Pakistan Oral & Dental Journal

EDITORIAL

Ahmad Iqbal — 2024-03-29

ORAL MANIFESTATION AND MANAGEMENT IN VITAMIN D-DEPENDENT RICKETS TYPE I: A CASE REPORT AND LITERATURE REVIEW

Saad Bin Saleh — 2024-03-29

Background: Vitamin D-dependent rickets type I (VDDR-I) is an autosomal recessive disorder caused by the inactivating mutations in the 25-hydroxy vitaminD-1α-hydroxylase genes. Clinical features in individuals with VDDR-I include growth retardation, generalized weakness, and an increased risk of pathologic fractures. Oral manifestations and their treatment associated with this disorder are limited, with only three case reports and one case series reported to date regarding the oral findings in VDDR-I patients.

Objectives: To increase awareness of VDDR-I, highlighting its characteristic features, oral manifestations, and treatment protocols.

Methodology: An 8-year-old male Saudi patient diagnosed with VDDR-I presented in the Pediatric Dentistry Clinic. The oral & radiological findings and their treatment protocol were documented.

Results: The dental examination of the patient revealed marked enamel hypoplasia in the permanent maxillary incisors, slightly enlarged pulp chambers in the molars, congenitally missing mandibular second premolar, and the presence of pulp stones in all the mandibular anterior teeth.

Conclusion: Mild to severe enamel hypoplasia can be managed with esthetic reconstruction using composite build-ups and ceramic veneers.

A SURVEY OF AWARENESS AND PRACTICES OF INFORMED CONSENT AMONG DENTISTS IN RAWALPINDI AND ISLAMABAD, PAKISTAN

Shaista Rafi — 2024-03-29

Objective: The aim was to determine the awareness and practices of dental professionals about informed consent among various levels of qualification. A total of 129 dentists from Rawalpindi and Islamabad were included by convenience sampling technique.

Methodology: Dentists practicing clinically in Rawalpindi and Islamabad were included. Undergraduate dental students, dental technicians and dental assistants were excluded.

Results: Data was collected using an especially developed questionnaire, and analyzed using SPPS through chi-square tests. The mean age was 33.89±7.57 years. A total of 126 dentists (96.67%), including 45 females (34.88%) and 84 males (65.12%), were familiar with informed consent. The most frequently reported “basic element of Informed Consent” was confidentiality (n=50, 38.76%), followed by treatment alternatives (n=33, 25.58%), and all of these (n=29, 22.48%). The most frequently reported “main purpose of Informed Consent” was legal (n=128, 18.12%), followed by ethical (n=45, 35.16%), and all of these (n=51, 39.72%). Most of the participants said they take Informed Consent prior to treatment (n=103, 79.84%), stating that it is not a waste of time (n=69, 53.49), that they take it verbally (n=107, 82.95%), and that the minimum age to sign Informed Consent by oneself is above 18 years (n=109, 84.5%). Only 6 (4.65%) said they provide a copy of Informed Consent to patients.

Conclusion: There was lack of awareness and good practices among dental professionals regarding the process of taking informed consent. More qualified dentists reported better awareness and practices compared to less qualified dentists. Only few dental professionals have the habit of obtaining written Informed Consent.

“MENTORING: AN INSIGHT OF STUDENT’S PERCEPTION”

Muhammad Wajahat Ghafoor Chaudary — 2024-03-29

Objectives: The objective of our study is to know the perspectives and expectations of undergraduate medical and dental students about implemented mentorship programs in their institutions.

Methodology: A cross-sectional and observational study was conducted after getting an ERC approval from the institutional (FUSH) review board. Study was carried out over a period of one year from June 2022 to June 2023. Students from first to final year MBBS and BDS of two different institutes, already running mentorship programs, were included in the study. Non-Probability convenience sampling technique was used, and proper consent was taken from each participant. Data was collected from 761 MBBS and BDS students from Islamic International Dental College and Foundation University school of Health Sciences (FUSH) on a predesigned, revalidated questionnaire. SPSS version 22 was used.

Results: 761 students participated in this study, comprising of 562 (74%) females and 199 (26%) male students. Out of this total 92% of the students considered mentorship as a mean of guiding the students, 89% agreed that mentorship is a relationship rather than set of activities, whereas 95% students felt that there is a definite need of mentorship in medical education. 74% of students felt that contact sessions with mentor should be done before exam.

Conclusion: Most of the students were of the opinion that mentorship is the need of the day of every academic institute and did not consider this program as an additional burden on them.

ASSESSMENT OF THE ORAL BEHAVIOUR, KNOWLEDGE, AND STATUS AMONG UNDERGRADUATES BELONGING TO MULTIDISCIPLINARY HEALTH SCIENCES AT A PRIVATE UNIVERSITY

Yousra Altaf — 2024-03-29

Objective: To assess the oral health behaviour, knowledge, and status of undergraduate students studying multidisciplinary health sciences at a private university.

Methodology: An analytical cross-sectional study was performed among n=400 undergraduate students selected through non-probability convenience sampling. The study duration was six months after approval from the ethical review committee. Data was collected by administering a self-reported questionnaire based on the domains related to oral health behaviour, knowledge, and status.

Results: Of n=400, 71% (n=284) of study subjects reported tooth brushing twice a day, and 49.5% (n=198) stated two minutes the duration of brushing. Regarding oral health knowledge, 35% (n=140) subjects stated that increased consumption of sugar causes dental caries, 53% (n=212) stated that hard tooth brushing leads to bleeding gums, 60.3% (n=241) said that fluoride application prevents oral diseases like dental caries. Regarding oral health status, 25.8% (n=103) said tooth discoloration, and 23.3% (n=93) had tooth hypersensitivity. Oral health behaviours were statistically insignificant among all five disciplines (p > 0.975, F (4, 395)= 0.120. Whereas oral health knowledge was statistically significant (p<0.001, H(4)=52.21) among dental and medical study subjects as compared to study subjects belonging to nursing, pharmacy, and rehabilitation sciences.

Conclusion: Oral health behaviour was statistically insignificant among participants from dental, medicine, nursing, pharmacy, and rehabilitation sciences. However, oral health knowledge was statistically significant among participants in dental and medicine disciplines as compared to nursing, pharmacy, and rehabilitation sciences.

AWARENESS OF INTERDISCIPLINARY ORTHODONTIC-ENDODONTIC PATIENT MANAGEMENT AMONG THE DENTAL PRACTITIONERS OF HAZARA DIVISION

Wasim Ijaz — 2024-03-29

Background: Collaborative orthodontic-endodontic approaches are vital in addressing complex dental cases. However, existing literature reveals a notable dearth in understanding and implementing this approach among dental practitioners.

Objective: This study aimed to bridge the gap in understanding current practices among dental practitioners, fostering enhanced patient care and ethical standards. This cross-sectional survey, conducted from September 1st to 30th, 2023, involved distributing a validated questionnaire to dental practitioners in the Hazara Division, yielding 96 responses from 105 visited clinics and 44 from hospitals. Descriptive statistics were used for frequencies and percentages using SPSS version 23.

Methodology: The survey involved 78.6% general dentists, 13.6% orthodontists, and 7.9% endodontists. Varying levels of correct responses were observed for the knowledge-based questions.

Results: Positive attitudes were seen, with 70% of respondents expressing an interest in enhancing knowledge through educational programs, and 73% agreeing to adhere to interdisciplinary guidelines. Furthermore, 79.3% of practitioners had experience treating cases requiring both orthodontic tooth movement and endodontic therapy.

Conclusion: Notably, orthodontists and endodontists showed higher percentages of accurate responses compared to general dentists. In conclusion, this study underscores the need for improved education, standardized protocols, and better patient communication for effective interdisciplinary dental care specifically in general dental practitioners.

PREVALENCE, AWARENESS, AND WILLINGNESS OF SOCIAL MEDIA USAGE AMONG ORTHODONTIC PATIENTS: A CROSS-SECTIONAL SURVEY AT AYUB MEDICAL COLLEGE, ABBOTTABAD

Wasim Ijaz — 2024-03-29

Objectives: To assess the prevalence, awareness, and willingness of orthodontic patients at Ayub Medical College, Abbottabad, regarding the usage of social media for accessing orthodontic information and their inclination to integrate it into their treatment.

Methodology: A prospective cross-sectional study was conducted at the Department of Orthodontics, Ayub Medical College, Abbottabad from June 2023 to July 2023. This study involved 255 consecutive patients who sought orthodontic care at the department. The inclusive sample encompassed individuals of varying ages and genders, including both existing and new patients undergoing orthodontic treatment. Exclusions were made for bloggers and social media influencers. A validated questionnaire was used to gauge their social media engagement. Data analysis employed SPSS version 23, computing descriptive statistics and using the Chi-square test for variable associations (p<0.05).

Results: The study encompassed 255 patients, with a significant female majority (78%). Most were receiving braces treatment (71.4%), predominantly aged 11-20 (49.8%), followed by 21-30 (35.7%) and 31-40 (14.5%). Results demonstrated noteworthy awareness regarding the usefulness of social media for orthodontic information (64.7%), although the prevalence of usage was comparatively lower (33.7%), with 62.7% expressing willingness to use a developed social media site. Notably, Instagram exhibited significant growth potential (19.6% to 35.3%) compared to Snapchat (3.9% to 13.7%). Statistical analysis suggested no substantial disparities between genders and age groups regarding social media use and platform preferences.

Conclusion: In conclusion, this study reveals significant potential for orthodontic patient education through social media, with notable awareness and willingness, despite the lower prevalence of usage. Tailored communication strategies are essential for enhancing patient engagement.

DENTAL ANXIETY AMONG PATIENTS UNDERGOING EXTRACTION OF TEETH

Gulsanga Shams — 2024-03-29

People avoid going to the dentist due to fear and anxiety related to dental procedures. The study aimed to determine the estimated percentage of anxiety among individuals undergoing exodontia and the association between gender, previous dental experience, and dental anxiety. A descriptive cross-sectional study was conducted in the oral and maxillofacial surgery ward of Peshawar Dental College Hospital from March to May 2022. A non-probability consecutive sampling technique was used. All adult patients were taken in the survey. Medically compromised patients were not included in the study. The Modified Dental Anxiety Scale was used to assess the anxiety of dental patients. The Chisquare test was used to find an association between variables. Out of 120 respondents, 57(47.5%) were male and 63(52.5%) were female. Most of the respondents were in the age group of 18-29 (40%). The majority (42.5%) of patients had a past dental history of extractions and had rated previous dental experience on a scale of 1-3 (58.5%). MDAS score 1-5 (31.7%) and 6-10 (25%) was found frequently. 16.7% of patients reported experiencing high levels of dental anxiety. A significant Association of MDAS was found with gender p=.001 and previous dental experience p=.041. Gender and previous dental experience impact the anxiety levels of patients undergoing teeth extraction.

AWARENESS, KNOWLEDGE AND ATTITUDE OF COMPUTER-AIDED DESIGNING AND COMPUTER-AIDED MANUFACTURING AMONG DENTAL SURGEONS IN LAHORE, PAKISTAN

Khadija Imran — 2024-03-29

The application, knowledge, and attitude dentists towards CAD/CAM technology in Pakistan showed very few publications.

Objective: The purpose of this study was to evaluate the awareness, knowledge, and attitude towards CAD and CAM among postgraduate dental students and practitioners in Pakistan.

Methodology: A cross-sectional questionnaire-based survey was conducted at various institutions including University College of Dentistry UOL, Fatima Memorial Hospital, private clinics throughout Lahore that focused on postgraduate students, private dental practitioners, and teaching faculty. Data was collected from September 2022 to November 2022. SPSS version 20.0 software was used to analyze the data collected through a Chi-square test to determine if there were any significant correlations between questionnaire items and practitioner type with a p-value significance level set at 0.05.

Results: The study had 220 participants. 118 (53.6%) house surgeons, 39 (17.7%) postgraduates, 26 (11.8%) private practitioners and 37 (16.8%) were teaching faculty. About 70% of the participants believed that CAD/CAM technology could be applied to implant restorations while 60 (27.3%) knew about its use for digital impressions; 40 (18.2%) acknowledged its superior precision as compared to conventional methods. In addition to this, the study found that 122 (55 5 %) participants deemed less chair-side time required by CAD/CAM advantageous in clinical scenarios.

Conclusion: This study showed that awareness about CAD/CAM does exist among dentists; however, they have very scarce knowledge about its applications to clinical settings and an urgent need at the undergraduate and post graduate level is needed.

EXPLORING THE GREEN ALTERNATIVE: A COMPARATIVE ANALYSIS OF MISWAK AND PLASTIC TOOTHBRUSH IN MAINTAINING GINGIVAL HEALTH

Sobia Hassan — 2024-03-29

Background: Plastic toothbrushes have long been recognized as effective tools for maintaining oral and gingival health, but their use comes at the cost of environmental degradation. In contrast, Miswak, an organic alternative, not only promotes oral and gingival health but also provides environmental protection.

Objectives: To compare the effectiveness of Miswak, an environmentally friendly option, with plastic toothbrushes in maintaining gingival health.

Method: This cross-sectional comparative analysis was carried over a period of 6 months. A pre-validated questionnaire was circulated online and filled by sixty individuals who were divided into three groups with 20 participants each: Group A: Toothbrush users, Group B: Miswak users and Group C: Both. The questionnaire included questions pertaining to their gingival health status. The collected data was analyzed using SPSS. Chi-squared test was performed to compare the gingival health of participants.

Results: Results showed no significant difference in the gingival health status of all three groups, with a p-value of 0.898.

Conclusion: Toothbrush and miswak are equally effective in the maintenance of oral health. Thus, miswak can serve as an effective alternative to conventional toothbrushes with positive implications on the environment.

A QUESTIONNAIRE-BASED SURVEY ASSESSMENT OF DENTISTS FOR REPAIR VERSUS REPLACEMENT OF DEFECTIVE RESTORATIONS

Shaista Rafi — 2024-03-29

Objective: To determine the practice of dentists for management of defective restorations. This cross-sectional survey was conducted on 124 qualified dentists who were either government employees or private practitioners, house officers, post graduate residents and fellows. Undergraduate dental students, dental technicians and dental assistants were excluded from the study. The questionnaire contained all close ended questions and was distributed through emails and whatsapp.

Methodology: The practice of managing defective restorations was compared among various level of experiences using chi-square test. The mean age was 33.95±7.65 years. The males were 79(63.71%) and females were 45(36.29%). Of total 77(62.10%) dentists frequently repair single tooth defective restorations. For 91(73.39%) dentists, the outcome of repaired restoration was satisfactory.

Results: The common reasons for repair of defective restoration was to ‘prolong life of restoration’ (n=54, 43.55%) and conservation (n=38, 30.65%). Most common reason for defective amalgam restoration was ‘Tooth Fracture’ (n=54, 43.55%) and for composite was ‘Secondary Caries’ (n=42, 33.87%). Statistically significant association was found between restorations placed and years of experience (p=0.001). Dentists with more experience were repairing more single tooth restorations as compared to less experienced statistically (p<0.001). In conclusion, more than 62% dentists repair defective restorations. Amalgam restoration is repaired mainly due to tooth fracture and composite due to secondary caries. Experiences of dentists affect their practice of managing defective restorations.

EVALUATION OF SHADE SELECTION ACCURACY: A COMPARATIVE STUDY USING SMARTPHONE CAMERAS AND VISUAL METHOD

Saqib Naeem Siddique — 2024-03-29

Objective: To assess the accuracy of shade selection through smartphone cameras using a smartphone application and to compare the results with the visual method.

Methodology: Two VITA classical A1-D4® shade guides (VITA North America) were used, one as a control and the other as a test shade guide in which the tabs were masked to hide the shade color and arranged randomly. Each of the 30 participants selected the best shade match of the test tabs with the control shade guide. For digital shade matching, shade tabs of the shade guide were individually mounted and pictures were taken using three different smartphones and the Lab values were recorded using Color Picker® App. The shade code of the reference tab with the smallest color difference from the test tab was manually identified and labeled as the correct match.

Results: The visual method achieved 56.9% correct shade matching while it was 77.08% by the digital method. Individually, it was 87.5% , 93.75% and 50% for phone A, B and C respectively. The comparison among the three phones showed a statistically significant difference in the results of phone C.

Conclusion: Color Picker® app offers a successful and straightforward way for dental shade selection. The results enforce that utilizing a smartphone application for shade matching could be a practical approach for selecting shades in a dental clinic.

EXPLORING ROOT CANAL MORPHOLOGY OF MAXILLARY SECOND PREMOLARS USING CONE BEAM COMPUTED TOMOGRAPHY

Asma Ali — 2024-03-29

Objective: The objective of this study was explore to root canal morphology of maxillary second premolars using cone beam computed tomography

Place and Duration of Study: This study was undertaken in department of radiology, Rehman college of Dentistry, Peshawar, from 15th Septmeber, 2022 till 15th March, 2023.

Methodology: Cone Beam Computed Tomography scans of 120 patients of both genders between 18 and 60 years of age were studied and The Cone Beam Computed Tompgraphy scans were studied for number of pulp canals and their configuration. Results were analyzed with the help of SPSS (version 21). Chi square test was done to stratify canal number among genders to see effect modifiers. P-value of 0.05 was considered significant.

Results: Out of 120 Cone Beam Computed Tomography scans (N=120), There were 69 females (57.5%) and 51 males (42.5%) having mean age of 32.02, ranging from 18-55 years with a standard deviation of 13.45 years. having mean age of 32.02, ranging from 18-55 years with a standard deviation of 13.45 years Most of the maxillary 2nd premolars had a single canal (n=65, 54.16%) followed by 2 canals (n=53, 44.16%) and 3 canals (n=2, 1.68%). The number of canals in genders was not statistically significant.

Conclusion: The most common type of maxillary 2nd premolars has single canal followed by 2 canals. Prevalence of teeth with 3 canals is very rare.

EXPLORING THE REASONS FOR SEEKING PROSTHODONTICS TREATMENT FROM UNQUALIFIED PRACTITIONERS IN PESHAWAR

Asma — 2024-03-29

Objectives: The study focused on investigating the reasons why participants visited quacks for prosthodontics therapy, what factors motivated them to do so, and how satisfied they were with both quacks and qualified dentists.

Methodology: This cross-sectional study was conducted between June 2023 and October 2023. A total of 110 patients, aged between 45 and 65 years, who had visited quacks for prosthodontics procedures in the past six months, were interviewed at three different well-equipped clinics in Peshawar. The collected data on their motivations/reasons for seeking treatments from quacks were collected through a pre-designed and pre-tested questionnaire and analyzed through basic statistical methods.

Results: Female to male ratio was 1: 1.75 in the current study. The pattern of awareness and reasons for visits to the quacks was observed same for both genders (P> 0.05). The primary reason for visiting the quack was often a lack of awareness. Other factors included economic considerations, proximity to one’s residence, the convenience of a single appointment, and referrals. The level of education and age of the participants did not have a significant effect on the scenario (P > 0.05). Many of the participants expressed dissatisfaction with the treatment they received from the quacks and stated that the services offered by qualified dentists were better, safer, and less painful.

Conclusions: Awareness programs for altering the attitudes of the community are mandatory. Furthermore, it is essential to implement strictly established laws to stop the illegal practice of quacks. In addition, doctors are deployed to rural areas for practice.

ASSESSMENT OF AWARENESS ABOUT FIXED PARTIAL DENTURE AMONG UNDERGRADUATE DENTAL STUDENTS

Aamna Khalil — 2024-03-29

Objective: Fundamentals of fixed prosthodontics are included in undergraduate curriculum in dental colleges. Due to rapid advancements and increased patient expectations, not only fundamentals but technical and laboratory skills and use of current developments of dental materials is also of vital importance. The aim of this study is to assess awareness about fixed partial dentures among undergraduate dental students and to compare the knowledge about fixed partial denture among different undergraduate classes.

Methodology: A descriptive cross sectional survey was conducted among dental students of watim dental college Rawalpindi in 2022. Using a pre-structured questionnaire data was collected from 264 students of different academic years. The questionnaire consisted of 10 questions about the components, indications, advantages, types and cleaning methods for fixed partial dentures. The responses recorded were tabulated and analyzed using SPSS version 17 with descriptive statistics. Difference with P< 0.05 was considered statistically significant.

Results: Out of 264 students, 211(79.9%) were females and 53(20.1%) were males. 75.8% of students were aware about use, 82.2% about type of prosthesis. 65.5% of students were aware of components of fixed partial dentures.

Conclusion: It can be concluded that the dental students displayed an acceptable level of knowledge in FPDs. However, there was lack of knowledge about the detailed design features. In order to further enhance the knowledge and awareness about fixed prosthesis, there should be better clinical exposure to all the academic years.

Obituary: Dr. Inayat ur Rehman Khalil (8.1.1944 - 19.12.2023)

Ahmad Iqbal — 2024-03-29

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