assessment of dentists' knowledge about medical emergencies

Medical emergency when occurs in a dental environment should be handled efficiently and effectively in order to sustain life until medical help arrives. This study aimed to enhance knowledge amongst dental practitioners about the possible risks of a medical emergency to improve patient care. A questionnaire based study was conducted in the dental teaching hospitals of the twin cities, Rawalpindi and Islamabad in 2015. The questionnaire comprised of three sections to assess dentists' perception and dentists' knowledge on the commonly faced medical emergencies along with dentists' confidence in performing Basic Life Support [BLS]. 215 questionnaires were distributed out of which 192 were returned. The study sample included 122 female and 70 male dentists with a minimum clinical experience of one year. The results showed 71.4% received a formal BLS training while 84.4% wanted to receive thetraining. Moreover, the mean medical emergency score obtained was 5.28 out of a maximum of 10. 55.2% of the dental practitioners felt confident in performing Cardio Pulmonary Resuscitation [CPR], out of which, 80.5% had the correct knowledge of performing a CPR according to this study. The most significant finding was almost half of the dentists lack the knowledge and necessary training. Hence, in order to improve quality of patient care annual BLS courses should be made mandatory

Applicability of Tanaka and Johnston mixed dentition analysis in a contemproary Pakistani population

Mixed dentition analysis is carried out to predict the size of unerupted canine and premolar in the developing occlusion. The aim of this study was to assess the applicability of Tanaka and Johnston method of mixed dentition analysis in predicting the size of permanent canines and premolars in patients visiting Islamic International Dental Hospital, Islamabad. The sample consisted of 80 dental casts [40 male and 40 female], obtained from patients reporting at the department of orthodontics, Islamic International Dental College, Islamabad with the age range between 12 to 21 years. Mesiodistal tooth widths were measured with a digital vernier caliper. A paired student t test was used to compare the predicted and actual sum of the maxillary [PUCPM and AUCPM] and mandibular permanent Canines and Premolars [PLCM and ALCPM] for both genders combined and separately. Significant difference was found between PUCPM and AUCPM in maxilla for both male and female together [M + F: 0.000] and when both genders were compared separately [M: 0.032, F: 0.001]. Tanaka and Johnston method was only applicable in predicting the space for unerupted canine and premolars in mandible in both male and female sample

Bolton tooth size analysis of Pakistanis of 13 to 20 years in Islamabad city

Bolton introduced the anterior and overall ratios that must exist between maxillary and mandibular teeth so as to obtain optimum occlusion. This study was conducted for the purpose of establishing the mean Overall Ratio [OR] and Anterior Ratio [AR] of the Bolton Analysis and the presence of Tooth size discrepancy [TSD] outside 2SD of the Boltoris mean in an orthodontic population, irrespective of -the type of malocclusion. The sample comprised 180pre treatment study casts with fully erupted and complete permanent dentitions from first molar to first molar. Selected randomly from records of the orthodontic patients. The mesiodistal diameters of the teeth were measured at contact points using digital calipers and the Bolton's analysis was carried out. The prevalence of tooth size discrepancies [TSDs] outside of 2 Standard Deviation [SD] from Bolton's mean were 18.8% for the overall ratio and 51% for the anterior ratio. Bolton tooth-size discrepancy is found in large number of Pakistani orthodontic patients which may effect orthodontic treatment goals and outcome. Thus, our results o support that Bolton analysis should be mandatory for every orthodontic case before starting the treatment

Evaluation of secondary alveolar bone grafting procedures

The most common procedure followed globally for the bony repair of a cleft palate is by grafting the iliac crest in the defect. The objective of this study was to evaluate the success of the alveolar bone grafting procedures carried out at our institute by using the Berglands Index. A total of 12 patients were evaluated by taking periapical radiographs of the grafted site 6 months post surgery. It was found that 77% of the patients had a bone level of more than 3/4. It was also deduced that the success rate of the grafted bone was 100% when the bone was grafted before the eruption of the canine while success rate dropped to 40% in patients in which the procedure was performed after the eruption of the canine

Correlation among different profile planes used to evaluate lower lip position

The objective of this study was to correlate the soft tissue profile planes proposed by Rickett [Eline], Steiner [S-line], Burstone [B-line], and Holdaway [H-line] used to determine the lower lip position. Pretreatment cephalograms of 150 patients [age 16.2 +/- 4.1 years] were evaluated. Lower lip [labrale inferiorus] position was measured relative to Rickett's E-line, Steiner's S-line, Burstone's B-line and Holdaway's H-line. Pearson correlation was used to determine the degree of correlation between the lower lip positions determined by the four reference planes. All the pairs of variables showed statistically significant correlation [p<0.01]. Strong correlation was found between E-line and S-line [0.868], and between S-line and B-line [0.733]. Rest of the pairs showed moderate to weak correlations. H-line showed weak correlations with rest of the reference lines. This study found little difference in validity among Ricketts E-line, the Steiners S-line or Burstone's B-line. Holdaway's H-line may be used in conjunction with these reference planes

Frequency of cleft lip and palate and associated dental anomalies at Islamic international dental hospital, Islamabad

The purpose of this study was to determine the frequency of cleft lip and palate [CL and P] patients and their associated dental anomalies in orthodontics department. The data were retrieved from file records of orthodontics department at Islamic International Dental Hospital, Islamabad [IIDH]. All the cleft patients were included in this study who visited orthodontics department, IIDH during the year 2009. The records included history and examination, radiographs [lateral cephalogram, Orthopantamogram, Upper occlusal], Study casts, Photographs [intra oral and extra oral] of the patients. Sixteen patients [10 females, 6 males] were included, 43.8% had left unilateral CL and P and 56.3% had bilateral CL and P. 43.8% had bilateral impacted maxillary canine, 31.3 showed left while 12.5% showed right side impaction. 75% had erupted maxillary lateral incisor. 31.3% had palatal fistula. One patient had a supernumerary tooth. More anterior crowding [75%; n=12] was evident. Crossbites were evident in both anterior [56.3%; n=9] and posterior [68.8%; n=11] segments. Maxillary deciduous canine was retained in 75% of cases. Short lip was also a common finding [75%; n=12]. Associated dental anomalies are very common in patients with cleft lip and palate though frequency varies with the cleft type

Assessment of gender disparity in orthodontic treatment need among patients attending Islamic international dental hospital

The objective of this study was to compare the orthodontic treatment need among male and female patients attending Islamic International Dental Hospital, Islamabad [I.I.D.H]. Different studies had been conducted to determine the orthodontic treatment need in Pakistan but so far no individual study had been done to compare orthodontic treatment need on basis of gender. Index of Orthodontic Treatment Need [IOTN] was used on a sample of 200 patients [100 male, 100 female] at Islamic International Dental Hospital, Islamabad Pakistan, to evaluate the need for orthodontic treatment. Using SPSS version 10.0 data was analyzed. Result showed that 36% of female patients and 41% of male patients needed definite orthodontic treatment according to DHC whereas 12.5% of female patients and 23.5% of male patients were needed definite orthodontic treatment according to AC. Greater percentage of males was found in definite treatment need than females [p =0.005] according to AC whereas DHC showed insignificant difference among males and females for definite treatment need [p =0.133]

Accuracy of linear cephalometric measurements with scanned lateral cephalograms

Digital Cephalometry needs to be as accurate as conventional cephalometry in order to be taken as a standard of care in contemporary orthodontics. Objective of this study was to compare the accuracy of linear cephalometric measurements on scanned cephalograms with manual tracing as the gold standard. Cephalometric analysis of specified linear measurements was performed on cephalometric radiographs manually. Radiographs were subsequently scanned and the images were analyzed digitally with a computer software for the same measurements. Paired sample t tests were used for statistical significance [p<0.05]. Clinical significance was set as more than 2mm difference between the methods for any linear measurement. Cephalometric comparisons between original and digital images showed statistically significant differences for S-Go, N-Me and ANS-Me. None of the means of the difference between the two methods exceeded 2mm. Although some measurements showed statistically significant differences, the difference was regarded as clinically insignificant. Scanned cephalograms can be safely used for linear cephalometric analysis

shape and size of the sella turcica in skeletal class I, II and III in patients presenting at Islamic international dental hospital, Islamabad

One of the most commonly used cranial landmarks for cephalometric tracing is sella point. The morphology and size of sella turcica is of importance because within its center lies sella point which helps in evaluation of craniofacial morphology. The objective of this study was to measure and describe the size and shape of the sella turcica and find a correlation between males and females and the three different skeletal classes. Lateral cephalometric radiographs of a total of 180 patients above age 15 years were divided equally into class I, IIand III [60 patients in each group] and with equal representation of both genders [90 males and 90 females]. The sella turcica was carefully analyzed and measured in linear dimension of length, depth and diameter. In addition the shape was also described. A student t-test was used to calculate the linear dimension difference, while a One way analysis of variance was done to study the relationship between skeletal type and sella size. Sella turcica presented with normal morphology in the greater part of the subjects [66.7%]. No significant difference was found in linear dimensions between males and females. When skeletal type was compared to sella linear dimensions no significant difference was found in any of the three dimensions as in length, depth or diameter

Effect of orthodontic treatment on periodontal health

This study was undertaken to assess the effects of orthodontic treatment on the periodontal health of young patients. 50 patients were randomly selected irrespective of sex from the orthodontic department of Islamic International Dental Hospital, Islamabad. Periodontal examination was performed before, after six months and after 18 months of treatment. CPITN [community periodontal index for treatment need] was used to assess the periodontal health of indexed teeth. SPSS version 17 and Chi Square test was used to analyze and compare the data. The results showed that patients undergoing orthodontic treatment do show the signs of periodontal disease. Comparison of patients of pre ortho and intra ortho revealed a p value of 0.02 while p value of patients during and after orthodontic treatment suggested a strong relationship between progress of periodontal disease during orthodontic treatment. P value of 0.456 of pre and post ortho patients suggested that there is no direct relationship between the two. The knowledge, attitude and practice on gingival health among orthodontic patients were poor

Comparison of measurements from manual and photographed lateral cephalograms

To compare the accuracy of cephalometric measurements on photographed cephalograms with traditional manual tracing as the gold standard. Cephalometric analysis of specified measurements was performed on cephalometric radiographs manually. Radiographs were subsequently photographed with a digital camera and the images were analyzed digitally with computer software for the same measurements. Paired sample t tests were used for statistical significance [p<0.05]. Clinical significance was set as more than 2o difference between the methods forany angular measurement. Cephalometric comparisons between original and digital images showed statistically significant differences for eight measurements. None of the means of the difference between the angular measurements in the two methods exceeded 20. Photographed cephalograms are reasonably accurate but careful photography technique must beadopted

Assessment of orthodontic treatment need among male and female patients attending Islamic International Dental Hospital Islamabad

The objective of this study is to compare the orthodontic treatment need among male and female patients attending Islamic International Dental Hospital, Islamabad [IIDH]. Across-sectional study. Ten months from September 2007 to July 2008 at Islamic International Dental College. Index of Orthodontic Treatment Need 10TN] was used on a sample of 200 patients [100 male, 100 female] at Islamic International Dental Hospital, Islamabad Pakistan, to evaluate the need for orthodontic treatment. Using SPSS version 10.0 data was analyzed. Result showed that 36% of female patients and 41% of male patients needed definite orthodontic treatment according to Dental Health Component [DHC] whereas 12.5% female patients and 23.5% male patients were needed definite orthodontic treatment according to Aesthetic Component [AC]. According to AC greater percentage of males was found in definite treatment need than females [p =0.005], whereas DHC showed insignificant difference among males and females for definite treatment need [p =0.133]. According to AC, there is more need of treatment for males than females. Whereas according to DHC there is no significant difference between males and females in treatment need

Management of gingival pigmentation: an experience at islamic international dental hospital, Islamabad

This study was undertaken to evaluate the difference between two surgical techniques; gingivectomy incision and epithelial denudation forthe management of melanin pigmented gingiva. Quasi experimental study. Islamic International Dental College, Islamabad. Twelve patients with healthy periodontium and complaining of black pigmented gingival with 20- 30 years of age, who reported at Islamic International Dental Hospital, Islamabad were selected. Six of them were treated with gingivectomy incision and other six were treated with epithelial denudation. The results were quite promising indicating that patients undergoing epithelial denudation showed healing more rapidly with little post operative complaints as compared to patients undergoing gingivectomy. Although both techniques can be used for treatment of pigmented gingiva but epithelial denudation is better than gingivectomy in terms of less post operative pain and sensitivity and early healing of the lesion

Comparative evaluation between cervical vertebrae and hand-wrist maturation for assessment of skeletal maturity orthodontic patients

The aim of the study was to find a correlation between the evaluation of skeletal maturation performed by the study of cervical vertebrae maturation indicators and the evaluation obtained by the hand and wrist maturation indicators. A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 100 patients [36 males and 64 females] ranging from 9 to15 years were examined. The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral analysis was assessed by the cervical vertebral maturation stages method of Bacetti. To define vertebral stages, morphological evaluation of three cervical vertebrae [2nd to 4th] was done. Bjork's nine stages were reduced to five growth intervals [A-E] to relate to five stages [I-V] of cervical vertebral maturation method. The spearman correlation coefficient was 0.944 [P<.01] between cervical vertebral maturation and hand-wrist maturation for sexes combined and 0.936 [P<.01] for males and 0.912 [P<.01] for females respectively. The result shows that cervical vertebrae can be used with the same confidence as hand-wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph

Success rate and pain perception in orthodontic patients receiving bone screws for anchorage: a pilot study

Anchorage enhancement through implants has received much consideration in the past decade. Recently small diameter orthodontic mini screws have been used to reinforce anchorage in orthodontic patients. Added discomfort may influence the patients decision to elect screws as alternatives to more conventional reinforcement systems. The purpose of this study was to evaluate the success rate, and pain anticipation before screw placement, and actual perception after placement based on a ten point Visual Analog Scale. 1.4mm diameter Biotech self tapping mini screws were placed in 11 patients selected for implants. Questionnaires were filled by patients on the first post operative appointment. Results showed that the success rate of mini screws was 86.36%. There was no significant different between the level of pain anticipated and that actually perceived by patients. Conclusively, a large scale study may throw further light on the acceptability and success rate of Orthodontic Mini Screws

Orthodontic treatment need in 13 - 30 years patients by using the index of orthodontic treatment need

To evaluate the orthodontic treatment need a study was conducted at orthodontic department of Islamic International Dental Hospital [IIDH]. Index of Orthodontic Treatment Need [IOTN] was applied in a sample of 300 patients. Data was analyzed using SPSS version 10.0. Out of 300 subjects 114 were males and 186 females with mean age of 18 +/- 4.8 years were reported. Dental Health Component showed 19% [Grade 5], 57% [Grade 4], 18% [Grade 3], 5% [Grade 2] and 2% [Grade1] results respectively and Aesthetic Component showed percentages as 31.66% [Scale 1-4], 32% [Scale 5-7] and 36.3% [Scale 8-10]. Strong association was found between aesthetic component and dental health component [p=.000]. According to Dental Health Component 75% of the population was found to be in definite treatment need and only 36.3% of the population was in definite treatment need according to Aesthetic Component. No significant gender difference was found for treatment need