Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study.

BACKGROUND: Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP. METHODS: Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models. RESULTS: Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96-15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28-0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09-0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08-0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP. CONCLUSIONS: Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.

Dental caries, tobacco usage and associated risk factor of dental caries in patients visiting a government hospital in Western, Nepal.

BACKGROUND: This study was conducted to assess the prevalence of dental caries, tobacco usage, and associated risk factors for dental caries in patients who visited a government hospital in Western, Nepal. METHODS: This analytical cross-sectional study was conducted from January to April 2022. Patients above 18 years visiting the dental OPD of a government hospital, and who had provided informed consent were enrolled in the study using a convenience sampling technique. As the study also involved an illiterate population, in that case, informed consent was obtained from their respective legal guardian as well. A pretested standardized, close-ended questionnaire was administered by researchers to gather information regarding the associated risk factors and oral hygiene practices. Clinical examination was done for dental caries according to the criteria by the World Health Organization (WHO) using the "DMFT" index (WHO modification 1987). Bivariate and multivariable logistic regression was done and the odds ratio and p-value was calculated. For all tests, statistical significance was set at p < 0.05. RESULTS: A total of 219 participants completed the study with a mean age of 31.73 ± 12.46. The prevalence of dental caries and tobacco was found to be 80.36% and 5.02% respectively. Participants without health insurance had 2.35 times higher odds of dental caries (95% CI: 1.03-5.36). Not rinsing the mouth after eating sweets was associated with 3.07 times higher odds of dental caries (95% CI: 1.31-7.18). Those who hadn't visited a dentist in the past 12 months had lower odds (0.42; 95% CI: 0.18-0.94). Eating fresh fruit daily showed statistically higher odds (2.70; 95% CI: 1.04-6.99) of dental caries. Non-tobacco users had higher odds (14.19; 2.55-78.99) of dental caries. CONCLUSION: Dental caries is highly prevalent, while tobacco usage is relatively low. Factors associated with dental caries included lack of health insurance coverage, consumption of fruits once daily, recent dental visits within the past year, not rinsing the mouth with water after consuming sweets, and non-tobacco users.

Oral health status and barriers to utilization of dental services among pregnant women in Sunsari, Nepal: A cross-sectional study.

OBJECTIVES: This study was conducted to assess oral hygiene practices, oral health status and barriers to utilization of oral health care services among pregnant mothers attending two family health care clinics in Sunsari, Nepal. METHODS: A cross-sectional study was conducted among 139 women using a purposive sampling technique. The data collection was done using a pretested standard semi-structured questionnaire. Face-to-face interviews of the participants were done by a single investigator in the local language (Nepali). The examination was done using a mouth mirror and CPI probe for periodontal status, loss of attachment and dentition status, and treatment needs. RESULTS: The majority of pregnant mothers brushed their teeth once a day or less than once a day (n = 106, 76.3%) and self-reported perceived oral health status was poor/fair (n = 93, 66.9%). The prevalence of dental caries was found to be 69.8%. Bleeding on probing was present in all participants. DMFT, presence of bleeding on probing and increased periodontal pocket was significantly high among women who had self-reported their oral health problems in comparison to those who had not reported any problem. The most common barriers reported by the participants were a lack of knowledge of dental checkups and a lack of perceived need for dental care during pregnancy. CONCLUSIONS: There was a high prevalence of dental caries and periodontal disease. Lack of knowledge and perceived need for dental care were the major barriers found in this study. Hence, this directs towards the utmost need for improvement in awareness level as well as oral hygiene practices.

Perception of Undergraduate Dental Students Regarding Teaching Learning Methods in Oral Pathology.

Background Third year is considered crucial in undergraduate dental education as this is when students start to have clinical exposure and taught about various oral pathologies. Many a times, students fail to make proper clinical and pathological correlation. It is the responsibility of teacher to impart adequate knowledge to the students regarding a disease in most effective way. Understanding the students perception is an effective way of making new roadmaps for teaching. Objective To assess undergraduate dental student's perspectives regarding oral pathology along with the effectiveness of various teaching learning methods and assessment methods currently used by faculties of Department of Oral Pathology. Method This cross sectional study was conducted from June 2023 to July 2023 among 136 undergraduate dental students of Kathmandu University School of Medical Sciences by using the pretested questionnaire. Convenience sampling method was used. The data collected were entered into the Microsoft Excel Sheet and statistical analysis was done using Statistical Package for the Social Sciences version 20. Result A total of 136 students participated in the study. Among them, 46 (33.8) were from third year, 51 (37.5) were from fourth year and 39 (28.7) were from fifth year. Half of the students believed that oral pathology is an interesting subject. Most of students; 66 (48.5) participants strongly agreed that knowledge of oral pathology helps in clinical training. Except two students, all the participants said that integration of oral pathology teaching with clinical training will help in better understanding of diseases. More than half of the students 71 (52.2) agreed that lectures and demonstrations taken by faculties has stimulated interest in the subject. Most students 80 (58.8) believe that formative assessment serve the purpose of analyzing the cognitive skill. Sixty six (48.5) students agree that MCQs are an effective tool for analyzing cognitive skills. Conclusion The overall perception of undergraduate dental students regarding the oral pathology subject and the teaching learning method used by faculties is good. However, incorporation of case based learning, integration of oral pathology with other clinical subjects and taking regular feedback from students may be of great use in providing holistic and effective learning environment.

Prevalence and Associated Factors of Dental Caries among School Children in Bharatpur, Chitwan.

Background The burden of dental caries among children is increasing due to consumption of sugary substances, poor oral care practices, and inadequate health service utilization. This study aimed to identify the prevalence and associated factors of dental caries among school children. The objectives of the study were to assess the prevalence of dental caries and associated factors among school children of private school of Bharatpur metropolitan city. Objective To assess the prevalence of dental caries and associated factors among school children of private school of Bharatpur metropolitan city. Method A descriptive cross-sectional study was carried out among 150 children of two different private schools of Chitwan by using multi-stage probability sampling technique. The data was collected from 22nd November 2019 to 4th December 2019. Data were collected by using a semi-structured questionnaire to identify the prevalence of and associated factors of dental caries and decayed, missing and filled Permanent teeth (DMFT) index criteria. Result Out of total 150 children, 68% had dental caries. Among them, 64.5 % had caries in deciduous teeth, 17.6 % in permanent teeth and 17.6% had caries on both types of dentition. Only 40.7% of children had received dental check-ups. The mean Decayed, missing and filled primary teeth (DMFT)/ decayed, missing and filled Permanent teeth (DMFT) was 1.91 and 0.54 respectively. 83.3% and 57.1% of children had low severity caries in permanent and deciduous dentition respectively. The educational level, brushing habits, sugar consumption, and snack consumption, bottle feeding at infancy and mother's occupation was found to be associated with dental caries. Conclusion The study showed high prevalence of dental caries among school children. Less than 50% of children had a dental checkup in case of dental problems only. Association of dental caries was found with level of education, brushing habits, sugar consumption, snack consumption bottle feeding at infancy and mother's occupation.

Specialist Periodontal Referral Knowledge, Attitude and Practice by General Dental Practitioner in Nepal.

Background To enhance the referral process, it is essential for the patient, referring practitioner, and specialist to establish effective communication and ensure they are wellinformed and educated about each other's requirements. Objective To assess the knowledge and attitude of general dental practitioners towards specialist periodontal referral. Method This cross-sectional study was carried out for 6 months from October 2022 to April 2023 using a self-administered questionnaire by general dental practitioners registered in Nepal Medical Council. Knowledge and attitude about periodontics, various diseases and referral to specialist for special treatment were analyzed. Result Total of 238 General Dental Practitioners (GDPs) participated in this web-based questionnaire survey. Majority of general dental practitioners (GDPs) reported that they always performed full-mouth and subgingival scaling (193, 81.09%), providing advice on proper brushing techniques (205, 86.13%), advising patients to stop harmful habits (212, 89.07%), and offering diet counseling (122, 51.26%) for patients displaying signs of gingival or periodontal diseases. Majority of GDPs also indicated that they occasionally consult a periodontist for specific periodontal problems, such as the presence of periodontal pockets (143, 60.084%), mobile teeth (150, 63.025%), gingival enlargement (145, 60.924%), periodontal abscess (146, 61.344%), and gingival recession (149, 62.605%). Conclusion General dental practitioners play a crucial role as the primary point of contact for patients seeking dental treatment. The periodontal health of the general population largely depends on the knowledge, attitude, and practice of GDPs.

Influence of gender and oral health knowledge on DMFT index: a cross sectional study among school children in Kaski District, Nepal.

BACKGROUND: Oral health problems are highly prevalent among school children in Nepal. Poor oral health condition may be influenced by various factors. However, little is known about the sociodemographic and awareness related factors on oral health problems among school children in Nepal. Therefore, this study aimed to assess the association of gender and knowledge on DMFT index among school children. METHODS: A cross-sectional study was conducted among school children of Grade Seven in 12 schools of Kaski district in Nepal. Schools were randomly selected from the urban and semi-urban areas in the district. Data were collected covering oral health knowledge, socio-demographic characteristics, oral health condition and practices. The factors of poor oral health condition and practices were examined using t-test, one-way ANOVA, and multiple linear regression. RESULTS: Of the total participants (n = 669), 54.9% were females and their mean DMFT score was 1.82 (SD = 1.07). Total decayed score was higher among those who did not have knowledge that fluoride prevents decay compared to those who had knowledge about it (Being aware of fluoride prevents decay: Mean = 1.21 (SD = 1.54) versus not being aware of that: mean = 2.13 (SD = 2.13); p = 0.029). Females were more likely to have higher DMFT scores compared to males (ß-coefficient = 0.43, 95% CI 0.13, 0.73, p = 0.005). In addition, higher knowledge score was negatively associated with higher DMFT score (ß-coefficient = - 0.09, 95% CI - 0.20, -0.01, p = 0.047). CONCLUSION: Being female students and those having lower level of knowledge on oral health attributed to higher DMFT index. Periodic dental check-up coupled with oral health education on regular brushing, use of fluoridated paste, tongue cleaning and care of gum diseases are recommended in schools.

Participant's Knowledge and Perception of Health Research Methodology before and after a Hands-on Workshop in a Medical College in Lalitpur, Nepal.

Background The basic principles of research methodology are very important for the successful conduct of research. Objective To evaluate the knowledge and perceptions before and after a three-day workshop on health research methodologies conducted at a medical college in Lalitpur, Nepal. Method The pre-post study was conducted during the workshop. There were 31 participants comprising of doctors (interns and residents), medical officers and dental surgeons and faculties. A questionnaire containing two sections related to various themes of the workshop was developed to measure the respondents' knowledge and perception of different concepts. Feedback regarding each session was also obtained. The median knowledge and perception scores before and after the workshop were compared using appropriate statistical tests (p < 0.05). Result More than half of the participants, [18 (58.1%)] were of 20-30 years of age. The total knowledge scores improved significantly after the workshop. The increase in the perception scores after the workshop was also significant. Feedback was positive. The highest feedback score was for the session on critical analysis of a published article. Conclusion Knowledge and perceptions increased significantly indicating such workshops can be effective and contribute to the capacity building of the early-stage researchers.

Semi-customized Scleral Shell Prosthesis for a Pthisical Eye.

One of the most common causes of eye loss is ocular trauma that overtime results in shrunken, non-functional eye known as a pthisical eye. The prosthetic options for such case include either prefabricated prosthesis or custom-made prothesis. Various materials and techniques are used for the fabrication of the prosthesis. Semi-customized prosthesis uses stock iris while the scleral shell is customized. This prosthesis has the advantages of both stock and custom-made prosthesis providing functionally and esthetically satisfactory result. This case report demonstrates the case of a 32 years old male who reported to the Department of Prosthodontics and Crown-Bridge, College of Dental Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal for eye prosthesis to mask his pthisical eye. For this case, a semicustomized scleral shell prosthesis was planned and fabricated.

Outcomes of Microvascular Free Flap Reconstruction after Major Head and Neck Ablative Surgery at a Tertiary Teaching Hospital in Eastern Nepal.

Background Reconstruction with free flaps has significantly changed the outcome of patients with head and neck cancer. Microsurgery is still considered a specialized procedure and is not routinely performed in the resource-constrained environment of developing country like Nepal. Objective To evaluate the clinical outcomes in patients who underwent different microvascular free flap reconstructions of head and neck defects after major ablative surgery. Method A retrospective study was conducted to review and analyze the data of patients with head and neck cancer who underwent microvascular free flap reconstruction after major ablative surgery from November 2017 to April 2021. The descriptive statistics were calculated using Microsoft Excel 2010. Result Out of 207 patients, 129 (62.32%) were males. Mean age was of 55.17±13.44 years. About 133 (64.25%) tumors were on gingivobuccal complex. Anterolateral thigh flap was the most common flap 112, (54.11%) used for the reconstruction. Facial artery was used in 174 (84.06%) patients for anastomosis. The overall success rate was 97.5%. Re-exploration was done in 22 (10.63%) cases out of which 11 (50%) cases were having flap compromise. Delayed flap failure occurred in 5 cases (2.5%) and salvage surgery was done with pectoralis major myocutanuos flap with a salvage rate of 54%. Minor complications were observed in 39 cases (18.84%) out of which donor site graft loss was observed in 19 (9.18%) patients. Conclusion In spite of advanced set up, with trained dedicated manpower the microvascular free flap reconstruction of head and neck defects is safe with high success rate even in resource constrained country like Nepal.

Radiographic Evaluation of Crestal Bone Loss in Pre-loading and Post-loading States of Endosteal Implants in Maxilla and Mandible- A prospective study.

Background Peri-implant tissue integrity depends upon healthy peri-implant mucosa and bone. The crestal bone is one of the governing factors for successful implant therapy both functionally and esthetically. There are limited radiographic studies in Nepalese population for determination of crestal bone loss around peri-implant area comparing the bone loss at pre- and post-loading state. Objective To evaluate the bone loss in mesial and distal, maxilla and mandible before and after the implant supported prosthesis delivery. Method A 6-months prospective study was planned and conducted in 26 endosteal implants (13 maxillary and 13 mandibular) which were placed in 20 patients fulfilling the inclusion criteria. The crestal bone loss was measured and compared using digital radiography images using the designated software. The differences among the crestal bone loss in mesial and distal, maxilla and mandible in pre- (3 months of implant placement) and post-loading states (3 months of prosthesis delivery) were evaluated using the appropriate statistical tests. Result The crestal bone loss was more pronounced in the pre-loading stage (1.12 mm) compared to post-loading (0.48 mm). Initially, the bone remodelling was higher in the distal aspect whereas there was no significant difference between mesial and distal aspect in post-loading phase. Comparing maxilla with mandible, there were no significant differences in bone loss in both phases. Conclusion Within the limitations of this study, the crestal bone loss was found upto the physiological limit of bone remodelling provided the implants placed in strict, aseptic condition with proper case selection and planning.

Prevalence, Pattern and Risk Factors of Oral Cancer -A single institute-based study from Nepal.

Cancer of lip and oral cavity is the most common type of cancer in male population in South East Asia. Although it is a multifactorial disease, tobacco and alcohol use are the most common risk factors involved. Oral cancer has a direct relationship with deleterious habits. Inadequate knowledge about the disease and lack of awareness about its risk factors play vital role in increasing incidence of oral cancer. Objective To determine the prevalence and pattern of oral cancer as well as to find out the risk factors associated with development of oral cancer. Method The hospital records of the patients with histo-pathologically confirmed oral cancer between November 2011 to December 2021 were studied. Data regarding age, sex, associated risk factors and pattern of oral cancer were recorded. Descriptive statistics were obtained and recorded in tabulated form. Result Total of 312 (53.6%) cases out of 582 biopsies turned out to be histo-pathologically confirmed oral cancer. Out of 312 cases of oral cancer, 294 (94.27%) were squamous cell carcinoma. Total number of males were 196 (66.7%) and females were 116 (37.1%). The mean age was 56.2±13.4 years. Smoking (34.7%) was the most common risk factor and gingiva (42.6%) was the most common site of involvement. Conclusion Squamous cell carcinoma is the most common type of oral cancer and gingiva is the most common site of involvement. Tobacco smoking is the major risk factor for developing oral cancer.

Innovative methodology to guide planning of dental workforce distribution: a GIS-based study in Nepal.

OBJECTIVES: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal. METHOD: Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists' data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built. RESULTS: Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters. CONCLUSION: There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries.

Dentists' situation and their needs during the COVID-19 pandemic in Nepal: an online questionnaire survey.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, ordinary dental services were sustained in Nepal. Because a dental practice is considered to involve a high risk of infection, the needs of dentists should be identified, and demand-driven support should be provided. The purpose of this study was to investigate the situation and needs of dentists during the COVID-19 pandemic in order to guide demand-driven support. First, we investigated how the situation of Nepali dentists differed according to their types of practices between private clinics and university/government hospitals. Second, we assessed the characteristics of dentists demanding four types of support: financial, material, technical, and guidelines/guidance support. METHODS: A cross-sectional online questionnaire survey was conducted between July 28th and August 7th 2020. Closed-ended questions were prepared regarding behavior, material availability, economic and psychological impacts, training, and the main support dentists wanted to receive. The situation of dentists between private clinics and university/government hospitals was determined using a chi-squared test for each variable. To examine the association between the characteristics of dentists and four types of support, multivariable logistic regression analyses were used to estimate adjusted odds ratios (ORs) with a 95% confidence interval (CI) for each variable. RESULTS: There were 352 dentists (137 males and 215 females) included in the analysis. Private clinic dentists experienced a bigger economic impact and demanded financial support that 45.5% of them did not receive a salary, compared to 18.9% in university/government hospitals. On the contrary, university/government hospitals experienced lack of PPE and demanded material support that 79.8% had personal protective equipment, compared to 92.5% in private clinics. Financial support was demanded significantly more by male than female dentists (ORs = 5.56; 95% CI = 2.96-10.45). Material support was demanded significantly more by dentists who received training regarding COVID-19 management (ORs = 1.96; 95% CI = 1.01-3.81). Technical support was demanded significantly less by male dentists (ORs = 0.44; 95% CI = 0.23-0.83). Guideline/guidance support was demanded significantly more by dentists who answered that Nepal Dental Association provided appropriate support (ORs = 2.21; 95% CI = 1.25-3.91). CONCLUSION: This study articulated the diverse needs of Nepali dentists during the COVID-19 pandemic. Demand-driven support should be provided in the future.

Prevalence of Oral Habits and its Association with Malocclusion in Primary Dentition among School Going Children of Nepal.

OBJECTIVES: The objectives of this study were to: (1) study the prevalence of oral habits among school going children with primary dentition; (2) determine the association of oral habits with malocclusion in primary dentition; and (3) compare the prevalence of oral habits based on gender, race, age and grade. STUDY DESIGN: A community based cross-sectional study was conducted among 625 school going children with a complete set of primary dentitions. A closed-ended questionnaire was developed to gather information about oral habits followed by clinical examination. RESULTS: The prevalence of oral habits was 42.7%. Finger nail biting (19.5%) was the most prevalent oral habit, whereas self-destructive oral habits (0.7%) were the least prevalent. Multivariate logistic regression analysis revealed significant association of (P<0.05): digit sucking habit with distal step molar relationship, class II canine relationship and increased overjet; pacifier sucking habit with presence of distal step molar relationship, class II canine relationship, crossbite and increased overjet; and finger nail biting habit with absence of primate spaces. CONCLUSIONS: Nearly half of the participating children indulged in one or more oral habits. There was significant association between some oral habits and malocclusion traits, indicating the requirement of timely screening and interception.

Emergence Time and Sequence of Primary Teeth in a Sample of Nepalese Children.

Background Primary teeth emergence is an important milestone in children and timing of emergence varies among populations. Objective To determine the emergence time and sequence of primary teeth in a sample of Nepalese children visiting Dhulikhel Hospital. Method A descriptive cross-sectional study was conducted in children of 5 months to 4 years visiting Dhulikhel Hospital. The emergence of incisal tip to incisal margin for incisors and canines, cusp tip to occlusal margin of molars visible were recorded along with age in months and gender. Descriptive statistics was done to calculate the mean age of emergence of each tooth with standard deviation. Unpaired t-test was used to assess the difference between the mean age of emergence of teeth between right and left sides and between boys and girls. Result The first teeth to emerge was mandibular central incisor at the age of 9.37 ± 1.42 months and the last one was maxillary second molar at the age of 32.91 ± 6.39 months. There was no significant difference in the mean emergence time between the maxillary and mandibular jaws, between right and left sides of jaws and between boys and girls except for primary maxillary right central incisor and mandibular right second molar which was found to be emerged early in girls. Conclusion The emergence time and sequence of primary teeth observed in the present study can be used as a baseline data for the children of Kavre district.

Incidence and Pattern of Patient-Perceived Oral Medicine Emergencies during Lockdown: Experience of Tertiary Health Care Centre of Eastern Nepal.

Background There has been a significant drop in the number of patients seeking oral medicine care during the lockdown period. Objective To find the incidence and pattern of patient perceived oral medicine emergencies in the tertiary healthcare centre of eastern Nepal, during the lockdown period. Method The clinical profile of patients seeking oral medicine care between 30th April 2021 to 25th June 2021 (period of strict lockdown in Sunsari district) was recorded. Data were recorded in an excel sheet and transferred to Statistical Package for the Social Sciences version 11.5. Frequency and proportion were calculated. Result During the lockdown, 300 patients had visited the hospital with different oral diseases seeking the care of an oral physician. The average number of patients seeking oral medicine care per day was approximately six. Of the total patients, 110 patients had pain as their chief complaint, 48 had wound and 34 had a burning sensation in the mouth. Among them 82% perceived their complaint as an emergency. The provisional diagnosis was temporomandibular disorders in 40 patients, trigeminal neuralgia in 38 patients and 34 had carcinoma. Conclusion Patients seeking oral medicine care during the lockdown period had decreased by about one-third. Pertaining to oral medicine, pain in any orofacial area was the most common patient perceived emergency condition followed by wound and burning sensation. Maximum number of patients visiting the department perceived their complain as an emergency.

Oral Health Care Practice and Circumstances during Covid-19 among Dental Patients in Tertiary Care Hospital in Nepal.

Background Patients are hesitant to enter a dental hospital because of the significant danger of cross infection and illness transmission due to rapid spread of corona virus. Objective To assess knowledge regarding Covid-19, oral health practices and circumstances on dental treatment during a pandemic. Method Cross sectional study was conducted among patients visiting dental department of Dhulikhel hospital from September to October 2020. Questionnaires were interviewed following safety protocols regarding the pandemic and descriptive analysis was performed. Both verbal and written consent as well as ethical approval was taken before the study. Result A total 411 patients aged 14 to 75 years old from 14 different districts across Nepal participated in the study. All of the patient were free of Covid-19 symptoms and had strong knowledge and awareness about disease transmission. During the crisis 96% of the people maintain good oral hygiene while 25.8% acquire new dental problems where majority experienced oral discomfort and swelling, 93.2% of them did not attend a dental clinic or hospital in the interim owing to fear and inaccessibility. Majority of the participants were impressed by the safety precautions and preparations during treatment and 99.3% strongly suggest or pledge to visit dental department if necessary during the pandemic. Conclusion Dental patient visiting Dhulikhel hospital is highly aware of current health crisis, possible transmission and preventive measures. Proper safe hospital setup can encourage them to seek dental treatment during crisis. Dental pain and swelling in Endodontic department recorded most common dental emergency during this pandemic.

Sagittal Root Position of Maxillary Anterior Teeth in Nepalese Population Using Cone Beam Computed Tomography.

Background There are no radiographic studies in Nepalese population for determination of sagittal root positioning in maxillary anterior teeth. The sagittal root positioning and root angulation plays a vital role for case selection in immediate implant placement. Objective To evaluate, classify and compare sagittal root position between different maxillary anterior teeth. Method A 2-year retrospective study was conducted on 100 patients (53 males and 47 females) who fulfilled the inclusion criteria using cone beam computed tomographic images. The relationship of root of tooth to its alveolar housing were recorded as Class I to IV. In addition, the root angulation relative to the alveolar process was also measured. Result The sagittal root position (SRP) calculated on six maxillary anterior teeth on average was found to be 87.83% for Class I, 6.67% for Class II, 0.67% for Class III and 5.17% for Class IV respectively. The mean root angulation was found to be higher with canines on both side whereas lateral incisors had lesser mean root angulation. Root angulation of maximum teeth were between 10-20 degrees where immediate implant placement is possible. Conclusion Within the limitations of this study, the sagittal root positioning and root angulation in Nepalese population showed a favorable result for immediate implant placement. Maximum teeth were found to be close to the alveolar process with the exception of few teeth.

The Need of Endodontic Therapy among Patients Attending Tertiary Care Center in Central Nepal.

Background Dental caries is considered as the most prevalent oral disease in Nepalese population that frequently needs endodontic therapy or root canal treatment (RCT). Pulp infection is one of the most common sequels of dental caries which when left untreated leads to pulpal necrosis and peri-radicular diseases. Patients usually reports to the dental hospital after there is pain, sensitivity, swelling or fracture of the tooth structure which usually impedes their normal routine of daily life. RCT is one of the efficacious therapeutic procedures that can save the teeth retaining its aesthetics and function. Objective To determine the need of RCT among patients attending Tertiary Care Hospital. Method A cross-sectional epidemiological study was conducted in the Department of Conservative Dentistry and Endodontics over the period of one year from April 2019 to April 2020. Ethical approval was taken from the Institutional Review Committee Kathmandu University School of Medical Sciences. In total, 7566 records of the patients that needed endodontic therapy and other treatments were collected and the need of endodontic therapy versus other treatments were assessed. The data obtained were analyzed using the SPSS version 20. The association between various patient-related variables were calculated by chi square test and mean, standard deviation, frequency and percentage were calculated using descriptive statistics. P value was set at < 0.05 for statistical significance. Result Among the total study population, (n=7566), the mean age was 34.97±14.34 years among which 4387 (58%) were females and 3179 (42%) were males. The type of treatment required by the study participants were significantly associated with age and sex (p < 0.001) and p < 0.001, respectively). Conclusion The findings of this study concluded that there was an increased need for endodontic therapy among patients visiting the department compared to other treatments. There was a significant association between gender and age showing females and elderly patients in greater need for endodontic therapy.