Knowledge of Impacted Teeth among the Undergraduate Dental Students of a Medical College: A Descriptive Cross-Sectional Study.

INTRODUCTION: Third molar impaction is a common patient complaint in dentistry. Common symptoms are localized pain, swelling, bleeding, and difficulty in mouth opening. Since dental students deal with patients early in their education, for better skill, they should have knowledge of various teeth impactions. Hence, the objective was to find out the knowledge of impacted teeth among undergraduate dental students of a medical college. METHODS: A descriptive cross-sectional study was conducted among bachelor in dental surgery students of a medical college from November 30, 2020 to April 3, 2021. Data collection was done by convenience sampling after receiving ethical clearance from Institutional Review Committee (Reference 1208202006). A structured questionnaire in Google Forms was sent to 221 participants via Viber. Out of 213 responses received, 144 were analyzed in Excel after discarding for duplication and other errors. Descriptive statistics such as mean, standard deviation, frequency, and percentage were analyzed. RESULTS: Out of the total of 144 participants, only 81 (56.3%) (47.89-91.4 at 95% Confidence Interval) had known about the term 'impacted teeth' before joining Bachelor in Dental Surgery course. The source of information was mostly the internet 27 (18.8%) followed by dentist 23 (16%). Most students 116 (80.6%) were familiar with third molar impactions, 62 (43.1%) knew about types of impacted teeth/impaction, and 100 (69.4%) were aware of the complications of not removing impacted teeth. CONCLUSIONS: Dental students should be provided with appropriate 'impacted teeth' education supported by practical experience. More detailed information regarding impacted teeth should be included in the curriculum for better understanding.

Multiple fibro-osseous lesions of the jaws: A report of a rare case with a literature review.

Fibro-osseous lesions are a poorly defined category of conditions affecting the jaws and craniofacial bones, and include developmental lesions, reactive or dysplastic lesions, and neoplasms. Fibrous dysplasia and ossifying fibroma are the 2 main types of fibro-osseous lesions affecting the jaw, and ossifying fibroma is a true benign neoplasm of the bone-forming tissues with several well-recognized variants ranging from innocuous to extensively aggressive lesions. However, multiple simultaneous fibro-osseous lesions of the jaw bones involving all quadrants are exceedingly rare. One such case diagnosed by conventional radiography and computed tomography is discussed here.

Smoking, general and oral health related quality of life - a comparative study from Nepal.

BACKGROUND: Perceived dental health has shown to have a significant predictive effect on overall health perception and life satisfaction. Thus, it seems plausible that Health Related Quality of Life (HRQOL) measures are associated with Oral Health Related Quality of Life (OHRQOL) dimensions in Nepalese context as well. The adverse effects of tobacco on oral health are reported worldwide including Nepal. However, evidence which can quantify effects of tobacco smoking on dental health perception is limited. Thus, a study was designed to find association of smoking and socio demographic characteristics with OHRQOl and to determine association between OHRQOL and HRQOL among dental patients in Nepal. METHODS: A cross sectional study was conducted among 125 current smokers and 125 non-smokers who attended oral surgery OPD of a teaching hospital in Kathmandu, Nepal. The study participants were enrolled through consecutive sampling and data was collected through a semi-structured questionnaire. The questionnaire consisted of questions related to sociodemographic characteristics, tobacco history, Oral Health Impacts Profile (OHIP)-14 and World Health Organization Quality of Life Brief version (WHOQOL-Bref) to assess OHRQOl and HRQOL respectively. Descriptive and inferential statistics were calculated by using SPSS version 18.0. The level of significance was set at 5%. RESULTS: Among the socio demographic characteristics, patients with education of more than Class 12 had significantly higher average OHRQOL scores (p = 0.013) compared to illiterate patients. Current smokers reported significantly poorer scores in sub scales of psychological disability (p = 0.001), social disability (p = 0.003), physical pain (p < 0.001), functional limitation (p = 0.007) and also overall perceived oral health compared to nonsmokers. OHRQOL was significantly correlated with overall HRQOL in physical (p = 0.015) and psychological (p = 0.04) domains in this study sample. CONCLUSIONS: Improvements in OHRQOL may require a multidimensional approach with focus of social factors like education and behavioral factors like cigarette smoking. Also, improvement in OHRQOL might also lead to betterment of perceived overall health as they are interlinked.

A Comparative Study of the Effect of Sutureless Versus Multiple Sutures Technique on Complications following Third Molar Surgery in Nepalese Subpopulation.

OBJECTIVE: To compare the effect of sutureless versus multiple sutures technique on postoperative variables such as pain, swelling, and trismus after surgical removal of the third molar in Nepalese subpopulation. Materials and Methods. Forty-eight patients were equally grouped into multiple sutures (group 1) and sutureless (group 2) groups using a computer-generated random table. The same operator performed all the surgical procedures. Postoperative variables such as pain, swelling, and trismus were measured by a single concealed observer using a 10 cm Numerical Rating Scale (NRS), flexible plastic measuring tape, and vernier caliper preoperatively and on 1st, 2nd, and 7th postoperative days. RESULTS: This study showed significantly more swelling measured from the gonion to lateral canthus in group 1 than in group 2 on all postoperative periods (P < 0.05). The mean NRS score was significantly higher in group 1 on the 1st postoperative day (P < 0.05). The mean NRS score was significantly higher in group 1 on the 1st postoperative day (. CONCLUSION: Our results support the use of sutureless technique after third molar surgery to minimize postoperative morbidity and the overall operative time and reduce the cost within the Nepalese subpopulation.

Anatomical Position of Lower Third Molar in Relation to Mandibular Canal on Cone-Beam Computed Tomography Images in A Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The positional relationship between the mandibularcanal with impacted mandibular third molar is the main factor of inferior alveolar nerve injury. The purpose of this study wasto classify the anatomical three dimensional relationship between the proximity of impacted mandibular third molars to the inferior alveolar canal. METHODS: The descriptive cross-sectional study was conducted inthe Department of Oral and Maxillofacial Surgery of a tertiary care hospital from July 2020 to August 2020 after obtaining ethical approval from the Institutional Review Committee (Reference number 2506202001). Cone-beam computed tomography images of 200 patient's mandibular third molars were used. A convenient sampling method was used. Data were analyzed using Statistical package for the Social Sciences. RESULTS: Mandibular canal relative to the roots of the mandibular third molar was observed on the apical side in 104 (52.0%) and 173 (86.5%) third molars had direct contact with the mandibular canal. About 36 (97.3%) lingually placed mandibular third molars had contact with the mandibular canal. CONCLUSIONS: The findings of the study conclude that most of the mandibular third molars situated lingually had a higher occurrence of mandibular nerve involvement. The anatomic structures of the mandibular third molar and the mandibular canal may be helpful to draw upon the adequate surgical plan to avoidor reduce nerve involvement.

Smoking and Quality of Life - Is there really an association? Evidence from a Nepalese sample.

Tobacco smoking has a negative impact on human health. Thus, it seems plausible for it to affect perceived quality of life as well. Information in this regard is lacking in Nepalese context. Thus, a comparative study was designed to assess association of cigarette smoking with Health Related Quality of Life (HRQoL). This study was conducted among 125 current and never cigarette smokers who attended a teaching hospital in peri-urban area of Capital city of Nepal from December 2015 to June 2016. The data regarding their socio-demographic characteristic, tobacco history and HRQoL was collected using a self administered questionnaire. QoL assessment was made with the help of valid, translated version of WHO QOL-BREF. Results showed current smokers on an average used 4 sticks of cigarettes per day. Significant proportions of current smokers also consumed alcohol compared to never smokers (p <0.05). Mean difference of both overall QoL score and domain scores among both study groups were relatively small and thus, failed to reach statistical significance. On the other hand, the socio-demographic characteristics like male gender, currently earning and attaining more than higher secondary education were predictors of better HRQoL scores. According to study results, relationship between smoking status and self reported QoL is unclear. Thus, the policy makers should also focus on wider determinants of ill health and well being and not just smoking status. Further research is still needed to understand the effect of tobacco on self perceived health related quality of life.

Dentigerous Cystic Changes in the Follicles Associated with Radiographically Normal Impacted Mandibular Third Molars.

OBJECTIVE: To assess the incidence of dentigerous cystic changes in the follicles of radiographically normal impacted mandibular third molars. METHODS: One hundred and thirteen follicles obtained after surgical removal of impacted mandibular third molars with radiolucency of less than 2.5 mm in the radiograph were sent for histopathologic evaluation to evaluate pathologic changes. RESULTS: The incidence of dentigerous cystic changes observed was 15.9%, that is, 18 out of 113 patients (51 males and 62 females), with the maximum incidence of cystic changes seen in the follicular space size of 0.5 mm. The mean age of the patients included was 27.8 ± 8.1. The most common indication for extraction among the patients in this study was recurrent pericoronitis (95%). There were no statistically significant differences in occurrence of cystic changes based on age, gender, angulation, relation to ramus, depth, side of impaction, and follicle size (P > 0.05). CONCLUSION: Dental follicles obtained from surgically removed impacted mandibular third molars should be submitted for histopathologic examination irrespective of the radiographic size of the follicle.

Animal Inflicted Maxillofacial Injuries: Treatment Modalities and Our Experience.

INTRODUCTION: Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients. The treatment of animal inflicted injuries must address the soft tissue defect, neurovascular injuries, and bone injuries as well as prevention of post treatment infection. Primary wound repair is the treatment of choice for most clinically uninfected bite wound where as delayed closure should be reserved for wounds at high risk of infection or already infected wounds and tissue defect may require local flap or micro-vascular re-implantations. MATERIAL AND METHODS: In this article, we have elicited up to date considerations regarding the management of animal inflicted injuries to the face based on literature search and exemplified by multiple case reports. CONCLUSION: For bite injuries on face, immediate primary wound repair after meticulous wound debridement and irrigation with sufficient volume added by antibiotic prophylaxis gives good cosmetic results with minimum risk of infection. Depending upon type of attack and age of victims, psychiatric or social counseling may also be required.

Use of traction screw to aid in fracture reduction in bilateral parasymphysis fracture of mandible.

Treatment of bilateral parasymphysis fracture often requires special attention due to airway considerations and difficulty in achieving precise anatomic reduction. The central fracture fragment is often displaced posteriorly and inferiorly due to muscle pull, and this adds to difficulty in reduction and stabilization of the central fracture fragment during plate fixation. With this article, we advocate a technique using stainless steel screw and self-holding screwdriver to manipulate the central fragment and achieve an anatomic reduction. We have used this technique in 12 patients with bilateral parasymphysis fracture without any complications and have found it very effective.

Use of cervical collar in temporomandibular dislocation.

Dislocation of the temporomandibular joint represents 3 % of all reported dislocated joints. In the last 3 decades many cases of TMJ dislocation have been reported with a wide variety of treatment options ranging from non-surgical conservative approaches to open joint procedures. The question remains whether one method is superior to the others. Conservative treatments are still the option in this part of the continent due to financial constraints and as well as due to availability of skilled manpower. A variety of conservative techniques have been described for reducing dislocations, all of which require 10-14 days of immobilization of the jaw post reduction so as to prevent further episodes of dislocation. Immobilization of the jaw can be done in the form of barrel bandage, barton bandage, head chin cap or maxillomandibular fixation using arch bars. We suggest the use of a cervical collar as a form of post reduction immobilization technique to overcome the inherent disadvantages of conventional forms of immobilization techniques.

Intubation techniques: preferences of maxillofacial trauma surgeons.

OBJECTIVE: To evaluate the clinical outcomes of alternative techniques of intubation in patients sustaining maxillofacial injuries, where nasotracheal intubation (NTI) is best avoided. MATERIAL AND METHODS: Alternative techniques to standard naso-tracheal intubation like submental intubation, orotracheal intubation-retrotuberosity/retromolar and missing dentition were used and variables of clinical outcome recorded. RESULTS: Submental intubation provides an unobstructed intraoral surgical field, avoids intraoperative and postoperative complications of tracheostomy, and overcomes the disadvantages of NTI. In our experience with submental intubation (6 cases), we only had complication related to tube apparatus like damage to pilot balloon. With retrotuberosity intubation (5 cases) we did not encounter any complications and the only limitations were bulbous maxillary tuberosity. Retromolar intubation (4 cases) a safe noninvasive technique has disadvantages like tube interference within the surgical field and not feasible in case of limited retromolar space. Orotracheal-missing dentition intubation (4 cases) is of great advantage i.e. it can be used in cases where NTI is contraindicated, no specialized skill required, no added cost, avoids the need for tracheostomy, no extra-oral procedures required and does not interfere with occlusion/MMF; with disadvantage of occasional tube interference within the surgical field. CONCLUSION: Preferred techniques of securing an airway like orotracheal, nasotracheal may not always be applicable, thus a trauma surgeon-anesthesist team should always have alternative techniques in their armamentarium to reduce the morbidity associated with these patients without interference with occlusion, which is prime goal in jaw fracture reduction. We have used these techniques in a country with limited resources and found them equally effective and convenient to use.

A randomized clinical trial of the effects of submucosal dexamethasone after surgery for mandibular fractures.

PURPOSE: To evaluate the effects of immediate postoperative submucosal dexamethasone administration on postoperative pain, edema, trismus, and mandibular functions after open reduction and internal fixation (ORIF) for mandibular fractures. PATIENTS AND METHODS: We conducted a prospective, randomized, controlled, double-blind study of 40 patients who required ORIF for mandibular fractures under general anesthesia. The patients were divided into 2 groups, an experimental group (n = 20) who received immediate postoperative submucosal 8 mg of dexamethasone through the surgical incision site, and a control group (n = 20) who did not receive dexamethasone. Pain was assessed using a visual analog scale (VAS) score and the frequency of analgesic consumption at the various postoperative intervals. The maximum interincisal distance and facial measurements were compared before surgery and at 24, 48, and 72 hours and 7 days after surgery. The difficulty in mandibular function after surgery was graded as mild, moderate, or severe. RESULTS: The analgesic drugs required 2 hours after surgery and the VAS score 72 hours after surgery were significantly less (P < .05) in the experimental group than in the control group. The total number of diclofenac tablets required by the experimental group was less than that for the control group, but the difference was not statistically significant. The control group had significantly increased swelling (P < .05) compared with the experimental group from preoperatively to 24 hours postoperatively (experimental group 0.115 ± 0.143, control group 0.253 ± 0.173). No statistically significant difference was present in the mouth opening or difficulty in mandibular function at the different follow-up intervals between the 2 groups (P > .05). CONCLUSION: The results of our study suggest that submucosal administration of dexamethasone after ORIF for mandibular fractures is effective in reducing postoperative pain and edema.

Conservative Management of Chronic TMJ Dislocation: An Old Technique Revived.

A temporomadibular joint (TMJ) dislocation is a condition in which the mandibular condyle is displaced from its articulations and requires manipulation by another individual to return to its normal position. TMJ dislocation is subdivided into acute, chronic recurrent or chronic persistent dislocations. Conservative (closed) or surgical (open) manipulation may be required to reduce the dislocated condyle. We present two cases of bilateral chronic protracted TMJ dislocation since 2 months. Following several unsuccessful attempts of manual reduction the patients were managed conservatively by placing posterior acrylic bite blocks and application of elastic traction which reduced the dislocated condyles satisfactorily in 2-3 weeks time. Every case of prolonged dislocation has its own unique features. Conservative approaches should be attempted initially, more radical treatment being used after these have failed.

Cleft palate lateral synechia syndrome.

Cleft lip and palate are the most common congenital craniofacial anomaly in humans. The presence of oral synechia along with cleft palate is a rare syndrome. We encountered one case that had a cleft palate accompanied by congenital oral synechia due to a membranous adhesion between the floor of the mouth and the free margin of the cleft palate.

Oral lesions and immune status of HIV infected adults from eastern Nepal.

OBJECTIVE: To document the prevalence, age and gender distribution of oral lesions in HIV infected adults and the influence of highly active antiretroviral therapy and correlate them to the immune status of the patients. MATERIALS AND METHODS: Oral lesions were diagnosed by a detailed physical examination by trained and calibrated examiners according to the case definitions established by the Oral HIV/AIDS research alliance. Demographic details, risk behavior patterns and oral symptoms and habits were collected by a questionnaire. RESULTS: 81 patients; 54 men and 27 women aged between 20 - 55 years participated in the study. A total of 49 patients; 60.5% had some oral lesion when examined. Oral candidiasis (21 %) and oral melanosis (21%) were the most common lesions, followed by linear gingival erythema, oral hairy leukoplakia, necrotizing ulcerative periodontitis/gingivitis, herpes labialis, parotid gland enlargement and reccurent apthous ulcers. Oral hairy leukoplakia was exclusively seen in men (p=0.018). All six cases of herpes simplex lesion were seen in non - anti retro viral group (p=0.073) while oral candidiasis was commonly noted in the anti retro viral group (p=0.073). Lowering CD4 counts had the strongest association with the prevalence of oral candidasis (p=0.012), pseudomembranous candidiasis (p=0.014) and oral hairy leukoplakia (p= 0.065). CONCLUSION: This study shows a high prevalence of oral candidiasis, melanosis, linear gingival erythema and oral hairy leukoplakia in the patients. Key words:HIV, AIDS, oral lesions, prevalence.