Evaluation of patient preparation and positioning errors on digital panoramic radiographs

Dental panoramic radiograph, in addition to clinical examination, is a valuable diagnostic tool for the dentist to obtain information. Quality of each radiograph is of supreme importance. Unsatisfactory quality of radiograph can lead to misinterpretation that may result in inadequate diagnosis and treatment plan. Good quality radiograph will avoid any further need of repeating radiograph, thus reducing any unnecessary exposure of ionizing radiation to the patient. The objective of this study was to determine the relative frequency of common preparation and positioning errors observed on dental panoramic radiographs and to assess quality of radiographs as well. Dental panoramic radiographs were obtained from pretreatment records of patient undergoing orthodontic treatment and each radiograph was assessed for preparation and positioning errors. A three point quality scale proposed by National Radiological Protection Board was used by the examiner to rate each radiograph as being excellent, diagnostically acceptable or diagnostically unacceptable. Out of 480 panoramic radiographs examined, 100 [21%] radiographs were free from any type of preparation or positioning error while 380 [79%] radiographs had some preparation or positioning errors. The most frequent preparation error observed was patient wearing nose pin [8.3%]. While the most common positioning error observed was patient's failure to position tongue against the palate [62.5%]. More than one positioning or preparation error was found in 41.6% of the faulty radiographic films. Only 21% of radiographs were rated excellent, 64.5% were diagnostically acceptable, and 14.5% were unacceptable. Quality of panoramic radiograph must be assessed regularly making sure that they are free of any preparation or positioning error. All dental professionals must identify patient preparation and positioning errors and must understand consequence of these errors on diagnostic yield of radiograph

Prevalence of malocclusion and its relation with crowding and spacing

Study was carried out to determine the prevalence of malocclusion and its relation with crowding and spacing in orthodontically referred patients in a Karachi sample. 1082 patients were examined [362 males and 720 females] over the period of three years. Malocclusion was categorized according to Angles classification. Study model of each subject was used to assess crowding and spacing in both maxillary and mandibular dentition. Chi Square test was used to find relationship of crowding and spacing with different categories of malocclusion. Class II division 1 was most prevalent type of malocclusion [32%]. Relation of maxillary and mandibular crowding or spacing with different categories of malocclusion was found to be statistically significant [p < 0.05]. Mild maxillary crowding, mild mandibular crowding and mild mandibular spacing were most common finding in all malocclusion categories. Except for Class III malocclusion category, where moderate maxillary spacing was more prevalent, mild maxillary spacing was most frequently observed in remaining categories. Class II was most prevalent category of malocclusion. Relationship of crowding and spacing with different malocclusion categories was statistically significant. These results do not necessarily reflect the trend of entire Pakistani population as study was conducted in southern Pakistani population

Anxiety levels in dental patients

The aims of the study were to describe the level of dental anxiety in a representative sample population. Experimental study.This study was conducted at the Fatima Jinnah Dental College, Karachi. The study was conducted 1[st] to 31[st] of March 2013. All patients coming to the dental OPD for different dental procedures during the month of March 2013 were included in the study. Study sample comprised of 213 patients 135 Females and 78 Males. The age of the patients ranged from 5 to 75 years. The study sample was divided into three groups: 1] 5-24 years 2] 25-39 years and 3] 40-75 years According to the performed dental procedures the sample was divided into two groups; 1] undergoing invasive procedures 2] undergoing non-invasive procedures Measurement of anxiety levels were recorded on the proforma using Norman Corah's anxiety scale data was entered on Microsoft Excel work sheet and was analyzed using SPSS 14. The results of this study showed women having higher DAS values as compared to men both in educated and non-educated strata regardless of the nature of the procedure being performed invasive or non-invasive. In the study 40% males and 25.5% females were relaxed when asked for their anxiety levels when visiting for a dental checkup and considered it as an enjoyable experience. 49.1% Males and 47.3% Females were relaxed waiting in the dental office. When asked regarding the noise of a drill 3.6% Males and 8.2% Females felt very anxious. For question relating to tooth cleaning and instrument preparation 5.5% Males and 8.2% Females were very anxious. This study has shown that educated individuals in both the genders have more anxiety as compared to uneducated individuals. Government funding should be directed towards awareness programs for population regarding dental treatments. Training of dental practitioners in patient counseling should be emphasized in the management of anxious patient

Comorbidities in patients requiring dental extraction

A cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery of Jinnah Medical and Dental College, Karachi [JMDC] to determine the frequency of comorbidities that may affect the dental extraction in patients older than 35 years of age. A total of 3986 patients visited the oral surgery OPD of JMDC during the period of December 2010 to October 2011. The history charts of 1867 patients aged 35 years and above were included in the study. The patient's medical and drug history was recorded on a predesigned Proforma to find out the frequency of different medical problems including hypertension, diabetes mellitus, hepatitis, anemia, gastrointestinal disorders, cardiac disorders, renal disorders and blood dyscrasias. From a total of 1,867 patients, 436 patients [23.4%] were having comorbidities. The age of patients ranged from 30 to 80 years with the mean age of 39.6 years. The majority of them [54%] were in the 4th to 6th decades of life. There were 898 male patients [48.1%] and 969 females [51.9%]. In this study, hypertension was the most prevalent comorbid accounting for [236/1867, 12.6%] patients, followed by diabetes mellitus [126/1867, 6.74%], peptic ulcer [48/1867, 2.57%] and ischemic heart disease [16/1867, 0.85%].It is very important for the attending clinicians to have an exact knowledge of the patient's medical condition, although the prevalence of patients having comorbidities was not very high, the dentist must bear in mind that some of these patients may have contraindications to certain surgical procedures and others may require special modifications in standard treatment protocols to provide safe and effective dental treatment in these groups of patients

Pattern of early loss of deciduous molars and a cross sectional study

A cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery of Fatima Jinnah Dental College, Karachi to find out the factors responsible for premature loss of deciduous molars in children aged three to nine years. All children aged 3 - 9 years visiting the Dental OPD of Fatima Jinnah Dental College Karachi for extraction of deciduous molars from Feb 2011 to Feb 2012 were included in the study. 256 children format the study group. The data were collected on a predesigned Proforma filled by a single operator. Parameters taken into consideration were age, sex, tooth brushing and reasons for extraction. In this study 176 were male and 80 female. Overall 368 deciduous molars were extracted, 237 deciduous molars were extracted in males and 131 in females. Among the investigated subjects, 17% of children reported no tooth-brushing. Caries was the commonest cause of premature loss of deciduous molars accounted for 96.1% followed by tooth fracture 2.3% and malocclusion 1.6%. The frequency of only one deciduous molar loss was 67.2%. Maximum deciduous molar loss 50.7% was observed in children aged 8 years. Most commonly extracted tooth was mandibular left first deciduous molar [37.7%]. Results of this study suggested that improper tooth-brushing dental caries and no-treatment of carious deciduous molars were major risk factors in its early loss

Maxillofacial trauma and associated brain injuries

The aim of this study is to find out the distribution of brain injuries in patients with craniofacial trauma. Retrospective study. This study was conducted at the Departments of Oral and Maxillofacial Surgery and Neurosurgery of Liaquat National Hospital from Jan. 2010 to Dec. 2010 History form and radiographs of 112 patients who visited the Departments of Oral and Maxillofacial Surgery and Neurosurgery of Liaquat National Hospital were reviewed. Mean age of the sample was 31.7 years [+/- 8.8], minimum 18 years and maximum 65 years. The most common cause of cranio-facial trauma was road traffic accidents accounting for 94.6% followed by gunshot 2.7% fall 1.8% and assault 0.9%. Young adult males were most frequently affected. The most common site of trauma was midface 49.5% followed by mandible 26.8%, orbit 16.1% and panfacial 8%.Brain injury was recorded in 37.8 % of patients. Contusion, concussion and direct trauma to the brain was most common in mid face fractures hemorrhage was most common in Panfacial fracture. Mean GCS score was 14.77 in Mandibular trauma, 13.17 in isolated orbital fractures 12.98 in Midface trauma and 9.18 in Panfacial trauma. There is a strong correlation noticed between the craniofacial trauma and brain injury in this study. Young adult males sustained most craniofacial fractures as a result of road traffic accidents. A clearer understanding of risk factors associated with road traffic accidents and strict implantation of road traffic safety measures should be emphasized to avoid serious complications. Education of oral and maxillofacial surgeons regarding brain injury and its significance in terms of neurological outcomes should be emphasized

Role of combining long buccal nerve block with inferior alveolar nerve block to improve success of local anesthesia for extraction of mandibular teeth

The aim of this study is to ascertain the role of combining long buccal nerve block with inferior alveolar nerve block in achieving local anesthesia for extraction of mandibular teeth. The study took place at two teaching hospitals simultaneously [Fatima Jinnah Dental College Hospital, Jinnah Medical and Dental College Hospital Karachi], from January 2011 to June 2011. A total of 300 patients were randomly assigned to 3 groups of 100 patients each. Lidocaine 2% with 1:100,000 epinephrine was used for all injections. Group 1: patients received an IAN block using 1 cartridge of L/A + 1 cartridge as Buccal infiltration. Group 2: patients received an IAN block using 2 cartridges of L/A + 1 cartridge as Buccal Infiltration. Group 3: patients received 1 cartridge as an IAN block and 1 cartridge as a long buccal nerve block. A visual analogue scale [VAS] was used to rate pain immediately post-operative while subjective discomfort experienced during the surgical procedure [rated as yes/no]. Data was also collected for patients who would require extra cartridge of IAN block to achieve complete anesthesia. Data was analyzed using SPSS 14.0. The success rates for groups 1 to 3 were 25.20%, 27.27% and 75.54% respectively. Group 3 had significantly better anesthesia compared with group 1 and group 2 [P <0.05]. Combining an IAN block and a long buccal nerve block provided more effective anesthesia in mandibular extraction

Immediate reconstruction with fibula free flap in patients with mandibular ameloblastoma

Management of ameloblastoma has been controversial because of the unique biologic behavior of this neoplasm as a slow-growing, locally invasive tumor with a high rate of recurrence. Recurrence rates of ameloblastoma are reportedly as high as 15% to 25% after radical treatment and 75% to 90% after conservative treatment. With the advancement of craniofacial surgical techniques, use of free flaps for mandibular reconstruction, and dental rehabilitation [such as osseointegration] the surgical management of mandibular Ameloblastoma has become more convincing. The aim of this article is to evaluate the clinical results of the patients with mandibular ameloblastoma who were treated with segmental mandibulectomy and immediate reconstruction with free flaps. Ten patients with primary ameloblastoma treated at Oral and Maxillofacial Surgery Department of Liaquat National Hospital from 2006 to 2010 were included. The average age of the patients was 36.3 years [range, 24-54 years]. Clinical information radiographs OPG [Orthopantomogram] and CT Scans were obtained. All the tumors were located in the posterior region of the mandible and confirmative diagnosis was made on histopathological examination of the biopsy specimen. We present 10 patients of mandibular ameloblastoma who had segmental mandibulectomy and immediate reconstruction with fibula free flap preformed. The average age of the patients was 36.3 years [range, 24-54 years]. There were 8 male and 2 female patients. All presented with the multilocular radiolucency in the posterior mandible. The patients were followed for a mean period of 22.4 months [range, 12-36 months]. All flaps survived. Recurrence was not detected during the mean follow-up period of 22.4 months. It was noted that all patients had remarkable changes in their function and esthetics after immediate reconstruction. We experienced that segmental mandibulec-tomy with safe borders and immediate reconstruction with fibula free-flap is an ideal reconstruction method for mandibular ameloblastoma

Pediatrics mandibular fractures: a study on the involvement of canine region

This study was conducted to compare the frequency of mandibular canine region fractures with fractures of other regions of mandible in patients with un-erupted canines at the Department of Oral and Maxillofacial Surgery, Abbasi Shaheed Hospital Karachi form January 2002 to March 2004. A Non Probability Convenience sample of all patients with age 6-12 years presenting with mandibular fracture were included. The sample was categorized into two groups: Age 6-9 years with un-erupted canines and Age 10-12 years with erupted canines. The fracture site parameter was categorized into two groups: Fractures in Canine Region and Fractures in other regions of the mandible. Total study sample was 76 subjects. Mean age of the subjects was calculated as 8.57 years [SD 1.94]. Male to Female ratio was 2.6:1. The most common cause of injury was recorded as fall 51.3% followed by road traffic accident 35.5%, assault and sports injuries accounted for 6.6%. The most common overall site of fracture was canine region 44.7%. In the age group [6-9 yrs] the fractures occurring in canine region were 51.3% and 15.8% in [9-12 years group]. Significant association was found to exist between the age groups [6-9 Years, 9-12 years] and fracture groups [canine region fractures, other region fractures] pvalue< 0.05. This study clearly demonstrates that mandibular fractures occur commonly in children in the region of un-erupted canines supporting the evidence of an area of weakness in the mandibular canine region, especially during the mixed dentition period

Causes of tooth extraction: three years follow-up of two teaching hospitals in Karachi

The objective of this study was to describe the causes on tooth extraction among the general population attending oral surgery outpatient department of two teaching hospitals in Karachi. Demographics of the public and private sector hospitals were compared. Prospective study of a cohort of adults [mean age 33.86 +/- 13.65] who had detailed extraction record and demographic data collected during the previous 3 years [2005 -2007]. The study was carried out at Oral Surgery Outpatient Department Fatima Jinnah Dental College Hospital and at Karachi Medical and Dental College. A total of 24580 subjects from KMDC and 21891 subjects from FJDC were included in the study. The main outcome measures were Chewing habits, education, brushing frequency and brushing timing in relation to tooth loss. The primary causes of dental extraction were dental caries 67.04% [31158], followed by periodontal causes 21.68% [10075] and impacted wisdom teeth 4.64% [2074]. Few extractions were performed in cases in which the patient needed a prosthetic solution 2.63% [1225] or orthodontic treatment 0.28% [130] or due to cosmetic concerns and discoloration 0.05% [26]. Dental carries came out to be the commonest cause of extraction. The results of this study demonstrated the need for policymakers in the country to consider oral health on priority so that people have awareness about the hazards thus leading to reduction of morbidity and tooth loss

Causes of zygomatic bone fracture reported at mayo hospital, Lahore

To assess the causes, incidence and demographics of zygomatic bane fractures managed at Mayo Hospital Lahore, Pakistan. This study was carried out at the Department of Oral and Maxillofacial Surgery King Edward Medical University/Mayo Hospital, Lahore. A total of 105 cases were studied. A detailed history and clinical examination was performed, and diagnosis confirmed by radiographs. A number of parameters, including the patient's age, gender, occupation, and cause of injury were assessed. In 105 patients majority were male, [M: F=3.5:1] with a peak incidence occurring in age group 21 to 30 years. Road Traffic Accident [RTA] was recorded as the most common cause with 54 patients [51.4%], followed by assault 27 patients [25.7%], fall 19 patients [18.1%] and sports 5 patients [4.8%]. The incidence of fracture as result of fall, sports and road traffic accident was almost equal on both sides of face, but those fracture from assault occurred more often on the left side 77.8%.of the face than the right side 22.2%.The findings of this study will help to provide a clearer understanding of the demographic patterns of zygomatic injuries and will assist health care providers as they plan and manage the treatment of traumatic maxillofacial injuries. Such epidemiological information can also be used to guide the future funding of public health programs geared toward prevention

Role of general health care providers in referring patients with odontogenic infection

To highlight the role of general health care providers in referring patients with odontogenic infection. This study was carried out at two teaching Dental Colleges simultaneously, the departments of Oral and Maxillofacial Surgery Hamdard University Dental Hospital, and Fatima Jinna 1 Dental College Hospital Karachi. A total of 108 cases were managed for clinically diagnosed fascial space infect from March 2004 to August 2006. From the total of 108, 76 patients were managed at Hamdard University w as 32 patients were managed at Fatima Jinnah Dental College Hospital respectively. The referral inform, I was extracted from the referral letter and patient interview [history and examination]. In cases where referral lettrs were not present the referral source was recorded as "self referral". The mean age of the sample was recorded as 26.7 years with minimum age .1d maximum age 63 years. In all, 64.8% patients were male and 35.2% patients were females with M:F ratio of 1.8:1. The referred cases accounted for 59.3% excluding the self referred cases. Most referrals were recorded from medi and surgical specialists [25%], followed by general medical practitioners [24.1%], and general dental practitioners [10.2%]. Self referrals accounted for 40.7% of the sample. Oro-facial infections occur in sites that lend themselves to early detection by most health-care providers and, to a certain extent also, by self-examination. These study findings raise the concern that lack of patient awareness and its associated inappropriate clinical management should be aimed at formulating referral guidelines for the GDP and the GMP to provide guidance for a detailed clinical examination of the oro-facial region, and to decide the need for urgent referral to the specialist Especially if severe fascial space infection is anticipated particularly in patients having compromised host defenses associated with poor oral health

Chemical constituents of flowers of saussurea sacra

From the flowers of Saussurea sacra three phenolic compounds p-hydroxy acetophenone, 3-methoxy kaempferol and acacetin-7-O-neo-hesperidoside have been isolated. Their structures were elucidated by chemical and physical data [IR, [1]H-NMR, [13]CNMR and mass spectra]

Efficacy of bupivacaine [with adrenaline 1: 200,000 for postoperative pain relief after the surgical removal of impacted third molars: a comparison with lidocaine with adrenaline 1: 80,000]

In a randomized, single-blind controlled study we compared the efficacy of 0.25% Bupivacaine [with adrenaline 1:200,000] [0.25% Marcaine, Cooke-Waite Labs] with 2% Lidocaine [with adrenaline 1:80,000] [2% Xylocaine, Astra] for postoperative pain relief in 53 patients having day care surgery under general anaesthesia for the removal of impacted mandibular third molars. PATIENTS AND METHODS: Patients were randomly allocated to receive 3 ml of 2% Lidocaine with 1:80,000 adrenaline on one side and 3 ml of 0.25% Bupivacaine with 1:200,000 adrenaline on the opposing side. The patient's pain response was recorded at every 10min interval till 80 minutes, visual analog pain score was taken for every interval. The time at which the patient requested first dose of post-operative analgesia was recorded and whether it was for the right side, left side or both sides was also noted. In total, 6 [11.3%] of patients demonstrated lidocaine as more effective, 34 [64.2%] of patients demonstrated Bupivacaine as more effective and 13 [24.5%] of patients were not able to demonstrate any difference in effectiveness between the two local anaesthetic agents. The study also showed that patients given Bupivacaine had lower average visual analogue pain scores [VAS]. The side of the jaw given Bupivacaine reported complete pain relief for a much longer period of time when compared to lidocaine. Bupivacaine seems to be a suitable alternative local anaesthetic and analgesic to lidocaine [with adrenaline] for post operative pain control

referral source of oral cancer patients in local population: a preliminary report

To ascertain the sources of referral of oral cancer patients on presentation at the Department of Oral and Maxillofacial Surgery. 70 consecutively selected patients with positive biopsy report for oral malignancy over a period of 19 months. Main source of presentation was the medical and surgical specialists accounting for 37.1% of all referrals and primary physicians accounting for 30% of referrals. This study suggests that significant number of patients present to the maxillofacial surgical specialist in second and third presentation. It is therefore imperative that any attempt at educating in early detection and prevention of oral cancer must include not only GP's but also other medical and surgical specialties