Frequency of common pathologies associated with impacted mandibular third molars teeth

Teeth that fail to erupt within the dental arch due to any hindrance in its path of eruption wheth-er it is a soft tissue lesion or any bony lesion that is causing hindrance are called impacted teeth. Mandibular third molar tooth is usually the last tooth to erupt in the oral cavity. The pathological changes associated with the impacted 3rd molar are cystic changes which include Dentigerous cysts ,Odontogenic keratocyst and Calcifying Odontogenic cyst .Ameloblastoma ,Myxoma and Odontogenic fibroma are the commonest neoplasms .Soft tissue pathological changes are hyperplasia's ,inflam-mation and calcification are the common findings around the impacted 3rd molar teeth. The present study is a descriptive retrospective study conducted to evaluate the frequency of pathological changes associated with impacted 3rd molar. The most common age group amongst these patients was second and third decade of life .The male to female ratio of these patients was 1: 1.86. Age range was 17 to 50 years, mean age of 24.16 SD + 7.05.The present study will help to support the prophylactic removal of impacted 3rd molar as some of these pathological changes may be life threatening

Buccal fat pad in reconstruction of oral defects

An ablative surgical procedure in the oral cavity is curative for oral and maxillofacial pathologies, but simultaneously produces hard and soft tissue defects. These defects produce functional and psychological problems in the post operative period

The Objective of the present study was to evaluate the efficacy ofbuccalfatpad in reconstruction of intra-oral defects, elaborate the surgical technique used and also identify its post operative complications

A prospective study was conducted on patients with oral defects covered by Buccalfatpad between July 2008 and January 2016 in department of oral and maxillofacial surgery of Khyber College of Dentistry Peshawar. The variables of the study were, Age, gender, cause of surgery and location of intraoral defect. Patients were subsequently evaluated for signs of epithelialisation and Post operative complications

A total of 50 patients [33 males and 17 females] were recruited in the study. Male to female ratio of patients was 1.94: Land Mean age of 51.25 years SD + 12.94. The most common cause of intraoral defect was because of excisions of malignant tumors of oral mucosa and salivary glands. Maxilla was the most common site for the surgical defects observed. The epithelialisation process was completed in 3 weeks without any complications in 44 patients. However dehiscence of the graft was seen in 6 patients, yielding success rate of 88%. We also noted limited mouth opening in cases of retro molar area defects, but this problem was resolved with post operative physiotherapy

It was concluded that buccal fat pad is a convenient, feasible and quick method of reconstruction for sealing intraoral defects

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

Common factors delaying the diagnosis of oral cancer

Oral cancer is a serious health issue that has a universal occurrence. Cancer is the top cause of death in economically developed countries and the second most lethal entity in developing countries. Oral cancer has a five-year survival rate of 50% or less. This rate is much improved when lesions are diagnosed at an early stage of the disease [i.e. small and localized]. Detecting oral cancer at an early stage is believed to be the most effective means to reduce morbidity and duration of treatment. The objective of the study was to determine the frequency of common factors delaying the diagnosis of oral squamous cell carcinoma. A Descriptive, cross sectional study was carried out in Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar over a period of six months. Using structured proforma, data from 108 patients with delay in the diagnosis of oral squamous cell carcinoma were collected through history taking, clinical examination and histopathological confirmation. Delay in the diagnosis of squamous cell carcinoma was predominantly found in male patients with a male to female ratio of 3.15: 1. The mean age of the patient was 59.59. Most of the patients reporting with delay in the diagnosis were in the 6th decade of life [30.5%] followed by 5th decade [24.99%]. The most commonly involved site was mandibular left gingivolabial sulcus [22.2%]. Most of the patients with delay in diagnosis reported in stage IV [75%]. Patient delay was seen in 26.85% of the patients, with a professional delay of 14.81% of the patients. Both types of delay i.e patient and professional delay was seen in 58.33% of the patients. Amongst 108 patients a total delay in days of more than 200 days was seen in 39.82%, 25.92% of the patients had delay of more than 50 days. Delay in the diagnosis of squamous cell carcinoma was found more in males than females. Delay was most commonly seen in the 6th decade of life with most of the patients reporting in stage 4. Patient delay was 26.85%, professional delay in diagnosis was 14.81%. Both types of delay was seen in 58.33% of the patients and 39.82% of the patients reported with total delay of more than 200 days

Frequency and clinical presentation of oral submucous fibrosis

Oral submucous fibrosis [OSMF] is a chronic, precancerous condition of oral mucosa characterized by juxta-epithelial inflammatory reaction along with hyalinization of lamina propria. These alterations causes fibrosis and stiffness of oral mucosa leading to limited mouth opening and related problems.

To evaluate the frequency and clinical forms of Oral Submucous fibrosis

A retrospective study conducted on patients from Oral and Maxillofacial Surgery department of Dr. Ziauddin hospital Clifton, Kemari and North Nazimabad campus from 2009 till 2013. Patients with OSMF irrespective of age and gender were the inclusion criteria. The demographic information along with clinical presentation of patients was tabulated and analyzed by descriptive statistics

A total number of 70 patients with OSMF were evaluated. The most commonage group was 11-20 years in the study. There were 42 male and 28 female patients with male female ratio. The most common complaint of OSMF patients was burning sensation in oral cavity followed by limited mouth opening and dryness of mouth. The majority of patients presented with an advanced stage of disease with grade 3 interincisal distance

OSMF is becoming a disease of younger adults with a slight male predilection. The majority of patients presents with a progressive and advanced form of disease

Pattern of mandibular fractures resulting from fall

Fall is the third commonest cause of mandibular fracture throughout the world while in Pakistan and India it is considered to be the second most common cause. Mandible fracture resulting from fall is of great concern particularly in children because it has been found that in children majority of cases of joint fracture has resulted from fall, and found to have temporomandibular joint [TMJ] ankylosis. The purpose of this study was to evaluate the pattern of mandibular fractures resulting from fall. This will help in the prevention of subsequent complications particularly in children like TMJ ankylosis and aesthetic problems. This is a descriptive [cross sectional] study which was carried out on 60 patients presenting with mandibular fractures resulting from fall to the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa Province of Pakistan from 4th April 2009 to 3rd October 2009. Each patient was thoroughly examined both clinically and radiologically for the site of mandible fracture. The age, gender and site distribution of patients were determined. Majority of the fall injury patients presenting with mandibular fractures were in the 1st decade of life followed by 2nd and 6th decade. In the first three decades of life, males were predominantly involved while the 5th and 6th decade was dominated by female patients with overall male preponderance. The most common pattern of mandibular fracture resulting from fall was combination bony trauma [i.e., more than one mandibular fracture site] and the para-symphysis and condyle were the most frequent mandibular fracture sites both in combination and isolation

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

Characteristics of symphysis and parasymphysis mandibular fractures

This descriptive study was conducted to determine the most common site of mandible fractures. 200 patients with fracture mandible who reported to Department of Oral and Maxillofacial Surgery from April 2012 to September 2012 formed study group. Data concerning age, gender, mechanism of injury and site of fracture evaluated and recorded on specially designed proforma. Orthopentomogram [OPG] and where necessary postero- Anterior and right and left lateral oblique views of the mandible were used to diagnose the fracture site. Fracture mandible was predominantly common in males [84%] as compared to females [16%] with male to female ratio of 5.25:1. The age range was 2-65 years with mean age of 21.45 S.D +/- 12.59 years. The most common age group involved was 21-30 years [30%] and road traffic accident was the common mechanism of injury [57%] followed by fall [31.5%]. Parasymphysis was the most common site when mandible was fractures at a single site i.e., 43%, while parasymphysis and angle fracture combination was observed in 31%. The study revealed that majority of the patients were young adult males. The most common etiological fracture was road traffic accident and isolated parasymphysis was the most common fracture site

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

Extraction of wisdom teeth under general anesthesia- a study

The objective of the study is to highlight the indications, surgical procedure and complications of 3rd molar removal under General Anesthesia among patients reporting to Khyber College of Dentistry Peshawar. Impacted teeth are teeth that fail to erupt into their proper functional position in the dental arch. These often need extraction due to reasons like pericoronitis, caries of 3rd or 2nd molar, periodontal pocket on distal aspect of 2nd molar, cysts, tumors and pain of unexplained origin. This Retrospective descriptive study was carried out in Department of Oral and Maxillofacial Surgery at Khyber college of Dentistry Peshawar during the period from July 2007 to October 2012 on 121 patients from whom 484 teeth were extracted under general anesthesia. All patients included in the study were advised panoramic X-ray study and Pederson scale was used to find out difficulty of extraction. Out of 121 patients, 71 were male and 50 female with the male to female ratio of1.42:1. The age range of the patient was from 19 years to 41 years. Majority of the wisdom teeth were extracted in the third decade of life. Among males, out of a total of 282 mandibular third molars, 70 teeth were most difficult, 40 moderate while 32 belonged to mildly difficult category. Among female patients, 46 were mildly difficult. Complication rate in current study was 4.5% [22 patients]. These included lingual and ID nerve paresthesia, tuberosity fracture and dry socket. Extraction of all four third molars is a safe procedure to be carried out under general anesthesia and has a low rate of complication

Clinical efficacy of herbal coded formulation Ocucure for the improvement of presbyopia: a randomized comparative clinical trial

A progressively diminishing capacity of eye to visualize for close proximity increasing by age is known as presbyopia which is usually resulted due to loss of elasticity of crystalline lens. A clinical trial was conducted to evaluate the efficacy of coded herbal formulation "ocucure" [Test drug] for the treatment of presbyopia comparing with leutivit [Placebo]. One hundred and eleven patients suffering from presbyopia from both groups [Males: 63, mean age: 34 +/- 14 and females: 48, mean age: 33 +/- 13 year, range: 20-60] were enrolled in the trial and divided in to two groups according to treatment regimens. Ocucure [Test drug] 500mg two tablets and leutivit [Placebo] 250mg tablets twice daily were prescribed for 6-8 weeks. Presbyopia was improved in 17 patients [28.81%] out of 59 patients by the use of ocucure [Test drug], and in 6 patients [11.53%] out of 52 by the use of leutivit [Control drug]. Furthermore, there was a significant improvement in presbyopic associated clinical features as compared to leutivit. It is concluded that ocucure possesses a therapeutic value for the improvement of presbyopia and its associated symptoms as compared to leutivit

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

Odontogenic fascial space infections in pregnancy - a study

Odontogenic infections are the most prevalent disease worldwide. These infections presenting initially as, localized periapical and periodontal abscess then perforate the cortical bone and spread causing facial cellulitis. Odontogenic infections spread along tissue planes involving initially primary and then secondary facial spaces depending upon the tooth involved and muscle attachments. Infections are common in pregnancy due to hormonal changes and altered immunological activity aggravating response to plaque accumulation and caries resulting in serious life threatening condition, like ludwigs angina. The present study carried out on 28 pregnant patients with severe odontogenic infections reporting to oral and maxillofacial unit of Khyber College of Dentistry, Peshawar, Khyber Pakhthunkhawa province of Pakistan. The age range was from 17 to 40 years and mean age of 24.78 SD +/- 5.043. Odontogenic infections were most common in the last trimester [50%] followed by late second trimester [28.5%]. The most common tooth involved is mandibular wisdom tooth [53.5%] and submandibular space [28%] being the most frequently involved. Patients presented with trismus, facial swelling and dysphagia on examination. Most patients were treated with incision and drainage under local or general anaesthesia depending upon the fitness of the patient and extraction of the offending tooth and intravenous antibiotic coverage

Management of dry socket: a comparison of two treatment modalities

The objective of this study was to compare the effect of local application of chlorhexidine digluconate and combination of lodoform with Butylparaminobenzoate in the management of dry socket. A Quasi experimental study was carried out on a total of sixty diagnosed cases of dry socket. Patients were randomly distributed among two treatment groups [30 patients in each group] i.e. patients of group A were treated by local application of chlorhexidine digluconate gel and of group B by local treatment with combination of lodoform + Butylparaminobenzoate [Alvogyl]. Both the treatment groups were given the same systemic analgesic i.e., Ibuprofen 400mg TDS along with thorough irrigation of the socket. Patients were followed for five consecutive days by replacing dressing each day and findings were recorded in the pro forma. Out of the sixty patients, forty five were males and fifteen were females [3:1]. In group A there were 22 [73.33%] males and 8 [26.66%] females and in group B there were 23 [76.66%] males and 7 [23.33%] females. Mean age was 31.68 [11.23+S.D]. There was no significant effect of gender [P=0.766] and age [P=0.668] on both of the treatment groups respectively. All patients measured their pain subjectively as S3 i.e. severe pain on day 1 on visual analogue scale. There was a significant difference in pain control of the two treatment groups on 2nd, 3rd and 4th treatment day with P=0.000, P=0.000 and P = 0.02 respectively. Significant difference was noted for sensitivity on gentle probing the extraction socket between the results of two treatment groups on 3[rd] and 4[th] day i.e. p=0.000 for both days. lodoform and Butylparaminobenzoate [Alvogyl] had been the most successful combination in relieving patient's pain

Post traumatic sialocele: a case report and literature review

Sialocele is an acquired lesion due to extravasation of saliva into the subcutaneous tissues due to trauma or surgery in the glandular region. Sialocele typically develops 8 to 14 days. Ultrasound of neck can be helpful in diagnosis of facial swelling. A case of 25 year old male patient with progressive facial swelling in the sub mental region with history of fire arm injury, which was diagnosed as sialocele is being reported. Sialography can be helpful in the diagnosis, but can increase further pressure in sailocele. In this case, diagnosis was made on history, clinical examination, aspiration of contents and ultrasound. The objective of the study is to present a case of post traumatic sialocele developing after fire arm injury. A detailed description of the condition and its management along with literature review is presented

Associated injuries with facial trauma - a study

Objectives: the objectives of the study were to determine the incidence of associated injuries with maxillofacial fractures and to enlist the age and gender distribution of maxillofacial trauma and also to find out cause, bone most frequently affected with it

Material and methods: history was taken from patients affected with facial trauma along with 2 diagnostic radiographs. Age, gender, cause, type of injury and fractures elsewhere in the body were recorded. Study was carried out at Emergency Department of Liquate University Hospital Hyderabad in a period of 1 year i.e. from 1[st] January 2011 to 30 December 2011

Results: total of 680 patients was included in this study. Out of these males were predominantly affected [72%], mean age was found to be 36.4 years. Road traffic accident [RTA] was the most common cause of injury [51%] and mandible was the most common bone involved [51%]. Out of associated injuries tibia [12.35%] and ulna [11.23%] were most common injuries

Conclusion: our study showed a high frequency of trauma in males in 3[rd] decade of life. Road traffic accident [RTA] was the most common cause and mandible the most common bone affected. Tibia and ulna were common associated injuries with facial trauma

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

Awareness of oral cancer in undergraduate medical and dental students

Cancer is the most common cause of death in economically developed countries and the second most lethal entity in developing countries. Oral cancer is a serious health issue that has a universal occurrence. The aim of this study was to determine the awareness level of undergraduate medical and dental students regarding oral cancer by assessing their knowledge of etiology, risk factors and signs of oral cancer. A self-administered questionnaire comprising of 12 questions was distributed amongst a random sample of 50 students each from Khyber Medical College and Khyber College of Dentistry, Peshawar. The study was conducted during December 2011 academic year. The data was compiled and analyzed using SPSS version 17. Our study showed that dental students were more likely to identify tobacco and alcohol use as the main risk factors for oral cancer. When asked about the signs of oral cancer, a greater number of medical students than dental students were able to name leukoplakia and erythroplakia. With regards to treatment modalities of oral cancer, 96% of the dental students while 56% of medical students listed surgery, radiotherapy and chemotherapy. The present study shows better knowledge and awareness of oral cancer amongst final year BDS students as compared to final year MBBS students. A poor level of awareness in the next generation of general medical practitioners thus highlights the need for improving the education of undergraduate medical and dental students regarding oral cancer

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