Surgical Management of Extruded Fractured Instrument Beyond the Periapical Area: A Case Report with Two-year Follow-up

@#A fractured instrument is an undesirable endodontic mishap that can prevent complete root canal disinfection, thereby affecting the root canal treatment outcome. The present case discussed the surgical management of an extruded fractured barbed broach at the apical third of maxillary right first premolar. A 28-year-old female presented with an endodontic failure on tooth 14 and was diagnosed as previously root canal treated with symptomatic apical periodontitis. Radiographic examination revealed a straightline radiopacity structure that was 2 mm in length extruded from the apical root-end, suggesting a fractured instrument. The case was successfully managed through endodontic microsurgery. The present case emphasises the significance of cone-beam computed tomography as a valuable tool for diagnosis and investigation, while also offering supplementary information for the planning of surgical treatment.

Assessing Inter-rater Reliability of the Dental Practicality Index and the American Association of Endodontists Endodontic Case Difficulty Assessment Form among Undergraduates

@#Dental Practicality Index (DPI) and American Association of Endodontists Endodontic Case Difficulty Assessment (AAECDA) form potentially can guide clinicians in making clinical decisions and triaging in large practices and academic settings. Nonetheless, the reliability and validity should be evaluated before institution-wide implementation. This study aimed to evaluate the inter-rater reliability of the DPI and AAECDA forms. Ten randomly selected, trained students rated 25 cases with both forms. The itemby- item inter-rater and overall reliability were estimated with Gwet’s agreement coefficient (AC2) and intraclass correlation coefficient (ICC), respectively. The association between clinical decisions and the scores was analysed with the Generalised Estimating Equation. The inter-rater reliability of DPI was generally very good (AC2 = 0.81–1.00), except context (good; AC2 = 0.718; 95% confidence interval [CI] = 0.575–0.861). The inter-rater reliability of AAECDA was generally very good (AC2 = 0.81–1.00) and good (AC2 = 0.61–0.80), except the radiographic appearance of the canal(s) (fair; AC2 = 0.424, 95% CI = 0.263–0.585). Moderate overall inter-rater reliability of AAECDA (ICC = 0.53, 95% CI = 0.38–0.70) and DPI (ICC = 0.62, 95% CI = 0.48–0.77) was observed. Referral to an endodontist was positively associated with AAECDA score (odds ratio [OR] = 1.323, 95% CI = 1.145–1.52, p < 0.001). The decision of tooth extraction was positively associated with the DPI score (OR = 1.983, 95% CI = 1.539–2.555; p < 0.001). In conclusion, DPI and AAECDA are methods with moderate inter-rater reliability when used among dental students.

Graduates’ and Employers’ Perceptions on Competencies Obtained from An Undergraduate Dental Curriculum Persepsi Graduan dan Majikan terhadap Kompetensi yang Diperolehi dari Kurikulum Program Pergigian Prasiswazah / Jurnal Sains Kesihatan Malaysia

@#The effectiveness of a dental curriculum as reflected by the competencies of the graduates is paramount in ensuring its relevance in the rapidly evolving field of dentistry. This work aimed to assess the competencies of dental graduates of the Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM) as perceived by the graduates and their employers on the basis of the core competencies listed in the undergraduate dental curriculum. A self-administered questionnaire consisting of 43 questions based on eight competency domains were sent to all UKM dental graduates of years 2012 to 2015 and to senior dental officers who represented their employers. The eight domains assessed were as follows: 1) gathering information at chair-side, 2) diagnosis, 3) treatment planning, 4) treatment and prevention, 5) communitybased, 6) management and administrative, 7) communication and 8) personal management and professional development. a total of 132 graduates (75%) and 18 employers (55%) responded. Only domain E on community-based skills was collectively rated ‘satisfactory’ while the rest of the seven domains had an ‘excellent’ rating by all respondents. With regard to individual skill, basic life support was rated very low for both groups (38.6% graduates and 23.5% employers). A strong association was found between the scores given by the graduates and their employers (p= 0.00). Generally, no difference was found between the scores of graduates from different years. The findings allow an evaluation of the curriculum in a myriad of angles. Although the graduates reported a good level of competency in most domains, the employers were reserved on the community-based skills. Poor competency in the key skill of basic life support in medical emergencies was highlighted and must be addressed in the curriculum or during training at the workplace.

Cross-Cultural Adaptation Of Modified Dental Pain Screening Questionnaire (M-Depaq) In A Primary Dental Care Clinic In Kuala Lumpur

A validated screening tool for patient triage based on the pain symptoms, could potentially optimize the resources and expertise available in dental pain management. The aim of this study was to translate and validate the Modified Dental Pain Questionnaire (M-DePaQ) for use in categorizing patients with pain into three groups of common dental conditions. Forward Malay and Chinese translation was performed, followed by backward English translation. The translation was reviewed by an expert panel and pre-tested on patients who are native speakers. Consecutive patients aged 18 years and older experiencing pain and attending the primary dental care clinic completed the questionnaires. Four calibrated dentists made clinical diagnoses independent of the questionnaire responses. For data analysis, the cases were split randomly into Random Sample 1 (RS1) and Random Sample 2 (RS2). Discriminant analysis was performed on RS1 to develop a model for classifying dental pain cases into three groups. The model was applied to cases in RS2, and a crossvalidated accuracy rate was obtained. Criterion validity was assessed using measures such as sensitivity, specificity, positive predictive value, and kappa. Of the 234 questionnaires distributed, 216 (92.3%) were returned. Classification rates were recorded at 73.8% for RS1, 75.0% for RS2, and 71.1% for all cases. The sensitivity values were 0.72, 0.39, and 0.43 for Groups 1, 2, and 3, respectively. The corresponding specificity values were 0.42, 0.87, and 0.94. The discriminant validity of the adapted questionnaire was satisfactory, but the criterion validity could not be established because of biases incorporated in the study.

The Dietary Intake, Oral Health Care and Caries Experience Amongst UKM Students / Jurnal Sains Kesihatan Malaysia

There are many factors that cause caries. This cross sectional study is to describe the relationship of oral hygience, dietary intake with caries experience among UKM students. A total of 93 subjects (19 - 24 years old) participated in the study. A food record for 3 days was used to assess fluoride ingestion from diet. Fluoride Ion Selective Electrode was used to analyse fluoride content in foods and beverages consumed. Foods frequency questionaires (ffq) were used to assess frequency of sugary foods intake and calcium ingestion. Oral health questionaire was used to assess the oral hygience status. DMFT (Decayed, Missing, Filled teeth) index was used to describe the rate and accumulation of caries in permanent teeth. Results showed only 20.4% of subjects were caries free. The mean DMFT score was 3.80. The mean score for filled component was the highest (1.88), followed by decayed component (1.64) and missing component (0.27). The mean of fluoride and calcium ingestion per day were 2.13± + 0.96 mg and 454.79 + 208.9 mg respectively. Mean daily frequency of sugary food comsumption was 2 times. The range of fluoride content in foods and beverages were 0.04 to 25.64 ppm and 0.03 to 0.72 ppm respectively. There were no significant relationship between fluoride, calcium ingestion and frequency of sugary foods intake with caries experience. There was a statistically significant relationship between oral hygience practices and caries experience. (p < 0.05).