Changes in oral functions and speech when using custom-fitted mouthguards: An uncontrolled before-and-after study.

BACKGROUND/AIM: Mouthguards are crucial for protecting athletes against orofacial injuries, yet concerns persist regarding their potential impact on oral functions. This study aimed to investigate the effects of sports mouthguards on oral functions and speech over time. MATERIAL AND METHODS: Thirty national rugby players received custom-fitted mouthguards. Questionnaire responses and speech recordings were collected before mouthguard use and at various intervals after using mouthguards: immediately, 1 week, 2 month, and 6 months. Spectrographic analysis was performed to measure voice onset time (VOT) for /p, b, t, d/ phonemes. Questionnaire responses were assessed with Friedman's test, while VOT changes were examined using one-way repeated measure analysis of variance. RESULTS: Compliance with mouthguard use improved during training and competitions, with consistent wear reported during matches. Over time, speaking difficulties and lisping decreased significantly (p < .001). The perception of nausea improved (p < .001), stabilizing after 1 month (p = .414). Sensations of bulkiness declined (p < .001). Mouth dryness reduced steadily, with no occurrences reported by all players by the end of the study. None of the participants reported bad breath, ulcers, or redness in the mouth. VOT changed immediately after wearing mouthguards (p < .001), gradually regressing toward the baseline, although not completely reaching it. Players held a favorable view of mouthguard use, with comfort and support for mandatory use increasing over time. CONCLUSIONS: Custom-fitted mouthguards do not lead to significant long-term disruptions in oral functions. Athletes generally adapt to mouthguard use, reporting improved comfort and greater support for their use.

Pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study.

This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; 'crowned' and 'untreated' groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy.

Impact of the COVID-19 pandemic on the self-reported competencies of dental graduates in a Malaysian setting.

INTRODUCTION: COVID-19 pandemic has disrupted the clinical training of dental programmes worldwide. This study aimed to assess the self-reported competencies of dental graduates directly affected by the COVID-19 pandemic, as compared to the cohort before the year 2020. MATERIALS AND METHODS: A questionnaire consisting of eight domains with 43 questions was sent to all the Universiti Kebangsaan Malaysia's (UKM) dental graduates of 2019 and 2020 cohorts. The domains were as follows: (A) gathering information at chairside, (B) diagnosis, (C) treatment planning, (D) treatment and prevention, (E) community-based, (F) management and administrative, (G) communication and (H) personal management and professional development. Three additional questions were included to assess satisfaction on clinical teaching and supervision, requirements and assessment and cross-infection control. RESULTS: A total of 54 (91.5%) and 45 (100%) questionnaires were returned by the 2019 and 2020 cohorts, respectively. The 2019 cohort consistently perceived their competencies to be high across all the eight domains, and these responses were significantly higher than the 2020 cohort for seven out of the eight domains (p < .005). The 2019 cohort also consistently perceived their competencies higher compared to the 2020 cohort for 40 out of 43 skills. Eleven skills were deemed to have "poor ratings," and seven of these skills were rated significantly lower by the 2020 cohort than the other cohort (p < .005). CONCLUSIONS: The findings of this study highlight the impact of the COVID-19 pandemic on the self-perceived competencies of dental graduates. The 2020 graduates reported lower percentages of competent responses, mainly for community-based skills and management and administrative skills, even though they were deemed competent and graduated. The loss of clinical time and the suspension of certain face-to-face activities significantly affected their perceived competencies.

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis.

OBJECTIVES: This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. MATERIALS AND METHODS: Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. RESULTS: The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. CONCLUSIONS: Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

Re-attachment of a Fractured Maxillary Central Incisor: A Case with Two Years Follow-up.

Crown re-attachment is the most conservative treatment that can be used to restore fractured tooth, even in an emergency situation. The re-attachment maintains original contour and incisal translucency of the tooth, and reduces the chair time and cost. In case of crown fracture with pin-point pulp exposure, irritation to the pulp should be minimised and consideration must be taken for pre-treatment pulpal status, choice of pulp capping material, choice of bonding system and treatment sequence during crown re-attachment procedures. This article reported a crown fracture case with pin-point pulp exposure that was treated using crown re-attachment with direct pulp capping. At two-year follow-up, the tooth was asymptomatic, remained functional, vital, and the appearance of restoration was acceptable with no colour change to the crown.

Evaluation of Pulpal Involvement, Ulceration, Fistula, and Abscess Index and Periapical Index in Screening for Endodontic Disease: Reliability and Accuracy.

INTRODUCTION: The pulpal involvement, ulceration, fistula, and abscess (PUFA) index was developed to screen for the clinical consequences of untreated dental caries. The aim of this study was to compare the diagnostic accuracy of the PUFA index and the periapical index (PAI) in identifying pulpal and periapical diseases. METHODS: A cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test. RESULTS: A total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05). CONCLUSIONS: The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.

Dentine hypersensitivity-like tooth pain associated with the use of high-dose steroid therapy.

Although corticosteroid provides many clinical benefits, it may cause a range of side effects. A 47-year-old female patient presented with a complaint of pain from her teeth, triggered upon taking cold, hot, and sweet food and drink. From her medical history, she was previously diagnosed with ulcerative colitis. She consequently developed pyoderma gangrenosum, and high-dose prednisolone was administered to treat this condition (prednisolone 30 mg bd for 4 months followed by tapering dose 5 mg/week). She claimed the pain started at the end of steroid therapy. The pain mimicked symptoms of dentine hypersensitivity, but without the presence of the clinical signs associated with hypersensitivity, suggesting that the pain was steroid induced. Patients in this condition will find that their dietary choices will be limited and effective oral hygiene be impeded. Reassurance and advising patients to maintain oral hygiene are the most appropriate treatment as this condition would eventually wear off with time.

An Interdisciplinary Approach for Management of an Extensive Carious Premolar.

The principle of ferrule effect is of prime importance when restoring an endodontically treated tooth. A severely broken down tooth due to subgingival caries almost always end up with extraction as inadequate ferrule effect would compromise the predictability of restorative treatment. This clinical case report describes a treatment approach that combines non-surgical endodontic treatment, orthodontic extrusion and prosthetic rehabilitation to restore the function and aesthetic aspect of an extensively carious premolar with compromised prognosis. One year follow-up indicated stable periodontal health with evidence of periapical healing radiographically.

Efficacy of Two Different Views of Video Demonstration in Teaching Access Cavity Preparation to Third Year Dental Students.

Introduction: Demonstration of the access cavity preparation procedures to dental students is challenging due to the limited operating field and the detailed nature of the procedures. The aim of this study was to develop and evaluate two different views in video demonstrations used to teach access cavity preparation. Methods and Materials: Two videos of access cavity preparation were filmed, one showing the occlusal view (OV) and one showing the sectional view (SV). Third-year dental students (n=57) who consented to participate in the study were divided into two groups to watch one of the videos. The perception and performance of both groups were compared using the Mann-Whitney U test and Fisher's exact test. Results: At baseline, group OV (n=29) and group SV (n=28) were not significantly different in terms of operative scores (P=0.330). After watching the videos, the basic understanding of the theories was similar in both groups. However, the SV group responded more positively towards the helpfulness of the video in visualizing the inner anatomy of the tooth and in implementing the procedures (P<0.05). The SV group also completed the exercise within a shorter time (P<0.001). Nevertheless, the quality of the prepared access cavities was not significantly different between groups. Conclusion: Within the limitations of this study, the additional step in sectioning a tooth before demonstration of access cavity preparation seems well worth the effort, offering the novice students advantages in visualizing certain anatomical landmarks and implementing access cavity preparation procedure within a shorter timeframe. Nevertheless, it did not improve the final quality of the preparations.

Management of Perforating Idiopathic Internal Root Resorption.

This case report describes the endodontic treatment of an idiopathic perforated internal root resorption. A 24-year-old male Malay patient presented with internal root resorption of two of his anterior teeth. The medical history was non-contributory and he had no history of traumatic injury or orthodontic treatment. Cone-beam computed tomography (CBCT) determined the nature, location and severity of the resorptive lesion. Non-surgical root canal treatment of tooth #22 and combined non-surgical and surgical approach for tooth #11 were carried out using mineral trioxide aggregate (MTA) as the filling material. The clinical and radiographic examination three years after completion of treatment revealed evidences of periapical healing. The appropriate diagnosis and the treatment of internal root resorption allowed good healing of these lesions and maintained the tooth in function for as long as possible.

Knowledge of managing avulsed tooth among general dental practitioners in Malaysia.

BACKGROUND: Dental and maxillofacial injuries are one of the areas of concern highlighted in the Malaysian National Oral Health Plan 2011-2020. General dental practitioners (GDPs) have the responsibility of diagnosing and assessing dental trauma and determining the prognosis and outcomes of trauma along with its management. The purpose of this study was to evaluate the knowledge base and preferred methods of general dental practitioners regarding the management of avulsed tooth. METHODS: A random convenient sampling methodology was employed for sample selection. A pre-tested 11-item questionnaire was validated on the dental officers. The survey was distributed to 182 GDPs attending the annual Malaysian Dental Association conference in January 2010. The data obtained was statistically analyzed using descriptive analysis and logistic regression was employed to predict the probability of achieving high scores. RESULTS: A total of 182 general dental practitioners participated in the study, with the majority being female (n=153, 75%). The place of practice significantly affected the knowledge score. In the group that scored more than 80 points (n=84, 46%), 76% of them worked with government hospitals. Age, work duration and number of traumatised teeth previously treated had no significant effect. The odds ratio for place of practice indicates that respondents who work in government hospitals are 3.6 times more likely to score more than 80 points compared to those who worked in private clinics (OR=3.615, P=0.001). CONCLUSION: The knowledge level on the management of avulsed tooth among general dental practitioners in Malaysia needs to be improved. Strategies in improvement of the Malaysian dental educational system, continuous dental educational activities and utilisation of guidelines on trauma management should be recommended to increase the knowledge level of avulsed tooth management to ensure good treatment outcomes. CLINICAL IMPLICATION: Trauma prevention and further education regarding the management of avulsed tooth is an essential requirement to improve general dental practitioners knowledge and clinical skills.

Factors Associated with Apical Periodontitis: A Multilevel Analysis.

INTRODUCTION: Ignoring the cluster effect is a common statistical oversight that is also observed in endodontic research. The aim of this study was to explore the use of multilevel modeling in investigating the effect of tooth-level and patient-level factors on apical periodontitis (AP). METHODS: A random sample of digital panoramic radiographs from the database of a dental hospital was evaluated. Two calibrated examiners (κ ≥ 0.89) assessed the technical quality of the root fillings and the radiographic periapical health status by using the periapical index. Descriptive statistical analysis was carried out, followed by multilevel modeling by using tooth-level and patient-level predictors. Model fit information was obtained, and the findings of the best-fit model were reported. RESULTS: A total of 6409 teeth were included in the analysis. The predicted probability of a tooth having AP was 0.42%. There was a statistically significant variability between patients (P < .05). Approximately 53.16% of the variability was accounted for by the patients, leaving 46.84% of the variability to teeth or other factors. Posterior tooth, inadequate root filling, and age were found to be significantly associated with AP (P < .05). CONCLUSIONS: Multilevel modeling is a valid and efficient statistical method in analyzing AP data. The predicted probability of a tooth having AP was generally small, but there was great variation between individuals. Posterior teeth and those with poor quality root filling were found to be more frequently associated with AP. On the patient level, advancing age was a factor significantly associated with AP.

Association of dental trauma experience and first-aid knowledge among rugby players in Malaysia.

OBJECTIVES: To assess and compare the knowledge of rugby players regarding first-aid measures for dental injuries. METHODS: A cross-sectional study was conducted at rugby tournaments in 2009 and 2010 on players aged 16 and over. Convenient sampling was performed. A total of 456 self-administered questionnaires were returned. Data collected were analysed using SPSS 21. Descriptive analysis was undertaken for the demographic data. The subjects were classified according to their experience of sustaining each type of injury. Cross-tabulation and chi-square tests were carried out to compare the responses. When the expected cell count was less than five, Fisher's exact test was used. The level of significance was set at P < 0.05. RESULTS: The prevalence of self-reported dental injuries was as follows: tooth fracture (19.3%), luxation (6.6%) and avulsion (1.1%). Significant differences were found, whereby 52.2% of those who had no history of tooth fracture were more likely to seek immediate treatment (P < 0.001), whereas 42% of those who previously experienced tooth fracture claimed that they would only visit a dentist if they experienced pain (P = 0.001). Management of luxation and avulsion did not differ significantly between the groups. However, about half of those who did not have a history of tooth avulsion admitted to not knowing the correct answer, while three of five casualties would keep the tooth iced. CONCLUSIONS: Knowledge of the management of tooth fracture and storage medium differs between previous casualties and non-casualties. Overall, knowledge of dental trauma management was insufficient, suggesting the need to educate and train the players.

Factors associated with mouthguard use and discontinuation among rugby players in Malaysia.

AIMS: To assess rugby players' preferences for using a mouthguard and to determine the factors contributing to the use and discontinuation of a mouthguard. METHODS: A cross-sectional study was conducted in two rugby tournaments from 2009 to 2010. Samples were selected by convenience sampling. Participants were required to complete a self-administered questionnaire, which inquired about awareness and pattern of mouthguard use, as well as reasons if discontinued. RESULTS: Completed questionnaires were returned by 456 participants, with an estimated response rate of 77.8%. All participants were male (mean age = 22.73, SD = 3.98). Median duration of playing was 6 years, and median frequency was 6 h per week. Overall mouthguard use was low (31.1%, n = 142), especially for custom-fitted mouthguard (1.8%, n = 8), followed by stock mouthguard (7.7%, n = 35). Boil-and-bite type was most commonly used (21.1%, n = 96). Of those who wore a mouthguard before, only 28% continued using it. The discontinuation rate for each type was as follows: stock, 57.1% (P = 0.032); boil-and-bite, 80.2% (P = 0.002); and custom, 37.5% (P = 0.04). Age was a significant factor for mouthguard use (P = 0.007, OR = 1.10, 95% CI = 1.03-1.17). Breathing disturbance (OR = 3.36, 95% CI = 1.17-9.72) and general discomfort (OR = 3.71, 95% CI = 1.68-8.20) were significant factors in discontinuing mouthguard use. CONCLUSIONS: The use of mouthguard was low among rugby players. Custom-made was the least worn type, possibly due to limited availability. The use of mouthguard increased slightly with age but was discouraged by breathing interference and general discomfort. Therefore, preventive effort should focus on early education and reinforcement, as well as on the improvement of wearability and accessibility.

An assessment of the prescribing skills of undergraduate dental students in malaysia.

Most dental schools lack a module on prescription writing in pharmacology. This study assessed the prescription writing skills of a group of Malaysian dental students at the end of their undergraduate training program. A quantitative study of a two-group posttest experiment was designed, and thirty-seven fifth-year (final-year) dental students were divided into two groups (A [n=18] and B [n=19]). Group A received a didactic lecture on how to write a complete prescription, while Group B served as a control group. For prescription writing, three standardized dental scenarios with a diagnosis of irreversible pulpitis associated with a child and a pregnant woman and periapical pulpitis for an adult man were administered. Thus, a total of 111 prescriptions (Group A [n=54] and Group B [n=57]) were collected. Twelve elements in each prescription were assessed by frequency and a chi-square test. Improvements in eight out of the twelve elements were observed in prescriptions written by students in Group A. The significantly improved elements were provision of the symbol R(x) (39.8 percent) (p<0.001), inclusion of the prescriber's signature (75.3 percent) (p<0.001), inclusion of the date with the prescriber's signature (54.6 percent) (p<0.001), and inclusion of the prescriber's registration (30.5 percent) (p<0.001). Overall, Group A gained almost a 50 percent improvement in writing complete prescriptions due to the intervening lecture. It appeared a traditional lecture led to the more accurate writing of a complete prescription. It was suggested that a module on prescription writing be added to the school's pharmacology curriculum, so that dental graduates will be competent in prescription writing for the sake of their patients' health.