Verruco-papillary lesions (VPLs) of the oral cavity
described in the literature involve a spectrum of conditions
including squamous papilloma, verruca vulgaris, focal
epithelial hyperplasia, condyloma, proliferative verrucous
leukoplakia and verrucous carcinoma. The majority of the
VPLs are slow growing, benign in nature and have a viral
aetiology (1). Mucosal HPV types (HPV 6, 11, 13, 30,
32, 45, 52, 55, 59, 69, 72 and 73) have been implicated
as possible etiological causes for these benign lesions (2)
while virus associated benign mucosal outgrowths are not
too difficult to diagnose either clinically or by microscopy.
Apart from virus-associated lesions, VPLs harboring
malignant potential such as verrucous carcinoma,
proliferative verrucous leukoplakia and oral verrucous
hyperplasia (OVH) need to be further clarified for better
understanding of their predictable biologic behavior and
appropriate treatment. In particular, the condition referred
to as oral verrucous hyperplasia (OVH) poses a major
diagnostic challenge. OVH represents a histopathological
entity whose clinical features are not well recognised and
is usually clinically indistinguishable from a verrucous
carcinoma (3).
In 1980, Shear and Pindborg classified OVHs into
two clinical variants, a sharp variety comprising of long,
narrow, heavily keratinized verrucous processes which
appears white as a result of heavy keratinization and a
second variant referred to as the blunt variety consisting
of verrucous processes that are broader, flatter and not
heavily keratinized (3). A new pathological entity distinct
from what Shear and Pindborg earlier described has been
found in recent years among betel-quid chewers mainly
from Taiwan. In 2005, Chung et al., in a field survey of
1075 adults noted 9 verrucous lesions which they described
as exophytic outgrowths, which the authors hinted had
hitherto not been reported in the scientific literature (4).
Their Figure: 1 illustrated this newly described “verrucous
lesion”. Subsequently in 2009 Wang et al described a case
series of 60 cases from Taipei and classified these lesions as
plaque-type and mass-type lesions primarily based on their
histopathological features. It was also documented that the
mass-type verrucous hyperplasia may manifest as single
or multiple verrucous whitish pink lesions clinically while
the plaque-type lesions may appear as whitish verrucous
plaques. They also concluded that the terminology OVH
should be reserved to denote only the mass-type lesions
both clinically and histologically and suggested that the
plaque-type lesions should be clinically classified as oral
verruciform leukoplakia and histologically as verruciform
hyperplasia (5).
In an effort to bring uniformity in reporting
these lesions both clinically and histopathologically a
consensus meeting was held in Kuala lumpur, Malaysia
during December 15-18, 2013. A working committee
that included specialists working on oral malignant andpotentially malignant disorders attempted to formulate the
clinical and histopathological criteria of OVH based on
the discussion among the participants in the meeting. The
meeting was attended by 46 participants from 7 countries
and included specialists and trainees in the disciplines
of Oral Medicine and Oral and Maxillofacial Pathology.
Consensus guidelines arising from this meeting is as
follows.
Background: In Malaysia, preschool teachers have long been utilised as oral health educators. However their level of oral health knowledge and effectiveness of the training they received are seldom investigated. This study aims to evaluate the of oral health education seminar (OHE) held for public preschool teachers (KEMAS) in terms of the improvement of their knowledge, practices and attitudes.
Methods: This was a one arm interventional study (before and after survey following OHE seminar intervention). All KEMAS preschool teachers (n=107) in Hulu Terengganu were invited to attend OHE seminar which consisted of 1 hour lecture and 40 minutes OHE demonstration. Pretest questionnaire was collected before the seminar started and post-test questionnaire was collected two weeks later. A self-administered questionnaire used in this study was adapted from “preschool teachers’ knowledge, practices and attitudes towards oral health”, National Oral Health Survey of Preschool Children, 2005. Data were analysed using descriptive and McNemar test, SPSS version 15.0.
Results: Of 107 subjects, only 61 teachers responded yielding to 57% response rate. All subjects were female with mean age of 46 years (SD: 6.03). Overall, there was an improvement of teachers’ oral health knowledge, practices and attitudes after the seminar. Several items seem to have be improved significantly after the seminar, for example knowledge item on factors causing periodontal disease (p=0.03). In terms of practice, all teachers reported they brushed teeth at least twice daily using fluoridated toothpaste and use of dental floss was increased significantly after the seminar (p<0.001). Majority of teachers have positive perceptions on their roles in oral health education.
Conclusion: Oral health education seminar appeared to be effective at influencing certain aspects of teachers’ oral health knowledge, practices and attitudes.
Keywords: attitudes, knowledge, oral health promotion, practice, preschool teachers
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.
A preliminary investigation to assess the relationship
in the severity of periodontal disease in diabetics when
compared with non-diabetic subjects. Materials and
Methods: A retrospective, comparative study using
periodontal case notes of 40 subjects (20 Type 2 diabetics,
20 non-diabetics) who were selected based on the
inclusion and exclusion criteria. Severity of periodontal
disease was assessed through number of periodontal
pocket ≥5mm. The results were compared between
subjects whose age, gender and plaque scores are matched
with the test group. Data obtained was then analyzed by
SPSS Version 12. Results: When comparisons were made
between test (Type 2 diabetic) and control (non-diabetic)
groups, there were no significant difference (p>0.05) in
the severity of periodontal disease. However, there was
a clinically mean difference between the two groups.
Conclusions: This preliminary investigation indicated
that the severity of chronic periodontitis, as indicated in
periodontal pocketing, increased in diabetic patients when
compared to non-diabetics clinically, although it was not
statistically significant. The finding of this investigation
was thus not conclusive as it was only a retrospective
study using patients’ case notes. However, the results
are now being further investigated with a proper clinical
trial which examines periodontal parameters and diabetic
status (HbA1c) of the subjects to determine the association
between periodontal disease and diabetes mellitus.
Supernumerary teeth have a genetic predisposition
with a predilection for males. This article reports an
uncommon radiological finding in a non-syndromic
sibling pair who presented with supernumerary teeth
of different morphologies on opposite and different
regions of the dental arches. A 14-year-old Chinese
male presented with a conical supernumerary palatally
placed between the upper right central and lateral
incisors. His older brother had unerupted bilateral
supplemental supernumerary teeth between the roots
of the lower second premolars and first permanent
molars. Trends of the phenotypic presentation of
familial non-syndromic supernumerary cases are
discussed. Familial supernumerary teeth have been
suggested to be due to autosomal dominance or
recessive traits. Variation in the numeral, spatial and
morphological phenotypic expressions suggests a
multifactorial model of multiple genetic, epigenetic
and environmental influences. Clinicians need to be
mindful of the possible phenotypic variations that may
present when treating cases with family history of
dental anomalies.
The purpose of this study was to determine the
DNA yield and quality from different non-invasive
sampling methods and to identify the method which
gave the highest DNA yield. Method: Thirty-eight
volunteers had been recruited in this study where
blood, buccal cells and saliva were collected using
various collection techniques. Buccal cells were
collected by 1) cytobrush and 2) saline mouth rinsing
or “swish”. Meanwhile saliva was collected by passive
drooling method. Upon processing the white blood
cell (WBC), buccal cells and saliva samples, DNA
extraction was performed according to the
manufacturer’s protocol. Quantification and quality
(DNA ratio at A260/A280) of the extracted DNA were
determined using NanoDropND-1000®. T-test was
performed to compare means between DNA obtained
from various collection methods. Results: DNA yields
from buccal cells collected with cytobrush, “swish”,
saliva and WBC (mean ± SD) were (8.2 ± 5.9)ng/μl,
(28.2 ± 14.9)ng/μl, (5.9 ± 9.5)ng/μl and (105.3 ±
75.0)ng/μl respectively. Meanwhile the mean DNA
ratio at A260/A280 for cytobrush, “swish”, saliva and
WBC were 2.3, 2.0, 1.7 and 1.8 respectively. Post hoc
test with Bonferroni correction suggested that DNA
yield from “swish” technique exhibited the least mean
different as compared to the DNA extracted from WBC
(p
Diagnosis and management of orofacial pain of non-odontogenic origin has always been a challenge to dentists. Inaccurate diagnosis would result in delay of treatment and in cases of orofacial pain, affects patient’s quality of life. Temporomandibular pain dysfunction syndrome is the most common temporomandibular disorder that presents to dental clinics. Trigeminal neuralgia, also known as ticdouloureux is a relatively rare condition that causes electric shock-like pain when the trigger zone is stimulated by triggering factor. Case report: A case of temporomandibular pain dysfunction syndrome in a 52 years old Indian lady that was managed as trigeminal neuralgia for 7 years is presented. Conclusion: The aim of this case report is to make dentists aware of the signs and symptoms of different orofacial pain, so that early and accurate diagnosis can be made and appropriate treatment instituted.
The study aimed to assess patient satisfaction with their orthodontic treatment outcome and type of cases accepted for orthodontic treatment at the Faculty of Dentistry, University of Malaya (UM) and to audit the quality of treatment outcome. The standard set were 100% patient should be satisfied with their treatment outcome and less than 5% of the proportion of cases should fall in the “worse/no different’ category with a mean reduction of Peer Assessment Rating (PAR) score being greater than 70%. Records of cases that had completed orthodontic treatment were traced. Survey forms were sent to 150 patients that had met the inclusion and exclusion criteria. Their intact study models were assessed for the Index of Orthodontic Treatment Need (IOTN) and PAR. 21.3% responded to the survey, of which 59.4% had treatment involving fixed appliances and 37.6% had either removable or functional appliances or retainers. 93.8% respondents were satisfied with their dental alignment and 87.5% with the overall treatment results. For the dental health component of the IOTN, 63.3% had ‘definite need’ and 21.1% had ‘borderline need’ for treatment. For the aesthetic component of the IOTN, 24.2% had ‘definite need’ and 32.0% had‘borderline need’ for treatment. For the PAR, 8.0% had an outcome of “worst/no different”. The mean PAR reduction score was 75.3%. In conclusion, although majority were satisfied with their treatment results, there is still a need to improve on the standard of care to address the issues of the minority who were not satisfied with the treatment outcome.
Background: In an academic setting due to financial constrain, it is not uncommon during non-surgical procedures dental students and clinical supervisors wash their gloved hands with disinfectants in between patients or when touching on non-contaminated objects. Whether this practice could cause any deterioration of the glove and expose clinicians and patients to infectious micro-organisms was a concern.
Aim: The aim of this study was to investigate the effect of multiple washes of gloved hands with a disinfectant on the integrity of the gloves. Methods: Three brands of commonly used gloves in a dental school were tested for leaks after multiple washes with a disinfectant. Thirty pairs of each type of gloves were subjected to 0, 1, 5, 10, 20 and 30 washes with a disinfectant solution at a 5-minute interval between each wash. After each washing cycle, the gloves were filled with 1L of water and hanged for 2 minutes to observe any signs of water leaks.
Results: The results showed that the type of gloves and number of washes were significantly associated with the leakage rates (p<0.001). Washing of gloves for more than 5 times were at least 6 times higher to suffer from leakage (OR=6.23, 95% CI=2.14–18.08). Powdered gloves were almost 13 times higher to leak in all washes (OR=12.78, 95% CI= 4.40–37.14) and were almost 25 times more likely to leak when washed for more than 5 times (OR = 24.92, 95% CI = 5.79 – 107.21) when compared to the non-powdered gloves.
Conclusion: The practice of washing gloved hands with a disinfectant deteriorates the integrity of the gloves.
Key words: Cross infection, disinfectant, glove, leakage, micropores
In Malaysia, training to enter dental
nursing profession is only open to women. Ironically,
there are no such gender restrictions on training for
any other health related professions in Malaysia.
Aim: Therefore this study aims to assess the
perceptions of Malaysian Senior Dental Officers
(SDOs) towards the employability of male workers in
the dental nursing profession and to compare findings
from male and female SDOs. Methods: This cross
sectional study was carried out on all SDOs in
Ministry of Health, Malaysia, using a self-administered
questionnaire. Descriptive statistics and a chi square
test were used to address the study objectives. Results:
Of the 112 participants, 78 SDOs returned the
questionnaire, yielding a response rate of 70%. The
majority of SDOs had positive perceptions of the
employment of male dental nurses. It was indicated that
gender is an important indicator for workforce
development, and that the employment of both male
and female dental nurses would enhance productivity.
Almost 70% of SDOs perceived that the productivity
of oral health service would be enhanced by having
male and female dental nurses but 84.6% disagreed
that male dental nurses would be more productive than
female. Two thirds of SDOs disagreed that male dental
nurses would increase satisfaction among male
patients. About 64% of male SDOs disagreed that
dental nursing profession is associated with female
traits. There was no significant difference between
perceptions by male and female SDOs for any
statements. Conclusion: The majority of Malaysian
SDOs have positive perceptions towards the
employability of male dental nurses, and perceived
dental nursing as a suitable profession for both
genders. Training for the dental nursing profession
should therefore be made available for men.
Tooth transposition is a rare developmental anomaly
affecting less than 1% of the population. The
permanent maxillary canine and 1st premolar are the
most commonly affected teeth. Bilateral maxillary
canine-1st premolar transpositions are extremely rare
with only a handful of cases being reported in the
literature. We report one such case of bilateral
maxillary canine-1st premolar transposition in a 28
year old Malaysian female which was associated with
other dental anomalies.
To determine the amount of displacement of a structure
noticed on an image when the tube of a dental X-ray
machine was shifted vertically and horizontally. In
addition, various intraoral images were combined with
dental panoramic images to determine the location of
structures. Our research is based on the parallax
technique which requires manipulation of horizontal
and vertical angulations of the X-ray tube. A metal
object is positioned on the buccal and palatal side of
the maxilla on the canine area of a skull. The X-ray
tube is shifted incrementally to obtain images on
phosphor plates. Subsequently, panaromic and occlusal
images were taken to assist in localization of the metal
object. To obtain a clear image shift of 2-3mm using
the parallax method, there must be an adequate
horizontal tube shift of approximately 30-35 degrees.
When images were used in combination of dental
panoramic images, it was found that the buccally
placed structures can be accurately located with the
periapical or occlusal images. However, the
displacement of images in the palatally placed
structures in panoramic imaging is not fully
appreciated with the principle of parallax method. Tube
movement of 30-35 degrees horizontally is needed for
a 2-3 mm image shift. To successfully localize a buccal
structure, a combination of either periapical or occlusal
images with a dental panoramic imaging can be
employed. However, this combination with panoramic
imaging is limited when looking at palatally placed
structures.
Background: MDM2 and p53 are involved in a negative feedback loop where p53 regulates MDM2 at the transcriptional level. MDM2, in turn, downregulates p53. This co-ordinated interaction between these proteins is set to play an important role in the regulation of cell cycle progression following DNA damage to cells. The over-expression of both p53 and MDM2 has been reported in various cancers. However there are only few studies discussing the co-expression of MDM2 with p53 in oral squamous cell carcinoma Aim: The purpose of this study was to determine the correlation of co-expression of p53, MDM2, and Ki-67 proteins with clinico-pathological factors in oral squamous cell carcinoma (OSCC) and to conduct a systematic review of the co-expression of p53/MDM2.
Method: This is a retrospective descriptive study and a systematic review. Formalin-fixed paraffinembedded tissues from 45 OSCC cases were stained by immunohistochemistry (IHC) for p53, MDM2, and Ki-67 proteins.
Results: Immuno-reactivity for p53, MDM2, and Ki-67 was seen in 75.6%, 97.8%, and 62.2% cases of OSCC respectively. The co-expression of p53 and MDM2 (p53/MDM2) was detected in 97.1%, however there was no significant correlation between p53 and MDM2 expression. Notably, p53/MDM2 coexpression was significantly associated with tumour differentiation (p-value = 0.045). The Ki-67LI was not significantly associated with neither MDM2 nor p53/MDM2 co-expression (p-value = 0.268, 0.916 respectively).
Conclusion: The expression of MDM2 was not signif icantly associated with p53 expression suggesting that MDM2 expression is mediated by p53-independent pathways or mutated p53 could not induce the expression of MDM2 in this set of OSCCs. The only clinico-pathological parameter that correlates significantly with co-expression of p53/MDM2 is tumour differentiation where it is suggestive that the co-expression of these 2 proteins is indicative of aggressive tumour behavior.
Tobacco use is linked with many serious illnesses, such as cancer, cardiopulmonary diseases, as well as with many health problems. Every year, the use of tobacco products causes a heavy toll of deaths and severe human disease worldwide. One of the many health problems linked to tobacco use is its detrimental impact on oral health. Tobacco causes a whole series of oral health problems, ranging from life-threatening (precancerous changes leading to oral cancer) and serious (periodontal disease, teeth decay) to social (bad breath). Tobacco is consumed through the mouth in a variety of forms, varied from smoked tobacco to smokeless tobacco chewing on itself or combined with areca nut. All these forms of tobacco have damaging effects on the oral health. The most significant preventive measure to prevent the oral health problems caused by tobacco use is to stop using tobacco products. The risk of developing oral cancer drops rapidly when a smoker ceases tobacco use. After ten years of not using tobacco, an ex-smoker/user's risk of oral cancers is about the same as that for someone who has never smoked. To stop using tobacco products is not an easy task. Fortunately, there are a number of therapies available to assist in quitting of tobacco. It is important to remember that, while it will be difficult, ceasing to use tobacco has immediate health benefits, including increased life expectancy and reduced risk of tobacco related diseases and conditions.
Osteosarcoma is a primary malignant neoplasm of the bone. Osteosarcoma of the jaws especially those of maxilla is rare. The diagnosis of osteosarcomas is difficult and challenging. In this case report we highlight a rare case of osteosarcoma of the maxilla in a 29 year old male patient which was highly aggressive and was initially diagnosed as rhabdomyosarcoma. This case highlights the difficulty in diagnosing osteosarcoma merely from incisional biopsy specimens which may not be representative of the whole tumour. Limited clinical information at incisional biopsy also adds to the difficulty in arriving at the definitive diagnosis. We further discuss the treatment modalities followed in this case.
Tumours that occur in the oral cavity may contain granular cells as a component of their pathology. A more common granular cell lesion occurring in the head and neck region is the granular cell tumour (GCT) that usually arises in the tongue or the buccal mucosa. Granular cell tumours are very rare in the parotid gland with only 11 cases previously reported in the English literature. We report a case of a benign tumour involving the parotid gland of a young female patient. The case was diagnostically challenging due to the large proportion of granular cells masking the underlying pathology. Histopathological features and immunohistochemical analysis favoured a diagnosis of a benign GCT. The present report provides an insight into the differential diagnosis and attempts to characterise the granular cells with the use of the wellestablished immunohistochemical markers and conventional histopathological techniques.
The aim of this study was to assess the wear of tungsten carbide burs and round rotary diamond instruments through measurements of rake angle and visual observations respectively under a field emission scanning electron microscope. Sixty short and long head pear-shaped tungsten carbide burs and 18 round rotary diamond instruments that had been used to complete < 5, > 5 and > 10 cavity preparations (n=10/group) were selected from the 3rd and 4th year dental students, Faculty of Dentistry, University of Malaya. There were two control groups consisting of long and short tungsten carbide burs of ten each. Two-way ANOVA was used to analyse the rake angle data. The data from the two control groups were collectively analysed following multiple paired t-test (p>.05) which showed no significant difference between the two types of tungsten carbide bur (short and long head). The mean rake angle of the control group was significantly higher (p < .05) compared to the < 5, > 5 and > 10 cavity preparation groups. The rake angle of the > 10 cavity preparation group was significantly lower than the other two test groups (p < .05). Round rotary diamond instruments in the < 5 cavity preparation group showed intact diamond particles with distinct cutting facets comparable to the control group. However, diamonds instruments in the > 5 and > 10 cavity preparation groups showed blunt diamond particles. In conclusion, wear of tungsten carbide burs and round rotary diamond instruments were evident after repeated use. Wear was more pronounced when instruments were used to prepare more than ten cavities.
The aim of the present study is to determine the “community indicator” for dental caries among secondary school children within the Federal Territory of Kuala Lumpur (FTKL). School factors were investigated for their ability to be used as community indicators. The components encompassing school factors include: type of school, school’s examination performances at the Peperiksaan Menengah Rendah (PMR) level, in the subjects of Mathematics, Bahasa Melayu (Malay Language), Science and English, school’s socioeconomic circumstances and school’s material deprivation. The study design is ecological in nature where schools were the unit of analysis. It used aggregated data for caries experiences acquired from the Oral Health Management Information System and the school factors which were extracted from the schools’ database. The subjects involved in this study were all the (75) day type secondary schools in FTKL. However, only 55 schools had complete information both for the dental caries factor and the school factors which were available for analysis. The use of bivariate analysis suggested that the school mean DMFT was significantly associated with the schools’ performance in English (p= 0.02) and the schools’ socioeconomic code (p= 0.005). The schools’ performance in English and socioeconomic code were able to explain about 10 percent and 14 percent of the variation in the school mean DMFT respectively. The final model that included both variables together explained about 17 percent of the variation in school mean DMFT. As a conclusion, this study suggests that the schools’ performance in English at the PMR level and the schools’ socioeconomic code could be used as community indicator to identify secondary schools with higher caries level in FTKL. Nevertheless, further
improvement of the model is needed in order to create a more reliable indicator.
The widespread use of aesthetic fillings has highlighted their advantages and disadvantages. One
of the most troublesome features of earlier aesthetic materials was the difficulty of finishing the restoration surface to decrease adherence of food debris. The rougher the finished surface, the greater the possibility of bacterial accumulation and discolouration of restoration along the restoration margin with secondary caries formation. Aside from these clinical implications, patients are highly discerning and could detect roughness of 0.30 μm with their tongue. The aesthetic restoration should mimic the appearance of natural dentition and should have an enamel-like appearance. An increased demand for superior aesthetics from composite resin has increased the
demand for more eff icient and simple polishing techniques. The development of nanocomposites has given a new perspective to the polishing of composite resins. Nanocomposites claim the advantage of improved gloss, optical characteristics and reduced wear. To date, results of in vitro studies have been equivocal regarding the most efficient and effective polishing system. There is variation in the effects of different finishing and polishing instruments on the surface roughness due to great diversity in size, shape, composition and distribution of the filler particles of composite resins, type of resin and a wide variety of finishing and polishing instruments. This paper will
review the different factors that affect polishing techniques used in achieving the desired polish on
composite resin restorations.