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.
Currently many dental implant systems with varied and numerous components are available commercially, and with new implant systems and designs emerging, it is essential that the user understands that any system selected should be based on sound scientific principles and capable of osseoil!tegration. This has been defined in many different ways, with biomaterial, biological and biomechanical factors being the main considerations. The final restoration is based on both biological tissue and mechanical components. As the success of osseointegration is based on the clinical outcome, clinicians must ensure that the stresses that the superstructure, implant, and surrounding bone are subjected to are within the tolerable limits of the various components, even though the degree of tolerance has not yet been fully defined.
The paradental cyst is an odontogenic cyst occurring near to the cervical margin of the lateral aspect of a root as a consequence of an inflammatory process in a periodontal pocket. A distinct form of the paradental cyst occurs not infrequently on the buccal aspects of erupted mandibular third molar, where there is an associated history of pericoronitis. A search of the literature revealed that these cysts had all been reported in relation to partially, newly or fully erupted molars. This report presents one case in which the cyst was noticed to be associated with an unerupted third molar. The histological appearance of the cyst and the gross relationship to the cemento-enamel junction is similar to those typical of paradental cysts reported in the literature. However, the radiographic and clinical appearance of the tooth being unerupted do not tally with paradental cyst and yet exclude the diagnosis of dentigerous cyst. The diagnosis of dental follicular tissue was excluded based on the histopathological presentation. The authors suggested that this case may represent an early form of paradental cyst which in the past may have been dismissed as dental follicular residues and thus, the prevalence of paradental cyst may have been under reported in the literature.
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.
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.
The objective of this study was to determine the effect chewing of two differently sized commercially available meswak might have on flow rate and pH of whole saliva. Twenty subjects participated in this study. They were distributed into two groups (A and B). Subjects in both groups A and B were asked to first chew on either a sized #1 or #2 cotton roll followed by the chewing of an equivalent sized piece of meswak (approximately 5 mm. and 10 mm. diameter) respectively. For subjects in group A, no differences in mean flow rate was seen after both the chewing regimes. In group B however, the increase in mean flow rate after the chewing of meswak compared to cotton roll was statistically significant at p < 0.05. Statistically significant lower values for pH were registered after the chewing of meswak compared to cotton roll in both groups A and B at p
A cross-sectional study was conducted to ascertain the relationship between parental oral health perception on the importance of the deciduous dentition and the dental caries status of their preschool children. Clinical oral examination of the preschool children was performed and self-administered questionnaires were given to the parents to be completed. Four hundred and eight preschool children were examined and 390 of their parents responded to the self-administered questionnaire. Those parents who brought their children for regular dental check-up at least once a year; favoured restorative treatment and practised tooth brushing habit before bedtime were more likely to have children with significantly lower mean 'dft' as well as higher proportions of caries free mouth (> 50 %). Those children who started early in practising tooth brushing also had better dental caries status but the differences were not significant. However, there were no significant and appreciable differences in their mean 'dft' with respect to the frequencies of tooth brushing per day. It was concluded that parents with better oral health perception as reflected by those parents who (a) practiced regular dental check-up for their children; (b) favoured restorative treatment for their children's decayed deciduous teeth; (c) ensured their children brushed their teeth before bedtime are associated with better dental caries status of their preschool children.
The estimation of age of human foetal remains is of great medico-legal importance. When the remains are intact and fresh, various morphological features such as crown-heel length, weight, appearance of ossification centres particularly around the ankles and knees and other parameters could be used to make a reasonable estimation of the period of gestation. In cases of criminal abortion, infanticide and child murder the question of age of the foetus, viability, live birth and a separate existence become very important. In practice, often at the time of detection, the remains are decomposed or skeletonised. In such a situation the examination of developing teeth will provide a reliable answer pertaining to the foetal age, the possibility of a separate existence and even the period of survival after birth. The.age determination from dental examination is possible from approximately 10 weeks intrauterine up to old age. The presence of neonatal line (birth line) in both dentine and enamel indicates live birth and a separate existence. It is possible that the time period of survival can be estimated by measuring postnatal deposition of these hard tissues. An intact human foetus that has undergone mild to moderate putrefaction was studied. The study of the morphological features and the ossification centres suggested that its approximate age was around nine months intrauterine. It was not possible to decide whether it was a live birth and had a separate existence. The examination of the developing first deciduous molar of the mandible suggested the approximate age was around 30-32 weeks intrauterine. The importance of examination of developing teeth in foetal remains (including neonates), particularly associated with putrefaction or skeletonisation is emphasized.
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.
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 role of smoking as a contributory factor in the progression of the periodontal disease process has long been suspected and recently a large number of studies have been published in the dental literature regarding this possible role. Much of the literature has also indicated that smokers affected with periodontitis respond less favorably to periodontal treatment be it non-surgical, surgical and regenerative. This paper will review the current literature regarding the effects of smoking on various aspects of the periodontal disease process and present an explanation for the possible association between smoking and the progression of periodontitis.
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.
Formalin is a clear solution of 37% formaldehyde in water. It is used in dentistry as a disinfectant, antiseptic and mainly as tissue fixative for preserving biologic specimens for histopathologic examination. The human knowledge on systemic formaldehyde intoxication is inadequate as only few cases of formalin ingestion have been reported. This paper presents a brief communication of the adverse effect of formalin to the human tissue.
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.
The aim of the study was to determine the characteristics and pattern of the betel/tobacco quid chewing habit in the estate Indian community. The study was conducted in 6 randomly selected estates. It involved oral mucosal examination and an interview to solicit personal data as well as history and details of oral habits. Of a total of 618 subjects studied, 19.3 % (n= 119; 89 females and 30 males) were betel !tobacco quid chewers. The youngest age of onset of betel quid chewing is 10 years. The mean frequency of chewing quid is 4.3 times/day and the mean duration of chewing is 8.1 minutes. Initiation to the habit occur at a young age and a major role is played by family and friends in initiation to the habit. Practises of adding tobacco and lime appear to have adverse effects and are associated with higher occurrences of precancer lesions in this study (p
Side effects such as abrasion of the dental hard tissue have been frequently observed following the extensive use of mechanical cleansing. As promising antiseptics like chlorhexidine produces extrinsic dental staining on long term usage, there has been increasing interest and research generated towards chemically based stain removing agents. This invitro studyexamined whether some commercial oral hygiene products could inhibit chlorhexidine derived stain independent of any mechanical cleansing action. Perspex blocks were soaked in triplicate in chlorhexidine solution for 2 minutesand stain inhibition by these products was determined by further soaking the blocks in productl water slurries for 2 minutes and finally in tea solution for I hourly periods. The optical density (OD) of each specimen was determined at each hourly interval by spectrophotometry at 395 nm and the mean values obtained. At the end of the study, most of the products inhibited stain compared to water control and there was a variation in the stain inhibitingefficacyof the products. It is thus concluded that oral hygiene products like dentifricesand mouthrinses can inhibit chlorhexidine derived extrinsic dental stain to a variable degree through a chemical action by contained ingredients.
The Combined Cleft Clinic at the University Hospital, Kuala Lumpur was organised in 1992. The team consists of Plastic Surgeon, Orthodontists, Speech therapist, Ear, Nose and Throat Surgeon, Audiologist, medical officers and the nurses. We attend the clinic on a regular basis. Specialists from other medical and dental disciplines as well as the members of the Cleft Lip and Palate Association of Malaysia (CLAPAM) do occasionally participate in this set-up.The team members formulate treatment plans for each cleft patient, monitor the patient's growth and development and manage the patient at different stages according to the individual needs. To date, the idea of team approach and an establishment of a centre towards management of cleft patients seem to be the most ideal as the patients are benefiting total treatment and care from various specialists from only one place. The experience of University Hospital as a centre for cleft patients is discussed.
The mercury controversy related to dental amalgam is still continuing. In Malaysia, part of, this controversy has been attributed to a recently - introduced dental amalgam claimed to be non-mercury releasing and causing no mercury toxicity. The purpose of this study was to investigate whether this amalgam, Composil, was indeed non-mercury releasing. Six specimens each of Composil and a control (GS-80) were incubated at 3TC in deionised-distilled water. The daily mercury release was determined over a four-week study period using the stationary cold-vapour atomic absorption spectrometric method. The mean mercury release of Composil was 30.9 Ilg/cm2/ 24hr whilst that of GS-80 was 0.9 Ilg/cm2124hr and the difference was found to be highly significant (P < 0.00l). Results of this study therefore did not substantiate the manufacturer's claim. The release of mercury from amalgam restorations and their implications in clinical practice were also discussed.
The purpose of this study was to gather information on the oral hygiene behaviour among the visually impaired adolescents. Interview and observation methods were used to collect data. A total of 114 visually impaired adolescents were interviewed and 10 of the interviewees were selected for observation on the actual oral hygiene practices. The mean age of the sample was 16 years old. The sample comprised of 53.5% female, majority were Malays (86.8%) and most of them were from the lower income group. Fifty four percent of the sample had low vision and 45.6% were blind. All of the participants reported that they brushed their teeth daily and most of them brushed twice a day or more. Flossing (6.1%) was not common practice among this group. It was observed that they encountered some difficulties, especially when putting the toothpaste on the toothbrush and also the way that they brushed their teeth could cause detrimental effect to the oral cavity. Thus, they need to be taught on proper oral hygiene care so that they can practice safe oral hygiene care and maintain their own oral health.