Temporomandibular Disorders among Dental Students in Pakistan: Assessment of Prevalence, Severity, and Associated Factors Based on Questionnaire.

Objective: To evaluate the prevalence, severity, and associated factors of temporomandibular disorder (TMD) among dental students. Methods: This cross-sectional study was performed on undergraduate dental students from four dental colleges in Punjab, Pakistan. Fonseca's questionnaire was used to measure the prevalence and severity of the TMD among the study participants. Bivariate and multiple logistic regression analyses were performed. Results: Of 364 dental students, 323 returned the completed questionnaires and the response rate of the study was 88.7%. The study included 52.6% males and 47.4% females. The prevalence of TMD was 66.9% with mild TMD in 40.90%, moderate TMD in 14.6%, and severe TMD in 11.50% of the participants. Psychological stress (29.6%), malocclusion (20%), and hypersensitivity (19.5%) were common among participants. The mean TMD score of the sample was 31.54 ± 24.86 which was significantly higher among participants with no/school-educated mothers (P=0.021) and fathers (P=0.002). The participants with arthritis (72.81 ± 32.19) and malocclusion (59.46 ± 31.09) and those who received orthodontic treatment (53.21 ± 34.21) demonstrated higher TMD. After controlling for other study variables, the participants with arthritis were 4.71 times more likely to have moderate/severe TMD (P=0.042) than those without arthritis. Similarly, the participants with malocclusion had significantly higher odds (OR = 3.57, P=0.029) of having moderate/severe TMD than those without malocclusion. Conclusion: This sample of dental students demonstrated a high prevalence and severity of TMD. The participants with arthritis and malocclusion demonstrated higher TMD. The study findings underscore the importance of prevention, early diagnosis, and management of TMD among the dental students.

Detection & recognition of veiled and unveiled human face on the basis of eyes using transfer learning.

Face detection and recognition are the most substantial research areas in computer vision and transfer learning due to the inspiring nature of faces as an object. In this paper, we show that we can obtain promising results on the standard face databanks when the features are extracted merely from the eye. The contributions of this work are divided into three parts, specifically face detection, eyes detection and recognition for individual identification. The key features for face recognition, used in this study are the eyes, nostrils, and mouth. The key features for eyes recognition are center of left eye, center of right eye, midpoint of eyes and extraction of eyebrows. Extracted Local Binary Pattern Histogram (LBPH) method is used to extract the facial features of face images whose computational complexity is very low and these features contain simple pixel values. Furthermore, neighborhood pixels are calculated to extract effective facial feature to realize eyes recognition and person verification. This study is able to identify an individual on the basis of even a single eye. The algorithm finds the brighter eye from the face and then, on the basis of that eye, the person is identified and the name of person is provided. The experimental results of this study show that faces are recognized accurately and LBPH method has achieved 98.2% accuracy.

A quantitative study of test anxiety and its influencing factors among medical and dental students.

OBJECTIVE: The study was conducted to assess test anxiety and its influencing factors on medical and dental students. METHODS: A cross-sectional study was conducted among students from three private and public medical and dental colleges in the Punjab province of Pakistan. The survey included statements about the demographic profile of the study participants and used the Test Anxiety Inventory (TAI) by Spielberger. RESULTS: The study included 680 students with a mean age of 20.93 ± 1.76 years. About half the sample (51.8%) scored high on test anxiety (TAI score > 45), and the mean TAI score was slightly higher for the dental (47.75 ± 11.45) than medical students (46.42 ± 12.79). Female students had a significantly higher mean TAI score (48.45 ± 12.79) than male students (41.85 ± 8.91; p < 0.001). The students from private colleges had a significantly greater test anxiety score (50.15 ± 13.23) than students from public colleges (42.88 ± 9.7; p < 0.001). Students whose parents were graduates from a college or university perceived significantly increased test anxiety than those of parents with no/school education (p < 0.001). A female gender (adjusted odds ratio (AOR) 2.10, 95% CI:1.37, 3.22), being a private college student (AOR 2.88, 95% CI:1.90, 4.38), and having a mother with a college or university education (AOR 2.05, 95% CI: 1.25, 3.35) were significantly associated with high on test anxiety. CONCLUSION: In our study cohort, test anxiety was common among medical and dental students. A female gender, being a student from a private college, and having a mother with a high education were significantly associated with high test anxiety. The study findings may guide the development of programs that can reduce students' test anxiety and potentially improve their education.

A Study of Dentists about Their Knowledge and Practice of Dentine Hypersensitivity.

OBJECTIVE: The aim of this study was to evaluate the knowledge and practice about dentine hypersensitivity (DH) among dental practitioners. MATERIALS AND METHODS: A pilot-tested questionnaire was sent to practicing dentists (n = 588) working in private and public sectors in Lahore, Pakistan. The questions assessed dentists' knowledge about type of pain and predisposing factors of DH. The dentists were asked about their preferred methods of diagnosing and managing the condition. STATISTICAL ANALYSIS: Basic statistics, chi-squared test, and multivariate logistic regression were performed. RESULTS: Most dentists (64.3%) reported examining one to five patients with DH per week in their dental clinics. A large majority (85.4%) indicated DH as a stimulated short pain from a tooth. Recession of gums (96.6%), aggressive brushing (88.2%), and frequent use of teeth whitening procedures (83.1%) were most frequently reported predisposing factors of DH. Among most commonly used methods of diagnosis, spontaneous pain after the application of air blast was reported by 74.8% of the participants and followed by spontaneous patient report confirmed by dental examination (57.7%). Most widely used management approaches of DH included the use of fluoride products (96.2%), use of desensitizing potassium nitrate toothpastes (75%), and application of bonding agents (56.2%). Female versus male dentists (odds ratio [OR]: 7.79, p < 0.001) and private practitioners versus public dentists (OR: 7.34, p < 0.001) were more likely to examine greater number of patients with DH. CONCLUSION: Dentists used various methods for diagnosing and managing patients with DH. Application of air blast to evaluate spontaneous pain and use of fluoride products were most widely used diagnostic and management preferences, respectively.

Dentists' awareness about the link between oral and systemic health.

BACKGROUND: Oral health is integral to systemic health. There is a growing body of evidence of an association between periodontal and systemic diseases. The aim of the study was to evaluate the awareness of dentists regarding link between oral and systemic health. MATERIALS AND METHODS: Data was collected using a self-administered pilot-tested questionnaire. Dentists awareness about link between oral and systemic link was assessed on five point likert scale. Data was entered and analysed using SPSS. RESULTS: Of the 588 dentists, 500 completed the questionnaire (response rate 85.03%). About 93% of the participants (mean age 25.82 ± 4.21 years) agreed that oral health was associated with systemic health. Most dentists were aware of a connection between periodontal disease and diabetes (84.4%) and heart disease (70.2%). Similarly, 85.6% believed in the negative impact of oral disease on the quality of life of patients. More female than male dentists were aware of the relationship between periodontal disease and adverse pregnancy outcomes, diabetes, and rheumatoid arthritis (P < 0.001). Most dentists (97%) believed that more patients would seek oral care if they were aware of the oral-systemic link. After adjustments, private dentists were 4.65 times more likely than public dentists to believe in improving access to oral care with increased patient awareness of the oral-systemic connection (P = 0.011). CONCLUSIONS: Most dentists were aware of the oral-systemic link. They believed that patients' access to oral care would improve if they were aware of a connection between oral and systemic health. Therefore, patients should be informed of the oral-systemic link to improve their oral health.

A cross-sectional study of dentists about the need for a practice management course in undergraduate dental program.

OBJECTIVE: To evaluate dentists' opinions about the need for a practice management course in the undergraduate dental program. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 on practicing dentists in Lahore, Pakistan. A self-administered pilot-tested questionnaire was distributed among 588 dentists using a convenience sampling method to obtain their responses about the need for a practice management course. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. RESULTS: About 83.8% of 588 dentists completed the questionnaires. There were 36.7% of males and 63.3% of females (mean age 26.22 ± 4.8 years). The principles of patient management (94.1%), time management skills (90.3%), and teamwork (89.2%) were the most commonly agreed topics of the practice management course. The least agreed topics included office design (59.2%), health-care systems (60.9%), and inventory systems (69%). Most participants (74.4%) thought that a practice management course is required to successfully manage a dental practice, and 63% recommended to include the course in the dental curriculum. Multivariate logistic regression showed that dentists working in private clinic (odds ratio (OR): 3.35, P = 0.001), dentists with graduation within ≤ past 5 years (OR: 3.64, P = 0.001), and dentists who attended a practice management course (OR: 3.12, P = 0.001) were more likely to agree to the need of a practice management course to successfully run a dental office. CONCLUSION: Most dentists believed that a practice management course is required for a successful dental practice. The development and implementation of such a course should be based on the feedback from dentists to ensure evidence-based approaches.

Effect on blood pressure and pulse rate after administration of an epinephrine containing dental local anaesthetic in hypertensive patients.

OBJECTIVE: To document safety for use, through recording changes in blood pressure and pulse rate, after administering 3.6 ml of a 2% lignocaine with 1:100,000 epinephrine dental local anaesthetic in a group of hypertensive patients. METHODOLOGY: The present study was conducted at Shaikh Zayed Medical Complex, Lahore, from May to December 2008, using a convenience sampling technique. The first 60 walk-in patients in the dental outpatient department planned for tooth extraction were enrolled in the study. Out of these 60 patients, 10 had pre-hypertension (BP = 130/90), 10 had stage 1 hypertension (BP =140-159/90-99) and 10 study subjects were suffering from stage 2 hypertension (BP = 160-179/100-109). Thirty age and sex matched normo-tensive patients requiring tooth extraction acted as the control group. All patients were administered two cartridges each of 1.8 ml of dental local anaesthesia containing 2% Lignocaine with 1:100,000 epinephrine. Blood pressure and pulse rate (PR) were the risk indicators that were measured thrice; pre-injection, 2 minutes and 5 minutes after injection. RESULTS: A decrease in systolic in stage 2 hypertension patients after 2 and 5 minutes of injections was noted. The diastolic BP (DBP) fell in all the groups after injections. Mean pulse rate increased from three to four beats per minute in all groups except in stage 2 hypertension patients where it slightly decreased. CONCLUSION: Epinephrine containing dental local anaesthesia decreased systolic blood pressure in stage 2 hypertension patients included in this study. There was an observed decrease of 21 mm Hg in systolic blood pressure hypertension patients but with no adverse effects.

Dental caries experience in preschool children: is it related to a child's place of residence and family income?

PURPOSE: To assess the caries prevalence in 3- to 5-year-old children and determine whether urbanisation and income are associated with the dental decay status of these preschool children residing in the district of Lahore, Pakistan. MATERIALS AND METHODS: Multistage random sampling was done to collect the sample of children from urban and rural areas. A list of children 3 to 5 years of age was prepared, and every 2nd child on the list was randomly selected until a total of 700 children were enrolled in the study. Lady Health Workers (LHWs) were trained to conduct this survey after permission from the pertinent authorities. The data of the children and their mothers regarding their age, gender, socioeconomic status (SES) and area of residence were collected. The caries status of children was recorded using the dmft index as per WHO criteria. RESULTS: The prevalence of dental caries in preschool children of Lahore was found to be 40.5%. Within this group, caries prevalence was 33.3% in 3-year-old children, 47.6% in 4-year-old children and 75% in the 5-year-old children. The mean dmft score for the entire child population was 1.85 ± 3.26. A significant association was found between caries prevalence, low socioeconomic status, female gender and rural residence. CONCLUSION: Preschool children in Lahore, Pakistan have average dmft scores of 1.85 (± 3.26), which are mostly related to untreated carious lesions. Lower caries experience was found to be associated with rural residence and low family income.

Bidirectional relationship between diabetes and periodontal disease: review of evidence.

Presently there are 170 million diabetic patients worldwide. Pakistan ranks sixth in the world with approximately 6.2 million in the 20-79 year age affected by the diabetes. 6-10% of the 35-44year old diabetic patients have been reported to be affected by moderate form of periodontal disease in Pakistan. Periodontal disease is referred to as sixth complication of diabetes. The association between diabetes and periodontal disease has been reported for more than 40 years but reverse has not been the focus of researchers until recently. Studies have suggested a bidirectional relationship between periodontal disease and glycaemic control with each disease having a potential impact on the other.

Estimating the burden of head and neck cancers in the public health sector of Pakistan.

This study was designed to establish the burden of head and neck cancers (HNCA) in public sector based cancer centres of Pakistan. Data were obtained from the central body governing all the cancer centres in the country. The frequency of treated HNCAs out of the total body cancers treated across Pakistan was found to be 14.5%. Highest prevalence rates amongst all cancers were noted in Sind, notably in Karachi and Jamshoro, followed by Multan in Punjab and a much lower frequency in Peshawar in the North West Frontier Province. This variation presumably reflects levels of betel quid consumption but more data are needed to be gathered in a comprehensive way if the findings are to be applicable for improvement of the national cancer control program.

Helicobacter pylori in dental plaque and gastric mucosa: correlation revisited.

Helicobacter pylori (H. pylori) related gastric infection is highly prevalent in developing countries. Prevalence of bacterium in dental plaque from these regions is also reported to be high, but association between simultaneous colonization of H. pylori in both these sites has not been established yet. Aim of this paper is to review possible association between simultaneous oral and gastric H. pylori colonization in dyspeptic patients. Pertinent literature was reviewed and all available evidence collected from Medline and PakMedinet. Studies conducted in the developing world show conflicting results. Some report a positive relation between oral and gastric H. pylori colonization while others deny any association. This may be due to the population sampled or methodology applied. Further studies are recommended to confirm the association between concurrent presence of H. pylori in dental plaque and gastric mucosa of dyspeptic patients using sensitive and specific tests for detection of bacterium in oral samples.