Need to revise oral pathology curriculum

Oral pathology is one of the major basic dental science subject taught to 3rd Year BDS students. Like other basic dental science subjects, oral pathology is gradually emerging as specialty in Pakistan as more students pursue post-graduation opportunities both nationally and internationally. Graduate students are trained according to standard outlines directed at familiarizing them to the pathologies of the oral cavity. However, at the undergraduate level the current oral pathology curriculum currently taught in Pakistan Dental College is quite vague and needs thorough revision. The aim of this article is to make some suggestions for the improvement of the oral pathology curriculum with emphasis on geographical variations of oral diseases worldwide

Removal of third molars-should we have guidelines for surgery?

Third molar surgery is the most frequent procedure carried out by the departments of oral and maxillofacial surgery all over the world. The procedure is accompanied by significant risks, with possible damage to the inferior alveolar and/or lingual nerve being of special concern. Considering these risks of morbidity, it is essential to establish the need of removal. National Institute of Clinical Excellence [NICE] in the United Kingdom introduced guidelines for removal of third molars in 2000, advocating that only pathological third molars should be removed. The following article makes reference to a study carried out in England where third molars are extracted in accordance with NICE guidelines. This study was carried out to assess the compliance of general dental practitioners to the NICE guidelines. It was noted that 95% of the patients referred for third molars extraction fulfilled the criteria set forth by NICE. 11% [15] patients who fulfilled the NICE guidelines criteria refused to undergo removal of third molars. Only 5% [7] patients did not meet referral criteria set by NICE guidelines. These guidelines cut down lot of unnecessary referrals and allowed for organization of the patient load by the secondary referral center, as well as limiting unnecessary surgeries and postoperative complications. There is a dire need to define similar guidelines in Pakistan pertaining to the local needs

Pathogenesis and management of dry socket [alveolar osteitis]

Alveolar osteitis is a common post extraction complication developing within 1-4 days following surgery.1-3. It is characterized by intense pain that is not relieved by analgesics. 1 The most frequent site of occurrence is the mandibular third molar region. Females are known to show a higher incidence of occurrence. 4 Studies indicate smoking, traumatic extractions, leaving tooth and bone debrisin extraction sockets, excessive irrigation of socket, compromised blood supply and use of contraceptives, as possible predisposing factors.5-25. Inflammation of the socket is believed to be a result of dislodgment or disintegration of the blood clot that forms within the socket immediately after extraction. 11, 26-27 Dry socket can be prevented by ensuring sterile surgery and by the use of numerous non-pharmacological measures; good history, identification and elimination of risk factors, and pharmacological agents; systemic antibiotics, antiseptics, antifibrinolytics, obtundant dressings and photodynamic therapy.8,28-34 Once the condition develops it is treated symptomatically and by use of obtundant dressings. Initial results of a study carried out in Khyber College of Dentistry, Peshawar are showing promising results with surgical management. This literature review summarizes the current understanding of etiology, pathogenesis, prevention and management of alveolar osteitis

Bisphosphonate therapy related osteonecrosis of jaw bones: a case report

Bisphosphonate related osteonecrosis of jaw bones is a relatively recent discovery with the first cases being identified in 2003. Bisphosphonates are used to treat multiple conditions especially metastatic bone diseases. Although the exact mechanism of action of Bisphosphonates is not well understood yet, efficacy of these agents in reducing bone pain, hypercalcaemia and skeletal complications has been widely accepted. The recently introduced intravenous use of new generation bisphosphonates [Pamidronate and Zolidronate] has proved to be highly effective in controlling bone symptoms. The past few years have shown that osteonecrosis of jaw bones can sometimes develop in relation to long term bisphosphonate treatment, either spontaneously or by trauma caused by dental procedures. The condition presents as a diagnostic challenge being rare and not well understood. We present a case report of a 56 years old female demonstrating a possible relation between osteonecrosis of jaws and long term bisphosphonate therapy in order to create awareness of this possible complication within the medical and dental community