effect of some missing teeth on a subjects' oral health related quality of life

Objectives: To determine the impact of missing teeth on the level of Oral Health Related Quality of Life [OHRQoL]in subjects reporting at a teaching dental hospital

Method:Using a structured Performa incorporating the 12-item General Oral Health Assessment Index [GOHAI] Questionnaire, and a consecutive [non-probability] sampling technique, data relating to 182 subjects fulfilling the study inclusion and exclusion criteria were collected using the method of interview and examination.Subjects responses to each of the 12 items of the GOHAI questionnaire were recorded to determine the impact of missing teeth on OHRQoL. Each of the GOHAI item had a maximum score of 5 thus giving a total of 60 as the maximum score. A high score of GOHAI indicated better ORHRQoL. The ORHRQol of subject was taken as good when the GOHAI score ranged 57-60, average when 51-56and poor when

Results: Subjects had a mean age of 35.6 +/- 5.8 [S. Dev] with males as 50.5% compared to females [49.5%]. The mean GOHAI score for all the subjects was 48.4 +/- 8.2 as compared to the mean GOHAI score of 48.4 +/- 8.2 for males and 47.6 +/- 8.3 for females. The ORHRQoL was good in only 27%. A high proportion of subjects [53%] had poor OHRQoL. The number and the frontal location of the missing teeth adversely impacted OHRQoL. Missing maxillary anterior teeth had the most negative effect on OHRQoL. Missing mandibular first molar was the most common missing tooth either alone or in combination with other missing teeth among the subjects studied. The most important GOHAI items contributing to the adverse impact on the OHRQoL of the majority of subjects with some missing teeth were;often worried/concerned about dental problems and never having been pleased or happy with the look of their teeth and gum

Conclusion: The adverse effect of missing teeth on OHRQoL was substantial necessitating the importance of preventing the condition of missing teeth or restoring when missing and maintaining the oral health of subjects

Type and location of unfavorable clinical findings in mandibular complete denture supporting tissues

Aims and Objectives: The rehabilitation of resorbed edentulous mandibles with conventional complete dentures can be a challenge due to presence of unfavourable local factors. This necessitates accurate diagnosis and knowledge of local anatomy, physiology and pathology as well as knowledge of the relative prognostic difficulties involved in the treatment. The aim of this study is to assess the type and location of unfavorable clinical findings in mandibular complete denture supporting tissues in patients reporting to the Prosthodontics Department, Dental Section, Bacha Khan Medical College [BMC], Mardan, Pakistan

Methods: A total of 102 subjects with edentulous mandibular arches who reported to BMC were included in this cross-sectional study. With the patient seated in the dental chair, a detailed history was recorded. They were also clinically examined to document the unfavourable clinical findings related to mandibular ridge using a mouth mirror, dental probe, tweezer and standard lighting condition. The unfavourable clinical findings, if any were limited to; residual ridge height, residual ridge width, ridge defects, status of mucosa [thin, ulcerated, flabby and inflamed], frenal attachment and tender areas of ridge. The collected data were analyzed using SPSS version 17.0

Results: Subjects [N= 102, 48 males and 54 females] had a mean age of 60.4 +/- 8.6 [SD] years. Some 80% subjects were older than 50 years with more than 42% above the age of 60 years. The duration of edentulism ranged from one month to 8.1 years. Common unfavorable clinical findings were; reduced ridge height in 76%, reduced ridge width in 30%, sharp bony spicules in more than 40% and undercut ridge in 59%. Mandibular tori/exostoses were seen in only 66% subjects. Among the unfavourable aspects related to soft tissues were; flabby mucosa [25%], thin atrophic mucosa [24%] abnormal frenal attachments in 46% and painful/ tender ridges in 42% subjects

Conclusions: The existence of multiple unfavourable clinical findings in many patients highlights the need for treatments of these patients with mandibular edentulism in specialist clinical set-ups

Some unfavorable intraoral features in edentulous patients reporting for complete denture treatment at the prosthodontics department of a teaching dental hospital

Introduction and Objectives: To gain an insight into the prognosis of complete denture treatment, the dental practitioner must be familiar with the anatomical and physiological condition of edentulous mouth of each individual patient. This study reports frequencies of some common unfavorable intra-oral features in edentulous patients reporting for complete denture [CD] treatment at the Prosthodontics Department, Khyber College of Dentistry [KCD] Peshawar [Pakistan]

Methodology: This was a descriptive, cross sectional study conducted during the period from February 2011 to February 2013.Using pre-structured data collection sheet, information of some unfavorable intraoral features of edentulism was recorded from patients seeking consultation for complete denture therapy in both jaws for the first time. History, clinical and radiographic examinations were the method for assessing the unfavorable intraoral features including mandibular bone height, maxillary residual ridge morphology, pattern of muscle attachment and maxillo-mandibular relationship

Results: Mean age was 61.8 +/- 9 years with male to female ratio of 1.27. Patients easy-to-treat with conventional CDs were 43 [27%] as compared to 116 [73%] who were difficult-to-treat. The frequencies of unfavorable features including mandibular bone height, maxillary residual ridge morphology, pattern of muscle attachment and maxillo-mandibular relationship were 60 [37.7%], 40 [25%], 54 [34%] and 55 [34.6%] respectively. Females had significantly reduced mandibular bone height

Conclusion: The high frequency of unfavorable intraoral features suggests screening of edentulous patients for knowing their levels of treatment complexity with conventional complete dentures

Functional assessment of removable complete dentures

The objective of this study was to evaluate the clinical quality of old removable complete dentures and to find out patient satisfaction. It was carried out from July 2011 to June 2012. It was case series descriptive study. Data relating to 72 patients wearing complete dentures were collected using structured eight categories, four point scale Proforma. Detailed patient history, clinical and prosthesis examination were undertaken. Data related to age, gender, fitting place and complete denture post-fitting duration were also recorded. Male to female patient's ratio was 2.2:1. Forty one [57%] complete dentures wearers had got their dentures made from public hospitals. Majority [42%] of evaluated complete dentures were not older than five years. Patients told us about good retention in 27 [37.5%] of maxillary and fair retention in 34 [47.2%] of mandibular complete dentures. Good mastication was reported by 40 patients [55.5%] and good esthetics by 34 [47.2%]. Sixty three [87.5%] patients complained about pain in their maxillary dentures and 54[75%] in mandibular dentures. Good stability was reported by 31 [43%] of mandibular dentures and 37 [51.3%] of maxiliary dentures. Good occlusion was seen in 37 [51.3%], oral hygiene in 45 [62.5%] and prostheses hygiene in 39 [54.1%]. It was concluded that retention and stability was good in maxillary dentures while fair in mandibular dentures. Majority of the patients showed poor oral and prosthesis hygiene. Pain was the most common complaint of these complete denture wear

Association of pathological activity of oral candida and denture wearing habit in denture wearers

To assess the effect of denture wearing on oral candidal activity through candida selective medium inoculated with standardized dilution salivary samples obtained from denture wearers. A cross sectional, comparative study during March-September 2007 was conducted at Khyber College of Dentistry Peshawar. Using a structured proforma, data were collected from 50 subjects [50 Denture wearers]. Stimulated salivary samples were collected from each subject. One ml of standard dilution saliva was mixed with 4ml sterile liquid candida -selective medium. The extent of candida activity was then determined, biochemically, through change in pH of the medium 24 hrs after inoculation and incubation at 37°C. Pathological candidal activity was seen in denture wearers. However, the association between the denture wearing habit and candidal activity was found significant, meaning that continuous denture wearing always showed a high pH change [t- value of 0.01] and mean pH decrease of 2.2 in continuous denture wearers as compare to 1.6 in only day time wearers. Beside this denture plaque score, type of dentures and denture hygiene maintenance was found to have insignificant association with the candida activity. Within the limits of this study, denture wearing significantly enhanced the pathogenic activity of oral candida. The importance of rest to denture supporting tissue is re-emphasized

Continued linear setting expansion in two proprietary type IV dental stones

Objective: To report linear setting expansion of two commercially available type IV dental stones at various time periods

Methodology: An Analytical study design conducted from December to June 2006 involving 60 stone casts poured in impressions of a machined brass model. After an elapse of a post-mixing and pouring period of 2 hours, the initial linear setting expansion as observed between chosen reference points on each cast was made using travelling microscope. On each cast, further observations and recordings of the linear expansion between reference points, were also made at test periods of 24, 48, 72, 96, 120 and 168 hours

Results: Generally, linear setting expansion continued over the test periods with the highest expansion values at 168 hours on some casts. Expansion reached at peak value for casts poured in Silky Rock at the 96 hours test period as compared to 120 hours in those made in GC Fuji Rock stone. In case of GC Fuji Rock, 44.8% of the overall expansion occurred by the test period of 2-hours as compared to 76.7% in case of Silky Rock. Furthermore, the observed values for the setting expansion at the 2-hours test period were different from those provided by the manufacturers and for one product were significantly different

Conclusion: Considering the observed varying setting behavior of the test stones and its deviation from the manufacturers provided data and the many available ones for dental application, the importance of continued research in the in the area is highlighted

Complications in metal-ceramic fixed dental prostheses: literature review

Introduction: Fixed dental prostheses [FDPs] using metal-ceramic [MC] technology are widely employed. Despite high success rate reported for MCFDPs, patients and dental practitioners encounter complications in these

Methodology: Seventy one English language publications with information and findings on various types of complications in MC FDPs during the period from 1961 to 2013, provided as the source for this narrative review

Results: Longevity and success of MCFDPs in general has been promising. This can be seen from their good success seen over a follow-up periods ranging from 15 to 20 years. The problems or complications observed in these prostheses have been attributed to reasons including; lack of attention to proper planning and case selection, inadequate clinical and technical expertise and lack of patients' compliance with the instruction. In general, complications occurring in MCFDPs have been categorized as simple or extensive with the latter requiring replacement or even using other alternatives. Complications that occur in abutments have also been categorized as biological or technical. Those in the former category occur in the supporting abutments. In this context, not only the extent of the FDP and the availability of required number of abutments is important but also is the health and integrity of their supporting tissues. Such complication includes primary and secondary caries, pulp pathology, periodontal disease and abutment fracture. Technical complications that occur in the prosthesis comprise in general the FDP de-cementation, ceramic de-bonding, aesthetic problems, occlusal errors and fracture of the FDP framework

Conclusion and Recommendations: MCFDPS having shown promising success rate shall continue to be provided to patients. However, proper treatment planning for these FDPs is necessary for avoiding and minimizing the reported rate of complications. Due consideration should be given to appropriate designing of the prosthesis [mechanical factors] as well as the evaluation of FDP abutments [biological factors]. It is important to assess abutments for features such as crown and root form and length, crown-root ratio, structural integrity, pulp health, periodontal status, available support, axial inclination and abutment mobility. Apart from these, factors such as number of missing teeth, alveolar ridge shape, arch curvature and occlusal forces should also be considered

effect of mouth remaining open or close on the depth of mandibular alveolo-buccal vestibule during impression recording

Objective: To examine the effect, on the depth of mandibular alveolo-buccal vestibule, of mouth remaining open or closed at the impression recording stage

Methodology: In the first place, in each of the 5 dentate subjects, with their teeth in light occlusion and no biting force, 5 recordings of the alveolo-buccal vestibule were obtained by injecting a cartridge type VPS impression material [Exahiflex, GC, Corp, Tokyo, Japan]. Impressions were made in controlled manner with the subjects performing a standard lip protrusion and retrusion exercise three time to shape the material accordingly. The procedure was then repeated in the same manner except the subjects keeping their opposing teeth apart by 10mm using a custom made bite-block fitting the central incisor teeth. For each subject, a mandibular arch stone-cast was also prepared from an alginate impression [Aroma Fine Mixer Type, GC, Corp, Tokyo, Japan]. The vestibular impressions were modified by removing the portion above the gum margins so as to leave the occlusal surfaces and the coronal third of teeth uncovered when adapted to their stone-casts. Subsequently, each of the impression on its cast was carefully sectioned between reference lines drawn on the cast to connect selected points on the occlusal surfaces of second molar [M2], first molar [Ml], second premolar [P2] and first premolar [PI] teeth with a corresponding point at the peripheral land around the sulcus. In all cases, these lines crossed the deepest part of the gum margin around the teeth and were made parallel to each other. After cutting, the mesial face of each impression section was scanned with Twain 32, Epson Twain Pro Version 1.5, at 400 resolution against a mm ruler. Using the Photo-Editor Software [Microsoft Co, USA] in an IBM compatible computer, the depth of the alveolo-buccal vestibule at the selected locations was determined between the deepest part of the gum margin and the peripheral-most outline of the impression section representing the sulcus. The data obtained were analyzed statistically, for significance of the within and between subjects variations, using student t-test and paired t-test respectively

Results: In the results, the depth of the alveolo-buccal vestibule was significantly less with the close-mouth method than that with the open-mouth method. In general, a depth reduction, ranging between 11.5 to 18.6%, was observed with the highest amounts of reduction between the first molar and second molar [M2-M1] region

Conclusions: Decreased vestibulor depth will be recorded when using an open-mouth impression technique

Frequency and severity of risk factors for temporomandibular disorders in young adults

Objective: To document the frequency and severity levels of risk factors for temporo-mandibular disorders [TMD] in young adults

Methodology: This cross-sectional study was conducted at the Department of Prosthodontics Khyber College of Dentistry [KCD], Peshawar. A structured proforma and the method of interview and clinical examination, was used to collect data from 100 young adults for the presence and severity level of TMD risk factors including socio-economic and psychological, dental and neuro-musculo-skeletal. Each of these broad categories of TMD risk factors were further elaborated into five sub-areas and their severity level ranked on a 5-point Likert scale with 0 [No Effect] to 4 [Extreme Worst Effect]. The total score of each category was determined from the sum of the scores of severity level of the individual risk factors. The grand total was calculated by adding the total scores of all categories. Risk for TMD was determined as nil if the score = 0, low if range was 1-20, moderate when 21-40 and high when it was 41-60

Results: Subjects having moderate severity risk level for TMD were 52/100 with 18 [47.4%] males and 34 [54.8%] females. Maximum score was noted for the socio-economic and psychological factors [19/20] with a mean of 7.3 + 4.2. Low score was noted for dental factors [8/20] with a mean of 1.8 + 1.9. The scores for any of the two main category factors came out higher for the socio-economic and neuro-musculo-skeletal categories risk factors and lower for the dental and neuro-musculo-skeletal factors. The order of decreasing importance of the three main category TMD risk factors appeared as socio-economic and psychological > neuro-musculo-skeletal > dental [t-value = 0.5, p-value = 0.000, df. - 99]

Conclusions: Addressing the psycho-socio-economic problems of young adults might help minimizing the risk for development of TMD

Types of maxillary tumours and the resulting post-surgical defects in patients at a teaching hospital

To report the frequency of the types of maxillary tumours and the resulting post-surgical defects based on Aramany classification. Study design, duration and setting: This descriptive study was done during the period of 5 years [2005-11] at the Otorhinolaryngology and Head and Neck Surgery Unit, Khyber Teaching Hospital Peshawar. A pre-structured proforma was used for data collection. Data recorded included patients' age, gender, type of maxillary tumour, type of maxillectomy and approach for resection, Post-surgical defect based on Aramany classification for acquired maxillary defects, neck dissection, radiotherapy, and prosthetic rehabilitation. Data were computed for descriptive statistics including frequencies, percentages and mean values. Patients [n=53] had a male to female ratio of 1.7. Some 26.4% patients belonged to the age group of 31-40 years. Maxillectomy was done for inverted papilloma, a benign tumour in 1.9% patients as compared to malignant squamous cell carcinoma in 66% patients. Maxillary resection for fibrous dysplasia was done in 3.8% patients who were relatively younger. Maxillectomy in all cases was performed using Weber-Fergusson incision approach. Surgical resection resulted in Armanay calls I defect in 73.58% patients. In 92.5% patients a surgical obturator was provided to patients at the time of maxillectomy. Maxillectomy was mainly performed for resecting malignant tumours using Weber-Fergusson incision with the fitting of immediate surgical obturator. The resulting defect was mainly Aramany Class I defects

Biochemically assessed pathological activity of oral candida in denture and non denture wearers

To assess the Candida activity through recording pH changes in Candida selective medium inoculated with standardized dilution salivary samples obtained from dentures wearers and non denture wearers. A Cross Sectional, Comparative study during March-September 2007 was conducted at Khyber College of Dentistry Peshawar and Zoology Department, University of Peshawar [Pakistan]. Using a structured proforma, data were collected from 100 subjects [50 DWs and 50 NDWs]. Stimulated salivary samples were collected from each subject. One ml of standard dilution saliva was mixed with 4 ml sterile liquid Candida-selective medium. The extent of Candida activity was then determined, biochemically, through change in pH of the medium 24 hrs after inoculation and incubation at 37°C. The influence of age, gender, socioeconomic status, smoking habits, medication-use, oral-hygiene maintenance method, denture-plaque level, and level of salivary function was also investigated. Pathological Candida activity was seen both in DWs and NDWs. However, it was significantly higher in DWs [p value = 0.00] with mean pH decrease of 1.9 as compared to 0.8 in NDWs. Except age, the effect of gender, socioeconomic status, medications, oral hygiene maintenance on the oral Candida activity was insignificant both within and between groups. Not-with-standing the varying effect of other variables, denture-wearing significantly enhanced pathogenic activity of oral Candida. The importance of meticulous oral and denture hygiene maintenance and rest to denture-supporting tissues is re-emphasized

Incorporating implant dentistry into undergraduate dental curriculum: need, problems and a simplified implementation strategy

As a consequence of several paradigm shifts and the increasing need and demand for implant restorations by patients, these days' implant related procedures are more frequently performed by general dental practitioners [GDP]. The resulting lack of not following a team approach by the GDP has increased the rate of implants related complications. Thus dentists upon graduation need to be made competent by incorporating, in the curriculum, relevant concepts and procedure related to dental implants. This will enable local dental institutes not only to be in line with those in developed countries but they will also produce dental graduates competent for the practice of dental implants. The implant related curricular content shall comprise of learning and training of; indication of oral implants in overall treatment planning of patients, understanding of the basic aspects of healing and tissue integration, basic biomechanical andmaterial science principles, patients' evaluation, selection and identification of their treatment complexity, relevant ethical and moral considerations, surgical and prosthetic techniques, monitoring,maintenance and management of complications related to peri-implant tissues and implant prosthesis. This writing elaborates upon the strategy for overcoming the barriers to introducing dental implants in dental undergraduate studies and for ensuring desired learning and the acquisition of skills related to these issues of implant-supported dental restorations by graduating dentists

Complications in metal-ceramic fixed dental prostheses among patients reporting to a teaching sental hospital

Aims and Objectives: This study aimed to report the distribution of biological and technical complications and their levels in patients' fixed dental prosthesis [FDPs] reported to Prosthodontics Department, Khyber College of Dentistry Peshawar [Pakistan]

Methods: During February 2007 to Jan 2008, a descriptive study was conducted. Data relating to 124 patients having complications with their levels in metal-ceramic FDPs were collected using a structured proforma, by the methods of patient's interview, clinical and radiographic examination. Data related to age, gender, types and levels of biological and technical complications, the FDP fitting place, FDP location in the dental arch as well as of the post-fitting duration were also recorded

Results: Subjects had mean age of 37+11 years. Male to female ratio was 1.3:1. Distribution of FDPs was; hospital-fitted [56.4%], private-practice-fitted [32.2%] and quacks-fitted [11.2%]. Distribution of 210 noted complication events with reference to fitting place was; hospital-fitted [60%], private-practice-fitted [30%] and quack-fitted [10%]. Some 29% complication events were in FDPs not older than a year, 46% in those not older than 5 years and 25% in those older than 5 years. Complication were; de-cementation [24.8%], caries [20.5%], peri-apical problems [18.1%], periodontal problems [11.1%], prosthesis fractures [9.1%], abutment fracture [7.1%], occlusal problems [6%] and esthetic-problems [3.3%]. Not-withstanding the varying levels of individual complication events, level-1 complications were 43%, level-2 were 44% and level-3 were 13%

Conclusion: Irrespective of the types and levels, some 75% complications occurred in FDPs not older than 5 years

Missing teeth, edentulous areas and socio-demographic status adversely affect the quality of life

To explore, in local subjects, the effect, on oral-health-impact-profile [OHIP] scores, of missing teeth, edentulous areas and some socio-demographic factors. During the period from June to November 2007, a cross-sectional study involving 243 partially dentate subjects was conducted at Khyber College of Dentistry, Peshawar [Pakistan]. With the method of interviewing and clinical examination and using a 33-OHIP-statements sheet, OHIP scores for subjects were determined. Socio-demographic as well as data for the number of missing teeth and edentulous areas were also recorded. OHIP scores were positively correlated with the number of missing teeth [r = 0.29] and the number of edentulous spaces [r = 0.37]. Subject's age and socio-economic status were more important co-variables influencing OHIP scores as compared to gender and educational level. Generally, higher OHIP scores were recorded for subjects who had anterior edentulous spaces, distal extension spaces or multiple and larger bounded spaces. Also much higher scores were recorded in those having bounded and distal extension spaces in addition to anterior spaces. OHIP-statements with high scores as an indication of adversely affecting QoL were those related to the function of chewing and esthetics. Some OHIP-statements that had been tested in other countries were found un-important for determining oral-health-related-quality-of-life [OHRQoL] in the present subjects. With their varying influence, missing teeth, edentulous spaces, age and socio-economic status proved important variables influencing both the OHIP scores and OHRQoL

Factors influencing the type of prosthetic restoration for partially dentate adults

In developed countries, patients' factors and esthetic concerns have predominantly influenced prosthodontic treatments. The objective of this investigation was to see if such factors in local partially dentate patients influenced the clinicians' decision regarding the prostheses planned. This was a descriptive study carried out in Khyber College of Dentistry, Peshawar from March to October 2007. Using a structured data collection-sheet, patient's data including gender, age, socio-economic status, educational level, oral-hygiene status, main concern of patients for consultation and the number, location and type of saddles in the jaws were all recorded. The type of prosthodontic service planned for each patient was also recorded. One investigator collected the required data from each of the 206 partially dentate patients by the method of direct interviewing. Acrylic removable dental prostheses [RDPs] were more frequently provided than fixed dental prostheses [FDPs]. No precision-retained or implant-supported prosthesis were planned. Irrespective of the type of prosthesis, the restoration of chewing function was the major concern of patients for consultation. Age, socioeconomic status, educational level and type of saddle in the maxilla influenced patients' treatment with RDPs. In comparison, better socioeconomic status and educational level were the reasons in case of planned FDPs. The reason for the planned FDPs in the maxilla was esthetics as compared to improvement in chewing function in case of the mandible. Acrylic RDPs were the most frequently planned prostheses. Patients; socioeconomic status and educational level and the type and location of saddle influenced the type of prosthesis planned for patients