Determination of radon concentration and heavy metals [Ni, Pb, Cd, As, Cr] in drinking and irrigated water sampled from Kulim, Malaysia

Background: the presence of heavy metals and radon in water are considered as a potential threat to public health. Modern day industrialization has led to increase pollutants in ecosystem whilst the main source of public radiation exposure, especially exposure from radon, is caused by portable water. This study aimed to estimate the health risk related to radon concentration and heavy metals in drinking and irrigated water

Materials and Methods: water samples, from different sources, were collected from Kulim, Malaysia and analyzed for radon and heavy metals using RAD7 and Atomic Absorption Spectrometry

Results: results showed that the maximum average value of radon concentration [16.06 +/- 1.7] Bq/l was found in well water used for drinking and irrigation. Minimum average value of radon concentration [2.65 +/- 0.33] Bq/l was found in tap water used for drinking purpose. From the measured radon concentrations, age dependent associated annual effective doses and contribution of radon in drinking water to indoor air was calculated which were found below the lower limit of recommended action level. Metal concentrations were found higher in stream and lake waters used for irrigation, compared to well and tap waters. The average daily intake of drinking water and health risk indices were found higher for infants and lower for children and adults

Conclusion: radon concentrations in well, stream and lake waters were found higher than EPA recommended level and lower than WHO action level while the annual effective doses and level of heavy metals in water reported in this study were found lower than recommended levels

Comparison of collum angle of maxillary central incisors in class ii div 1 and 2 malocclusions

The Collum angle or the cephalometric crown-root angulation of permanent maxillary central incisors is an angle formed between the long axes of the crown and root of upper central incisors. This study aimed to evaluate the Collum angle in patients with Class II division 1 and 2 malocclusions for identifying the nature of differences, if any. Out of a total of 565 lateral cephalograms available at Lahore Medical and Dental College Orthodontic department during 2013-2014, 60 satisfied the inclusion criteria and 30 each were selected for the two malocclusion groups. The Collum angle of the permanent maxillary central incisors differ significantly among Class II division 1 and 2 permanent maxillary central incisor and showed pronounced axial bending in division 2 incisors [10.03° +/- 4.37°] as compared to division 1 [3.65° +/- 3.79°]. The mean difference between both groups was 6.38° + 5.81°. This feature could possibly contribute to the development of a deep overbite in Class II division 2 malocclusion and also may limit the amount of root torque during fixed appliance therapy

Effect of acquired knowledge on the status of caries in dental undergraduate students

The aim of this research was to study the evolution of dental health of dental students during their academic training and to assess the extent to which the knowledge acquired was reflected in their own dental care. A cross sectional survey was carried out in a Dental College of Lahore. The sample was selected randomly choosing 40 students from each year with an age range between 18 and 24 years. The data for this study were collected using a pre-tested self- administered questionnaire and was considered mandatory for all participants to fill out. All participants were clinically examined. Their oral cavity was thoroughly checked for any ongoing disease process and a DMFT chart was filled accordingly. Data entry and analysis was done using the IBM SPSS version 20. Final sample size was 160 [Females: 75.6% / males: 24.4%]. The highest frequency of females and males was observed in 3rd year and 1st year respectively Frequency distribution and Chi-Square tests of significance were performed. High levels of DMF were not that evident. Almost 30% [48] students had .00 DMF and 23% [37] had 1.00 DMF [p<0.05]. Only a small number of students were found using non-fluoridated toothpaste [p< 0.01]. Chi-square Analysis revealed a significant relations between the year of study and DMFT of the students [p<0.05] along with Gender and age as well as year of study and age [p<0.01]

Etiological factors and patterns of presentation of radicular cyst :a study

Radicular cysts are the most common odontogenic cysts of inflammatory origin affecting the human jaws. Radicular cysts are usually asymptomatic but can result in slow growth tumefaction and involve many adjacent sound teeth endangering their vitality and prognosis. The objectives of this study were to enumerate and evaluate the etiological factors and the pattern of presentation of radicular cysts in a tertiary care centre in Pakistan. A total of 58 patients were included in this case series study after taking history, clinical examination, radiological findings, aspiration test and histological diagnosis of lesion by biopsy report. It was carried out at the Oral and Maxillofacial Surgery Department, Lahore Medical and Dental College, Lahore from April 2012 to August 2014. The patients in the study included 30 male [51.72%] and 28 female [48.28%]. Most cases were diagnosed in the second decade of life [50.00%] which declined in the later age groups. The most affected region was the anterior maxilla [65.52%, n=38], followed by anterior mandible [18.96%, n=11]. The main etiological factor was dental trauma followed by unrestored nonvital carious teeth. Radicular cyst is the most commonly occurring odontogenic cyst which affects the maxillofacial skeleton with varying frequency. A proper early screening of dental trauma can significantly reduce the incidence of some of these cystic lesions. In addition, patient education with regards to improved oral health and regular dental check ups is important for reducing the caries prevalence in the population

Self-reported confidence levels of dental graduates in performing clinical procedures

This survey was conducted to study the levels of confidence in performing basic dental procedures, reported by graduates of three different dental colleges of Lahore. A Sample of 180 students was surveyed through specially designed proformas, using five points Likert's Scale. A total response rate of 90.5% was achieved. The null hypothesis was that graduates from different institutions have equal levels of confidence. Analysis of variance was used to assess difference of scores among institutions. P value pf 0.05 was considered to be significant. Statistically significant differences among institutions were noted[p=2.44]. Students were most confident in simpler procedures in which they had had most clinical experience. They were least confident in more complex procedures in which they had the least clinical experience during third and final year of BDS. Increased clinical time in complex procedures may help in increasing graduating students' confidence procedures highlighted in this study

Effect of two triangular flap designs for removal of impacted third molar on maximal mouth opening

The aim of this study was to compare the effect of marginal flap and paramarginal flap designs on maximum mouth opening following surgical removal of impacted mandibular third molars. This comparative study consisted of sixty patients which were divided into two groups of thirty each and was carried out at Oral and Maxillofacial Department, Lahore Medical and Dental College, Lahore from June 2012 to October 2013. Maximum mouth opening was recorded preoperatively. A marginal flap was used in one randomly chosen half of the patient's sample, and a paramarginal flap was used in the other half. The effect of these flaps on maximum mouth opening was studied postoperatively. No significant difference was found between marginal and paramarginal flaps on maximum mouth opening at second and seventh days after surgical removal of impacted mandibular third molar [P>0.05]. Therefore, the decision to use a marginal flap or a paramarginal flap may be based on surgeon's preference

Outcome of management of mandibular third molar impaction by comparing two different flap designs

The aim of this study was to compare the outcome of management of mandibular third molar impaction in terms of wound healing and periodontal probing depth of the adjacent second molar in patients treated by marginal flap versus paramarginal flap. This quasi experimental study consisted of sixty patients divided into two groups of thirty each [ages 18 to 30 years], who required surgical removal of impacted mandibular third molars. Periodontal probing depth of the adjacent second molar was recorded preoperatively. A marginal flap was used in one randomly chosen half of the patient's sample, and a paramarginal flap was used in the other half. The influence of these flaps on wound healing and periodontal probing depth of the adjacent second molar was studied postoperatively. No wound dehiscence occurred with the use of marginal flap or the paramarginal flap at 1 and 2 weeks after surgery [P>0.05]. The buccal and distal probing depths of the adjacent second molar showed no significant difference between marginal flap and paramarginal flap before surgery and at 2 weeks and 4 weeks after surgery [P>0.05]. No significant difference was found with the use of paramarginal flap instead of traditional marginal flap in the removal of impacted mandibular third molar

Cesium-137 activity concentrations in soil and brick samples of Mirpur, Azad Kashmir; Pakistan

The aim of this study was to measure137Cs levels in soil and brick samples to set the baseline data and an indicator of fallout radioactivity for this part of the world. This study will help to probe, if there is any health threat posed by [137]Cs exposure to the residents of the area. Twenty five samples of soil and 6 samples of bricks were collected from different locations of Mirpur of Azad Kashmir. A P-type HPGe detector was used to measure gamma spectra of samples. Results showed that for soil samples activity concentration range from 0.076 +/- 0.071 to 2.94 +/- 0.17 Bq.Kg[-1] with average value of 1.39 +/- 0.17 Bq.Kg[-1]. Similarly activity concentration of [137]Cs in Brick samples range from 0.22 +/- 0.09 BqKg[-1] to 2.14 +/- 0.13 BqKg[-1] with average value of 0.73 +/- 0.10 Bq.Kg[-1]. For soil samples the average values of outdoor, indoor and annual effective dose were found to be 5.12 × 10[-5], 20.47 × 10[-5] and 25.58 × 10 [-5] mSv.y[-1] respectively. For brick samples specific activity of the [137]Cs range from 0.22 +/- 0.09 to 2.14 +/- 0.13 Bq Kg[-1]. The average values of outdoor, indoor and annual effective dose for brick samples were 2.71 × 10[-5], 10.52 × 10[-5] and 13.23 × 10[-5] mSv.y[-1]respectively. The results indicate that the measured values were extremely small when compared with the annual dose rate recommended by ICRP [1.0 mSv.y[-1]], as well as the annual external gamma radiation dose [0.48 mSv.y[-1]] received per head from the natural sources of radiation

Attitudes, practice and addiction towards water-pipe/ shisha smoking in Lahore city

This study was aimed at assessing the various factors associated with shisha smoking such as attitudes, practice and addiction among the adult population aged 15 - 44 years in Lahore city. A cross-sectional survey was held in Shisha bars, tobacco shops and Shisha cafes along with some major undergraduate colleges and Universities of Lahore in summer of 2013. All adults aged between 15 and 44 years of age who consumed Shisha were included in the sample. All other age groups and people not smoking were excluded. The data for this study were collected with the participants using an approved self- administered questionnaire. Data analysis was done using the IBM SPSS version 20. The final sample size was 300 [male 194 and female 106]. The largest group was of young adults aged 21-25 years. Out of all the participants, 65% of the sample was smoking shisha for over a year. It was noteworthy that encouragement for shisha smoking was brought on more by friends [61%] as compared to colleagues [9%] and the money spent on such activities was utilized from their own pocket money [70.3%]. It was also observed that 42.3% of the sample recognized water-pipe/shisha as being a stress reliever and 68.7% admitted it to be a status symbol. Hence, 77.7% of the sample smoked shisha in the company of friends with 11.3% claiming to be completely addicted to it. In addition, 72.3% of the participants of this study refused to quit water-pipe/shisha smoking. Significance was found in Pearson's correlation between gender and duration, expenditure and frequency of consumption, addiction and duration, status symbol and stress reliever, company and status symbol and addiction with duration and wanting to quit [p < 0.05]. A high significance was observed in age with duration, expenditures, company, stress reliever and status symbol [p < 0.01]. Frequency of consumption with addiction, and stress reliever [p < 0.01]; stress reliever with age [p < 0.01]; addiction with stress reliever and status symbol [p < 0.01]; wanting to quit with gender and duration [p < 0.01]; and lastly expenditures with encouragement, addiction, status symbol and stress reliever [p < 0.01] were also observed in 2-tailed significance of Pearson's correlation. This study concludes that shisha smoking is responsible for a lot of ill-effects in the oral cavity apart from the body itself. This habit should be minimized and the misconceptions related to it should be made clear to all young population to avoid further harm to their health

Ice-on-Eyes Test in the Diagnosis of Myasthenia Gravis.

Myasthenia gravis is the most frequent autoimmune neuromuscular transmission disorder with incidence of 2-20 patients per million. Its pathophysiology is autoimmune, with acetylcholine receptor auto antibodies damaging the post-synaptic fold at the muscle membrane. The diagnostic confirmation of myasthenia gravis is often challenging. Ice-oneyes test can be used to diagnose this disease for its simplicity, safety and cost-effectiveness. Here we report a case of myasthenia gravis in Enam Medical College Hospital, Savar, Dhaka where ice-on-eyes test was done with improvement of ptosis of the patient. Aim of this case report is to make aware our physicians to apply this simple bed side test instead of common traditional edrophonium (tensilon test) test for confirmation of the diagnosis of ocular myasthenia gravis.

Assessment of lung cancer risk due to indoor radon exposure in inhabitants of the state of Azad Kashmir; Pakistan

Several epidemiological studies conducted on underground miner's show that exposure to elevated levels of radioactive radon gas is expected to increase the risk of lung cancer. Relative risk of lung cancer is almost linear with radon exposure. Elevated concentrations of radon are not only reported within mines but also for closed indoor environment of general public houses. Measurements of radon play a serious role in scrutinizing public health and safety in homes. Indoor radon measurements were taken over a period of year, using CR-39 detectors. Measured indoor radon concentrations, was converted in to excess relative risk [ERR] factors by using the risk model reported in the Biological Effects of Ionizing Radiation [BEIR VI] report. ERR was calculated for age groups of 35 and 55 years. A careful selection of occupancy factor based on interviews with house occupants has been made. Using this local occupancy factor, average excess lung cancer risk for the age group of 35 and 54 y peoples was found to 0.51 +/- 0.03 and 0.42 +/- 0.03. Similarly average values of ERR for local occupancy factor with ages 35 and 55 years was found as 0.59 +/- 0.03 and 0.45 +/- 0.03. The overall average excess lung cancer risk for the studied area was 0.46 +/- 0.03. The study suggested that United State Environmental Protection Agency [US EPA] occupancy factor gave a higher excess lung cancer risk as compared with the local occupancy factor used for studied areas. The ERR due to indoor radon is within the standard limits and does not pose any serious threat to the occupants of the houses under investigation

Trends for choosing composites for posterior restorations by the dentists in Lahore

The aim of this study was to evaluate the attitudes of dental surgeons towards posterior composite restorations in terms of case selection and concerns. 100 questionnaires were randomly distributed to the dental surgeons working in hospitals and clinics in Lahore. The questionnaires were designed to elicit information regarding case selection criteria and main concerns while placing posterior composite restorations. 92 completed questionnaires were returned. 58 general dental practitioners and 34 specialists responded to the questionnaire. 81.5% of the dentists preferred composites for restoring only small defects. 46.5% selected composites for posterior restoration on patient demand. Conservation of tooth structure was the causq for placing 81.5%, esthetics for 67.4% and patient preference for placing 74% restoration by these dentists. 69.5% of the dentists reported to adopt methods to maintain isolation during composite placement, 60% showed concern about contact point generation and 32.6% adopted techniques to minimize polymerization shrinkage stresses. Differences in responses were not remarkable between general dentist group and specialist groups. Conservation of tooth structure and esthetics were the main reasons for selection of posterior composites. Posterior composite restorations were chosen mainly for small defects. Patient preference was given weightage for material selection

Oral health related quality of life [OHRQoL] in dental undergraduates

The objectives of this study were to assess the Oral Health-Related Quality of Life [OHRQoL] among students in a private Dental Undergraduate School in Lahore. A cross sectional study design was used. One hundred and twenty dental students of years 2 and 3 returned completed forms containing the 14 item Oral Health Impact Profile [OHIP-14]. Old and new batch students of both years were included giving a sum to four batches of students. Data analysis was done using IBM SPSS version 19. The results showed the perceived OHRQoL among students studying in two different stages [year 2 and 3] of the dental course. Age was found to be significant [P < 0.05] with the OHRQoL dimension of 'Physical pain: discomfort eating food' [p=0.043] and highly significant [P < 0.01] with the dimensions of 'Physical discomfort: poor diet' [p=0.007], 'Psychological Discomfort: Selfconsciousness'[p=0.004], 'Functional Limitation: worsened taste'[p=0.007], 'Handicap'[p=0.001] and 'Psychological disability: embarrassment'[p=0.001]. Gender was found to be significant with 'Psychological disability: embarrassment' [p=0.046] and 'Social disability: difficulty in doing job' [p=0.040] and was highly significant with 'Psychological Discomfort: Self-consciousness' [p=0.001], 'Functional Limitation: trouble pronouncing words' [p=0.002] and 'Social disability: irritability' [p=0.010]. Year of study showed high significance with Psychological discomfort: self-consciousness [p=0.002]. The results of this study underscored the relationship between the OHRQoL and age, gender and study year and their impact on OHRQoL among the dental student community. It is essential that students are enlightened with oral health problems and how to overcome them, so that subsequent years of study in a Dental School and the OHRQoL are least affected

Dental health awareness amongst school children aged 5-10 years in Lahore sample

An investigation was carried out to assess the dental health awareness amongst school children aged 5 to 10 years in the city of Lahore, Pakistan. This cross-sectional survey included nine different schools of Lahore City having a total sample size of573. The assessment of the children's level of awareness was done by clinical examination of their teeth followed by an interview. One dentist carried out all dental examinations. The examiner recorded caries incidence in all erupted teeth. Following the clinical examination, children participated in an interview using a questionnaire. The questionnaire included information about gender, age, family structure, and information regarding tooth brushing habits, routine, knowledge about brushing, amount of tooth paste used, who taught them about brushing and visits to the dentist. Data analysis was done using SPSS version 19.0 and included descriptive statistics which was frequency distribution and cross-tabulation. It was found that teachers had played a very little role in educating the children about tooth brushing and providing dental awareness [6.8%]. It was the parents, however, who brought about more dental awareness in their children and gave them the necessary knowledge about oral hygiene [36.1%] especially male children. This association was highly statistically significant [p= 0.001]. Majority of the children used half-length of toothpaste for tooth brushing and this frequency increased 2 in 8 year olds therefore reducing their decayed missing filled teeth index score to a 0.31 as compared to 9 year olds [0.71]. A statistically significant association was also seen between age and toothpaste size [p= 0.003]