Tooth embedded in upper lip after dento-alveolar trauma: a case report

Most of dental injuries involve maxillary anterior teeth along with soft tissue injury in children as well as in adolescent. Thorough clinical and radiographic examination is necessary to prevent any future complications. Dental trauma accompanied by soft tissue laceration is of careful importance as embedding of tooth or fractured tooth fragment in a soft tissue particularly lip is a common finding. This case report shows embedded tooth in upper lip after trauma that was unnoticed and extruded spontaneously after Smonths of trauma which was then extracted after clinical and radiographic evaluation. This case report enlightens the importance of proper clinical and radiographic examination especially in cases of dental trauma associated with soft tissue laceration

Enamel defects frequency in deciduous teeth

Developmental defects of the enamel are the result of alterations during amelogenesis due to hereditary, systemic or environmental factors. The present study was done to determine the frequency of developmental defects of enamel in primary teeth at Children Hospital PIMS, Islamabad from February 2011 to January 2012. The study was cross sectional and sample comprised of 300 children, which included 182 [60.7%] males and 118 [39.3%] females. The mean age of the studied population was 3.63 +/- 1.05 years. Enamel defects were present in 115 [38.3%] children. Out of 182 males 69 [37.9%] males and out of 118 females,46 [38.9%] females had enamel defect; thus frequency of enamel defect was not significantly different between the two genders [p=0.852]. The mean age of the children with enamel defect was 3.74 +/- 1.00 and mean age of children without enamel defect was 3.55 +/- 1.06 years respectively. This difference was not statistically significant [p=0.124]. Frequency of enamel defect was significantly higher among families with higher income categories [p=0.020].Out of 300 children, 185 [61.7%] had normal enamel, 5 [1%] had only demarcated opacity, 9 [3%] had only diffuse opacity, 80 [26.7%] had only hypoplasia, 3 [1%] had demarcatead diffuse opacity, 3 [1%] had demarcated opacity with hypoplasia, 13 [4.3%] had diffuse opacity with hypoplasia and 2 [0.7%] had all three defects. Present study concluded that more than one third of the children had developmental defects of enamel in primary teeth and most frequent lesion was enamel hypoplasia

Molar-like incisors: a rare case of multiple anomalies of the developing dentition

A rare case of a 9-year-old child is presented. The child was brought to the dental department of Children Hospital of Pakistan Institute of Medical Sciences, Islamabad in 2005, with severe toothache. His painful tooth was a mobile left lower central incisor which was cavitated, abnormal in shape and bigger in size. His other erupted teeth were also of abnormal shape [lowers anterior teeth resembled molars and upper anteriors resembled premolars], hypocalcified and cavitated. The mobile tooth was extracted under local anaesthesia. The extracted tooth had a hollow crown without any root. The panoramic radiograph of the patient showed generalized macrodontia, abnormal shaped teeth with almost no roots in both primary and permanent dentition. There were missing primary and permanent anterior teeth in both jaws possibly resulting in impaction and ectopic position of the other teeth. Due to uncooperative behaviour of the patient's father investigations of any systemic involvement could not be performed. It is believed that no similar case has been previously reported in literature

Comparison of paralleling and bisecting angle techniques endodontic working length radiography

This cross sectional comparative study was carried out to compare paralleling technique [PT] and bisecting angle technique [BAT] for working length radiography in endodontics. A sample of 120 patients was selected through purposive sampling. The patients were divided into two groups depending on the arch to be radiographed namely Group A for maxillary arch and group B for patients with mandibular teeth requiring endodontic radiography. Each patient underwent two radiographs, one with each paralleling and bisecting angle techniques respectively giving a total of 240 radiographs. Endo Ray II film holder [Dentsply] was used for PT while a hemostat was utilized for BAT. The results showed a higher accuracy in terms of decreased procedural errors with paralleling technique as compared to bisecting angle technique for teeth in maxillary arch [p<0.05], whereas for mandibular arch there was insignificant difference [p>0.05] between the two techniques. Overall paralleling technique was found to have better results than bisecting angle technique, during endodontic working length radiography

Comparison of periodontal health status of smokers versus non-smokers

This study aims to compare the periodontal health status of current smokers versus nonsmokers. The study was carried out in the Dental department, Pakistan Institute of Medical Sciences [PIMS] between May 2009 and June 2010. A total of 280 male subjects, married, over the age of 18 were selected to take part in the study and their periodontal health was assessed by presence of calculus, bleeding on probing and pocket depth greater than four millimetres. Patients including smokers and non smokers were selected on the basis of the inclusion and exclusion criteria. Subjects were clinically evaluated by using a specially designed CPITN probe which was used to measure pocket depths in the mouth. The mouth was divided into six sextants. The other variables examined included bleeding on probing and presence of calculus. The data was subsequently analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. There was decreased incidence of bleeding on probing [31.7%] in smokers than non-smokers [53.5%] however, there was an increased incidence of calculus formation among smokers [89.4%] compared to the subjects who did not smoke [69.6%]. There was a significant difference between the overall mean pocket depth in smokers [3.7 +/- 1.4] and non-smokers [3.0 +/- 1.1]. All of the above differences were found to be statistically significant. There was a marked association between cigarette smoking and periodontal disease

Dental management of haemophilic pediatric patients

The aim of the study was to evaluate the effectiveness of a standard protocol to prevent bleeding episode/s after dental procedures. Eighty-six pediatric patients [5-13 yrs] of both genders requiring minor invasive dental procedures were screened by the Haemophilic Center and referred to Dental Department of Children's hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad. Protocols observed to provide correct homeostasis included pre-operative intravenous factor replacement therapy and post-operative local and systemic application of tranexamic acid. Treatment outcome rated as excellent [achievement of normal haemostatic with local and orally agents] was achieved in 57% patients. A good outcome [mildly abnormal haemostatis requiring systemic agents but not requiring factor therapy] was found in 39% while only 3 patients exhibited a poor outcome [severely abnormal haemostatis requiring factor therapy]. No bleeding event required hospitalization. It was concluded that strict observance of this protocol can be termed successful in achieving haemostatis in haemophilic patients undergoing minor invasive dental treatment

Incidence of endodontic flare-ups using either calcium hydroxide or creosote as intracanal medicament in symptomatic teeth

To enhance our knowledge about the superior intracanal medicament available for reducing the interappointmentpain in endodontic treatment. Hundred symptomatic teeth presenting to the Department of Operative Dentistry, Khyber College of Dentistry were included in this study. All teeth underwent conventional root canal treatment. The canals were dried and one of the following two medicaments was inserted into the canal in random sequence: Group 1: Calcium Hydroxide paste; Group 2: Creosote. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were instructed to record the degree of pain experienced 4 hours, 12 hours, 24 hours and 48 hours after the treatment. Patients who received Calcium hydroxide have a lower incidence of flare-up when compared to Creosote. Based on this study, Calcium Hydroxide is the superior intracanal medicament in terms of postoperative pain

Comparison of microleakage in resin modified glass ionomer cements and poly acids modified composites [compomers]

Microleakage of oral fluids and microbial components is a dynamic factor occurring at the tooth-restoration interface. Different restorative materials show different values of micro-leakage depending upon their composition, setting reaction and nature of physical and/or chemical bonds with the dental tissues. The aim of this study was to compare the microleakage of Resin modified Glass lonomer [Fuji II.LC] and Polyacid modified Composite Resins [Dyract]. It was a comparative cross sectional study which was carried out in the Department of Dentistry, Pakistan Institite of Medical Sciences [PIMS] Islamabad. Fifty healthy, unrestored extracted premolar teeth allocated randomly in to two groups. Class V cavities were prepared at the cemento-enamel junction in all fifty teeth, and restored with Fuji II.LC [GC America] and Dyract [Dentsply], 25 teeth in each group. All the teeth were placed in 2% basic fuchsin dye for 24 hrs at37C. Teeth were then embedded in cold cure acrylic resin, resectioned longitudinally in - ISOMETA, and the dye penetration at the enamel and cementum margin were scored at 10 X magnification stereo microscope and distinct leakage patterns were recorded. Data was analyzed using SPSS version 10.0. The resin-modified glass ionomers showed less microleakage than the polyacid modified composite resin especially at gingival margins

Cross sectional analysis of endodontic failure in PIMS

The purpose of this study was to determine the different reasons for root canal failure in the department of dentistry at Pakistan Institute of Medical Sciences. It was a cross sectional study which was based on collection and interpretation of data. Seventy patients of both genders were selected from dental out patient department of PIMS. All patients selected, presented with post endodontic complaints. Majority of the endodontic failures, reported with periapical infection or pain on percussion. The main reason for endodontic failure was unfilled or untreated root canals, followed by underextended and overextended root canal fillings

Dental caries status in 6-9 years old children

The purpose of this study was to determine the dental caries status in six to nine years [6-9 years] old children. Total [n=543] patients with dental caries between 6-9 years were selected from dental OPD of Children's Hospital, PIMS, Islamabad. Names, ages, sex, addresses and caries status of each patient was recorded in separate questionnaires. Intra oral examinations were performed with mirror, probe and good light. X-rays were not taken to diagnose the caries. Among total n=543 patients, the female were 244 [45%] and male were 299 [55%]. The dmft was 7.45, 6.52, 5.74 and 5.33 for aged six, seven, eight and nine respectively. The frequency of caries was higher in age group of eight. The DMFT was 0.39 for each child. In present study the frequency of caries was found to be higher than reported by Almoudi in Saudi children and reported by Kerala in India

Risk factors for dental caries in Pakistani children

The present study was carried out to determine any possible association of caries with oral hygiene and food habits. This was prospective descriptive study. Total [n= 543] patients with dental caries between 6-9 years were selected from dental OPD of Children's Hospital, PIMS, Islamabad. Questions regarding brushing habits and food habits were asked by interviewing the accompanied adults and caries status of teeth after intra oral examination were recorded in questionnaire. X-ray was not taken to diagnose the caries. The frequency of caries was higher in age group of eight and nine. Children who ate candies daily had statistically [p<0.05] high caries. Negative correlation was found between mother's education, father's education and caries- Significantly high frequency of caries [P<0.05] was found in children who ate bread in their breakfast with sugar sweetened tea and patients used fluoride containing toothpaste had less caries. Surprisingly, in comparison of food habits between male and female subjects no significant difference was found

Traumatic injuries of the permanent maxillory incisors at dental department, Pakistan institute of Medical Sciences Islamabad: a retrospective study

The study aims to ascertain the prevalence of traumatic dental injures of the maxillary permanent incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad during the years 2003-2005. Information concerning age, sex, cause, type of tooth, number of injured teeth and patterns of tooth injury were recorded retrospectively from 336 patients aged between 8-40 years, comprising 498 traumatized teeth. The dental records of all the patients presenting with dental trauma were examined for collection of data relating to age, sex, cause, number of injured teeth, type of tooth and type of tooth trauma. Type of tooth trauma was recorded according to the Andreason classification. The data was subsequently processed and analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. Of the 336 patients, 227 were males [67.6%] and 109 were females [32.4%]. The gender difference was statistically significant [P < 0.0001]. The patients had a total of 498 traumatized teeth. A large number of dental trauma occurred in patients aged between 9-11 years. Most injuries involved one tooth in 227 patients [67.6%]. However two teeth in 90 patients [26.7%], three teeth in 11 patients [3.2%] and only in 8 patients [2.3%] four teeth were involved. Fractures in enamel only occurred in 74 teeth [14.6%]. Uncomplicated crown fractures in 208 teeth [41.9%] were the most commonly encountered dental trauma. 137 teeth [27.6%] suffered complicated crown fractures, 44 teeth [8.9%] uncomplicated crown-root fractures, 19 teeth [3.8%] complicated crown-root fractures and avulsion in 16 teeth [3.2%] only. The main causes were falls in 225 patients [66.9%], collision with objects in 40 patients [11.9%], road traffic accident in31 patients [9.2%] violence in 21 patients [6.2%], and sports in 19 patients [5.6%]. The maxillary central incisor was traumatized in 384 teeth showing a high percentage of 77%. Raising public dental awareness regarding the serious outcome of traumatic dental injuries is mandatory to improve the prognosis of dental trauma and to avoid complications

Comparison of radiographic and electronic working length in anterior teeth

The aim of this study was to compare the endodontic working length of anterior teeth by electronic apex locator and conventional radiographic method to determine the accuracy and reliability of latest generation electronic apex locator [Sybron Endo]. The study was carried out in the dental department of Pakistan Institute of Medical Sciences, Islamabad from April 2004 to January 2005. The use of electronic devices to determine working length has gained increasing popularity in the recent years particularly after introduction of latest generation of apex locators. An in vivo study was conducted on 30 permanent single rooted anterior teeth that were indicated for root canal treatment. First the working length was taken by electronic apex locator followed by conventional radiographic [Ingle's method]. After recording both measurements, the difference between the two results were compared to evaluate the diagnostic efficacy and ability of an electronic apex locator for accurate determination of working length. In 23 among 30 root canals, [76.6%] electronic measurement coincided with the radiographic measurements. In 4 cases [13.3%] it was short of radiographic measurements by 0.5mm. Both these results were considered acceptable however, in the remaining 3 cases the results were considered unacceptable, as in 2 cases [6.67%] it was more than radiographic measurement by 0.5mm and in 1 case electronic measurement was more than radiographic by 1.5mm. It has been concluded from the present study that the electronic apex locator is an effective device with an accuracy of more than 90%; hence it can be used as adjunct to conventional radiography but cannot replace it

Dentinogenesis imperfecta- a case report

A young 18-year old female patient reported to PIMS with pain in left upper first molar. Intra oral examination revealed infected, grossly carious left upper first molar and marked attrition of her all teeth. The colour of her teeth was also not normal, and opalescent She did not mention any complaint regarding tooth color or gradual reduction on height of her teeth. Extra oral and physical examination revealed no abnormality. Radiographic examination showed bulbous crowns, obliterated pulp chamber and canals. She had three brothers and two sisters. Her one sister and two brothers were also suffering from same dental problem. Except for her youngest brother, all others were wearing full dentures. Only one sister and one brother were normal. Her father had three brothers and three sisters. Out of the seven, three brothers [including her father] and all three sisters had the same disease. She also mentioned that the grandmother [paternal] of her father was also suffering from same problem

Dental management of patients suffering from [Lowe syndrome]

Lowe syndrome [LS] is an x-linked recessive disorder of unknown etiology resulting in ocular, cerebral and renal disorder. It is X linked recessive disorder, caused by a defective gene on Chromosome number Xq 26. Males are more affected than females. Clinical features are bilateral congenital cataract [100%], Glaucoma, Infantile hypotonia, gross motor developmental delay, reduced or absent deep tendon reflexes, muscle wasting, moderate to severe mental retardation, frequent high pitched scream seizures, growth failure, Rickets, Joint hyper mobility and renal manifestations. Prognosis is poor for normal life style. There are developmental delays, visual problems and progressive mental retardation. The patient dies in the first decade of complication of Fanconi syndrome if treatment is not provided. Lifespan can be extended with supportive therapy. A case of LS with dental management, although not ideal is presented. Mentally retarded patients needs regular dental visits to reduce avoidable dental pain

Management of papillon lefevre syndrome

It is a rare, autosomal recessive disorder occurring between the first and fifth years of life and is characterized by palmoplantar keratoderma and periodontitis followed by the premature shedding of both primary and permanent teeth. The teeth are affected in the order of their eruption, exhibiting inflammation of the periodontal tissue, bleeding of the gums, pocket formation, loosening of teeth, and finally spontaneous exfoliation without showing definite signs of root resoption by about age five. After an edentulous interval, the same process begins shortly after the second dentition. PLS [Papillon Lefevre Syndrome] is transmitted as an autosomal recessive trait. In addition, some patients manifest excessive sweating, the growth of fine body hair and the development of dirty colored skin on the affected parts. Genetic analysis of several affected families suggests that the disorder may result from mutations of a gene that regulates production of an enzyme known as cathespin C. A case of PLS is presented along with management of this condition. The result was satisfactory with limited resources. The patient was satisfied with improved esthetic, speech and chewing abilities

Conclusion: Any young patient who exhibits palmar hyperkeratosis should be examined carefully for periodontal breakdown

cross sectional analysis of amalgam restorations

The objective of this study was to determine the different causes of failures of amalgam restorations in the department of dentistry at the Pakistan Institute of Medical Sciences, Islamabad. It was a cross sectional study and was based on collection and interpretation of data

Eighty [80] patients of both genders were selected randomly from outpatient department of the department of dentistry. All the patients selected presented with post restoration complaint after amalgam fillings. Majority of cases reported with fractured restorations followed by recurrent caries and over hang fillings. Food lodgment due to poor proximal contact was the fourth common complaint

Clinical considerations and application of posterior composite resin restorations

Many varieties of posterior composites are marketed now a days. The success rate of posterior composites vary depending upon whether they are used in clinical studies in an institutional environment or by general dental practitioners. This paper offers a guide to the general practitioners to determine when to use these materials

Behaviour mangement of paediatric dental patients with pharmacological agents part-II

This two series article, part-I addressed various routes of sedative drug administration [Vol 16, No 2 of Pakistan Oral and Dental Journal]. In this part various sedative agents; used in paediatric dental practice have been discussed in detail. Their pharmacological advantages and side effects are highlighted. Monitoring the paediatric patient during sedation is also discussed

Chemotherapy/radiotherapy: effects on dental growth and development

Paediatric oncology patients receiving chemoradiation therapy often develop dental developmental anomalies which may affect the future dental care. Chemoradiation therapy may cause tooth and root agenesis, root shortening and thinning and localized enamel defects. These enamel defects histologically appear as niches in the developing dentin which alters the overlying enamel. The odontogenic cell sensitivity depends upon the position in the cell cycle and mitotic activity at the time of chemoradiation therapy. It is, therefore, important for the clinician to have the knowledge of the stages of dental development at the time of oncology treatment. The type of therapy to allow him to predict the eventual dental effects and to plan future dental care