The objective of this retrospective study was to investigate what percentage of the dental students in the University of Malaya has a tooth size discrepancy. The sample comprised 40 good quality pre-treatment study models with fully erupted and complete permanent dentitions from first molar to first molar, which were selected from the dental students of the University of Malaya. The mesiodistal diameter tooth sizes were randomly measured manually from first molar to first molar using digital calliper (Mitutoyu) accurate to 0.01 mm, and the Bolton analyses for anterior and overall ratios were calculated by scientific calculator. Reproducibility analysis for intra- and interexaminer calibrations was assessed by measuring 10 study models twice, a week apart. A paired sample t-test and the correlation coefficient were used to evaluate the systematic and random errors of the measurements using Statistical Package for Social Sciences (SPSS) version 12.0. The reproducibility of the intra and inter-examiners for the sum of upper and lower mesiodistal tooth size were high (average mean difference = 0.62, r = 0.82). This study found 47.5% of the samples had anterior, and about 10% had overall· tooth width ratios greater than 2 standard deviations from Bolton's mean. Large percentage of the dental students of the University of Malaya has tooth size discrepancies outside of Bolton 2 standard deviations. It would seem prudent to routinely perform the tooth size analysis and include the findings into orthodontic treatment planning.
Besides other indications, the spring cantilever bridge can solve the difficult clinical problem of providing diastema on either side of a pontic. Unlike the conventional bridges, it has a somewhat controversial design in that the anterior pontic is connected to its retainer on a posterior abutment by a relatively long flexible palatal bar. This paper presents a case report of a spring bridge which fractured due to metal fatigue after 30 years of continued service. Other studies reported a mean life span of 8-10 years for conventional bridges. The advantages of the spring cantilever bridge are also discussed.
Direct composite veneers can be used to mask tooth discolorations and/or to correct unaesthetic tooth forms and/or positions. However, these type of restorations are often regarded as one of the most challenging in aesthetic dentistry presumably due to the extent of natural tooth structure that must be recreated. This paper discusses easy application techniques and tips for Ceram.X Duo™, a nano ceramic composite restorative material. Its natural shading system allows the restoration of tooth with both dentine and enamel shade and transforms it into a final direct veneer restoration that mimics a natural tooth.
This article reviews the concept of Combination Syndrome and presents a clinical case of a patient with a modern variation to this clinical scenario': The clinical procedures involved in the provision of a maxillary complete denture against a mandibular implant-supported complete fixed prosthesis is described with some suggestions on how to optimise the treatment outcome for the patient.
The presence of macroglossia, a tendency towards poor cooperation and the inability to adapt to compl~te dental prostheses due to motor and mental deficiencies makes the oral rehabilitation of Down Syndrome patients difficult. This article reports on the use of mini implant supported overdenture to rehabilitate a Down Syndrome patient who had difficulty adapting to his new mandibular complete denture. The patient's ability to cooperate during treatment as well as the maintenance of an optimal oral hygiene practice enabled mini-implants to be inserted and maintained 20 months post insertion as evidenced by clinical and radiological findings. To the author's knowledge, this is the first reporting of a successful mini implant supported overdenture in a Down Syndrome patient.
Arrested root development of permanent te~th can occur due to local factors such as infection and trauma or general factors such as radiation and odontodysplasia. This case report presents a 11 tooth with arrested root development requiring endodontic treatment. Following obturation with MTA, a minor surgical procedure was performed to remove periapical pathologic tissue. The tooth had remained asymptomatic at the 6-month review and the case will be followed-up for at least 2 years to ensure complete healing.
According to the 3rd edition of the international
classification of headache disorders (ICHD3 2013),
Trigeminal Neuralgia (TN) is classified into two types:
1. Classical TN, purely paroxysmal 2. Classical TN
with concomitant persistent facial pain. In this article,
the authors describe a 47 year-old, male with unilateral,
severe, recurring, electric shock-like pain involving left
lower jaw, teeth and gingiva. Diagnosis of classical TN
of the left 3rd division of the trigeminal nerve was made.
The patient was treated with pharmacotherapeutic agents
but without relief. Magnetic resonance imaging (MRI)
of the brain showed medial vascular compression of left
trigeminal pontine root entry zone caused by superior
cerebellar artery. A microvascular decompression (MVD)
surgery was done at the left trigeminal pontine root entry
zone resulting in good relief of pain. This article highlights
the differential diagnoses to be considered with TN and
also emphasize the difference between the two types of
the TN according to ICDH3 (2013). It also highlights the
difference between classical TN purely paroxysmal with
and without vascular compression by imaging techniques
and their differing treatment modalities, which therefore
should be reflected in future ICDH classification.
There is significant amount of research done
on Oral Squamous cell carcinoma (OSCC). One research
technique is immunohistochemical (IHC) analysis using
whole sections. With little availability of OSCC tissues
high throughput analysis such as Tissue Microarray
(TMA) are capable of efficient analysis of small samples.
However, the results become questionable if the tumor
exhibits high degree of heterogeneity as TMA cores might
not accurately represent the whole section. Aim: The aim
of this study is to determine the optimal number of TMA
cores required to provide an accurate representation of
the whole section with IHC analysis in OSCC. Materials
and Methods: Twenty tissue samples stained with
anti-p53 antibody were scanned at 40x magnification.
Three to six virtual cores of size 0.6 mm, 1.0 mm and
1.5 mm were drawn on the scanned slides. H-scores
were obtained for both whole sections and cores using
NuclearQuant (3DHistech, Budapest, Hungary) software
after eliminating non-tumour cells and artifacts manually.
The correspondence between the cores and whole sections
were calculated using intra-class correlation and one
sample t-test. Results: Good correlation was obtained
with just a single core of 0.6mm (0.826). Subsequent
increase in core number and size resulted in improved
correlation coefficient and smaller confidence interval.
Conclusion: Three TMA cores of 0.6 mm would be the
most optimal, as not only was there very strong correlation
with the whole tissue section, the extra core will also be
able to act as confirmation if the results of the first 2 cores
are in doubt.
The study aimed to evaluate the quality of the hybrid
layer form by three different adhesive systems. Class V
cavities were prepared on the buccal surface of fourty
extracted human premolars. The prepared teeth were
randomly assigned into four groups according to the
adhesive system and application mode. The systems
were: Optibond S (OS, total-etch); Optibond Versa (OV,
two-bottles, self-etch); Single Bond Universal (SBU,
one-bottle, self-etch) and Single Bond Universal with
etchant (SBU + etchant). All cavities were restored with
composite (Filtek Z350XT). The samples were sectioned,
polished and pretreated to remove minerals, protein
and water prior to SEM evaluation. From the images,
thickness of the hybrid layers was measured. Present of
resin tags and adaptation failure were also recorded. The
data obtained were analyzed using ANOVA, Dunnett’s
T3, Kruskal-Wallis and Mann-Whitney tests. OS group
showed the highest average hybrid layer thickness (4.34
µm), followed by SBU + etchant (3.06 µm), OV (1.91 µm)
and SBU (0.95 µm). Both adhesive and cohesive failures
were observed in SBU group. Present of prominent resin
tags were seen in both OS and OV groups. In conclusion,
all the investigated adhesive systems were able to perform
distinguishable actions as shown in micro-morphological
alteration and hybrid layer thickness. Two-bottles, selfetch
adhesive (OV) was proven to produce negligible
adaptation failure compared to other adhesive systems in
the present study. Combined all-in-one adhesive (SBU)
was found to render a superior bonding performance in
total-etch mode comparing to self-etch mode.
The audit aimed to investigate the availability of
orthodontic instruments and materials at Faculty of
Dentistry, University of Malaya. The standard was set as
100% of instruments and materials should be available
when required for orthodontic treatment. The form
comprised of six sections, which listed the commonly
used instruments and materials involved in the procedures
of impression taking, fitting and removal of molar bands,
bonding and debonding of orthodontic brackets and
activation of orthodontic appliances. The fifth section listed
the less commonly used instruments and materials and a
part for the clinician to list down instruments that were
used but not listed in the form. Whilst the last section is for
the clinician to list down the instruments or materials that
were not available when requested. A total of 567 forms
were completed and it was found that 97.6% instruments
and 98.6% materials were available. Overall, 22 types of
instruments were temporary not available with frequency
mean of 2.1 (Minimum: 1; Maximum: 7) whilst 6 types of
materials were temporary not available with a frequency
mean of 2.3 (Minimum: 1; Maximum: 8). In conclusion,
majority of the instruments and materials required during
orthodontic clinical sessions were available. The check list
of frequently used orthodontic instruments and materials
from this audit could aid inventory and help future
management of the material and instruments.
The prevalence of oral mucosal lesions in elderly
population is 22.8% to 61.6%. Conventional oral
examination (COE) is usually carried out to detect oral
mucosal lesions (OML). However, new diagnostic aids
have been introduced to improve OML detection. This
study aimed to determine the utility of autofluorescence
(AF) imaging in detecting OML from normal oral mucosa
and its anatomic variation among institutionalised elderly
Malaysian when compared with COE. Fifty subjects
randomly selected from 9 nursing homes and COE and AF
imaging using VELscope Vx, (LED Dental, Vancouver,
British Columbia, Canada) were carried out. Sensitivity,
specificity, positive (PPV) and negative predictive value
(NPV) and accuracy of AF imaging were calculated.
From the study, fifteen subjects had normal oral mucosa,
15 anatomic variations and 36 lesions were identified.
The sensitivity and specificity of AF imaging were 100%
and 70% whereas the PPV and NPV were 80% and 100%
respectively. The accuracy of AF imaging was 86.37%
when compared to COE. In conclusion AF imaging was
able to detect OML and differentiate them from normal
oral mucosa. However it has limited usefulness in
differentiating between these lesions. This study however,
was able to detail the AF imaging profile of normal oral
mucosa, its normal variants and some common reactive or
infective lesions which can be used in future OML studies
as comparison to oral potentially malignant lesions.
Oral lichen planus (OLP) which belongs to the spectrum of LP, is a commonly encountered
oral mucosal problem among patients seeking treatment in the Oral Medicine clinic. Its counterpart, oral
lichenoid reaction (OLR), which resembled OLP clinically and microscopically, is often encountered in
these patients as well. Although the various clinical forms of OLP/OLR are well-recognized, the disease
pattern in regards to lesion-active and lesion-free periods in these patients remains poorly characterized.
Thus the aim of this study was to determine the clinical and demographic profile of those patients with
active OLP/OLR lesions and compare them with those patients who are clinically lesion-free.
Materials and methods: The study subjects comprised 20 patients who attended the Oral Medicine
Clinic at the Faculty of Dentistry, University of Malaya for follow-up appointments/management. They
were interviewed according to a pre-designed questionnaire, and clinical examination was carried out. All
these were conducted under the supervision of Oral Medicine specialists. OLP was diagnosed according
to the internationally accepted criteria.
Results: The cohort consisted of predominantly female (n=14; 70%) and Chinese (n=9; 45%) patients,
with an overall age range of 26-79 years (median, 56 years). Fifteen (75%) patients presented with
active OLP/OLR lesions and the remaining 5 (25%) were lesion-free. The lesion-active group comprised
3 (15%) males and 12 (60%) females whereas the lesion-free had 3 (15%) males and 2 (10%) females.
Reticular LP was the most common type (n=21/35; 60%) and the gingiva was the most prevalent site
(n=21/46; 45.65%). Social habits, medical histories and medications were not significantly different
between lesion-active and lesion-free OLP patients.
Conclusions: Findings suggest that demographic parameters, lifestyle and systemic diseases do not
appear to influence the disease pattern and lesion severity in OLP.
Oral health literacy (OHL) is important in empowering people to improve their general and oral health. Carers’ OHL may be associated with their ability to deliver good oral healthcare to their children. The aim of this pilot study was to assess the OHL among carers of special needs children. This is a descriptive cross-sectional study of carers in four Community-Based Rehabilitation Centre. Data were collected through a structured face-to-face interview of 40 carers. Oral Health Literacy Malay Version (OHLI-M) was measured using text passages and prompts with a total of 57 items. These items were used to assess comprehension and numerical ability of carers based on domains namely, accessing dental care, understand appointment and following medication instructions. The results showed that majority of the participants had ‘marginal’ and ‘adequate’ OHL level of 32.5% and 52.5%, respectively. Only four (10%) participants had ‘inadequate’ OHL level. The ‘reading comprehension’ and ‘numeracy’ sections’ mean scores were 37.54 (95% CI 35.7-39.4) and 38.17 (95% CI 34.8-41.6). The total OHL mean score was 75.7 (95% CI 71.2-80.2). In conclusion, majority of the carers of special needs children in this sample had moderate OHL. Such information is important to develop more appropriate intervention programmes for carers to match their OHL.
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.
The gram-positive, mesophilic and non-motile coccus Streptococcus gordonii is an important causative agent of infective endocarditis (IE). This pioneer species of dental plaque also causes bacteraemia in immune-supressed patients. In this study, we analysed the genome of a representative strain, Streptococcus gordonii SK12 that was originally isolated from the oral cavity. To gain a better understanding of the biology, virulence and phylogeny, of this potentially pathogenic organism, high-throughput Illumina HiSeq technology and different bioinformatics approaches were performed. Genome assembly of SK12 was performed using CLC Genomic Workbench 5.1.5 while RAST annotation revealed the key genomic features. The assembled draft genome of Streptococcus gordonii SK12 consists of 27 contigs, with a genome size of 2,145,851 bp and a G+C content of 40.63%. Phylogenetic inferences have confirmed that SK12 is closely related to the widely studied strain Streptococcus gordonii Challis. Interestingly, we predicted 118 potential virulence genes in SK12 genome which may contribute to bacterial pathogenicity in infective endocarditis. We also discovered an intact prophage which might be recently integrated into the SK12 genome. Examination of genes present in genomic islands revealed that this oral strain
might has potential to acquire new phenotypes/traits including strong defence system, bacitracin
resistance and collateral detergent sensitivity. This detailed analysis of S. gordonii SK12 further improves our understanding of the genetic make-up of S. gordonii as a whole and may help to elucidate how this species is able to transition between living as an oral commensal and potentially causing the lifethreatening condition infective endocarditis.
This study aims to identify the relationship between dietary intakes of β-carotene with risk of oral cancer.
Methods: A hospital-based, case-control study was conducted on 306 Malaysians who seek treatment at participating centres/hospitals. Subjects selected from the Malaysian Oral Cancer Data and Tissue Banking System (MOCDTBS) consisted of 153 cases and 153 controls that were matched for gender, age (±5 years) and ethnicity. Food consumption was measured using Food Frequency Questionnaire (FFQ). NutrieMart Version 2.0.0 software was used to estimate daily nutrient of each subject from the FFQ. Logistic Regression analysis was conducted to compute the odds ratio (OR) for intakes of β-carotene and oral cancer risk.
Results: Intake of β-carotene was found to be not associated with risk of oral cancer (OR 0.83, 95%CI: 0.42-1.66, p>0.05).
Conclusion: No significant association was found between dietary intakes of β-carotene with oral cancer risk in this study population.
This study was undertaken to explore the perception of Year IV and Year V University of Malaya dental
students on different domains related to the competency based test (CBT). Methodology: A questionnaire
was constructed and a survey conducted to explore the students’ perception on four domains related to
the competency test: 1) benefits, 2) readiness to take, 3) timing and 4) lecturers’ supervision. Results: In
general, majority of the students agreed that they benefited from the competency test and felt adequately
prepared for each test. Students’ agreeing on feeling confident to sit for each test ranged from 70.0%-
81.4% for Year IV and 45.1%-70.4% for Year V. Majority of Year IV and Year V students perceived that
the timing of each competency test was ‘just right’. There was a high response of ‘Strongly agree/agree’
to availability of patients for practice and assessment, self-confidence and amount and distribution of
clinical session as factors affecting when they take the CBT. Majority of Year IV students agreed that the
assessment of lecturers was consistent for each tests while Year V had a high percentage of ‘Neutral’
response. Students’ agreeing that there was feedback after the test was 52.9%-71.4% for Year IV and
31.0%-56.5% for Year V. ‘Strongly agree/agree’ response of 68.6%-75.0% for Year IV and 36.6%-52.1%
for Year V was recorded for the level of supervision being the same after passing the test. Conclusion:
Overall, majority of students gave positive perception towards CBT in relation to four main domains
explored in this reseThis study was undertaken to explore the perception of Year IV and Year V University of Malaya dental
students on different domains related to the competency based test (CBT). Methodology: A questionnaire
was constructed and a survey conducted to explore the students’ perception on four domains related to
the competency test: 1) benefits, 2) readiness to take, 3) timing and 4) lecturers’ supervision. Results: In
general, majority of the students agreed that they benefited from the competency test and felt adequately
prepared for each test. Students’ agreeing on feeling confident to sit for each test ranged from 70.0%-
81.4% for Year IV and 45.1%-70.4% for Year V. Majority of Year IV and Year V students perceived that
the timing of each competency test was ‘just right’. There was a high response of ‘Strongly agree/agree’
to availability of patients for practice and assessment, self-confidence and amount and distribution of
clinical session as factors affecting when they take the CBT. Majority of Year IV students agreed that the
assessment of lecturers was consistent for each tests while Year V had a high percentage of ‘Neutral’
response. Students’ agreeing that there was feedback after the test was 52.9%-71.4% for Year IV and
31.0%-56.5% for Year V. ‘Strongly agree/agree’ response of 68.6%-75.0% for Year IV and 36.6%-52.1%
for Year V was recorded for the level of supervision being the same after passing the test. Conclusion:
Overall, majority of students gave positive perception towards CBT in relation to four main domains
explored in this resarch.
This retrospective study aimed to determine the prevalence of temporomandibular disorder (TMD)
secondary to orthognathic surgery (OGS) in various types of dentofacial deformities, to access the
relationship of new onset of TMD in different types of OGS to pain-related TMD and intraarticular TMD,
and to evaluate the chronic facial pain, temporomandibular joint (TMJ) function, and masticatory efficiency
after OGS.
A total of 26 patients who were previously treated with OGS in University Malaya Medical Centre,
Kuala Lumpur from January 2005 to June 2015 agreed to participate. The subjects had either undergone
bilateral sagittal split ramus osteotomy (BSSRO) or bimaxillary osteotomy (BIMAX). All subjects were
assessed using Diagnostic Criteria for Temporomandibular Disorder (DC/TMD). Data collected from
patients’ records showed absence of TMD at presurgical stage. The present study showed 42.3% of 26
patients experienced TMD after OGS in various types of dentofacial deformities, 19.2 % of them presented
with post-operative facial pain, 30.8 % had limitation in mastication, 19.2 % experienced limitation in
mobility of the jaw, and 11.5% of them experienced limitation in verbal and emotional commences. In
conclusion, there was no association between prevalence of TMD secondary to OGS in either type
of dentofacial deformities or type of surgery involved. We also noted that the minority of the patients
suffered chronic facial pain and jaw function limitation after OGS.
To assess the oral health related quality of life
(OHQoL) of a selected population of Malaysian adults and to compare the OHQoL by periodontal status. Material & Methods: This cross-sectional study comprises a convenient sampling of fifty subjects from the Primary Care Unit, Faculty of Dentistry, University of Malaya. OHQoL was assessed using the Malaysian version of Oral Health Impact Profile-14 (OHIP-14). Basic periodontal examination (BPE) was performed on all subjects to determine their periodontal status. Descriptive statistics and bivariate analysis were performed.
Results: Psychological discomfort, physical pain and psychological disability domains were the most affected dimensions in this population. Subjects with income levels >RM2,500 had higher impacts on their OHQoL as compared to those from other income levels (p0.05).
Conclusion: Subjects with high income levels had high impacts on their OHQoL. Those with periodontitis experienced higher impacts on their OHQoL as compared to those who had a healthy periodontium or gingivitis and affected a wide range of domains of quality of life.