Item analysis of multiple choice questions

Any academic course or program is incomplete without an assessment plan. Of late, MCQs have been widely used for assessment of medical and dental undergraduate students. Often enough, poorly constructed MCQs are used that do not fulfil the requirement of an assessment. Therefore, it is neces-sary that quality of MCQs be frequently evaluated. A quality assessment of MCQs is known as "item analysis". Item analysis allows identification of good-quality MCQs based on their Difficulty Index [DIF I/P], Discrimination Index [DI] and Distractor efficiency [DE]. The aim of this paper was to conduct an item analysis to evaluate the quality of MCQs being used to assess final year BDS students in the subject of Prosthodontics. An internal assessment for the subject of Prosthodontics was undertaken by fifty dental undergraduate students of final year in March 2018. The test consisted of 40 'one best type' MCQs, each with four options a - d. Post-validation of the test was done by item analysis. Data were analyzed using SPSS version 24. Majority [52.5%] MCQs were "too difficult" with a Diff Index less than 30%. About 67.5% MCQs had a poor discrimination index [DI < 0.2]. Of the 120 distractors, 62 [51.6%] were non-functional and only 5 MCQs had no non-functional distractors. It can be concluded that the items administered in this test need careful revision to improve their quality before using them in any future assessments

Antibacterial activities of Diospyros blancoi, Phoenix dactylifera and Morus nigra against dental caries causing pathogens: an in vitro study

The study was undertaken to determine the in-vitro antibacterial potential of Diospyrosblancoi, Phoenix dactylifera and Morusnigra leaf extracts in hexane, chloroform, methanol, ethyl-acetate and aqueous extracts against dental caries causing bacteria. Disc diffusion assay was used to determine the antibacterial efficacy; the extracts were further separated using Thin Layer Chromatography and the anti-biofilm activity of the extracts was also determined. The preliminary phytochemical screening of the extracts revealed the presences of flavonoids, saponins, alkaloids and tannins because of which the extracts showed strong antibacterial activity against the selected pathogens. The ethylacetate extracts showed maximum inhibitory effect on biofilm formation by S. mutans.96% inhibition was observed in methanol extract of Diospyrosblancoi, and 95% in ethyl acetate extract. The results evidenced that the plants inhibit the growth of oral bacteria responsible for dental caries with their abundance source of secondary metabolites and can be used as an alternative treatment for caries, thus minimizing the antibiotics used to treat the disease in local medicine

Psychological stress associated with aphthous ulcers and temporomandibular disorders

Objective: To assess the prevalence of stress as an etiological factor for aphthous ulcers and temporomandibular disorders

Study Design: Cross sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Dentistry Rawalpindi, from Oct 2015 to May 2016

Material and Methods: Two groups of patients were selected. Group I included 119 patients presenting with Aphthous Ulcers while group II had 64 subjects with complaints of temporomandibular disorders [TMDs]

After a thorough history, Hospital Anxiety and Depression Scale [HADS] was used to assess stress in the patients. A HADS-A score of 7 was taken as significant anxiety while a HADS-D score of 7 depicted significant depression

Both groups were then subjected to laboratory examinations. Serum cortisol levels were assessed for both groups while Serum Folate, Ferritin and Vitamin B12 level for group I only. Data were analyzed using SPSS version 21 to calculate descriptive statistics including mean and standard deviations as well as frequencies and percentages

Relationship between HADS score and serum cortisol levels was assessed using Pearson's correlation coefficient

A p-value<0.05 was considered significant

Results: For TMDs, 53 [82.8%] patients were found positive for stress while for aphthous ulcers, 61 [51.3%] were positive for stress. The correlation between HADS score and serum cortisol levels was found significant for both groups at a p=<0.001

Conclusions: Patients showed a high prevalence of stress as an etiological factor for aphthous ulcers and temporomandibular disorders in a local setting

Surgical correction of grade III hypertelorism

Orbital hypertelorism is an increased distance between the bony orbits and can be caused by frontonasal malformations, craniofacial clefts, frontoethmoidal encephaloceles, glial tumors or dermoid cysts of the root of the nose, and various syndromic or chromosomal disorders. We report a series of 7 cases of hypertelorism that were treated in our hospital. The underlying causes in our series were craniofacial clefts 0 to 14 (4 cases), craniofacial clefts 1 to 12 (1 case), and frontonasal encephalocele (2 cases), all congenital. Surgical techniques used to correct the deformity were box osteotomy and medial wall osteotomy with or without calvarial and rib grafts. A few of our cases were reoperations with specific challenges.

Platform-switching to preserve peri-implant bone: a meta-analysis

The objective of this meta-analysis was to determine the literature-based evidence if platform-switching has an effect in preventing marginal bone loss around prosthodontic implants following their functional loading in comparison to conventional platform-matching. A systematic literature search was performed on PubMed, Science Direct, Google Scholar for Literature from 1950 to January 2015, human randomized clinical trials [RCTs] and prospective clinical controlled cohort studies [PCCS] reporting marginal bone loss around platform-switched and matched implants. Six RCTs with a low risk of bias revealed a significantly less mean marginal bone loss [0.57 mm [CI 95% 0.30; 0.84]] around platform-switched implants in comparison to platform-matched implants [1.14 mm [CI 95% 0.69; 1.6, p < 0.001]]. The meta-analysis revealed a significantly less peri-implant marginal bone loss with platform-switched implants as compared to platform-matched implants. The qualitative analysis depicts a trend favouring the platform-switching technique over platform- matching technique to prevent marginal bone loss. However, owing to the heterogeneity of the included studies, their results necessitate cautious interpretation

Awareness about prosthodontic treatment for missing natural teeth among patients seen at afid

Loss of teeth significantly impairs oral functions and masticatory efficiency. Due to lack of awareness about importance of prosthodontic replacement, mostly patients do not seek treatment immediately after tooth loss. Patients with different educational and socioeconomic background may have different reasons for not replacing teeth after extraction such as financial issues, lack of time and lack of motivation. The objective of this study was to determine the awareness level about prosthodontic treatment for missing natural teeth among patients seen at prosthodontic department of AFID in Rawalpindi. The study was carried out on 137 subjects over a period of almost six months. Based on the criteria of awareness defined in methodology, 19 patients [13.9%] had low awareness level, 89 [65%] had medium awareness level and 29 [21.2%] had high level of awareness. There was significant association of awareness level with gender [p=0.009], education [p=0.00] and occupation [p=0.001]. It was concluded that patients visiting AFID have medium level of awareness about prosthodontic treatment options. Dentists were the most common source of information for the patients in terms of education about different treatment options available to replace the missing teeth

Ergonomic hazards to dental surgeons: a cross-sectional study

Ergonomics is the working condition which facilitates the performance of labor and promotes worker's welfare. Dentists all around the world have been challenged with issues related to the musculoskeletal system. Mostly musculo - skeletal problems start during the learning period of the dentist and then continue throughout his/her life, affecting spine, neck, shoulders, hands and other body parts. The aim of this study was to assess the awareness of graduate and postgraduate dental students about the role of ergonomics in dentistry and to evaluate the presence of any pain I discomfort during the last twelve months

A cross-sectional study was carried out on 120 dental graduate and postgraduate students working in Armed Forces Institute of Dentistry, Rawalpindi using the Standardized Nordic Musculoskeletal Questionnaire. All of the respondents endorsed the significance of maintaining an ideal posture during their clinical activities. However, 65% reported that they seldom assumed an ideal posture during work. About 70% of the participating dentists reported one or more episodes of musculoskeletal disorders over the last 12 months. The highest frequency was observed for lower back ache [65%] followed by neck pain [53.3%] and pain in wrist I hand [37.5%]. A positive correlation was found between the musculoskeletal disorders and the average working hours per week [P<0.05]

Mind the crown margins

Metal free ceramic restorations have increased in demand due to their superior esthetics and more resemblance to the natural teeth, more so now that metal-free biocompatible options are preferred. Although porcelain fused to metal crowns are also used owing to less tooth structure loss in their preparation, the metal portion shows through the marginal area giving a blue-gray, cyanotic appearance to the tissue. Margins are one of the most important components in the success of a ceramic restoration. ssential prerequisites for the clinical success of an all ceramic restoration includes good esthetics, a high resistance to fracture and perfect marginal fit. A poor marginal design or one that is not prepared well may be a source of plaque accumulation, other than being esthetically unpleasing. Different marginal designs have been proposed and the most acceptable ones for all-ceramic restorations are either the rounded shoulder or the large chamfer margin. A major part of the current literature and research done on this subject falls into two broad categories that are affected by the type of marginal finish line - marginal fit and fracture resistance

Bridging the gap. quality of communication between prosthodontists and lab technicians

This descriptive study was carried out at dental out-patient department of Liaquat medical University Hospital Hyderabad from January 2013 to December 2013. Thirty-five patients wearing auto polymerized [self-cured] fixed partial dentures provided by unqualified and qualified dental practitioners were assessed. Condition of oral health was evaluated on the basis of proper history and clinical examination. Prosthesis condition was also assessed. Oral health of underlying soft and hard tissues was carefully evaluated after removing the prosthesis with the help of slow speed hand piece without jeopardizing oral tissues. It was evident in this study that fixed partial dentures made from auto polymerized [self cure] acrylic resins had adversely affected the oral tissues compelling the patients to visit the qualified dentist for proper treatment of their problems

Aglossia: a rare case report and review

Aglossia is a rare malformation resulting in the partial development or complete absence of the tongue. It is commonly associated with craniofacial and limb defects [Oromandibular Limb Hypogenesis Syndrome].The etiology is unknown and various theories have been proposed for this. The objective of presenting the case report and literature review is to discuss the clinical presentation, causative factors and possible management strategies of this rare malformation

Comparison of local and imported osteosynthetic mandibular bone plates in terms of micro hardness in modified simulated body fluid at periodic intervals

To determine the micro hardness of novel Pakistani manufactured osteosynthetic titanium bone mini plates [MPP] and imported osteosynthetic titanium bone mini plates [MPG] in body like conditions. Descriptive study. This study was carried out at School of Chemical and Material Engineering, NUST from March to May 2013. Microvicker hardness tester was used for assessment of micro hardness of two types of plates. The hardness was checked before conditioning and after conditioning at [six different places] on interval of 1, 7, 14, 21, 28 and 40 days in modified simulated body fluid with ph 7.4 and temperature 37[degree]C. Result showed that hardness of MPG was higher than MPP and after conditioning in simulated body fluid at all time periods, hardness of both types of plates was increased. It can be concluded from this study that micro hardness of imported plates is more than local plates so recommendations should be sent to manufacturers of local industry of Pakistan to improve the hardness of local plates so that they can meet international standards

Fronto-orbital advancement and total calvarial remodelling for craniosynostosis

To describe the results of fronto-orbital advancement and remodelling for craniosynostosis in children. Case series. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to June 2012. All the patients with cranial suture synostosis operated were included in the study. Those patients who were lost to follow-up were excluded. Variables considered were age, gender, type of synostosis, intracranial pressure, and history of previous surgeries for the same problem. Outcome measures were studied in terms of improvement of skull measurements [anteroposterior and bicoronal], duration of surgery, hospital stay, blood transfusions, complications and parents satisfaction. A total of 36 patients were included in the study. Male to female ratio was 3:1. The age ranged from 5 to 54 months. Thirty two patients presented with non-syndromic and four with syndromic craniosynostosis. Fronto orbital advancement and total calvarial remodelling was done in 26 and 10 patients respectively. There was improvement in the skull measurements and the parents were satisfied in all cases with the skull shape. Complications occurred in 11.1% including chest and wound infection and one death. Fronto-orbital advancement and remodelling is an effective procedure for the correction of craniosynostosis, however, individual cases may require other procedures like total calvarial remodelling

Selection of Appropriate Artificial Maxillary Central Incisor Size Using Dimensions of Hard Palate

To determine the ratio between width of hamular notches and maxillary central incisors' width at cervical, incisal and contact points. Cross–sectional descriptive study. Department of Prosthodontics, Armed Forces Institute of Dentistry, Rawalpindi from Feb 2010 to Aug 2010. Impressions of the maxillary jaw of 125 subjects were made and casts were obtained. A precise caliper was used to make the measurement ofthe widths of the maxillary central incisors at three different levels; the incisal edge [IW], at the level of interdental contact points [ConW] and in the cervical region [CerW]. The hamular width [HW] was measured between the most mesial demarcation point of the left and the right hamular notches.The ratios between the hard palate width [HW] and maxillary central incisor widths at all the three levels [IW, ConW, CerW] were calculated.Data was analyzed using SPSS 16. Of the125 subjects, 52 [41.6%] were males and 73 [58.4%] were females while mean age of the subjects was 26.56 years. Ratios HW/CerW, HW/IW and HW/ConWwere calculated as 6.08+0.18mm, 5.9+0.17mm and 5.81+ 0.17mm. The HW can be used as a preliminary method for determining the width of the maxillary central incisor

Frequency of dementia in patients with Parkinson's disease in a tertiary care hospital in Lahore

Objective: the objective of the study is to determine the frequency of dementia in patients with Parkinson's disease

Material and Methods: a hundred patients of Parkinson's disease presenting to OPD between the ages of 40 and 100 years were enrolled in the study and dementia was assessed in these patients by performing mini-mental state examination

Results: mean age was 69.31+/-16.37years,. The age range was 40-100 years, but 68 [68 %] patients were more than 60 years of age. Out of the 100 patients, 66 [66%] were males and 34 [34 %] were females. Mean mini-mental state score at admission was 16.75+/-2, 7[24%] Patients were having mini-mental score of 5-10, 10 patients [34%] had mini-mental score 11-18, and 12 patients [41 %] had mini-mental score of 19-24 at presentation. Mean duration of disease was 11 +/-2.08 years. Out of total 100 patients, 29 [29%] patients had dementia, whereas 71 [71 %] did not have cognitive impairment

Conclusion: it is concluded from the study that dementia develops in considerable number of patients and is most commonly associated with late onset of disease and with longer duration of PD. Most of the patients had moderate dementia. Therefore, it is recommended that every patient with PD should be assessed for cognitive impairment so as to enable early detection of dementia and to halt the progression in such patients

Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle

The anterolateral thigh flap [ALTF] has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle