was performed for each subject. The results demonstrated that more than half of the subjects (54 %) had no fluorosis, 13.2% had questionable fluorosis, 31.3% had very mild to mild fluorosis, 1.4% had moderate fluorosis and only 0.1 % exhibited severe fluorosis. The mouth prevalence was 32.8 %. The Community Fluorosis Index was 0.48 indicating a borderline score for public health significance. Fifty-two percent of the children were caries free. The mean DMFT for all subjects was 1.1, F(0.6) being the main component. Although girls had a higher mean DMFT score as compared to boys this difference was not significant. Significant differences in DMFT scores were observed by urbani rural distributions and ethnic groups (p < 0.01). No significant correlation was found between fluorosis and caries status. It is concluded that dental fluorosis does not appear to be a public health problem. Further coordinated in-depth research using similar criterias for assessing dental fluorosis is highly recommended.
The objective of the study was to attempt to verify the cause of self-reported oro-facial pain among 12-yearold children, objectively via a clinical examination. This is a descriptive, cross-sectional survey using a combination of self-reported questionnaire, face-to-face interview and clinical oral examination. The children were first asked to answer a self-filled questionnaire about their oro-facial pain experience in the past 4- weeks. In order to verify its cause, a clinical examination and an interview followed. Normative oral health status data was also collected. The sample was 1492 Malay schoolchildren with diverse socioeconomic background from the states of Johore, Kelantan and Sabah. The sample size for each state was calculated to give a sampling error of not more than 5 %. In each state, quota sampling was done to achieve a balanced distribution between gender and location. The data collected were normative status for caries, periodontal disease and traumatized teeth. Orofacial pain experience represented the subjective status for oral well-being. The cause of pain was confirmed through a clinical examination. The normative oral health status data implies a very low untreated disease and good oral health among the schoolchildren. However the subjective health status, as reflected by the prevalence of pain suggested that oro-facial pain and suffering was high (27.3%) with about 49% "of moderate and severe" intensity. The two main causes were caries and mouth ulcers. However in about onequarter of pain cases, diagnosis cannot be confirmed in the field survey setting. More than one-half of those with pain experienced disturbed sleep and study. It was concluded that overall oral health status and well-being can be better described if normative data is complemented with subjective data such as pain prevalence. The study shows that the majority (more than 75 %) of cases of subjective pain can be objectively verified in a field epidemiology survey setting. The reliability of the subjective data can be improved by a clinical examination as compared to unverified self-report. The study also confirms that the major source of oro-facial pain among the 12 year-olds were caries and mouth ulcers.
The purpose of the present study was to determine the periodontal profile, toothbrushing habits and oral hygiene status of patients referred to a teaching institution for periodontal treatment, based on patients' treatment records. A total of 207 consecutive patients diagnosed with periodontitis who had been interviewed and clinically examined over a period of approximately one year were included in this study. The assessments of plaque levels, bleeding on probing (BOP) scores, probing pocket depth (PPD) and degree of bone loss from radiographs were made. The average age of this study group was 45 ± 12.8 years old with an age range of 20 to 76 years. The subjects comprised of 40% Malays, 34% Chinese and 26% Indians. The male to female ratio was almost 1.5: 1. These patients presented with high plaque and BOP scores. These findings do not concur with the high frequency of toothbrushing reported (86.5 % of subjects brushing twice or more times per day). This may reflect on the ineffectiveness of brushing as evident from their high plaque scores. Periodontal pockets were detected in 69 % of the teeth in these patients with an average of 17 teeth per patient being involved. Probing pocket depths of >6mm was found on the average in 3 teeth per patient. Alveolar bone loss as assessed from radiographs was detected in 52 % of the teeth in this study group of which 12 teeth per patient on the average exhibited this. Advanced bone loss involving about 2/3 and more of the root length was detected on the average on 1 tooth per patient. Early onset periodontitis accounted for about 5% of the total cases seen. About 21 % of subjects suffered from advanced adult periodontitis. Hence about a-quarter of the patients referred already had marked periodontal destruction.
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.
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.
Tissue-integrated oral implants have opened-up a new perspective in oral rehabilitation of tumour patients who had undergone surgery. The present case demonstrated a simple approach to rehabilitate a patient who had subtotal maxillectomy using dental implant. The use of an implant in combination with a natural abutment tooth was shown to improve the retention and stability of the obturator. Magnetic attachment and telescopic restoration were the retainers of choice and they provided good aesthetic result.
The aim of this research is to study how the physical changes in the maxillofacial trauma patients affect them psychologically in patients of different ages, sexes, races, socioeconomic backgrounds, types and severity of injury. The study was conducted by doing a questionnaire survey, which was divided into physical and psychological components. In the physical component, the questions were mainly related to the physical injuries to the patient, which could be visualized clinically and functionally. The psychological component consisted of analyzing the impact of the maxillofacial trauma to the psychological profile. Twenty patients of both sexes and ages, ranged from 15 to 62 years old were interviewed. The main cause of trauma was from motor vehicle accidents. This study appears to show that maxillofacial trauma may have a psychological impact on patients.
Human saliva contains a large number of proteins which can be separated using polyacrylamide gel electrophoresis (PAGE). In this study the protein profiles of whole saliva of diabetic and non-diabetic were compared. Considerable variations between individuals in the protein profiles were observed. The saliva from diabetic patients appeared to have more of proline-rich protein bands in the molecular weight region below 56 KOa. Further investigations using individual gland saliva should be carried out.
Saliva collection is non-invasive and less stressful when compared with blood collection. Extensive studies on saliva has been carried out and the use of saliva as a biological sample in clinical diagnosis and for monitoring hormones, drugs and pollutants and viruses has been recommended. The complexities associated with saliva such as proper collection device and strict standardisation of a number of factors which include time of collection, types of saliva and storage made it less favourable to blood.