Tooth Mobility among Patients visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Periodontitis is a chronic inflammatory disease that results in the destruction of supporting tissue and bone leading to tooth mobility. Tooth mobility if untreated can lead to tooth loss. However, very few studies exist for its assessment. The aim of this study was to find out the prevalence of tooth mobility among patients visiting a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among individuals visiting a tertiary care dental hospital from 1st April to 30th June 2022 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 2202202202). Individuals more than 13 years who gave consent and fulfilled the study criteria were enrolled. Tooth mobility was assessed using Lindhe and Nyman's classification. Proforma also included demographics, simplified oral hygiene index, gingival index, body mass index, and smoking status. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 163 patients, 65 (39.88%) patients (32.36-47.40, 95% Confidence Interval) had tooth mobility. Conclusions: The prevalence of tooth mobility was higher than in studies done in similar settings. Keywords: periodontitis; prevalence; tooth mobility.

Mean Distance of Mental Foramen from Inferior Border of Mandible among Patients Visiting the Outpatient Dental Department in a Tertiary Care Centre.

Introduction: Among many anatomical landmarks in the human skull, the mental foramen is a stable landmark on the mandible. The diverse morphology of the mandible indicates the specific characteristics of such anatomical structures in each individual. The aim of this study was to find out the mean distance of mental foramen from the inferior border of the mandible visiting the Outpatient Dental Department in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing orthopantomogram in the Outpatient Dental Department of a tertiary care centre from 3 February 2022 to 31 July 2022. Ethical approval was obtained from the Institutional Review Committee. The patients with complete denture in the region of measurements were included in the study. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 207 patients, the mean distance from the inferior border of the mandible to the lower border of the mental foramen was 11.83±1.83 mm (11.58-12.07, 95% Confidence Interval). Conclusions: The mean distance of mental foramen from the inferior border of the mandible was found to be similar to other studies done in similar settings. Keywords: gender; mandible; mental foramen.

Perception of Online Lectures among Students of a Medical College in Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: The COVID-19 global pandemic has affected all aspects of human life, with education no exception. Online lectures have been practiced in different academic institutions around the world. The objective was to know the perception towards online lectures by the undergraduate students of a medical college. METHODS: This descriptive cross-sectional study was conducted among the undergraduate students of dentistry, medicine, and nursing at Kathmandu Medical College via self-administered online questionnaire. Data were collected from November to December 2020 after ethical clearance from institutional review committee (Ref. no. 0311202002). Students who had not attended even one hour of online learning per week were excluded. Responses were collected using Google Forms which were analysed in Microsoft Excel. Descriptive statistics are presentedas means, standard deciations, frequencies, and percentages. RESULTS: Out of 318 valid questionnaires, 143 (44.97%) students agreed that online lectures were effective but 138 (43.4%) disagreed that online lectures were more useful than traditional lectures. One hundred and forty five (45.60%) found online classes difficult to concentrate and 175 (55.03%) agreed that they preferred a combination of traditional teaching and online tutorials. Only two (0.63%) students strongly agreed on excellent internet during classes and 104 (32.70%) agreed it caused economic burden. Mean age of participants was 20.75±1.538 years; 202 (63.52%) were females; online learning per week was 18.75±9.157 hours; and duration of online learning was 20.28±9.997 weeks. CONCLUSIONS: Most of the students had a positive attitude towards e-learning when compared to similar studies. Further multicentric studies with larger sample size would better demonstrate whether online education partly or fully can be effective adjunct to traditional face to face interaction.

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.

Anxiety among Patients Visiting for Periodontal Therapy in a Tertiary Care Dental Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The aetiological factors of dental fear include negative information, witnessing or having a bad experience, and negative conditions related to periodontal treatment. Modified Dental Anxiety Scale Nepali version, is one of the tools used in epidemiological studies to measure dental anxiety in adults. The objective was to find out the prevalence of anxiety among dental patients visiting for periodontal therapy in a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted among patients visiting for periodontal therapy from November 2020 to January 2021 at a tertiary care dental hospital. Ethical clearance from Institutional Review Committee (Reference no. 0311202001) was taken before the study. Convenient sampling was done. A standard questionnaire for dental anxiety was used for data collection after receiving informed consent from the participants. Data were entered and analyzed in Microsoft Excel Sheet. Descriptive data are presented as means, standard deviations, frequencies, and percentages. RESULTS: Among a total of 311 participants visiting for periodontal therapy, 297 (95.49%) (92.57-97.42 at 95% Confidence Interval) were having anxiety. Among total patients, 113 (36.33%) were fairly anxious, 111 (35.69%) were slightly anxious, 62 (19.94%) very anxious and 11 (3.54%) were extremely anxious. Majority of males 54 (17.36%) were slightly anxious while most females 67 (21.54%) were fairly anxious. Mean Modified Dental Anxiety Scale-Nepali score of all the participants was 11.59±3.808. Extreme dental anxiety was observed in 11 (3.54%) participants 7 (2.25%) females; 4 (1.29%) males. CONCLUSIONS: The prevalence of anxiety among patients visiting for periodontal therapy in this study was found to be higher compared to other studies done in similar settings.

Periodontal Disease in Patients Visiting a Tertiary Care Dental Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Periodontitis is chronic disease leading to tooth loss. Oral hygiene practices combined with regular dental examinations keep oral cavity disease free and maintain periodontal health. The primary objective was to find out the prevalence of periodontal disease of patients measured by the Simplified Oral Hygiene Index and Community Periodontal Index. METHODS: This descriptive cross-sectional study was conducted in department of Periodontics of a tertiary care dental hospital from April to June 2019 after obtaining ethical clearance and informed consent. Participants were recruited by convenience sampling and 183 sample size was calculated. Proforma included demographics, Simplified Oral Hygiene Index, Community Periodontal Index, body mass index, and smoking status. Data were entered in Statistical Package for Social Sciences version 23 and descriptive statistics were presented as frequency, percentage, mean, and standard deviation. RESULTS: Prevalence of periodontal disease corresponding to loss of attachment 1, 2, 3, and 4 was found to in 104 (56.83%) participants. Simplified Oral Hygiene Index score was 1.67±0.89 with "fair" status in majority 114 (62.30%). Gingivitis (Community Periodontal Index 1, 2) was seen in 136 (74.32%). The mean age was 36.37±14.43 years of which 92 (50.27%) were female but smoking was more in males. CONCLUSIONS: This study suggests deteriorating periodontal health related to age, sex, oral hygiene, smoking, and BMI. As updated information on oral and periodontal health in Nepal is limited, this assessment would help the national policy makers on oral health intervention measures to prevent periodontitis and develop future programs to improve oral health.

Dental Floss Prescription Pattern among the Dental Interns of Nepal.

INTRODUCTION: Periodontal disease is regarded as one of the preventable diseases. It can be prevented through effective plaque control measures that require mechanical instrumentation with various surgical or non-surgical periodontal therapies as well as daily oral hygiene measures. Dental professionals must be competent enough to promote good oral health by educating patients with daily oral hygiene practice measures. In this regard, the study was designed to assess the knowledge, attitude, and practice behaviour for using as well as prescribing dental floss among the dental interns of Nepal. METHODS: An online questionnaire consisting of two sections; the first comprised of the socio- demographic and professional aspects and the second consisted of questions related to knowledge, attitude, and practice regarding the use of dental floss, and its prescription was prepared using Google forms and the link was shared. The data were analysed in Statistical Package for Social Sciences (SPSS) version 20 software. RESULTS: In this study, the participants were familiar with the dental floss, but many lacked awareness regarding its proper use. Ninety-nine (64.3%) of the participants personally used dental floss. Only six (3.9%) never prescribed it to their patients. Among those who prescribed, only 37 (25%) always demonstrated the techniques. CONCLUSIONS: The study indicated that many participants used dental floss, however, educating and recommending the patient about it was comparatively low. This emphasizes the need to increase the awareness and use of interdental aids among dental interns to provide good oral self-care practices for the patient.

Sub Sinus Ridge Height at First Molar Region- A Panoramic Radiograph Based Study.

BACKGROUND: Among various replacement options available for maxillary molars, implants necessitate the need to examine available ridge height and width. Panoramic radiographs (orthopantomograms) are routinely used for preliminary determination of ridge height which is helpful in communicating with patients regarding treatment needs and options. This study was designed with the aim to assess the sub sinus ridge height at dentulous and edentulous first molar sites. METHODS: A cross-sectional study was conducted from March to November 2019 among patients visiting the dental college. The orthopantomograms of 455 patients were prospectively collected and analysed using Carestream imaging software (version 7.0.0). Distance from alveolar crest to maxillary sinus was measured in first molar region. RESULTS: Mean minimal sub sinus ridge height at non-missing maxillary first molar site was 8.16 ± 2.6 mm, whereas for missing maxillary first molar site it was 5.25 ± 2.28 mm and the difference was statistically significant (p<0.001). Statistically significant difference among the age groups and minimum subsinus ridge height (p<0.001) was observed. CONCLUSIONS: Missing maxillary first molar sites may often require vertical bone augmentation with direct sinus lifting procedures if it has to undergo replacement with dental implants in the representative Nepalese population.

Assessment of Palatal Plane and Occlusal Plane for Determining Anteroposterior Jaw Relation.

INTRODUCTION: Sagittal jaw relationship is an important parameter for orthodontic treatment planning. Angular and linear measurements both have been proposed and used in orthodontic cephalometrics to assess the sagittal jaw relationships. However, angular measurement has been questioned over the years for its reliability as a result of changes in facial height, jaw inclination and the variable positions of Nasion. So, the objective of our study was to assess the linear anteroposterior jaw relation in a sample of Nepali population using occlusal (Wits appraisal) and palatal planes as reference lines. METHODS: A descriptive cross-sectional study was conducted using the lateral cephalogram of 101 individuals visiting the Department of Orthodontics, Kantipur Dental College, Kathmandu, Nepal. Individuals with Class I skeletal relation were selected using convenience sampling method. Radiographs were standardised and traced. Occlusal and palatal planes were drawn that were bisected by the perpendicular lines from Point A and Point B. The linear distances between the intersections were measured to determine sagittal jaw relations. RESULTS: In Nepali individuals with normal ANB angle (3.05°±2.511°), the sagittal jaw relation with reference to occlusal (Wits appraisal) and palatal planes were found to be 0.203±3.343mm and 3.574±4.074mm respectively. CONCLUSIONS: Various methods has been proposed and used to assess the sagittal jaw relation and each method has its own strength and limitations. So, it is well advised to use additional cephalometric analysis whenever possible before arriving at any diagnosis and treatment plans.

Knowledge of Use of Antibiotic, its Resistance and Consequences among Students in Private Schools.

INTRODUCTION: Self-medication among adolescents has become a serious global problem that plays an important role in irrational use of medication and tends to increase with the age of adolescents. Limited research has been done in Nepal regarding antibiotic knowledge among non-medical students. Hence, this study aims to assess the knowledge of higher secondary non-science students regarding antibiotic use, resistance and its consequences. METHODS: A cross-sectional descriptive study was done during antibiotic awareness week 2017 among 471 grade 11 and 12 non-science students of private schools in Kathmandu. Convenience sampling technique was used. Data was collected through self-administered questionnaires. Descriptive statistics was utilised to find out the knowledge level of the students. RESULTS: The mean age of the students 245 (52%) male, 226 (48%) female) was 17.19 years and 335 (71.1%) were from grade 12. Approximately all 462 (98.1%) the participants had inadequate knowledge regarding antibiotic and their knowledge mean score was 5.8±2.56. More than half 277 (58.8%) of the students had not heard about antibiotic resistance, among those who had heard 113 (24%) said that doctors and nurses were the source of information. CONCLUSIONS: Almost all of the participating students lacked adequate knowledge regarding antibiotic. Thus, it is imperative to create school and community based awareness programs by policy makers for adolescents to upgrade their knowledge on safe use of antibiotics as well as to prevent the consequences of antibiotic resistance during their adult life.

Location of Mental Foramen in Dentate Adults using Orthopantomogram.

INTRODUCTION: Understanding the anatomical variations in the position of mental foramen are significant for different dental procedures. This study identified the position of the mental foramen among a sample of Nepalese population visiting a dental college in Kathmandu. METHODS: Total 417 panoramic radiographs (orthopantomograms) were selected from a total of 567 radiographs. The mental foramen location was determined by drawing imaginary line parallel with the long axis of the lower premolars . The mental foramen location was then classified into six classes. RESULTS: In the study population, the mental foramina were located mostly between the lower premolars 163 (39.1%), followed by in line with second premolar 148 (35.5%) of the mental foramen was located under the second premolar apex. CONCLUSIONS: The study shows that the anaesthetic solution should be injected between the lower premolars or below the lower 2nd premolar in the Nepalese population for successful and secure mental nerve blocking.

Periodontal Health Status and Pregnancy Outcomes: A Survey in Medical Doctors.

INTRODUCTION: Periodontal disease and caries are the most common causes of tooth loss worldwide. Studies have demonstrated strong association between periodontitis and adverse pregnancy outcomes. Medical doctors, who are the primary healthcare providers, seldom advise women to seek dental care during pregnancy. This study was undertaken to explore the knowledge, attitudes and behaviours of medical doctors towards oral health and to identify the barriers of prenatal periodontal healthcare in their practices and its possible implications on pregnancy outcomes. METHODS: Total 377 doctors filled the questionnaire. The data collected through personal contacts, social networking, emails, online forms and networking at conferences were analysed using Statistical Package for the Social Sciences 20 software program and presented in tables, charts and diagrams. RESULTS: Out of 263 (69.8%) male and 114 (30.2%) female doctors enrolled in the study, only 52 (13.8%) had received education or training on oral care during pregnancy. Among them 299 (79.3%) agreed that there is possible link between health of teeth-gums and pregnancy. Approximately 105 (27.9%) encountered patients with oral/periodontal problem every week but only 108 (28.6%) "always" advised their patient for regular dental check-ups. Similarly, 358 (95%) agreed that there is need for universal guidelines however, 133 (35.3%) thought there was insufficient time to advise patients on oral health during check-ups. CONCLUSIONS: There is need for training on 'oral healthcare during pregnancy' for medical doctors. Developing universal guidelines for oral healthcare in pregnant women for all health professionals would be another important step. An adequate referral system to oral healthcare providers and biannual check-ups is recommended for both general patient as well as pregnant women for preventing adverse situations related to oral and specifically periodontal diseases.

Oral Cancer Knowledge and Awareness in Patients Visiting Kantipur Dental College.

BACKGROUND: Lack of knowledge and awareness about oral cancer, its risk factors and negligence of the early warning signs play crucial role in raising the incidence of the disease. The present study was carried out to evaluate the awareness of oral cancer among patients visiting Kantipur Dental College, Kathmandu, Nepal. METHODS: The cross-sectional study was done in 471 patients from 15-85 years. Self administered questionnaire was prepared which comprised of knowledge of oral cancer, source of information, its early signs and symptoms along with the awareness of its risk factors. RESULTS: Most of the participants (41.80%) had not heard of oral cancer. 31.60% recognized tobacco smoking and tobacco chewing as the chief risk factor with 15.50% and 10.80% of participants who identified white patch and red patch as early sign of oral cancer respectively. Pearson's chi square test was used which showed statistically significant association of total mean knowledge score and awareness score with age, education level and occupation (p<0.05). CONCLUSIONS: This study done in dental patients showed lack of knowledge and awareness in general public about oral cancer. There seem to be a need for more planned awareness programs through newspapers, radio, television and health campaigns regarding the association of habits in the development of oral cancer and benefits of detecting oral cancer at early stage for better prognosis.

Status of Tobacco Smoking and Diabetes with Periodontal Disease.

INTRODUCTION: Periodontitis is multifactorial disease that along with dental caries remains one of the commonest cause of tooth loss worldwide. Effective management requires clear understanding of risk factors. Smoking has a dose-dependent effect on periodontium. Similarly, individuals with diabetes have severe forms of periodontal diseases. We aim to assess the prevalence of periodontal disease in dental patients in relation to smoking and diabetes. METHODS: The study was conducted among 522 patients visiting the Periodontics Department, Kantipur Dental College. Individuals willing to participate had to sign an informed consent and undergo interview and clinical examination. Data collection, done on a structured proforma, was analysed using SPSS 20.0. RESULTS: Prevalence of periodontitis was 372 (71.3%), diabetes 33 (6.3%) and smoking as 138 (26.4%). Hypertension was observed in 64 (12.3%) patients and family history of diabetes among 94 (18%). Among the 372 periodontitis patients, smoking behaviour was present in 120 (32.3%), diabetes in 32 (8.6%), family history of diabetes in 72 (19.4%) and hypertension in 62 (16.7%). Conversely, 120 (87%) smokers, 33 (97%) diabetics, 72 (76.6%) with family history of diabetes, 62 (96.9%) hypertensive, 216 (41.4%) male and 156 (29.9%) female participants had periodontitis. Smoking behaviour was more in males: 115 (39.4%) compared to 23 (10%) females. CONCLUSIONS: Periodontitis was significantly associated with smoking, diabetes, hypertension and age. It is recommended that tobacco cessation and diabetes control be promoted as an integral component of periodontal therapy and oral health be included as an essential element of general health when conducting national health surveys.

Prevalence of Oral Mucosal Lesions in a Tertiary Care Dental Hospital of Kathmandu.

INTRODUCTION: Oral mucosa can be affected by a variety of soft tissue lesions and conditions. Benign as well as malignant lesions of oral cavity are common. Squamous cell carcinoma is one of the commonest malignancies. The present retrospective study was undertaken to study the prevalence of various oral mucosal lesions in a tertiary care dental hospital of Kathmandu. METHODS: This retrospective study was carried out in the Department of Oral and Maxillofacial Pathology at Kantipur Dental College and Teaching hospital from January 2015 to January 2017. The study included biopsy specimen from the oral cavity. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. The data collected was statistically analyzed. RESULTS: A total of 111 biopsy cases were included in the present study. Out of which, there were 16 (14.4%) cases of non-neoplastic and 16 (14.4%) cases of benign pathology. The oral cavity lesions were commonly seen in age range between 6-74 years where males 59 (53.2%) were mostly affected. The most common site for oral lesion was buccal mucosa 23 (20.7%) and anterior gingiva 23 (20.7%). Total 15 (13.5%) cases of oral squamous cell carcinoma were seen as the predominant malignancy affecting in the vestibular region 8 (7.2%). CONCLUSIONS: The present study shows benign as well as the non-neoplastic lesions were more prevalent in oral mucosa with the buccal mucosa and anterior gingiva as the commonest site of occurrence.

Mesiodens: A Hospital Based Study.

 Background: A mesiodens, is the most frequent supernumerary tooth present in the maxillary central incisor region. This study is conducted to know the radiographic characteristics and management of mesiodens in children visiting hospital. METHODS: A cross-sectional retrospective data collection was done from hospital dental records of children who visited the institution from December 2015-December 2016. Radiographic characteristic of mesiodens including the number, shape, position, direction of crown and complication caused by mesiodens were recorded. Data were analyzed using IBM SPSS v.20.0. RESULTS: Out of 1871 dental records, it was found that 40 children had 53 mesiodens, with male female ratio of 3:1 and most of them were discovered at 8 years. Majority of mesiodens, 54.7% were erupted, conical, palatally placed with 77.3% vertically directed crown.Complications associated with it were crowding followed by diastema and delayed eruption. Among 40 children, one had three mesiodens, eleven had two mesiodens and rest had one each. Radiographically fully formed tooth was seen in 29 mesiodens. Immature apex was seen in 38 central incisors associated with mesiodens. Management undertaken was simple/surgical extraction and only few cases were kept for periodic observation. CONCLUSIONS: Periodic radiographs act as an important tool for clinicians in detecting and managing mesiodens.