Spindle-cell lipoma (SCL) of the oral cavity is very rare. There are only four such reported cases in the literature. A concise literature review of SCL and a case report of a SCL affecting the cheek and lip of a 23-year-old man is presented.
Long term evaluations of impacts of community
based health promotion programmes are not an easy or
straightforward task to do due to lack of validated and
reliable indices. Objective: To develop and test an index
to measure schoolchildren’s oral health knowledge,
attitudes, and behaviour as a result of a school-based health
promotion programme in Malaysia called the Doktor
Muda (Junior Doctor) Programme (DMP). Materials and
Methods: The index was developed in English based on
the DMP module and translated into Malay. The Malay
version was tested on 174, 11-12 year old schoolchildren.
Psychometric analysis of the index involved content and
face validity tests as well as factor analysis, internal and
test-retest reliability. Results: Factor analysis yielded 3
factors with groups of items viz. oral health knowledge
(OHK), oral health attitudes (OHA) and oral health
behaviour (OHB). The Cronbach’s alpha coefficients of the
three factors were 0.61, 0.73, and 0.64, respectively. The
Kappa coefficients were 0.70, 0.77 and 0.73, respectively
(intraclass correlation coefficients = 0.72, 0.70 and 0.78).
The final questionnaire comprised 33 items, namely; OHK
11 items, OHA 15 items, and OHB 7 items. Conclusion:
The Health Promotion Questionnaire Index (HPQI) to
measure the DMP impact on schoolchildren’s oral health
knowledge, attitudes, and behaviours was empirically
verified to be valid and reliable for use among 11-12 year
old Malaysian schoolchildren.
Water delivered through dental unit waterline system
(DUWS) is often reported contaminated with microbes
dislodged from biofilm that forms within the tubing
of a dental chair unit (DCU). ADM: The study aimed
at evaluating the sanitary level of DCU water from
a teaching dental clinic. Materials: The presence of
pathogenic bacteria which include total coliforms, faecal
coliforms, E. coli, faecal streptococci and P. aeruginosa
were determined using conventional microbiological
methods while PCR technique was used to identify other
microbial contaminants. Result: pH of DCU water was
found slightly acidic at pH 5.4-5.5 and the temperature
was 23°C. Pathogenic contaminants were absent but
the DCU water was highly loaded with Sphingomonas
rhizogenes (17.9%), Sphingomonas dokdonesis
(79.5%), Sphingomonas mucosissima (1.1%) and
Methylobacterium radiotolerans (1.5%). The high load of
microbes that exceeded 200 cfu/ml was of great concern
as it failed to meet recommendation set by the American
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.
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
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.
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.
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
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
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
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
In response to the introduction of an integrated dental education program at University of Malaya (UM) in 2011, a study was conducted to develop a caries risk assessment model (CRA) for use in non-surgical caries management for Year 3 and 4 students of the new integrated program. Methods: The CRA model was based on risk indicators used by dental students in the Preventive Dental Clinic (PDC). Patients aged 15 years and above who attended the PDC for the first time in year 2009 and 2010 were used as study sample. Four hundred and fourteen patient names were identified from the student PDC logbook. Of the 414, 359 dental records had complete data and included in the analysis. Data were analysed using SPSS version 17.0. Chi-square test was used for group comparison and associated factors for coronal caries were analysed using Multiple Logistic Regression (MLR). Results: The final model showed that adults, brushing teeth once daily, and not having dental prosthesis/appliance were 3.31 (CI=1.64-6.69), 2.53 (CI=1.19-5.40), and 2.25 (CI=1.25-4.10) more likely to develop coronal caries, respectively, than adolescents, brushing teeth at least twice a day, and having dental prosthesis/appliance. Conclusions: The results indicate that age group, toothbrushing frequency and dental prosthesis status are significant indicators for coronal caries among patients. Outcomes of the study contributed towards bridging the gap between cariology
and preventive modules in the new integrated dental program.
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.
The purpose of this study was to assess the tissue
response of Type 2 diabetic subjects towards non surgical
periodontal therapy as compared with matched, nondiabetic
subjects. This was a retrospective, comparative
study using periodontal case notes of 40 subjects attending
undergraduates’ periodontal clinics (20 diabetics, 20 nondiabetics),
who were selected based on the inclusion
and exclusion criteria. Response towards non surgical
periodontal therapy was assessed through three clinical
periodontal parameters, namely plaque score, gingivitis
score and number of periodontal pocket ≥5mm at the
baseline and after initial non surgical periodontal therapy.
Data obtained was then analyzed by SPSS Version 12.
Both diabetic and non-diabetic subjects showed significant
improvements (p-value = 0.021; 0.000; 0.001 and 0.010;
0.014; 0.001) in all three parameters after the therapy.
However, when comparison was made between the two
groups, there was no significant difference (p-value = 0.913;
0.892 and 0.903) in any of the parameters. Periodontal
conditions improved clinically in both diabetic and nondiabetic
subjects after non-surgical periodontal therapy.
Therefore, both groups responded similarly towards the
therapy and thus it can be postulated that well-controlled
diabetic status does not have a significant effect on the
outcome of periodontal therapy.
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
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.
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.
Conventional oral squamous cell carcinomas are readily
recognized histopathologically but the presence of
additional atypical features may be challenging from
a diagnostic point of view. We present a case of a welldifferentiated
oral squamous cell carcinoma with pseudoglandular
differentiation and discuss the possible differential
diagnoses on a histopathological basis. Accurate diagnosis
is imperative for timely and appropriate intervention and
denotes distinctive prognostic implications. The presence
of perivascular and perineural infiltrations as observed in
this case would indicate the need for further post-operative
therapeutic decision-making aimed at controlling local
spread as well as distant metastases
Background: The high prevalence and impacts of orofacial pain (OFP) have caused major sufferings to individuals and society. The purpose of the study was to investigate the problems and impacts of OFP among a group of Malaysian aborigines. The objectives were to determine (i) the prevalence, aetiology, duration, severity, types and persistence of OFP during the past 3 months preceding the study; (ii) its associated impact on daily performance; and (iii) the measures taken for pain relief.
Methods: This is a cross sectional study carried out in Kuala Lipis, Pahang involving 6 villages of Orang Asli Bateq and Semai. Study sample was chosen using convenient sampling including adults aged 16 years and above. Participants were invited for an interview using structured questionnaire followed by clinical examination. Data analysis was carried out using SPSS ver12.
Results: Response rate was low at 20% (n = 140). Over one-quarter (26.4%) of the sample experienced OFP in the previous 3 months. Toothache was found to be the main aetiology (83.3%) followed by gingival pain (18.9%), temporomandibular joint (10.8%) and facial pain (8.1%). Mean duration of pain was 9.8 days for toothache, 162.4 days for gingival pain, 7.3 days for TMJ and 5.7 days for facial pain. Of those who had OFP, over half rated the pain as moderate (37.8%) and severe (29.7%) and most of the pain was ‘intermittent’ in nature (81.1%). Over half (62.2%) admitted the pain had disappeared during the interview. In terms of pain relief, 56.8% of the sample used traditional medicine. The pain had impacted on the chewing ability (70.3%, p=0.01), ability to sleep at night (73.0%, p<0.001), levels of anxiety (70.3%), ability to perform daily chores (33.3%) and social life (35.1%) of the Orang Asli sample.
Conclusion: This study suggests the prevalence of OFP was high among the Orang Asli sample, which imposed considerable physical and psychological impacts on daily life.
Key words: orofacial pain; impacts; quality of life; Malaysian aborigines