Rapid and promising technique to treat gummy smile -lip repositioning

Beautiful smile is a booster to person's confidence. Gummy smile is a term used for excessive gingival display [EGD]. Its etiology is multifactorial. Bone vertical maxillary excess [VME] is one of the cause of EGD. In this case series, lip repositioning was performed to treat mild to moderate degree of gingival display [ 2 to 8 mm] due to VME. Lip repositioning is simple, promising, meticulous and comparatively cheap alternative technique for treating gummy smile

Efficacy of peripheral streptomycin injection in the treatment of idiopathic trigeminal neuralgia

To evaluate the efficacy of peripheral streptomycin injection in relieving the pain of idiopathic trigerninal neuralgia. Quasi experimental study. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry Rawalpindi, from 1[st] June 2006 to 31[st] December 2007. Thirty patients of idiopathic trigerninal neuralgia were selected. They received five consecutive injections of streptomycin Ig in 3 ml of 2% Lignocaine [Septodont] with 1: 100,000 adrenaline at one week interval. Follow up was carried out at one, two and six months after the last injection. Age ranged from 15-78 years [mean 44.67]. Male to female ratio was 1:1.14. Right side of the face was involved in 70% and left side in 30% cases. Mandibular division of trigeminal nerve was involved in 43.3% and maxillary division in 40% of the cases. In the rest both maxillary and mandibular divisions were involved. Pain was significantly decreased from baseline to 1 month [p < 0.001]. The level of pain was increased a bit but the increase was significant at two months [p = 0.006] and at 6 months [p = 0.020]. Best treatment modality for this devastating disease is yet to evolve. Within the confines of the study it can be stated that efficacy combined with low post treatment morbidity makes streptomycin a useful treatment option

Bioresorbable versus titanium plates for mandibular fractures

To compare bioresorbable plates with titanium plates for treatment of mandibular fractures. Randomized controlled trial. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, from January to December 2010. Patients with mandibular fracture were randomly divided in to two groups. The control group received titanium plates while the experimental group received the bioresorbable plates. All the procedures were carried out under general anaesthesia using standard surgical techniques. Frequency of plate/screw breakage or loosening, development of infection, malocclusion, malunion, wound dehiscence, the need for hardware removal and any other technical difficulties were compared between the two groups using chi-square test with significance at p < 0.05. A total of 34 patients were included in the experimental group where 53 resorbable plates were applied. The control group consisted of 35 patients and received 52 titanium plates. The mean age in the experimental group and the control group were 31.35 +/- 11.16 years and 34.31 +/- 10.69 years respectively. Breakage of 16 screws and 03 plates was seen in the experimental group while no screw or plate broke in the control group. The results showed significant association of screw breakage with resorbable plates and plate removal with titanium plates. Bioresorbable plates can be used as an alternative to titanium plates in mandibular fractures but with caution. They are a good means to stabilize fractures in patients where growth retardation and hardware removal may be a consideration

Prevalence of radiographic classification of impacted mandibular third molars - an overview

The purpose of this study was to evaluate radiographically the position of mandibular third molars. It is a descriptive study carried out at 1 Military dental Centre, Sialkot Cantt from August to March 2011. The patients who came with the complaints of pain or swelling in the lower third molar area were clinically assessed and advised radiograph [peri apical view or orthopantomograph] for their lower third molar. These radiographs were assessed according to the Winter's classification for angulation and Pell and Gregory classification was used to access the space and depth of impaction. A total of 415 patients were examined. 73.7% patients [n=306] were males and 26.3% [n=109] females. Most of the patients were between 20-29 years of age [n=244]. Mesioangular impaction was the most common found in 38.5% [n=160] patients. Position A 66% [n=274] and class II 55% [n=229] were found to be the most common

Transpapillary versus palatal injection technique for maxillary tooth extractions

To compare the pain during injection administration and efficacy of transpapillary injection with palatal injection for simple maxillary tooth extractions. Randomized control trial. The oral and maxillofacial surgery department of Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from July to December 2009. Patients requiring simple extraction in maxilla were randomly divided into two groups each consisting of 100 patients. Group 1 was given conventional palatal injection and served as a control, whereas Group 2 received the transpapillary injection. Two percent Lignocaine with Adrenaline [1:100,000] was used for both groups. Pain during injection and then during the extraction were recorded for both groups using the Visual Analogue Scale and Faces Pain Score Scales on specially designed proformas. The data was analyzed using SPSS version 17.0 and independent t-test was applied to compare pain between both groups. P-value of less than 0.05 was considered to be statistically significant. Group 1 consisted of 61 males and 39 females with an age ranging from 11-73 years [mean= 39.92 + 14.85 years] while Group 2 consisted of 59 males and 41 females with an age ranging from 10-70 years [mean= 39.31 + 18.53 years]. Results of FPS and VAS scores for injection and procedure were analyzed using independent t-test. Difference of scores for pain during injection were found to be significant [p < 0.05] while the scores for the procedure were seen to be statistically insignificant [p > 0.05] showing that transpapillary injection is equally effective for maxillary extractions as palatal injection but with significantly decreased pain during injection. Transpapillary injection is an easy and effective way of eliminating the pain of palatal injection for maxillary extractions

Efficacy of intra-alveolar chlorhexidine gel in reducing frequency of alveolar osteitis in mandibular third molar surgery

To determine the efficacy of intra-alveolar administration of chlorhexidine [CHX] gel in reducing the frequency of alveolar osteitis [AO] after impacted mandibular third molar surgery. A randomized control trial study. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January to December 2007. One hundred patients including 65 males and 35 females with the age range 18-40 years were divided in two equal groups [50 each in the CHX and the control groups]. Surgical removal of impacted mandibular third molar was carried out and after surgery CHX gel was placed into the alveolus of CHX group. Patients were followed at the first, second and third postoperative days. A proforma indicating presence or absence of pain, blood clot disintegration, halitosis and AO was filled for each patient. Frequencies and percentages were calculated for qualitative data. Chi-square test was applied to compare both subgroups. Eighteen patients [18%] were diagnosed with AO [11 males and 7 females]. Out of these 18 cases, 14 [28%] were found in control group [9 males and 5 females], while 4 cases [8%] in the CHX group [2 males and 2 females]. This was statistically significant p=0.017. Single application of CHX gel was effective in reducing frequency of AO following mandibular third molar surgery

Pattern and presentation of oral white lesions

Oral white lesions are not uncommon and a significant number of patients are asymptomatic. The purpose of this study was to determine the pattern and presentation of oral white lesions in patients reporting at oral and maxillofacial surgery department of AFID. World Health Organization [WHO] guidelines for oral mucosal examination were used to record data of 100 patients who presented with oral white lesions. Biopsies were performed in lesions whose definitive diagnosis was deemed difficult purely on the basis of history and clinical examination. The mean age was 38 +/- 13years with 57[57%] males. Forty two [42%] patients were asymptomatic. The most frequent site was buccal mucosa [64%] and more than half of these lesions appeared white [57%] while others were yellowish white [18%], grey white [15%] and with areas of redness within the lesion [10%]. Among habits, smoking was most common. The most common lesion was lichen planus [28%] followed by frictional keratosis [15%] and oral submucous fibrosis [13%]. Other rare lesions were geographic tongue, mucosal burns, candidiasis. As some of these lesions are premalignant, it is imperative for the dental and medical professionals to familiarize with their pattern and presentation to effect early diagnosis and management

Etiology and pattern of swellings in mandible and maxilla

To determine the etiology and pattern of swellings in the mandible and maxilla. A descriptive study. This study was conducted at Oral and Maxillofacial Surgery Dept, Armed Forces Institute of Dentistry Rawalpindi for two years from December 2004 to December 2006. Three hundred and fifty patients with swellings in the jaws reporting to AFID were included in this study. After history, clinical examination and radiographic evaluation, patients were registered. All patients whether admitted to hospital or treated as outdoor patients in oral surgery clinic were included. Swelling of the parotid region, nasal and para nasal sinuses and neck were not included. In majority 131 [37.42%] the patients were of age between 21 to 30 years [mean 25.5 years]. Males were affected more than females with ratio 1.3:1. The most common swellings found were inflammatory which accounted for 138 cases [39.42%] due to odontogenic reasons i.e. caries and non vital teeth. The most frequent site involved was mandible which accounted for 202 cases [57.71%]. In 111 cases [31.71%] the treatment modality used was incision and drainage followed by antibiotics. Caries and non-vital teeth were cause of the most common inflammatory swellings. The predominant site of swellings was the mandible. Every person must visit a dentist for oral examination six monthly so that early lesions in mandible and maxilla can be detected and treated more conservatively

Management of medical emergencies in dental practices- an audit

To assess the knowledge, preparedness and practices of the dental practitioners to recognize and manage medical emergencies occurring in their dental practices. Descritive; Cross-sectional Study. Carried out in 126 clinics of Pakistan Medical and Dental Council [PMDC] registered dentists in Rawalpindi/ Islamabad over a period of 06 months from September 2009 to March 2010. A questionnaire and an observation Proforma were used for data collection. The questionnaire and observational proformas were distributed among 160 randomly selected dental clinics by the authors out of which 126 completed performas and questionnaires were returned. collected data was analyzed usign SPSS version 17. Majority [73.8%] of the dental practitioners believed that they were appropriately trained either in their undergraduate or postgraduate training in recognition of medical emergencies. However most of these clinicians felt that they were not adequately trained in the management of these emergencies and only 29.4% of the dentists had taken Basic Life Support courses. A good number of the dental clinics had little or no equipment or medicaments for management of common medical emergencies. Only 49.6% of the dental practitioners claimed that they were satisfied with their preparedness regarding management of medical emergencies. Good majority [73.8%] of our dental practitioners are able to recognize medical emergencies, however, their resourcefulness in terms of their management is seriously lacking

Oral cancer - are the dentists doing enough for its prevention and early diagnosis? - a study

The aim of this study was to determine whether and to what extent the dental profession is helping in the prevention and early diagnosis of oral cancers. Data were collected by distributing self administered questionnaires among two hundred randomly selected dentists of Rawalpindi and Islamabad to know what role they play in the prevention and early diagnosis of this deadly disease. More than half [52%] of the dentists did not ask or asked rarely about the use of tobacco, alcohol and other risk factors and only about a third [34%] advised and helped their patients to quit these habits. Only 22% of the dentists regularly examined the entire oral mucosa of all their patients and even fewer [12%] considered the possibility and then searched for a coincidental oral cancer. Only about 06% took biopsies of suspicious lesions regularly. The findings of this study indicate that the dentists of this region need to do a lot more for the prevention and early diagnosis of oral cancer

Frequency of hepatitis b and c in oral and maxilofacial surgery patients at Armed Forces Institute of Dentistry

To see the frequency of hepatitis B virus [HBV] and hepatitis C virus [HCV] carriers in oral and maxillofacial surgical patients. Descriptive study. This study was carried out at Oral and Maxillofacial surgery department of Armed Forces Institute of Dentistry [AFID], Rawalpindi from June 2006 to July 2007. Patients who were admitted at Oral and Maxillofacial Surgery Department during the study period for any kind of maxillofacial surgery were screened before operation for HBV, and HCV. A total of 842 patients were screened. Eighty percent were males and 20% were females with age ranging from 5-70 years. HBV was positive in 7% patients and HCV was positive in 9% of patients. The high frequency of HBV and HCV in maxillofacial surgical patients suggests a routine screening for HBsAg and anti-HCV for all patients prior to surgery

Inadequacies in history taking and clinical examination by the dentists

History taking and clinical examination are the most important steps in the diagnosis and hence overall patient management in medicine, surgery and dentistry. The purpose of this study was to determine the history taking and clinical examination practices of dentists. Self-administered questionnaires were distributed among two hundred randomly selected dentists of Rawalpindi and Islamabad. The questionnaire assessed how often these dentists recorded all the steps of history and how often they examined their patients thoroughly. While the vast majority of dentists asked most of their patient's demographics, chief complaint and the history of their chief complaint and examined all teeth of their patients, a considerable number of them missed the medical, family and socioeconomic history, did not record vital signs, and did not examine the entire head and neck and oral mucosa of all their patients. This study emphasizes deficiencies and inadequacies in the history taking and clinical examination practices of dentists in the studied sample

Comparison of analgesic efficacy of tramadol hydrochloride with diclofenac sodium in dento-alveolar surgery

The purpose of this study was to find a safe and effective analgesic alternative to non-steroidal anti-inflammatory drugs [NSAIDs] for patients undergoing dento-alveolar surgery who could not tolerate NSAIDs. We have compared on a double blind, randomized basis the efficacy of Tramadol hydrochloride with Diclofenac Sodium.. Sixty patients undergoing third molar surgery were divided into two groups. One group was given tramadol hydrochloride 50mg three times daily and the second group diclofenac sodium 50mg three times daily for three days. Pain control was measured using a 0 to 10 numerical scale. The analgesice efficacy of the two drugs was equal except on day one when tramadol did better than diclofenac. Tramadol can be used safely for post operative analgesia after dento-alveolor surgery especially in situations where NSAIDs are contraindicated

audit of the pathologies associated with impacted wisdom teeth

The purpose of this study was to find out the types of pathologies that can arise in association with impacted wisdom teeth. Two hundred consecutive patients scheduled for extraction of one or more of their impacted wisdom teeth were evaluated clinically and radiographically. Orthopantogram [OPG] was the standard radiograph. 194 [97%] of the teeth were associated with pathologies. Pericoronitis was the most common condition followed by caries, periodontal disease, facial space infections, cyst / tumors and resorption of adjacent second molar. Six [3%] of the teeth were extracted for orthodontic reasons. Younger patients had acute reversible conditions whereas with increasing age chronic destructive lesions became more prevalent. Retaining impacted teeth can lead to recurrent pericoronal infections and damage to adjacent structures

Pattern of maxillofacial injuries in the earthquake victims

To observe the pattern of Maxillofacial injuries in Earthquake victims and to discuss their management. Descriptive Study. This study was conducted at the Maxillofacial Surgery Department, Armed Forces Institute of Dentistry [AFID], Rawalpindi over a period of six months following the 8[th] October, 2005 Earthquake. 176 patients who sustained maxillofacial injuries during the earthquake were included in this study. The pattern of maxillofacial injuries and their management was documented. Out of the 176 patients, 141 [80.11%] had fractures of the maxillofacial bones. The remaining 35 [19.89%] patients sustained minor maxillofacial injuries e.g. soft tissue injuries, dentoalveolar fractures and temporomandibular joint arthritis / dislocation. Isolated mandibular fractures were seen in 64 [36.4%] patients. Fifty-seven [32.4%] patients had multiple fractures of the facial bones. Zygomatic bone was fractured in 18 [10.2%] patients whereas 02 [1.1%] patients had isolated fracture of the maxilla. Fifty-nine [41.8%] patients were treated by closed reduction and IMF, 55 [39%] patients by open reduction and transosseous wire fixation in addition to IMF and 27 [19.1%] cases by open reduction and miniplate osteosynthesis. Postoperative complications were noticed in 18 [10.2%] of the patients. Multiple fractures of the facial bones were far more common than the routine trauma cases. The magnitude of the disaster dictated simple and timesaving conventional methods of management in majority of the cases