Pattern and management of iatrogenic displacement of teeth in maxillofacial anatomical spaces

Iatrogenic displacement of teeth is a rare incidence in expert surgical hands but they are frequently encountered when a difficult surgical extraction of the tooth is attempted by inexperienced dental surgeons. The present study is aimed at knowing the frequency, pattern and the surgical technique of retrieval of such displaced teeth. This study comprised of 21 iatrogenically displaced teeth over a period of 9 years in two hospitals i.e., Sardar Begum Dental hospital and Khyber College of Dentistry and Hospital Peshawar. Iatrogenic displacement was predominantly common in males as compared to females with male to female ratio of 2.5:1; the most common age group of the patient was the third decade of life i.e., 38.06% with age ranging from 19 to 57 years and mean age of 32.381 SD +/- 10.195. Only two patients presented delayed, all the rest of the patients presented the very second day of their previous surgery. Eighteen patients were operated under general anesthesia while the rest of the three were managed under local anesthesia using lignocaine 2% with adrenaline. The surgical approaches used for retrieval were intra oral using three corner flap, extra oral, intra oral through the socket using 3 corner flap and Caldwell luc operation

Pattern and management of palatine bone fractures

The aim of this study was to determine pattern of palatal fractures, review management options and find out other injuries associated with it. This retrospective study was carried out in the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar over a period of three years. All the patients having maxillofacial injuries were evaluated for the presence of palatal fractures. Orthopantomogram [OPG] and Para Nasal sinus [PNS] views were advised to each patient. CT scan and 3D CT scan were advised in cases with pan facial trauma and comminuted fractures. All the data were entered in specially designed proforma. A diagnosis of palatal fracture was made after correlating clinical and radiographic signs. The pattern of palatal fractures was determined along with associated facial injuries. A total of 65 cases of palatal fractures were found in this study. Majority of patients [33.8%] were in the 3rd decade of life. Regarding the pattern of fracture, majority [65%] were sagittal fractures. Most of these fractures [54%] occurred with maxillary Le Fort fractures, regarding management, 9% of the cases were treated with open reduction while 81% were managed with closed reduction techniques. Palatal fracture is often overlooked and is a cause of post op malocclusion in trauma patients. Patients with palatal bone fractures were mostly males in their 3rd decade of life. Sagittal fractures were common and the Le Fort fractures were associated with it. Closed reduction was done in most of the cases of palatal bone fractures

Oral myiasis: a case series of 11 patients treated at Khyber College of Dentistry Hospital, Peshawar

In order to determine the clinical presentation and management f 11 patients suffering from Oral myiasis a descriptive case series study was carried out at Khyber College of Dentistry, Peshawar, from June 2008 to December 2011. 11 patients of Oral Myiasis reported over a time period of 5 years. Thorough history was taken from each patient followed by complete clinical examination, relevant radiographs were advised where necessary. Surgical debridement was carried out followed by larvae removal with the help of maggot oil. Two patients were advised systemic therapy with Ivermectin. Mean age of the patient at the time of presentation was 39.72 years SD + 21.5. Majority of patients were males [64%]. Anterior maxilla was found to be the predominant site. Head and neck malignancies were found to be the most common cause of Myiasis. Thus Oral myiasis is a rare but serious condition, involving necrotic and suppurative wounds in patients with deranged systemic conditions. Treatment includes cleaning, debridement, removal of larvae and systemic therapy with Ivermectin

Gap vs interpositional arthroplasty in the management of temporomandibular joint ankylosis

The objectives of the study were to evaluate the outcome of Gap arthroplasty and Interpositional arthroplasty in terms of mouth opening for management of TMJ ankylosis. This Quasi experimental study was carried out in Oral and Maxillofacial Surgical unit, Khyber College of Dentistry, Peshawar from May 2006 to August 2007. Sixty patients of TMJ ankylosis seeking treatment for the first time, irrespective of age and gender were included in the study. Thirty patients were treated by gap arthroplasty [group A], while thirty patients by disc interpositional arthroplasty [group B]. A postoperative jaw opening exercise regimen was followed and interincisal distance/ mouth opening was measured at each follow up visit. Both groups were evaluated for difference in mouth opening. Descriptive statistics and Independent samples T-test was applied with significance level at P < 0.05. After 6-months postoperative follow up, mean interincisal distance was 30.80 mm [+/- 3.17 mm] for group A, and 32.20 mm [+/- 4.14 mm] for group B. Difference between the two groups was not significant [p= 0.147]. Postoperative jaw opening exercises are crucial for lasting success

Professional hazards among dentists of the two public sector teaching hospitals of khyber pakhtunkhwa province of Pakistan

Professional Hazards are becoming an impending health problem in various specialties and dentists are no exception because of the nature of the stressful work they perform. A study was carried out among dental professionals working in two teaching hospitals, Khyber College of Dentistry, Peshawar and Ayub Medical College, Abbottabad, to find out prevalence of professional hazards including psychological, muscuoskeletal, biological and allergic problems. Questionnaires were distributed among 150 dentists having BDS degree and registered with Pakistan Medical and Dental Council [PMDC]. Questions pertaining to psychological, musculoskel-etal, biological and allergic hazards were included in the questionnaire. Data collected were analyzed using SPSS version 17. Out of 150, 113 questionnaires were returned. Among the dental professionals, 50% were dental graduates, 35% post graduate trainees and the rest were either Members or Fellows of the College of Physicians and Surgeons i.e., MCPS, FCPS respectively or MSc. Work experience was < 5 years among 61% of the dentists while only 9.7% had work experience of > 20 years. When asked about any current psychologically traumatic condition, 42% dentists answered with yes. For psychological stress, 18.6% stated it had negative influence on the working environment. Regarding various I musculoskeletal disorders, 33.6% of the dentists had no complaints, while 9.7% suffered from back ache, headache, knee ache, and neck pain. About the approach for treating maxillary teeth, 48.7% used direct approach [direct vision for dental procedures], while 45.1% treated patients using sitting posture. When inquired about frequency of needle stick injuries, 54% were pricked <5 time. Also 46.9% had eye splash from infected saliva and 43.4% had experienced glove puncture during surgical procedure < 5 times during their work. 82.3% dentists were immunized against Hepatitis B. Concerning allergic reactions, 17% suffered from latex allergy and 8% had allergy from acrylic resin, An increased prevalence of psychological and musculoskeletal problems were found among dentists. Majority of dentists came across eye splash, needle stick injury and glove puncture during-their practice. Rate of immunization was effective but use of universal precautions was found to be inadequate among them

Clinical presentation and management of naso-labial cysts case series

Nasolabial cysts are rare non-odontogenic cysts of soft tissues of the nasolabial fold. They are

Cross infection control

The objectives of this study were to assess the level of awareness about cross infection control among dentists and to find out what measures were being taken by dental staff to avoid cross infection and to know the reasons why standard precautionary measures could not be used to curb cross infection. Specially designed questionnaires were distributed among dental practitioners at two major dental hospitals, attached to Khyber College of Dentistry [KCD] and Sardar Begum Dental College [SBDC] and various private clinics throughout Peshawar, to evaluate the awareness about cross infection control and its application in a dental setting. The overall response rate was 100%. According to the present study 80.5% of the dental practitioners were immunized against Hepatitis B. The verbal history taking method is predominantly adopted by most of the practitioners in the region i.e., 76.5%. Most of the dental practitioners routinely screen their patients for Hepatitis B and C i.e., 83%. They were very well aware of the sterilization methods, 93.5% were of the opinion that autoclave was the best method for sterilization. Only 40.5% of them used sterile covering and 55% disinfected the working surfaces. Examination gloves were used by majority, even for examination purpose i.e., 94%, and 92% of them handled one patient with a single pair of gloves. Mask wearing for examination purpose was noted in 68% and the numbers of masks worn in a single day were one to two masks in 63.5% of the practitioners. With regards to autoclaving of handpieces, 47.5% of the dentists autoclaved them every day. Protective Eye shield wearing at the time of surgery was often neglected by the majority of practitioners i.e., 65%. Resource deficiency was considered to be the primary reason [38%] for not following standard precautions. It was concluded that the knowledge of the dental practitioners in the region was good and there was increased awareness as far as sterilization and cross infection was concerned but when it comes to practice, it is lacking. Various reasons for not practicing universal precautions were cost, resource deficiency and large number of patients

Awareness about oral cancer among non medical university students of Peshawar

The objective of the study was to determine the awareness level of university students, their attitude and habits of tobacco use amongst them. A self-administered questionnaire was used to collect data from a random sample of 236 students from 5 non-medical universities of Peshawar. The questionnaire included 12 questions pertaining to knowledge about oral cancer, its causative factors, key symptoms and habits of snuff dipping and smoking. In this study 64% students were males and 36% were females. Only 3% of students were familiar with the word oral cancer, 45% of students were aware that cigarette can cause oral cancer while 22% stated niswar as cause of oral cancer. 58% of students had no idea about signs of oral cancer. With regards to dental attendance 89% students said that they will visit a dentist when in trouble. 7% were in habit of snuff dipping and 19% were found to be smokers. This study revealed that the student population was unaware about oral cancer especially about its signs

Characteristics of skeletal class III malocclusion and its associated dento alveolar compensation

To determine the extent of contribution of the maxilla to the development of class III malocclusion and the associated dentoalveolar compensation in such patients. Pretreatment cephalometric radiographs of 45 patients were obtained from the records of Department of Orthodontics, Khyber College of Dentistry, Peshawar. Different landmarks namely Sella, Nasion, point A, point B, ANS, PNS, Gonion and Menton were identified and four angular measurements were recorded. Out of 45 patients, 24 were male and 21 female. It was found that 60% of patients had a prognathic mandible, 31% had a retrognathic maxilla, while in 9% of patients both maxilla and mandible were at fault. The dentoalveolar compensation was 93% in maxillary arch and 40% in mandibular arch. This study revealed that majority of class III patients suffered from mandibular protrusion and that maxillary incisors showed greater compensation as compared to mandibular incisors

in vivo study to evaluate the efficacy of electronic apex locators in the determination of working length

The aim of this study was to determine whether the performance of electronic apex locators can equal or outdo the radiographic technique and establish itself as a standard baseline entity for the determination of working length. One hundred and seventy five canals of 84 patients were included in this study at the Department of Operative Dentistry, Khyber College of Dentistry for the preparation phase of root canal treatment. The canals were dried and the Joypex 5 apex locator was used to record the working length. The patients were sent for aperiapical radiograph and radiographic working length was calculated. Both values were recorded on specially designed proforma; the difference was noted and subjected to statistical analysis using a Paired-samples T test with a critical p-value of<0.05. Out of 175 canals measured, the radiographic working length coincided with the electronic working length in 101 [60.0%] cases. In 31 cases [17.7%], the electronic working length was short by 0.5mm and in 24 cases [13.7%,] the electronic working length was over by 0.5mm. In 7 cases [4%,] the electronic working length was short by 1mm and over by 1mm in 4 cases [2.3%]. In 2 cases each, the apex locator underestimated the working length by 2 and 3mm [1.1% each]. Overall, the difference between the working lengths measured by the two methods was statistically insignificant [p=0.294]. The difference between the two working lengths obtained was not significant [b=0.294,]. The apex locator was able to locate the apical foramen to within +/- 0.5mm in 91. 1% of the cases. However its solo application for determining working length is discouraged and must be used in tandem with conventional radiography

Dental anxiety scale in exodontia patients

The objectives of the study were to determine the frequency of dental anxiety, its age, gender distribution and to find out the fear of local anesthesia amongst patients reporting for extraction to the Department of Oral and Maxillofacial Surgery Khyber College of Dentistry Peshawar. Questionnaires were constructed with questions directed at covering the necessary variables and using the International Dental Anxiety Scale to determine the anxiety level of the patients. The study was carried out in the Department of Oral and Maxillofacial Surgery Khyber College of Dentistry over a period of 4 months. A total of 200 patients were questioned in this study and out of these 27% were phobic. Severe anxiety was noted in 14.5% of patients, 19.5% were moderately anxious, 28% mildly anxious and 11% were not anxious at all. The ratio of phobic female patients was greater than males, 5.75:1. Our study showed high frequency of phobia. This highlights the need or implementation of integrated dental care to patients treatment. This will ensure patients comfort and will bring a positive increase in dental attendance of patients

frequency of caries in school going children of Peshawar

To determine the frequency of dental caries, the gender distribution, the most commonly involved deciduous and permanent tooth in dental caries and to evaluate tooth brushing habits in school going children of Peshawar. This descriptive study consisted of 1000 children aged between 6 to 14years old. The information was gathered by taking a detailed history and clinical examination of the students and noted in a structured questionnaire. Brief biodata and oral hygiene levels were recorded in descriptive form while the carious teeth were recorded in tabulated form. Data was analysed using SPSS 10. Out of a 1000 students, 642 [64.2%] had caries. The caries distribution was more in boys [54%] as compared to girls [46%], with male to female ratio 1:0.85. The highest prevalence of caries was found in 12 year old children [77%]. Highest numbers of caries were found in first molar in both primary [262] and permanent dentition [188]. Thirty eight percent children claimed to have brushed their teeth once daily and 11.5% did not brush their teeth at all. Our study showed that there is a lack of awareness of oral hygiene and its importance has not been emphasised enough to the school going children