CWorhexidine gluconate, a dicationic bisbiguanide agent, contains anti-plaque properties. Most chlorhexidine gluconate mouth rinses presently available contain alcohol in varying concentrations. The role of alcohol in these mouth rinses is to act as a preservative and solvent although it may have deleterious effects on the oral epithelium on long term usage. Recently, an alcohol-free 0.12 % w/v chlorhexidine gluconate mouth rinse (Oradex®) has become available in Malaysia. This clinical study is aimed at determining the effects of this alcohol-free product compared to a placebo. A group of 60 meticulously screened subjects were assigned into two groups of 30 each. The first group started using the test product for 2 weeks followed by a washout period of 4 weeks. After this duration, this group used the placebo for a further 2 weeks. The 2nd group underwent similar protocol as the 1st except that this group started with the placebo. Measurements consisting of the following scores were recorded at baseline and after 2 weeks for each group: Plaque, Gingivitis: Papillary Bleeding, Stain and Calculus. Full mouth prophylaxis was carried out for all subjects after measurements at baseline as well as after the 2-week period. They were told to rinse with 15 ml of the designated mouth rinse twice daily for thirty seconds each after tooth brushing. The results of this study indicated that there was significant improvement in the plaque, gingival and papilla bleeding scores compared to the placebo. Stain and calculus scores were significantly increased for the test product when compared to the placebo. In conclusion, this study showed that alcohol-free 0.12 % w/v chlorhexidine gluconate mouth rinse is effective in reducing plaque and gingivitis but causes staining and calculus formation.
The purpose of this study is to assess the effectiveness of C02 laser in relieving symptoms associated with Oral lichen planus (aLP) and lichenoid lesions (aLL) and the event of healing. Six patients were selected for this study with 13 sites treated. Each lesion was ablated with C02 laser and the wound allowed to heal undisturbed. Prior to treatment, 4 patients had both unprovoked and provoked pain and 2 patients rated for provoked pain only. After laser ablation, five out of six patients treated recorded no pain / 0 pain score. One month post-laser, the treated area was almost the same colour as the surrounding normal mucosa and soft in texture in all but one patient in which there was some fibrosis and residual plaque-like patch. Weconclude that the use of C02 laser in the treatment of aLP and aLL shows positive results in relieving symptoms associated with these lesions.
Until today there are still a high percentage of oral microorganisms have not been identified due to inability to isolate using the cultural method. However, identification of uncultivable microorganisms associated with disease will permits clinicians for a more accurate diagnosis, treatment and preventive measures. Unculturable microorganisms are also involved in disease and may account for treatment failure since their susceptibility to antimicrobial agents would be unknown. Thus, the opportunity for a rational approach to the treatment of disease relies on the state of knowledge concerning its aetiology and pathogenesis. Recently developed molecular methods have made it possible to characterise mixed microflora in their entirety, including the substantial numbers of unculturable bacteria. The development of rapid molecular methods like PCR provides a reliable identification of unculturable microorganisms. This paper will review the current literature regarding the PCR techniques used to identify uncultivable oral microflora.
Mental nerve neuropathy is an important presenting complaint that may be encountered by dental surgeons in their daily practise. There are various pathological processes that could bring about this symptom, ranging. from simple dental cause to vague, life threatening diseases. We present three cases of mental paraesthesia of different aetiologies. A literature review on mental nerve neuropathy related to malignancies and infection is discussed. The importance of a thorough chair side history taking, clinical examination and relevant investigations are emphasised in a suggested clinical approach to obtaining the diagnosis of a numb chin.
Polishing of dental ceramics has become an increasingly important procedure in restorative dentistry as allceramic restorations, which require post-cementation occlusal adjustment, are gaining in popularity. There are numerous studies in both dental and ceramic literature on polishing of dental ceramics and the effects of polishing on their mechanical properties. However, lack of standardization in polishing parameters, precludes comparison among these studies. A clear understanding is lacking of the relative roles and interdependence of handpiece speed, abrasive characteristic, and polishing load. This paper will discuss the mechanism of polishing and review the literature on polishing and its effect on the mechanical properties of ceramic restorations.
The habit of chewing betel quid has been practised since ancient times. Although the world has gone through modernization, a significant proportion of people still practices this habit. Substantial evidence has shown that betel quid chewing is associated with the occurrence of oral cancer and precancerous lesions, which has a tremendous psychosocial impact on an individual's life. Thus it becomes significantly important to dentistry to look into this matter. Since betel quid chewing is one of the causes of oral cancer, effort in cha~ging this habit is essential. This article addresses this issue.
This paper attempts to review epidemiological studies of oral cancer and precancer in Malaysia. The defmitions of prevalence, incidence, risk habits and oral cancer and precancers were discussed to better understand' the different types of studies conducted, which would be important in making comparisons between studies. Currently, epidemiological data on oral cancer in Malaysia are sketchy. The only incidence data for oral cancer in Malaysia was reported by Hirayama in 1966, 35 years ago. He estimated that 3.1 new cases per 100,000 population were diagnosed for the year 1963. A number of histopathological data of oral and maxillofacial biopsies were reported. Oral cancer accounted for one-fifth of all oral biopsies. A national study on oral mucosal lesions in Malaysia carried out in 1993/4 reported that there was a variation seen in the occurrence of oral premalignancy among the ethnic groups. The Indians and the indigenous people of Sabah and Sarawak were identified as high risk groups for oral cancer and precancer. It was also observed that both of the ethnic groups chewed betel quid. In conclusion, the epidemiological studies have provided useful data, which may be used in planning for future oral health programmes and research towards enhancing Malaysia's on-going effort in preventing the occurrence of these diseases.
Twenty-one patients who underwent ablative surgery for head and neck cancer at Bristol Dental Hospital and School, England between the years 1996 and 2002 were enrolled in the study. A self-completed questionnaire based on Head and Neck Specific measures was addressed to the patients. The overall post-operative quality of life among these patients is acceptable. About half of the patients complained of moderate to severe difficulty in opening mouth wide (55%) and dry mouth (45%) and about one-third had major problems in swallowing solid food (36%), sleep disturbance (32%), trouble eating and enjoying meals (32%) and speech problems (32%). The study shows a tendency for the quality of life to improve steadily with increasing post-operative interval. It is hoped that the results will provide an insight into the patients' functional and psychological recovery, which will in turn help to facilitate the planning of appropriate strategies to improve their quality of life.
Simulated canals in clear resin blocks have been widely used in pre-clinical endodontic teaching. The artificial canal provides direct visualisation of procedures in root canal treatment. Stanuardised simulated root canals have been produced in the Faculty of Dentistry, University of Malaya for dental education and research. The canals are easy and inexpensive to construct. An outline of the method of construction of resin simulated canals is presented in this paper.
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.
Craniofacial superimposition methods are employed for the identification of unknown skulls or living persons. There are many such methods and of particular interest is that technique developed by Furue which is inexpensive to set-up. A study was undertaken to ascertain the validity of this technique and to correlate our findings with other researchers.
The controversy on malignant transformation of oral lichen planus has always intrigued researchers. We present a case of lichenoid lesion and squamous cell carcinoma of the tongue, occurring in a middle aged Indian lady. The diagnosis and timing of these lesions is discussed.
Most prosthetic joint infections originate from wound contamination or haematogenous seeding from distant sites of infection. Bacteraemia may follow dental treatment but there is little evidence of it related to prosthetic joint infection. Nevertheless, controversy continues with regards to the effect of dental treatment in patients with prosthetic joints. This article reviews current English literature regarding the use of antibiotic prophylaxis in the dental management of patients with prosthetic joints. Routine antibiotic prophylaxis is not recommended for every patient with prosthetic joints when receiving dental treatments. However, antibiotic prophylaxis may be prescribed for high-risk groups with predisposing factors to infection when undergoing dental treatment with high risk of bacteraemia.
This study is conducted to compare two resin luting cements (Rely XTMARC,3M and Compolute™ESPE) on their microleakage with one composite inlay system (Filtek™ Z250 Universal Restorative Materials, 3M). Thirty conventional inlays, Class II MOIDO cavity with gingival margin I mm above the cementoenamel junction, were prepared in premolar teeth. The composite inlays were fabricated directly on the prepared teeth using layering technique. Fifteen of the inlays were cemented with RelyTMX ARC and fifteen with Compolute™ (ESPE). The specimens were kept at 370 C for 10 days before thermocycling and immersed in methylene blue 2% solution for 24 hours. The teeth were sectioned mesio-distally. The site and degree of leakage of each section was scored using a visual scoring system under a stereomicroscope at a magnification of 1.5X. Results showed that there was no significant difference in'leakage extent (p>O.05), between Rely X™ARC and Compolute™. For both materials, leakage occurred most commonly within the enamel surface and between the cement-tooth interfaces. None of the leakage occurred between inlay - cement interface. There is no significant difference in the extent of leakage between Rely XTMARC compared to Compolute™.
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.
Proliferating Cell Nuclear Antigen (PCNA) is one of the several markers of cellular proliferation. Epithelial proliferations play a significant role in the behaviour of odontogenic lesions. The objective of this study was to describe and compare the distribution of PCNA expression within the epithelial linings of odontogenic cysts. A total of 49 cases of odontogenic cysts consisting of 18 radicular cysts, 16 dentigerous cysts, 15 odontogenic keratocysts (OKCs) was studied. All tissues were processed routinely prior to embedding in paraffin. PCNA immunohistochemical staining was performed on 4 !-tm thick deparaffinized sections mounted on sialinized slides using the peroxidase antiperoxidase method. The distributions of PCNA expression in the cysts linings were noted and comparison was made qualitatively and quantitatively. PCNA labelling index was used for the quantitative assessment. The results showed that PCNA staining was distributed in the basal and supra basal cells for radicular cysts, dentigerous cysts, and OKCs. PCNA labelling index was highest in OKC (22.33±4.07). The high PCNA labelling index in OKC is indicative of high proliferative activity thus supporting previous reports of OKC as the most aggressive type of odontogenic cysts.
Decalcified permanent teeth were sectioned and stained with Van Gieson and Gomori trichome dyes. Sections dyed with the Van Gieson dye did not produce any zones in dentine but with the Gomori trichome dye, four different zones of dentine were produced. Zone 1 begins at the predentine-dentine junction while zone 4 ends at the enamel - dentine junction. In zone 1, the intertubular dentine was stained clearly while in zone 3 intense staining of the peritubular dentine was observed. The result of this study supports the previous findings reported by other workers that the formation of intertubular dentine takes place in zone 1 while peritubular dentine occurs in zone 3.
Phosphophoryn, a higWyphosphorylated protein, is the most abundant protein among the non-collagenous protein of dentine. The staining of phosphophoryn can be done by using the silver colloid staining. In this paper, the staining effect of the silver colloid stain on both non-sclerotic and sclerotic dentine was investigated. Eight teeth from donors aged 14, 17, 22, 34, 55, 57, 60 and 65 were used for this experiment. The younger teeth were used to demonstrate normal root dentine while the older age teeth were used to demonstrate sclerotic root dentine at the apical region of the root. There was no staining of the normal root dentine as compared to sclerotic dentine when the silver colloid staining was used.
The ultrastructure of the odontoblast reflects the certain phases that the cell undergoes in their lifecycle. Ultrastructure studies of the odontoblasts have often been carried out using young teeth. In this study, teeth from an older individual have been used to study the odontoblasts from the crown and root area. The odontoblasts from the crown area retain their columnar shape while odontoblasts from the root area appeared to be flattened. The organelles present in the odontoblasts either from the crown or root area was observed to be reduced.
Oral cancer is the sixth most common malignancy in the world. Despite recent advances in cancer diagnoses and therapies, the five-year survival rate of oral cancer patients has remained at a dismal 50% in the last few decades. Oral cancer is of major concern in Southeast Asia primarily because of the prevalent oral habits namely betel quid chewing, smoking and alcohol consumption. This paper provides a brief overview on the various aetiological agents and risk factors implicated in the development of oral cancer.