Prosthodontic Rehabilitation of Hypodontia – A Team Approach

Hypodontia can have an impact on speech, aesthetics, function and psycho-social behavior of individuals afflicted by the problem. Rehabilitation of patients with hypodontia usually requires complex treatment planning, depending upon the pattern of tooth absence, amount of residual spacing, presence of malocclusion and patient compliance. It is an interdisciplinary intervention, involving prosthodontists, orthodontists, oral surgeons, speech pathologists and psychologists to achieve an optimal outcome for the patient. This case report describes the close work of a committed team from orthodontic, oral surgery and prosthodontic department of de'Montmorency College of Dentistry, Lahore, to reach final aesthetic and functional outcomes for an 18 year old girl with oligodontia. Her chief complaint was poor esthetics and absence of multiple anterior teeth with unsightly spacing between remaining teeth. Orthodontic redistribution of spaces followed by fixed full arch prosthetic rehabilitation were the goals achieved at the end of her treatment. KEYWORDS: Oligodontia, interdisciplinary team work, prosthodontic rehabilitation, fixed restorations.

Management Strategies for Oral & Maxillofacial Surgery Amid the COVID-19 Pandemic

The novel-coronavirus (2019-nCOV) emerged in Wuhan City in December 2019, this resulted in a quick and catastrophic health problem all over the world but our country is slightly less affected by the pandemic. There could be a number of reasons for less numbers of Covid positive cases and lack of awareness and reduced Covid testing capacity and hence less mortality in Pakistan. In order to provide assistance to an ever increasing number of infected patients and, at the same time taking care of urgent maxillofacial conditions. This manuscript gives the reader in a nutshell the overall surgical experience of oral and maxillofacial practice at Aga Khan University Hospital, Karachi, Pakistan in the COVID-19 pandemic and would like to provide a number of recommendations that would assist the scheduling process of surgical management during the COVID-19 pandemic and reduce the risk of infection among healthcare workers and others involved with the service. KEYWORDS: Maxillofacial surgery; Coronavirus; COVID-19; Pandemic

Knowledge and Behavior of Dentists, and Practice Modifications in Response to the Outbreak of Novel COVID-19 in Dentists of Pakistan

OBJECTIVES: The current study is conducted to assess the knowledge and behavior of dentists in Pakistan and various practice modifications adopted in response to current outbreak of COVID-19. METHODOLOGY: Well-constructed online questionnaires were distributed among 300 subjects including dental students (3rd year and 4th year), house surgeons, and dental surgeons of two public hospitals of Punjab, Pakistan. RESULTS: 90% of dentists are afraid of getting the infection and reluctant to continue their dental practice. Most of the dentists 95% are aware of the mode of transmission of disease and follow WHO guidelines but still a large number of dentists are in fear and anxious to perform only emergency dental procedures. CONCLUSION: Most dentists resume their dental practice by following WHO new guidelines related to practice in COVID -19 outbreak but still a significant number of dentists close their dental practice for an indefinite period due to anxiety and fear of being ill or got infected by COVID-19. KEYWORD: anxiety and fear, practice modifications, outbreak, COVID-19, knowledge and behavior

Evaluation of Cross Infection Control in Dentistry; A Patients’ Perception Study

OBJECTIVE: To assess the perception of patients visiting a dental OPD in Karachi regarding cross infection control measures that should be taken in dental practice. METHODOLOGY: A cross-sectional study was conducted at the OPD of Altamash Institute of Dental Medicine from January to August 2020. A total of 546 patients aged 20-75 years of either gender coming for routine dental check-ups were included in the study using non-probability convenience sampling. A well-structured and validated questionnaire was used to assess the knowledge, attitude and practices of patients regarding cross infection measures that should be present in dental practices. SPSS-25 was used to analyze the data. Descriptive statistics was used to calculate frequency and percentage of qualitative (gender, socioeconomic and education status, knowledge attitude and practice levels of patients) and quantitative variables (age groups). Chi-square test was used to detect the relation of patient's knowledge levels with potential factors like the age groups, gender, socioeconomic and education status. The p-value of (< 0.05) was considered as significant. RESULTS: Out of the total participants, 79.1% had good knowledge about cross infection control measures in dental practice. Majority of the patients (84.6%) agreed that dentists should wear gloves during treatment, though majority were of the opinion that a dentist can treat several patients with the same set of gloves. About 4.9% of the patients said that they ask the dentist to wear face mask and gloves while treating them, and only 3.3% said that they ask the dentist about sterilization of instruments. The knowledge level of patients showed variation with their education status but not with respect to socioeconomic status, age and gender. CONCLUSION: Although overall the patients visiting dental clinics had good perception and showed positive attitudes towards cross infection control, the dental health practitioners need to disseminate basic technical information about the infection-control practices required for safe dental practice to dental patients and the community at large. KEYWORDS: cross infection, knowledge, dentist, dental patients, perception

Preparation and Assessment of Antimicrobial Property of Resin Based Composites Impregnated with Proanthocyanidin and Titanium Dioxide

OBJECTIVE: To synthesize three experimental resin based composites (RBCs) out of a commercial preperation (Control) by impregnating into each a fixed weight (0.01%) of titanium dioxide (TiO2) and three different weight % (0.01, 0.02 and 0.03) of proanthocyanidin (PA) and to compare antibacterial property, from the zones of inhibition of streptococcus mutans (S. mutans), of the specimen restorations made in the experimental and control RBCs. METHODOLOGY: In the first phase, Streptococcus mutans were isolated and identified from the oral cavity of patients and identified on the basis of morphogenic appearance of colonies and confirmed through catalase test and microscopic examination. Isolates were then incubated and cultured for sensitivity. Specimens for control and experimental RBCs were made through a metallic mold having 2mm thickness and 5mm diameter for all the 4 groups. Specimen restorations made in the commercial as supplied RBC acted as the control (Group A). Specimen restorations in the Group B, C, and D were made in each of the experimental RBCs modified with 0.01% proanthocyanidin (PA) and 0.01% titanium dioxide (TiO2), 0.02% PA and 0.01% TiO2 and 0.03% PA and 0.01% TiO2. The antimicrobial property of all the specimen restorations in all the groups was evaluated by Bauer-Kirby (Disc Diffusion) method through the formation of zones of inhibition of S. mutans colonies on blood agar plates. Data were computed using SPSS version 21 for descriptive statistics and analyzed using one-way ANOVA with p value 0.05 taken as significant. RESULTS: The range of the zone of inhibition for specimen RBC restorations (N= 12) containing PA and TiO2 was 0.00 for Group A, 10-12mm for Group B, 12-14mm for Group C and 9-10mm for Group D. The mean inhibition zone for the experimental restoration specimens was 11±2mm for Group B, 12.7±1mm for Group C and 9.7±1mm for Group D compared to no inhibition zones (0.00 mm) with the control RBC Group A. The order of the inhibition zones from maximum to minimum was Group C > Group B > Group D > Group A. The differences between the mean values for the control and the experimental RBC restoration specimens were significant (p < 0.000). The specimen restorations in the Group D appeared under cured and could impact on their mechanical properties. CONCLUSION: Irrespective of the mentioned concentrations, impregnating PA and TiO2 rendered the RBC antimicrobial. RBC restorations made with the experimental RBC with 0.02% PA and 0.01% TiO2 proved relatively more effective in terms of antimicrobial effect. KEY WORDS: dental materials, resin based dental restorations, antibacterial resin based composite, proanthocyanidin, titanium dioxide.

Comparison of Repeated Chemical and Microwave Disinfection on Dimensional Accuracy of Gypsum Casts

OBJECTIVE: The aim of this experimental study is to compare the dimensional accuracy of gypsum casts after repeated disinfection in microwave at 900 Watts, 2450 MHz (5 minutes) and immersion in 0.5% Sodium hypochlorite (10 minutes). Disinfecting casts is recommended to prevent cross infection but may cause dimensional changes. During fabrication of prosthesis, a cast may get contaminated several times so there is a need of repeated disinfection. METHODOLOGY: Sample size was 33 (11 in each group), calculated through WHO software for sample size determination by using standard deviation of 0.16 at 95% confidence interval and 80% power of study. Impressions in irreversible hydrocolloid were recorded of an acrylic cast fabricated for this study. The impressions were poured with die stone and were randomly divided into 3 groups; Group I: Microwave disinfection, Group II: Immersion disinfection in 0.5% Sodium hypochlorite, Group III: Control group. For Groups I and II, each cast was disinfected 7 times with 5 minutes interval between two disinfection cycles, after every cycle anteroposterior and mediolateral measurements were recorded using digital Vernier caliper (accuracy upto 0.01 mm). For group III, casts were rinsed with distilled water, dried in open air within temperature range of 28+/-2OC for 10 mins followed by anteroposterior and mediolateral measurements. This procedure was repeated seven times for each cast. RESULTS: Anteroposterior and Mediolateral differences of dimensional change between and within the Group A, B and C was calculated by One Way ANOVA. Inter/intra examiner reliability was taken into consideration at the time of study. Mean dimensional change in the casts were insignificant through six disinfecting cycles. However, in the seventh cycle, a significant difference (p=0.003) was observed in the anteroposterior dimension (0.03% dimensional change for Group A and 1.26 % for Group B whereas, in mediolateral dimension, dimensional change was 0.35% for Group A and 0.59% for Group B (p=0.004). Dimensional change of >0.5% was considered as the cutoff value for casts to be considered as dimensionally accurate. Casts disinfected through immersion disinfection did not produce dimensionally inaccurate casts in anteroposterior dimension after third cycle and in seventh cycle in mediolateral dimension. However, result is significant only in seventh cycle. Microwave disinfection produced dimensionally accurate casts throughout all cycles. CONCLUSION: Microwave disinfected casts remained dimensionally stable compared to immersion disinfection. KEYWORDS: Disinfection, microwave, immersion, dimensional stability, gypsum casts

Quality and Readability of Online Information Available for the General Public on Orofacial Granulomatosis

OBJECTIVE: Orofacial granulomatosis (OFG) is a relatively rare entity. The information pertaining to it is accessible to patients and care-givers on the internet in a scarce quantity. The aims of the current study were to evaluate quality, readability, understandability and actionability of information regarding the disease-orofacial granulomatosis-available to the public on the internet. The purpose of the study was to evaluate ease of access and understandability of language available for individuals affected by OFG. Although the incidence of the disease is very low in Pakistan, patients with symptoms of OFG rarely report to clinics due to social stigma. METHODOLOGY: A vivid selection process was chosen for the study. The study was conducted online on 'google scholar' website. Four different search terms were used 'ofg disease', 'orofacial granulomatosis', 'cheilitis granulomatosa' and 'Melkersson Rosenthal Syndrome' to seek information on orofacial granulomatosis. All of this was done during July, 2020 to October 2020. The first 100 results from each term were shortlisted and evaluated further. Exclusion criteria was used and several repetitive sites, non-functional links, sites containing content irrelevant to the search were excluded. This resulted in 58 websites relevant to the search that were then categorized according to affiliation, specialisation, content type as well as content presentation. Three grading assessments were utilized to assess the quality of this online information; the Journal of the American Medical Association (JAMA) benchmarks, the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) and the presence of Health on the Net (HON) seal. In order to assess the readability of the content in the websites, the Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) were used. RESULTS: The overall quality of online information on orofacial granulomatosis is difficult to comprehend and act upon as assessed by the PEMAT. The HON seal was visible on only 5 (9%) websites. In terms of readability, only one (2%) website was fairly easy to read. CONCLUSIONS: The online information on orofacial granulomatosis is qualitatively poor and does not serve its purpose in true sense. There is a need to devise better, high quality online readable information for patients and the public to understand. KEY WORDS: Orofacial granulomatosis, cheilitis granulomatosa, PEMAT.

Evaluation of Tooth Wear and its Causative Risk Factors Amongst Patients Attending Dental Hospital of Karachi

OBJECTIVE: Tooth wear is a term defined as the loss of dental hard tissue in a damaged tooth if there is no existing dental caries or trauma. Tooth wear rarely exists alone and is observed clinically and experimentally in combination. Excessive tooth wear leads to hypersensitivity and exposed dentin. Tooth wear can be classified as attrition, erosion, abrasion. The frequency of normal tooth preservation is greater than ever, thus a better prevalence of tooth wear is experiential in the population. Therefore, the objective of the present cross-sectional study was to evaluate tooth wear and its causative risk factors amongst patients attending the Dental Hospital of Karachi. METHODOLOGY: The current study was a cross-sectional study conducted on adult patients recruited from the Out-Patient Department of Oral Diagnosis from May 2018 - December 2018. A consecutive sampling method was used and 250 adult patients aged 18-45 years were included. Tooth wear was assessed by using Smith and Knight Tooth Wear Index (TWI index).Data was entered and analyzed by using SPSS, frequency, percentages were calculated, and a chi-square test was performed to find the association between gender and risk factors. RESULTS: The subject populations of 250 were assessed. Out of which 178 were male (71.2%) and 72 (28.8%) were female with age ranging between 18 to 48 years old. In this study, 92.4% of them were suffering from tooth wear and only 31.2% have extended to the severe stage of the tooth surface loss. CONCLUSION: The present study concluded that there is an association between tooth wear and its risk factors. KEYWORDS: Tooth Wear; Dental Wear; Tooth Wear Indices; Sensitivity and Specificity; Risk Factors.

Perception of Academic Stressors Among Dental Undergraduate Students

OBJECTIVE: Present study was conducted to assess the perceived academic sources of stress among undergraduate dental students and determine its association with gender, year of study, pre-university education and accommodation. METHODOLOGY: This study was conducted in dental section, Islamabad Medical and Dental college, Islamabad from July to November 2016. BDS students were asked to rate their perceived stress on four point Likert scale of modified version of Dental Environment Stress (DES) questionnaire. Descriptive statistics were applied to find the mean scores and SD on all items. Using SPSS v.21, Kruskal Wallis test was used to compare stress levels among different undergraduate professional years and Mann-Whitney U test was applied to determine the association and stress sources and demographic variables. RESULTS: A total of 172/200 participants responded (86%) to the survey. Overall stress in undergraduate dental students was in moderate range. Majority of students (93%) reported that syllabus load was either stressful or very stressful (3.53±0.64), 85% students reported lack of relaxation time as stressful or very stressful (3.42±0.86) and fear of failing was reported as stressful or very stressful by 82.5% (3.34±0.87). When stress scores of all classes were compared third year reported more mean stress scores than other years (2.50±0.50). Females were more stressed compared to males with mean score of (2.37±0.39), students living at home were more stressed than hosteilites (2.38±0.38) and those with GCE A-levels had higher stress (2.40±0.38) compared to HSC background students. Academic performance was the most stressful of the five stress domains (3.07±0.74). CONCLUSION: Syllabus load followed by lack of time for relaxation and fear of failing were the most perceived sources of stress. Academic performance was the most stressful of the five stress domains and third year BDS was the most stressed class. KEY WORDS: Dental Education; Dental Students; Psychological Stress, Stressor, Undergraduate,.

Effect of Buccal Corridors Width on Smile Quality and Esthetics

OBJECTIVE: To assess the perception of buccal corridor width on smile esthetics by Orthodontic residents, General dentists and Laypersons. METHODOLOGY: A smile photograph was taken of an adult female. The image was modified to obtain five different buccal corridor widths and were assessed by different evaluators grouped into general dentist, orthodontic resident and laypersons who rated the attractiveness of each smile by means of a visual analog scale (VAS). Sample size was 97 participants to rate the picture. Non-probability purposive sampling was done The data was analyzed and mean and SD were calculated for the scores of rating. ANOVA and Tukey's post hoc test was applied to compare the different ratings of buccal corridors in three groups. The data of this cross sectional study was collected from general population belonging to different communities, general dentists and orthodontic residents of different dental colleges of Karachi, Pakistan from August 2019 to March 2020. RESULTS: There were 97 participants who responded to the images. Highest scores were obtained for Image 1 having buccal corridor width ratio of 16% followed by image no. 3 having buccal corridor width ratio of 10% and lowest scores were obtained for Image no. 6 having least buccal corridor widths ratio that is 34% followed by image no 5 having 26% buccal corridor widths. Among the groups of participants, the highest scores were given by laypersons for all images. Significant differences were observed between evaluation of groups of Orthodontic resident and layperson in most images. CONCLUSION: There was a remarkable influence of buccal corridor width on smile esthetics, with the 16% ratio group being rated as the most attractive by all three groups. KEYWORDS: Buccal corridors, Smile, esthetics, Attractiveness