Prevalence of molar incisor hypomineralisation among school children in Kavre.

BACKGROUND: Molar incisor hypomineralisation is defined as the hypomineralisation of systemic origin of one to four permanent first molars, and frequently associated with affected incisors. Till date, there is no data available on molar incisor hypomineralisation in any parts of Nepal. OBJECTIVE: To determine the prevalence and characteristics of Molar incisor hypomineralisation in 7 to 12 years old school children of Kavre. METHOD: A total of 749 school children of age 7 to 12 years from four different randomly selected schools with at least one of the first permanent molars fully or partially erupted were evaluated using European Academy of Paediatric Dentistry criteria for molar incisor hypomineralisation. The examinations were conducted at respective schools by a single calibrated examiner. RESULT: Molar incisor hypomineralisation was present in 13.7% of children. No gender differences were found.The mild type of defect (without structural loss of tooth) was the most prevalent type of molar incisor hypomineralisation with white/creamy demarcated opacities more frequent than yellow/brown demarcated opacities. Post eruptive breakdown was more in boys than in girls and this difference was statistically significant (p<0.05). Also, maxillary molars were affected more than mandibular molars and this difference was also statistically significant (p<0.05). CONCLUSION: The prevalence of molar incisor hypomineralisation in Kavre was 13.7%. Demarcated opacities were more prevalent than breakdown. The hypomineralised defect was more prevalent in maxillary teeth than in mandibular teeth. The severity of defect increased with age and there was no difference in prevalence between girls and boys.

Different pharmacological solutions in intracanal irrigation.

Irrigation of root canals during endodontic therapy is an important step. Sodium hypochlorite (NaOCl), hydrogen peroxide (H2O2), chlorhexidine (CHX) and normal saline are commonly used intracanal irrigants to disinfect and clean the root canals. This prospective study was set to observe the efficacy of normal saline (0.9% NaCl) irrigation with sequential irrigation of 3% H2O2, 5.2% NaOCl and 0.9% NaCl. A total number of 228 dental patients were screened and 104 patients fulfilling the inclusion criteria were enrolled for the endodontic therapy of mature permanent teeth for the period of one year. Two treatment groups were constituted in which patients were randomly allocated equally in each treatment group. Post-obturation pain, swelling, analgesic use and eight weeks post-obturation radiological evaluation of the patients were carried out as the measurement of clinical and radiological success of the endodontic treatment. No statistically significant differences were observed in the measured treatment outcomes between two groups. However, studies involving larger sample size and longer post-obturation follow up are recommended for the further either confirmation or rejection of present findings.

Peripheral ulcerative keratitis triggered by bacterial conjunctivitis.

BACKGROUND: Periphpral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma. CASE: We present a case of PUK following acute bacterial conjunctivitis in a 60-year-old lady with a history of on-and-off joint pain for two years. After admission to the hospital, she underwent conjunctival resection and was given topical and oral steroids. She was prescribed hydroxychloroquine after confirming the diagnosis of rheumatoid arthritis with a positive RA factor. CONCLUSION: This report highlights the role of infection as a triggeringagent in the induction of PUK in an otherwise quiescent cornea.

Prevalence of complications of simple tooth extractions and its comparison between a tertiary center and peripheral centers: a study conducted over 8,455 tooth extractions.

This study was conducted to investigate and compare the prevalence of complications of simple tooth extractions in a tertiary centre (BP Koirala Institute of Health Sciences, Dharan) and the peripheral centers (Mechi and Koshi zonal hospitals). This is a prospective descriptive study. Tooth extractions were carried out under local anesthesia in the tertiary and the peripheral centers during one year period (March 15"th 2004 to March H"111 2005). Intraoperative and postoperative complications were recorded and analyzed. Out of 8,455 tooth extractions in 6,639 [male-2,465 (37.12%) and females - 4,174 (62.88%)] patients aged between 5yrs- 65 yrs, 7,152 extractions were done in tertiary center and 1,393 extractions were done in peripheral centers.90 complications (1.06%) were observed. 53(58.89%) complications were intraoperative and 37(41.12%) complications were postoperative. 60(0.84%) complications were observed in the tertiary center and 30 (2.3%) complications were observed in the peripheral centers and the difference was highly significant (P<0.000001). The most frequent complication in the tertiary centre was fracture of tuberosity (0.15%) and in the peripheral centers it was 'roots left' (0.77%). Prevalence of 'roots left', injury to adjacent tooth and postoperative hemorrhage was significantly high (P<0.05) in peripheral centers. The higher prevalence rate of complications of tooth extractions in the peripheral centers should not be overlooked and well equipped and organized extraction procedure with qualified dental practitioner is strongly suggested to minimize the complications.

Integrating oral health into primary health care--experiences in Bangladesh, Indonesia, Nepal and Tanzania.

When primary health care (PHC) was developed and implemented in developing countries, oral health was not included. The present consequences are marked disparities in the distribution of oral health care, since conventional dentistry can only serve relatively few people and at high costs. Oral health care is virtually non-existent in rural areas of most developing countries where more than 80 per cent of the population live. More recently, community based oral health programmes have been initiated in some countries to fill the gap. These programmes give more emphasis on oral health promotion and on the prevention of oral diseases than on treatment of its consequences, since history has shown that the latter is ineffective in preventing oral diseases. Unfortunately, most of these oral health programmes have been implemented next to the existing PHC system and hence they face enormous management, logistic and financial problems, which seriously threaten their sustainability. This paper presents a proposal to counteract the problems that many countries face in developing an adequate primary oral health care (POHC) service.

Analysis of epidemiological data on oral diseases in Nepal and the need for a national oral health survey.

This paper reviews and analyses the results of epidemiological studies on periodontal diseases and dental caries in Nepal and considers the need for additional data on oral diseases for the planning of a national oral health strategy. Almost all subjects aged 12 to 19 years (68-97 per cent) and 35 to 44 years (93-100 per cent) had calculus. The various studies showed that a median 29 per cent of subjects aged 35-44 years had deep periodontal pockets. According to this estimate it can tentatively be concluded that Nepal belongs to the 15 per cent of countries in the world where periodontal conditions of the population are among the worst. An accurate DMFT-value for different age groups at present cannot be estimated due to period and sampling effects. The observed cohort effect over time suggests that caries has increased in the 12-19 years age group in Nepal in the period 1980-1996. The estimated range of DMFT-values for 12 years old children is between 0.6-1.9 and for 35 to 44 years old persons between 2.5-4.0. With these DMFT-values Nepal belongs to the countries with a 'low to very low' caries experience according to the WHO decay rating. The present epidemiological data do not justify a claim for a national oral health survey as a starting point for a national plan of oral health since more accurate data do not add additional value to that planning, particularly not in poor countries as Nepal where the oral health service is still in its infancy.