Abstract Haemangioma, a common benign proliferation of blood vessels, often emerges in childhood and manifests in two primary forms: capillary and cavernous. Capillary haemangiomas exhibit flat areas with numerous tiny capillaries, whereas cavernous haemangiomas present as raised, deep-red lesions consisting of enlarged sinuses filled with blood. Here, we report two cases. The first case was a 53-year-old female with swelling along the right lateral border of the tongue involving the dorsum for 1 month. Magnetic resonance imaging performed on this patient showed a lesion with likely neoplastic etiology. The second case was a male patient of age 60 years who presented with a lesion on the right upper lip for 1½ years. Histopathological examination in both cases was performed, and diagnosed as capillary haemangioma. Haemangiomas are benign tumour characterized by endothelial cell proliferation. It is commonly reported in the head and neck region, yet its presence in the tongue/lips is uncommon. Oral haemangiomas are consistently clinically significant, necessitating prompt diagnosis and appropriate treatment. Swift identification and histopathology are vital for determining the tumour clinical behaviour and potential future complications.
Abstract Background: Orthodontic clinical photographs are essential for accurate diagnosis, treatment planning and monitoring. Clinical photographs augment traditional records, such as study models and radiographs, by providing detailed documentation of soft-tissue and skeletal relationships. Objectives: This audit aimed to assess the quality of orthodontic photographs taken at Queen Elizabeth II Hospital, determine if they met established standards and identify areas for improvement. Materials and Methods: A retrospective two-cycle audit was conducted. Cases with complete pre- and post-treatment photo sets were included. The first audit, conducted in 2019, evaluated 270 photographs from 15 cases in 2015, while the second audit, in 2024, assessed 522 images from 29 cases in 2023. Images were rated as good, acceptable or unacceptable by an orthodontist based on predefined criteria. The gold standard of this audit was to achieve 100% images with at least acceptable quality. Results: In the first audit, only 51% of images were rated as good, 38% acceptable, and 11% unacceptable, with common errors including improper angulation, overcropping and poor focus. Following the identification of contributing factors and the implementation of corrective actions, the second audit revealed substantial improvement, with 89.8% of images rated as good, 9.6% acceptable and only 0.6% deemed unacceptable. Conclusion: The gold standard was not fully achieved. Targeted interventions led to a marked improvement in the quality of orthodontic photographs. The implementation of standardized protocols is essential to ensure the sustained quality of orthodontic documentation. Continued audits are crucial to ensure consistent quality and strive to achieve the gold standard.
Abstract An 11-year-old girl presented with avulsion of the maxillary right central incisor following trauma. The tooth was briefly rinsed, remained dry for approximately 1 h, and was subsequently stored in pasteurized cow’s milk for 48 h before replantation and wire–composite splinting. The splint was removed at 2 weeks, followed by placement of a calcium hydroxide intracanal medicament for 3 months before definitive obturation. Initial extrusion and periapical radiolucency were noted and subsequently resolved, followed by replacement resorption from 3 months. This case report illustrates that even after prolonged extra-oral storage in milk for 48 h, replantation should still be performed in young patients despite the expected outcome of replacement resorption, in accordance with International Association of Dental Traumatology (IADT) guidelines.
Tooth extraction is one of the most common dental procedures performed by the dentist. The indication for dental extraction may depend on the patient’s economic status, lack of resources and facilities in the dental setting, and proper information dissemination to the populace. Hence, this study aimed to present an analysis of reasons and patterns of teeth extraction among patients presenting in a tertiary healthcare sector in the northwestern part of Nigeria. This was an 8-year cross-sectional retrospective study conducted after obtaining consent from an ethical committee of the institution. Demographic variables, presenting complaints, history of dental visitation, indication, and the tooth extracted were recorded. Data were analysed using Statistical Package for the Social Sciences version 25 (IBM Corp., Armonk, NY, USA). A total of 536 teeth extractions were carried out among 508 patients within the study period. There were 359 (70.7%) males and 149 (29.3%) females in the age range of 18–70 years and a mean ± SD of 34.26 ± 11.85. Most of the patients 425 (83.7%) visited for the first time, and pain 462 (90.9%) was the main reason for the presentation. Dental caries and its sequelae 401 (74.8%) constitute the main reason for the extraction and, lower molars were the most commonly extracted teeth compared to others, with a statistically significant difference. Dental caries and its sequelae have been the most common indication for teeth extraction, especially in association with the most vulnerable lower molars. With available resources, expertise, and proper information dissemination, damage to more teeth could have been avoided through prevention and conservation.
Abstract Context: Dental therapists are the first liners in screening oral problems in Malaysian school children under the School Dental Service Programme, which can detect and refer interceptive orthodontic cases early to dental officers. Aims: This study intends to develop a valid and reliable instrument to evaluate knowledge, attitude and screening practices on interceptive orthodontics among dental therapists in Johor. Settings and Design: This cross-sectional study was conducted among 91 dental therapists in Johor. Materials and Methods: A bilingual questionnaire was developed and underwent content, face and construct validity. Statistical Analysis Used: Content validation was performed by five experts using the content validity index (CVI). Knowledge domain was validated using the item response theory Rasch model, while attitude and screening practice domains were validated using exploratory factor analysis (EFA). Results: All items demonstrated fair item-level CVI (>0.80) and substantial modified Kappa (K* >0.76). Scale-level CVI (Scale-level Content Validity Index/Average) and Scale-level Content Validity Index/Universal Agreement scores were 0.99 and 0.95, respectively. For the knowledge domain, the Rasch model retained 9 out of 14 items, with overall difficulty ranging from −3 to 0 and a discrimination parameter of 1.27. The Kaiser–Meyer–Olkin measure of sampling adequacy for attitude and screening practice domains was 0.82 and 0.71, respectively, with significant Bartlett’s test of sphericity ( P < 0.001). EFA revealed that the attitude domain comprises two factors with a total of eight items, while the screening practice domain consists of two factors with a total of seven items, with good factor loadings (>0.6) for all items. Cronbach's α scores indicated satisfactory reliability across all domains (>0.6). Conclusions: The developed questionnaire demonstrates valid psychometric properties and good reliability, making it a suitable tool for evaluating knowledge, attitude and screening practices related to interceptive orthodontics among dental therapists in Johor.
Mandibular condylar osteoma is a rare condition that causes asymmetry, occlusal discrepancies, and functional issues. This case report outlines a multidisciplinary treatment approach. The initial diagnosis used a bite splint to confirm joint-origin pain. Treatment began with condylar resection and reconstruction plating to maintain vertical ramus height. Surgically assisted expansion was done with an acrylic cap-splint hyrax appliance, followed by orthodontic decompensation. The second surgery included a Le Fort I osteotomy, right-side sagittal split Ramus osteotomy, and a left-side costochondral graft. Post-surgical orthodontics lasted 12 months. Aesthetic crown-lengthening periodontal surgery preceded full-mouth rehabilitation. Three-year post-orthodontic and 1-year post-restorative follow-up showed long-term case stability.
Abstract Objectives: To evaluate the validity and reliability of the family impact scale (FIS) after it has been translated and culturally adapted for Malayalam-speaking parents and to assess the impact of children’s traumatic dental injuries on family functioning. Materials and Methods: A case–control study was conducted across eight schools. A total of 258 children aged 12–15 years were examined for dental trauma, with 86 identified as cases and 172 as controls. Their parents completed the Malayalam version of the FIS tool, which was translated and back-translated by professional bilingual translators, reviewed by experts and pilot-tested for clarity and cultural appropriateness. Internal consistency, test–retest reliability and criterion validity were analysed. Results: The Malayalam FIS demonstrated high internal consistency (Cronbach’s α = 0.838). The test–retest reliability was also strong, with intra-class correlation coefficients values indicating stability over time. The total FIS score was significantly higher in the case group (20.73 ± 6.69) compared to the control group (14.98 ± 2.04), with a mean difference of 5.75, indicating a greater negative impact on families in the case group. Domains of the FIS – parental activity, parental emotions and financial burden showed a moderate-to-strong correlation with the total FIS score, supporting the tool’s criterion validity. Conclusion: The Malayalam-translated FIS is a valid and reliable instrument to assess the impact of dental trauma on families. The results suggest that traumatic dental injury has a negative impact on the family, affecting various aspects of daily life and emotional well-being.
Abstract Background: A retrospective audit of 360 referral letters sent to the Department of Oral and Maxillofacial Surgery at Hospital Kuala Lumpur was carried out. The received referrals were evaluated against predetermined criteria. The findings revealed that the majority of the referral letters exhibited deficiencies and necessitated revisions to ensure they contained comprehensive clinical information. This paper delineates the study’s findings and proposes a referral pro forma aimed at enhancing the quality of future referrals. Aim: To perform a comprehensive comparative analysis of referral letters submitted to the Department of Oral and Maxillofacial Surgery at Hospital Kuala Lumpur against a benchmark published paper, in the absence of local guidelines, with the objective of identifying any deviations from established standards. Design: A retrospective analytical review was conducted on a randomly selected sample of 360 referral letters submitted to the Department of Oral and Maxillofacial Surgery at Hospital Kuala Lumpur. Materials and Methods: The study encompassed referral letters spanning from January to December 2022. Upon selection, the referral letters were meticulously evaluated against a predetermined checklist for systematic comparison. Results: The analysis revealed significant deficiencies in the referral letters, with critical information such as patient date of birth, patient telephone number, general dental practitioners address, duration of symptoms, diagnosis, treatment provided medical and drug history, drug allergies, social history, required treatment and inclusion of radiographic evidence being notably inadequate or frequently omitted entirely. Conclusion: The findings of this study underscore a pressing need to enhance the quality of referral letters within Kuala Lumpur. The current state of referral documentation is fraught with inconsistencies and omissions that can severely impact patient care. The implementation of a standardized proforma is not just a recommendation, but a critical imperative to address these pervasive discrepancies and ensure the reliability and completeness of referral information.
Abstract Background: This study was carried out to explore the levels of knowledge and understanding of coronavirus disease 2019 (COVID-19) as well as the post pandemic challenges of orthodontic patients. Materials and Methods: A cross-sectional questionnaire-based study involving Malaysian adult patients from five orthodontic clinics was carried out over 6 months using a validated, self-administered, bilingual questionnaire composed of 12 questions across three domains; knowledge, understanding and impact. Results: There were a total of 537 respondents. The median age of respondents was 22 years (interquartile range 4.0) and was predominantly females 68.9%. Overall, only a very small proportion of respondents (3.2%) were not aware at all that COVID-19 can spread very easily in the orthodontic setup. Majority (88.8%) were agreeable to visit the orthodontist during the pandemic if proper infection control was adhered to. Almost half of all respondents (47.3%) experienced some degree of pain due to missed appointments; however, only 2.0% experienced severe pain. Most respondents (73.6%) were aware that missed appointments could prolong orthodontic treatment. The majority (66.1%) of respondents were willing to undergo additional treatment to compensate for lost time. About 5.0% of respondents were adversely affected by the pandemic and unable to afford further treatment if necessary. Conclusions: Patients generally demonstrate good knowledge of COVID-19 transmission, the importance of cross infection procedures, and were supportive of adhering to strict appointment schedules. Insight into these domains provides valuable information that will assist healthcare workers and policy-makers in planning for effective pandemic preparedness.
Root canal treatment (RCT) and teeth replacement are essential for oral function, as emphasised in Malaysia’s National Oral Health Strategic Plan, which aims for 50% of individuals aged 60 and above to retain at least 20 teeth by 2030. To assess knowledge, attitude and practice regarding RCT and teeth replacement among adult patients in Kuala Langat, Selangor, and associated factors. A cross-sectional study with ethical approval was conducted among 456 adults aged 18–59 years attending three government dental clinics in Kuala Langat. Systematic random sampling was employed, and data were collected using a validated self-administered questionnaire. Descriptive and inferential statistical analyses were performed. Half (50.4%) were unaware of RCT, and only 15.1% had undergone the procedure, though most (94.2%) reported a positive experience. However, 52.2% did not receive cuspal coverage or a crown post-RCT, and 42.8% preferred extraction over RCT. Removable dentures were the most preferred replacement option (46.5%), primarily for functional reasons (74.1%). Among those who did not replace missing teeth, the main reason was lack of knowledge (45.7%). Regression analysis showed higher education ( P = 0.011) and income ( P = 0.035) were significantly associated with greater RCT knowledge. Education was also associated with preference for RCT over extraction ( P = 0.002). Lower knowledge of replacement options was observed among non-Malays (including Orang Asli) ( P = 0.008) and those single, divorced or widowed ( P = 0.023). Knowledge gaps persist in Kuala Langat, highlighting the need for targeted awareness among groups influenced by education, income, ethnicity and marital status.
Sjögren syndrome (SS) is a progressive chronic autoimmune disease characterised by mononuclear cell infiltration of exocrine glands. This results in dryness of the eyes, mouth and other exocrine glands. SS is rare among the paediatric age group. The diagnosis of SS can be challenging due to its heterogeneous clinical presentation and nonspecific symptoms. Labial salivary gland biopsy (LSGB) plays an integral role in the diagnosis of SS. Here, we describe a case of a 9-year-old female patient who presented with the dryness of mouth. This case report highlights the role of paediatric dentists in the early diagnosis of SS among children, through clinical examination and LSGB. LSGB is a low-risk procedure with high disease specificity for SS and is minimally invasive. Timely diagnosis of SS necessitates appropriate vigilant monitoring for potential symptoms, along with referrals and collaborative communication among rheumatologists, dental professionals, paediatricians and ophthalmologists. The patients symptoms were better controlled following intervention, and ongoing preventive dental care was established.
Abstract Background: There is limited published data on the histopathological findings of oral biopsies performed in private oral surgery practices. This study reviews biopsy specimens collected in a single private practice to determine the relative frequency of oral pathologies. Materials and Methods: A retrospective review was conducted on oral biopsies performed by a single oral surgeon in Sydney, Australia, between 2021 and 2024. A total of 263 biopsy reports were analysed: 161 (61.2%) under general anaesthesia (GA) and 102 (38.8%) under local anaesthesia (LA). Results: Under GA, the most common diagnoses were dentigerous cysts (52.1%), dental follicles (17.8%), and radicular cysts or granulomas (8.1%). Under LA, fibroepithelial polyps (21.6%), radicular cysts or granulomas (17.6%), osteomyelitis or medication-related osteonecrosis of the jaw (7.8%), and squamous cell carcinoma (SCC) (6.9%) were predominant. Eight malignancies (3.0%) were identified: seven SCC and one metastatic colorectal adenocarcinoma. Compared with institutional series, private practice data revealed higher frequencies of benign cysts and reactive polyps and a fewer malignancies. Conclusion: This is the first comprehensive audit of oral biopsy histopathology from an Australian private oral surgery practice. The diagnostic profile differs from tertiary centres, with benign cystic and reactive lesions being predominant. Nonetheless, malignant lesions were identified, underscoring the importance of vigilance in primary surgical practice.
Abstract Introduction: This cross-sectional study analyses the smile perception of patients undergoing orthodontic treatment and dental professionals. Methods: A photograph of a woman’s smile was digitally altered in relation to three variables: dental midline, overbite depth and occlusal canting. Ninety-one evaluators rated 16 photographs of two groups: patients undergoing orthodontic treatment ( n = 45) and dentists ( n = 46) in rural Pahang. Sixteen photographs, 13 digitally altered and three original photographs were randomly compiled into a catalogue of four pages. Both groups scored the photographs using a visual analogue scale. Data were analysed using SPSS Version 22.0. The mean and standard deviation values were tabulated and calculated for each group. The comparison between both groups was conducted using an Independent t test. Results: There was no significant difference in the perception of the dental smile between patients undergoing orthodontic treatment and dentists for midline deviation and overbite depth. The results showed a significant difference between varying levels of canting of the occlusal plane. Patients’ undergoing orthodontic treatment perceived the canting of the smile more critically, as shown through the changes in 1 mm ( P value < 0.022), 2 mm ( P value < 0.022) and 3 mm ( P value < 0.027) of the occlusal plane. Conclusions: The overall aesthetic perception was similar for deviated upper midline position and overbite level; however, there is a significant difference, in which patients undergoing orthodontic treatment are more aware of the occlusal canting. Therefore, it is of paramount importance to understand different aesthetic norms to achieve excellent treatment results in line with expectations for each patient.
The most important aspects in the management of trismus are to achieve satisfactory mouth opening, and it is best evaluated by measuring the interincisal distance (IID). Hence, this study aimed to evaluate the pre-, intra- and postoperative IID achieved during the management of trismus secondary to noma. This was a retrospective study conducted at Noma Children’s Hospital Sokoto using 3-year record. After obtaining ethical approval from the state ministry of health, the case records of patients who were managed for trismus secondary to noma were retrieved. Patients’ demographics, site of ankylosis, surgical procedure, preoperative, intraoperative and postoperative IID were extracted and analysed using SPSS version 25. There were 16 (38.1%) males and 26 (61.9%) females in the range of 5–25 years with mean ± SD of 10.0 ± 5.1 years. Unilateral ankylosis constitutes the majority 32 (76.2%). The mean ± SD preoperative (P1) and intraoperative (P2) IID are 5.0 ± 4.7 mm and 41 ± 6.6 mm, respectively. The mean ± SD postoperative IID at first and second reviews (P3 and P4) are 35 ± 8.2 mm and 32 ± 8.0 mm, respectively. Comparison of age categories and P3 yielded a reduction in IID with decreasing age which was not statistically significant ( χ 2 = 12.336) df=6, P value = 0.055. However, a comparison of age categories and P4 revealed a reduction in IID which was significant ( χ 2 = 30.707 df=6, P value = 0.000). The amount of mouth opening achieved following noma trismus release has been shown to be decreasing over time and has been also affected by age. Aggressive jaw exercise is a key factor in maintaining the achieved intraoperative IID during TMJ ankylosis management.
Abstract Aims: This review aims to evaluate orthodontic referral patterns by dental officers in public clinics in Labuan, assessing the accuracy, completeness, and compliance with the Ministry of Health (MOH) Malaysia’s referral guidelines and identifying areas for improvement. Materials and Methods: A retrospective cross-sectional review was conducted to review 77 orthodontic referrals made between June 2023 and June 2024. Data from referral records and patient files were analysed, including patient demographics, referral details, Index of Orthodontic Treatment Need (IOTN) grading, and referral outcomes. SPSS version 26 software was used for statistical analysis. Results: The mean age of the referred patients was 17.49 (±6.99) years, with 68.8% being female. Only 71.4% of referral forms were complete, with dental history most frequently missing (22.1%). Of the referred patients, 44.2% had good oral hygiene, while 16.9% still had active caries. Class III malocclusion was the most referred (33.8%). Inaccurate IOTN scoring was noted in 20.8% of cases, and 27.3% of incisor classifications were incorrect. About 90.9% of referrals met the MOH requirement for IOTN grades 4 or 5. Conclusion: The review highlights the need for refresher training on IOTN and caries assessment for dental officers to enhance referral quality and patient care in Labuan’s orthodontic services.
Abstract Bone loss after any tooth extraction procedure is inevitable with alveolar bone and soft tissue changes that may jeopardise aesthetic and complicate functional rehabilitation. This study presents a case of a 38-year-old man with a recurrent abscess on his upper anterior tooth that has periodontal pocket depth measuring 10 mm on the mid-labial site and Grade 2 mobility. A clinical diagnosis of root fracture of tooth 11 was made, and extraction was done. This case illustrates the use of sub-epithelial connective tissue graft and platelet-rich fibrin (PRF) in an alveolar ridge preservation procedure for severe dehiscence passing more than two-thirds of the facial bone of the alveolus. The additional use of the PRF membranes contributed significantly to the outcome of the procedure.
Abstract The purpose of this case report is to describe the clinical presentation and management of a progressive calcifying fibroblastic granuloma (CFG), or epulis located at the maxillary posterior region of an adolescent female with periodontitis. This case report describes a 17-year-old female, who presented with a recurrent CFG. Clinical and radiographic examinations revealed a localised gingival enlargement associated with a bony defect. Management included excisional biopsy of the lesion, open flap root surface debridement, and subsequent histopathological analysis. Histopathological analysis of the biopsy specimens revealed ulcerated hyperplastic parakeratinised stratified squamous epithelium, and fibrous connective tissue with some areas of calcifications, consistent with a diagnosis of CFG. The surgical site healed without mucogingival deformities and recurrence during the 12-month review. The recurrence rate of gingival enlargement can be reduced by complete excision along with open flap root surface debridement. Effective patient plaque control and regular periodontal therapy are critical for maintaining long-term treatment outcomes.
Abstract Background: Complete orthodontic photograph documentation is essential for efficient healthcare delivery, litigation, and publication. A well-managed photographic documentation system ensures easy retrieval. Incidences of failure in orthodontic clinical photograph tracing in Queen Elizabeth II Hospital triggered the need to explore the underlying problems. Aims: This audit was conducted to evaluate if record-keeping of orthodontic photographs taken in Queen Elizabeth II Hospital, Sabah, achieved the gold standard. Settings and Design: The gold standard was that 100% of the cases should consist of a minimum number of photographs needed. Photographs should be taken at the two distinct stages of orthodontic treatment, which are the pretreatment stage and post-treatment stage. A minimum of nine photographs, four extra-oral and five intra-oral photographs, should be taken in each stage of the treatment. Materials and Methods: Photographs of patients who completed their orthodontic treatment in the second half of the years 2015 ( n = 68) and 2023 ( n = 41) were audited. Contributing factors of the shortfall were identified. Remedial actions were then implemented prior to re-audit in 2023. The results between these two years were compared. Results: In 2015, 22% of cases had the complete set of photographs. The shortfall was attributed to factors related to the individuals, team, technology, and environment. After remedial actions, record-keeping quality significantly improved to 71% in 2023 ( P < 0.05). Conclusions: The completeness of clinical photographic records has not reached the gold standard, highlighting areas for improvement. Regular audits and strategic actions are needed to meet this standard.
Abstract Context: Fake braces are defined as orthodontic attachment lookalikes, which are fitted to the teeth by unqualified providers at unregistered premises. Aims: This study aimed to investigate the content and engagement metrics of TikTok videos in relation to fake braces. Settings and Design: TikTok videos were collected via four hashtags: #fakebraces, #bracesmurah, #fashionbraces and #realbraces. Characteristics, content and metadata of each video were extracted, recorded into Microsoft Excel and analysed using SPSS. Statistical Analysis Used: Fisher’s exact test to identify any association between the identity of uploaders and the theme of TikTok videos produced. One-way analysis of variance (ANOVA) used to compare engagement metrics between various groups of uploaders and themes. Results: A total of 1150 videos were screened, and 378 videos were analysed in the study. Videos uploaded since 2020 had 77,500,000 views, 6100,000 likes, 59,255 comments, 355,912 saves and 60,152 shares in total. The majority of videos were uploaded by fake braces sellers (79.9%), health professionals (15.6%) and laypersons (4.5%). Theme with the highest frequency was marketing (66.9%), informational (16.7%), procedural (12.4%), humour (2.4%) and testimonial (1.6%). A significant association was found between the identity of uploaders and the theme of videos uploaded ( P < 0.001). Significantly higher shares were reported for humour-themed videos ( P < 0.05). Conclusions: Fake braces videos on TikTok were uploaded by various groups presenting different themes that could be beneficial or misleading to the public. Oral health literacy in using social media should be strengthened to counteract misinformation online.
Abstract Objective: This clinical audit aims to enhance the quality of care for paediatric patients undergoing dental procedures under general anaesthesia (GA) by evaluating the completeness of standard pre-operative preparations at the Department of Paediatric Dentistry, Hospital Teluk Intan. Materials and Methods: Conducted from August 2022 to December 2022, this audit involved a retrospective review of patient records from two cycles: March 2022 to May 2022 (Cycle 1) and September 2022 to December 2022 (Cycle 2). Data were collected using a standardised checklist that covered demographic information, pre-admission instructions, proposed treatment type, consent, and medications. The completeness of documentation was assessed against the Safe Surgery Save Lives guidelines by the Ministry of Health Malaysia, with a target of 95%. Results: In Cycle 1, 30 patient records were reviewed, showing a mean completeness of 90%. Demographic information, proposed treatment and consent were fully documented (100%), while pre-admission instructions and medications had lower completeness (75.8% and 96.5%, respectively). Following the implementation of a standardised checklist, 24 records were reviewed in Cycle 2, achieving and achieved 100% completeness across all variables. Conclusion: The introduction of a standardised checklist significantly improved the completeness of pre-operative preparations for paediatric dental patients under GA. This audit highlights the importance of standardised protocols in enhancing documentation practices, minimising medical errors and improving patient outcomes.
