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

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

Number and pattern of root canals in mandibular incisors

This descriptive study was conducted to study the variation in number and pattern of root canals in mandibular incisors in a sample of Pakistani population. A Sample of 100 teeth extracted due to periodontal or carious destruction was surveyed through labio-lingual and lateral periapical radiographs. Roots were then sectioned at 1, 2 and 3mm from apex at 20 degree angulation along the long axis of roots. Sections were observed under stereomicroscope and number and shapes of root canals were recorded. Both observations were combined to classify the root canal patterns according to Vertucci's Classification. Ninety one [91] roots canals were classified at Vertucci's type I. Eight teeth showed double root canals. Two roots had Type V and six had Type III canal configuration. Labio-lingual periapical radiographs were unable to detect the second root canals in any of the teeth with double canals. The need for conducting more research with advanced imaging techniques and larger sample size was highlighted in this study. The limitation of periapical radiographs in locating lingual canals in mandibular incisors was also observed

Diabetes mellitus and osteomyelitis of the jaws

The Diabetes Mellitus is a prevailing medical condition worldwide [6%] and also in Pakistan. Infection in the orofacial wounds of these patients is common. The aim of the study was to determine the effect of diabetes mellitus on the healing process of alveolar sockets/bone after tooth removal. Eighteen diabetic patients with chronic jaw bone infections were examined and managed in oral and maxillofacial surgery department of de, Montmorency College of Dentistry, Lahore from 2009 to 2013. All patients gave history of tooth extraction about two months earlier. Orthopantomograph [OPG] were used to confirm the diagnosis. Fourteen patients [77.77%] were on oral hypoglycemic agents, four did not know their diabetic status, four patients [22.22%] were on intermediate acting insulin. All patients were managed under general anesthesia for involucrum sequestrectomy followed by primary closure. One insulin dependent patient with radiated lower jaw developed osteomyelitis after tooth extraction and was also on bisphosphonate medication followed by breast cancer surgery. This patient was operated twice to resolve the osteomyelitis of the lower jaw in follow up six months. It was concluded that diabetes effects the healing of sockets after tooth removal

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

Treatment of odontogenic ameloblastomas and their long term follow up at tertiary centre

Fifty-two patients of ameloblastoma were operated with special emphasis on radiographic and histological appearance. The unicystic radiographico-histological [38] cases were managed conservatively with marsupialization followed by enucleation [Group A' 15 Patients] and enucleation with peripheral ostectomy [Group B' 23 Patients]. The radiographico-histological multicystic [solid] variety [Group C' 14 Patients] was treated aggressively by resection. In conservative treatment regimens Carnoy's solution was applied after enucleation of the tumour whereas, the patients of aggressive surgery were operated with minimum 5mm safety marginal clearance of the tumour. The recurrence rate with average four years follow up was 0.0% for resection, 13.33% for marsupialization followed by enucleation and 8.69% for enucleation with peripheral ostectomy. The results were encouraging for unicystic ameloblastoma treated patients [Group A' and B'], in best interest of jaw bone contour preservation

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

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]

Oral health related quality of life [OHRQoL] in 40 to 70 years

This study was aimed to assess the Oral Health-Related Quality of Life [OHRQoL] among aged 40-70 years. The survey was conducted in Prosthodontics department of a private Dental College in Lahore, Pakistan. A cross sectional survey was carried out over a period of three months [August-October 2010]. New male and female patients aged between 40 and 70 years, who came to the department of Prosthodontics for partial and complete denture problems were included in the sample. All other age groups and old [who were undergoing treatment in the department] patients were excluded. Data for this study was collected by carrying out an interview using the Oral Health Impact Profile 14 which is the shorter version of OHIP 49. Two hundred and ten patients completed the questionnaire forms containing the 14 item Oral Health Impact Profile [OHIP-14]. Data analysis was done using IBM SPSS version 19. The results showed the perceived OHRQoL among adults ranging from 40-70 years in age. Age was found to be highly significant [p < 0.01] with the OHRQoL dimension of 'psychological discomfort: feeling tense' [p=0.002] and 'physical disability: interrupted meals' [p=0.006] and significant [p < 0.05] with the dimensions of 'functional limitation: worsened taste' [p=0.04] Gender was found to be significant with 'psychological disability: difficulty relaxing' [p=0.04] and highly significant with 'social disability: irritability' [p=0.003], 'handicap: life less satisfying' [p=0.002], 'physical disability: poor diet' [p=0.01], 'handicap: inability to function' [p=0.002] and 'handicap: inability to function' [p=0.002]. Complete and partial denture appliances showed significance with the dimensions of 'functional limitation: worsened taste' [p=0.02] and portrayed high significance with 'physical pain: aching in mouth' [p=0.01] and 'physical pain: discomfort eating food' [p=0.001]

Awareness of needlestick injuries among the dental health professionals at Lahore medical and dental college

Health care associated transmission of blood borne diseases has always been an important public and medical concern worldwide. Objective of this study was to assess the degree of awareness of needle stick injuries among dental health professionals working at LMDC. Dental students during clinical training are at high risk for needle stick injury while administering local anesthesia. This fact has been known for the past few decades to be the founder of several blood borne diseases such as Hepatitis B [HBV], C [HCV] and AIDS [HIV]. Several studies have reported the high incidence of such practice among dental students and graduates. Study was conducted on 139 Dental Health Professionals at the Lahore Medical and Dental College in the year 2010 based upon questionnaire developed by a team of senior faculty members. Exposure to needle stick injury was found among 63[45%] subjects. 118 [85%] of Dental health professional were found to be aware of precautionary measures and first aid management for a needle stick injury respectively. The number of Dental Health Professionals who had been vaccinated for Hepatitis B [HBV] 121 [87%] and those who had never been vaccinated were 18 [13%]. Among nonvaccinated group 90% were Dental assistants. Proper work practices and continued Education seminars and workshops regarding awareness of needle stick injuries have the prime importance of creating awareness. The prevention and management protocol for such injury should be displayed in the clinical departments of all institutions. These steps will assure safe practicing methodology among dental health professionals

Temporomandibular disorders

Temporomandibular joint has been a subject of intense debate and interest for researchers since long. Temporomandibular disorders are one of the most intriguing and controversial subject in the world of dentistry. This study reviews the possible etiological factors and the management protocol for these disorders. The key to successful management is an appropriate diagnosis, for alleviating pain and restoring physiological functions. The choice of treatment provided to the patient depends on the degree of the problem. On time referral to an oral and maxillofacial surgeon is essential for the treatment of temporomandibular disorders to avoid complications

Oral hygiene status of patients undergoing orthodontic treatment

The aim of the present study was to evaluate oral hygiene status of patients receiving fixed orthodontic treatment and to monitor it longitudinally. Main sample consisted of one hundred patients with an age range of 12-25 years, having a full complement of permanent dentition, reporting to the orthodontic department of the Punjab Dental Hospital, Lahore. Patients having major medical problems, history of having antibiotics, orthodontic treatment and smoking were excluded. Community Periodontal Index was used to assess the periodontal status of these patients. From these 100 patients, 20 patients having good oral hygiene and in need of fixed orthodontic treatment were selected, and their periodontal status was assessed before and during fixed orthodontic treatment. Data was analyzed by using SPSS [Version 8.0] in personal computer. Results showed that periodontal status of patients receiving orthodontic treatment significantly worsened after the placement of fixed orthodontic appliances

Pyogenic granuloma - review

Pyogenic granuloma is a common non-neoplastic soft tissue growth seen on a variety sites in the body including the oral cavity. It may also occur in pregnant subjects and is referred to as a granuloma gravidarum. Although the precise etio-pathogenesis is not established, it is regarded as a reactive lesion secondary to trauma or non-specific local irritation. Hormonal stimulation during puberty, pregnancy or oral contraceptive use may also be responsible. A variety of angiogenic factors may mediate exuberant endothelial proliferation. Mostly commonly it affects adolescents and young adults with preponderance in females. The most familiar site is anterior maxillary gingivae but may also affect the mandibular gingivae, lips, tongue and buccal mucosa. Conservative surgical excision is usually curative but recurrence is not unusual. Lasers and cryotherapy may also be employed. Granulam gravidarum, however, is best left untreated until parturition

Current concepts in central giant cell granuloma

Central Giant Cell Granuloma is a nonneoplastic intraosseous lesion, and constitutes a common nonodontogenic pathology to occur in the jaws. It is characterized histologically by cellular fibrous tissue containing multiple foci of haemorrhage, aggregations of multinucleated giant cells, and occasionally, trabeculae of woven bone. Various theories brand it from being a 'reactive' to hamartomatous to a neoplastic lesion. It has now been hypothesized that it is the mononuclear spindle shaped cell which controls the proliferative activity of this lesion, as opposed to the more frequently seen giant cell. It has an increased predilection for mandible and females, in younger age groups. Various radiological and histopathological differential diagnoses should be considered in case of giant cell lesions. Some of the lesions are thought to display a markedly 'aggressive' behaviour and a clinically 'aggressive' model of CGCG has been proposed. Smaller, 'nonaggressive' tumours generally respond very well to conservative enucleation or curettage but recurrence is seen to be common with 'aggressive' lesions. Various medical therapies including injections of intra lesional steroids, subcutaneous calcitonin and interferon have been proposed for the treatment of 'aggressive' lesions

Disorders of temporomandibular joint: a retrospective study

A retrospective study was conducted on 486 patients with temporomandibular joint disorders to evaluate the frequency of their occurrence. The most common disorders found were trauma followed by pain, dysfunction syndrome, osteoarthrosis, ankylosis, internal derangements and dislocations