Evaluation of mechanical properties of anatomically customized fiber posts using E-glass short fiber-reinforced composite to restore weakened endodontically treated premolars.

OBJECTIVE: This study was conducted to assess the influence of combining different forms of fiber-reinforced composites (FRC) on the mechanical behavior and bond strength of compromised endodontically treated teeth (ETT). MATERIALS AND METHODS: Eighty extracted human premolar teeth were randomly divided into five experimental groups according to the type of intra-radicular restoration and the canal preparation design which was either non-flared (Group 1), flared (Groups 2-5), closed-apex (Groups 1,3,5) or open-apex (Groups 2,4). Standard prefabricated fiber posts were used as intra-radicular restoration for Groups 1-3 while Groups 4-5 were restored with anatomically customized relined fiber posts. After composite core fabrication, all samples were sent for an artificial aging process. Fracture resistance and push-out bond strength tests were then carried out through a universal testing machine followed by mode of failure analysis via a stereomicroscope and scanning electron microscope. RESULTS: Pairwise Log-Rank comparisons revealed that the survival rate of Group 2 and Group 3 was significantly lower than all other groups after artificial aging. The highest fracture resistance value (1796 N) was recorded in Group 5 and was significantly higher than that of the other groups (p < 0.05), while Group 2 exhibited the lowest fracture resistance (758 N), which was significantly lower compared to the other groups. Group 5 and Group 4 demonstrated a significantly higher push-out bond strength, at all root thirds, than Group 3, Group 2, and Group 1 (p < 0.05). The most frequently observed failure mode in the tested groups occurred between the resin cement and radicular dentin. CONCLUSION: The use of short fiber-reinforced composite (SFRC) to reline the prefabricated FRC post has been proven to have superior fracture resistance with favorable failure patterns and increased push-out bond strength values compared to standard prefabricated FRC posts.

Identification of copy neutral loss of heterozygosity on chromosomes 1p, 1q, and 6p among nonsyndromic cleft lip and/or without cleft palate with hypodontia.

BACKGROUND: Nonsyndromic cleft lip and/or without cleft palate (NSCL/P) with or without hypodontia is a common developmental aberration in humans and animals. This study aimed to identify the loss of heterozygosity (LOH) involved in hypodontia and NSCL/P pathogenesis. METHODS: This is a cross-sectional study that conducted genome-wide copy number analysis using CytoScan 750K array on salivary samples from Malay subjects with NSCL/P with or without hypodontia aged 7-13 years. To confirm the significant results, simple logistic regression was employed to conduct statistical data analysis using SPSS software. RESULTS: The results indicated the most common recurrent copy neutral LOH (cnLOH) observed at 1p33-1p32.3, 1q32.2-1q42.13 and 6p12.1-6p11.1 loci in 8 (13%), 4 (7%), and 3 (5%) of the NSCL/P subjects, respectively. The cnLOHs at 1p33-1p32.3 (D1S197), 1q32.2-1q42.13 (D1S160), and 6p12.1-6p11.1 (D1S1661) were identified observed in NSCL/P and noncleft children using microsatellite analysis markers as a validation analysis. The regions affected by the cnLOHs at 1p33-1p32.3, 1q32.2-1q42.13, and 6p12.1-6p11.1 loci contained selected genes, namely FAF1, WNT3A and BMP5, respectively. There was a significant association between the D1S197 (1p33-32.3) markers containing the FAF1 gene among NSCL/P subjects with or without hypodontia compared with the noncleft subjects (p-value = 0.023). CONCLUSION: The results supported the finding that the genetic aberration on 1p33-32.3 significantly contributed to the development of NSCL/P with or without hypodontia. These results have an exciting prospect in the promising field of individualized preventive oral health care.

Work-related musculoskeletal symptoms and coping strategies among dental auxiliaries at hospital universiti Sains Malaysia.

BACKGROUND: Dental personnel are vulnerable to work-related musculoskeletal symptoms (WMSS) due to the nature of their profession. AIM: To determine WMSS experienced by dental auxiliaries and their coping strategies toward these symptoms. SETTING AND DESIGN: A cross-sectional study was conducted on 82 dental auxiliaries at a university dental hospital in Malaysia. MATERIALS AND METHODS: Nordic musculoskeletal questionnaire and the Brief COPE questionnaire were used to measure the musculoskeletal symptoms and coping strategies of the respondents, respectively. Data were analyzed using IBM SPSS version 22.0. RESULTS: Dental auxiliaries consisted of dental staff nurses (30.5%), dental surgery assistants (40.2%), dental technologists (18.3%), and healthcare assistants (11.0%). Their mean [standard deviation (SD)] age was 33.4 (7.60) years. Most of the respondents had been troubled with ache, pain, and discomfort at the neck, 54.9% (95% confidence interval 44.0%, 66.0%]. In addition, they were troubled mainly with distress at the low back (34.1%) and the ankle or feet (34.1%) which had prevented the respondents from doing their regular job over the past 12 months. The most common areas that had troubled the respondents over the past 7 days were the neck (36.6%), low back (36.6%), and ankle or feet (36.6%). The coping strategy most commonly practiced by the respondents was religion with a mean (SD) score of 3.70 (2.15), followed by active coping [3.13 (0.68)] and acceptance [3.13 (0.69)]. CONCLUSION: The prevalence of WMSS was high in the dental auxiliaries particularly in the neck region. The most common coping strategy used was religion. Awareness programs on the prevention of WMSS among the dental auxiliaries should be increased.

Citation Classics on Dental Caries: A Systematic Review.

OBJECTIVE: A systematic search was performed for the identification and analysis of the 100 most often cited articles on dental caries and to highlight the changing trends in the field of dentistry over time. MATERIALS AND METHODS: The search was performed without any restriction on the study design, publication year, or language using the Web of Science (WoS) group of Clarivate Analytics enabling the search through "All Databases." Based on the citation count as available in WoS, the articles were sorted in a descending manner. Information regarding each article was then extracted, which included its authorship, counts of citation (in other databases), citation density, current citation index (2019), publication year, country of publication, journal of article, evidence level based on study design, and keywords description. RESULTS: The count of citation for each article varied in each database, that is, 175 to 2,003 in WoS, 89 to 1,981 in Scopus, and 126 to 3,492 when searched in Google Scholar. The highest number of articles (n = 10) related to dental caries were published in 2004. A total of 301 authors made valuable contributions to this field, out of which J.D. Featherstone had coauthored 6 articles. A significant negative correlation (p < 0.01) was found between the age of the article and the citation density (r =-0.545). However, a nonsignificant correlation (p = 0.952) occurred between the age of publication and the citation count (r = 0.006). CONCLUSION: The results of this systematic review provide a critical appraisal of the context underpinning scientific developments in the field of dental caries and also highlighted trends in clinical management and research.

Closed and Open Reduction of Nasal Fractures.

AIM: The objective of this review was to determine the different types of surgical intervention in the management of nasal bone fractures, the outcomes, and complications associated with each intervention. METHODS: A search was conducted using the PubMed and Cochrane Database of Systematic Review databases from January 1, 1997 until September 9, 2017. The search strategy was constructed using the Population Intervention Comparison Outcome framework with keywords related to nasal fracture and its treatment. Two sets of independent researchers performed the analysis. Qualitative analysis was performed using the Methodological Index for Non-Randomized Studies and National Institute for Clinical Excellence methodology for randomized controlled trial checklists. RESULTS: The 4276 titles were obtained from PubMed database alone. Exclusion was made based on the title, abstract and full-text analysis. Finally, 23 papers were included and analyzed. Of the 23 papers, 13 (56.5%) were retrospective record review, 2 (8.7%) were randomized clinical trial or a randomized study and 8 case series (34.8%). 16 (69.6%) studies addressed closed reduction, 3 studies (13%) on open reduction and 4 studies (17.4%) addressed both open and closed reduction. The main focus in the outcome in all studies was accuracy of the anatomical reduction of the nasal bones. Three studies (13.0%) reported restoration of function such as breathing comfort or release in respiratory obstruction and another 3 (13.0%) addressed both cosmetic and breathing outcomes. Residual deformity was the most described complications in the studies (30.4%). In general, most of the studies were not of high quality as they lacked in some key elements in the Methodological Index for Non-Randomized Studies checklist. CONCLUSION: Both closed and open reduction provided good outcomes in cosmetic and breathing. Septoplasty is recommended to be performed simultaneously with fracture reduction.

Oral health and nutritional status of children with cerebral palsy in northeastern peninsular Malaysia.

AIMS: To investigate the oral health and nutritional status of children with cerebral palsy (CP). METHODS AND RESULTS: Oral health assessment included dental caries and dental plaque maturity scores (DPMS) while the nutritional assessment included children's height-for-age Z-score (HAZ), body mass index-for-age Z-score (BAZ), mid-upper-arm circumference (MUAC), nutrient intake, cariogenic food frequency (CFF) and daily sugar exposure (DSE). Ninety-three CP children were recruited. The prevalence of caries was 81.7% (95% CI: 72.7%-88.3%). The median (IQR) of the DMFT and dft scores were 0.5(4.0) and 3.0(8.0), respectively. Most of the participants had acid-producing plaque (90.3%), severely stunted (81.4%), and 45% were severely thin with acute malnutrition. Intakes of calcium, iron, zinc, vitamin A, vitamin D and total fat were below 77% of the Recommended Nutrient Intakes for Malaysian children (RNI 2017). Nine types of cariogenic foods/drinks were consumed moderately, and DSE indicated that 45% of the children were at moderate risk of dental caries. CONCLUSION: Untreated dental caries, severe stunting and thinness were prevalent, and cariogenic foods/drinks were consumed moderately suggesting a moderate risk of caries. Therefore, controlling cariogenic food intake is crucial, but monitoring daily nutrient intake is needed for the optimum growth of children with CP.

Nonprescription Bleaching versus Home Bleaching with Professional Prescriptions: Which One is Safer? A Comprehensive Review of Color Changes and Their Side Effects on Human Enamel.

OBJECTIVES: This study evaluates the efficacy and safety of the professionally prescribed and nonprescription over-the-counter (OTC) bleaching agents. MATERIALS AND: METHODS: Extracted human upper central incisors were prepared and stained with red wine for 14 days before being subjected to four different bleaching agents: professionally prescribed opalescence PF 15%, VOCO Perfect Bleach 10%, nonprescription OTC Crest 3D Whitestrips, and Whitelight Teeth Whitening System. Colorimetric measurement was performed with Vita Easyshade Handheld Spectrophotometer, enamel surface microhardness measured using Vickers Hardness machine, and surface roughness was evaluated with profilometer, before and after bleaching. Scanning electron microscope (SEM) evaluation and atomic force microscopy were conducted postbleaching. STATISTICAL ANALYSIS: The data were analyzed with t-test, two-way ANOVA, one-way ANOVA, and Turkey's test at a significance level of 5%. RESULTS: All bleaching products have the same efficacy to whiten stained enamel. Opalescence PF 15% showed significant increase in the microhardness (92.69 ± 68.316). All groups demonstrated significant increase in surface roughness (p < 0.05). SEM evaluation showed that Opalescence PF 15% resulted in same microscopic appearance as unbleached enamel, while VOCO Perfect Bleach 10%, Whitelight Teeth Whitening System and Crest 3D Whitestrips demonstrated mild to moderate irregularities and accentuated irregularities, respectively. CONCLUSION: Professionally prescribed bleaching agent of Opalescence PF 15% is effective tin whitening the teeth, while the other bleaching products may be effective but also have deleterious effects on the enamel.

Evaluation of Microleakage Between Different Post and Core Systems Under Gradual Loading: an In-Vitro Study.

OBJECTIVE: This study aimed to compare the difference in marginal dye penetration between everStick, Parapost XP, Parapost fiber white and control groups under gradual loading. MATERIALS AND METHODS: Sixty-eight human maxillary permanent incisors were divided into four groups. Each specimen was endodontically treated with step-back technique and prepared for each post system according to experimental groups, subsequently cemented in the canal. Composite resin cores were built and laboratory fabricated metal crowns were cemented. All specimens except those in the control group were subjected to thermal cycling. All groups were subjected to gradual loading from 0N-50N for 100 cycles. Specimens were sectioned transversely and the depths of dye penetration along the post were measured. Data were entered in SPSS ver. 22 and analyzed using two-way ANOVA test. RESULTS: There was no significant difference in marginal dye penetration between each group (p-value>0.05). However, there was a significant difference in percentage of marginal dye penetration between all groups (p-value<0.05); post-hoc comparison showed significant difference between Fiber White and Control groups (p-value=0.009). CONCLUSION: All the groups showed dye penetration but the percentage was significant only between Parapost Fiber White and the control groups.

Adaptation and Validation of the Malay Version of the Index of Dental Anxiety and Fear (IDAF-4C+) for Malaysian Secondary School Children.

BACKGROUND: Many questionnaires have been developed to measure dental anxiety and fear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of a dental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module (IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children. METHODS: This was a cross-sectional validation study. The original English version of the IDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via an expert validation and face validation by the target student population. Three hundred and seventy questionnaires were then distributed among 16-year-old school children. Confirmatory factor analysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihood estimator. Spearman's rank correlation was used to assess the relationship between the IDAF-S and IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of the IDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module. RESULTS: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed the existence of only one factor with a reliability estimate of 0.921, obtained via Raykov's procedure. All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P < 0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed model with absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showed satisfactory stability, as assessed via kappa values. CONCLUSION: The Malay version of the IDAF-4C+ is valid and reliable in measuring dental anxiety and fear among Malaysian secondary school children.

Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study.

OBJECTIVE: Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. MATERIALS AND METHODS: A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. RESULTS: A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. CONCLUSION: Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia.

Screening of Transforming Growth Factor Beta 3 and Jagged2 Genes in the Malay Population With Nonsyndromic Cleft Lip With or Without Cleft Palate.

OBJECTIVE: To determine the prevalence of mutations in transforming growth factor beta 3 (TGFß3) and Jagged2 genes and their association with nonsyndromic cleft lip with or without cleft palate (CL±P) patients. DESIGN: Cross-sectional study on nonsyndromic CL±P and noncleft patients. SETTING: Reconstructive clinic and outpatient dental clinic, Hospital Universiti Sains Malaysia. PATIENTS: Blood samples of 96 nonsyndromic CL±P and 96 noncleft subjects. MAIN OUTCOME MEASURE: Prevalence and association of mutations in TGFß3 and Jagged2 genes with nonsyndromic CL±P. RESULTS: Most of the nonsyndromic CL±P patients (53.1%) had left unilateral CLP. There were slightly more females (56.6%) compared with males. The prevalence of the mutations in the TGFß3 gene was 17.7% (95% confidence interval [CI]: 9.5, 24.5) and in the Jagged2 gene was 12.5% (95% CI: 5.5, 18.5), which was higher compared with the noncleft group. For the TGFß3 gene, there was no mutation in the coding region in either of the groups. All variants were single nucleotide polymorphisms located within the intronic flanking region. Two variants were identified (g.15812T>G and g.15966A>G) in both nonsyndromic CL±P and noncleft patients. However, the association was not significant (P > .05). Three variants (g.19779C>T, g.19547G>A, and g.19712C>T) were identified in the Jagged2 gene among nonsyndromic CL±P and noncleft patients. Only g.19712C>T showed a significant association with nonsyndromic CL±P patients (P = .039). CONCLUSION: g.19712C>T might play a crucial role in the development of cleft lip and palate. To the best of our knowledge, this is the first report of the mutation found within intron 13 of the Jagged2 gene among nonsyndromic CL±P Malay patients.

Screening of Transforming Growth Factor Beta 3 and Jagged2 Genes in the Malay Population With Nonsyndromic Cleft Lip With or Without Cleft Palate.

OBJECTIVE: To determine the prevalence of mutations in transforming growth factor beta 3 (TGFß3) and Jagged2 genes and their association with nonsyndromic cleft lip with or without cleft palate (CL±P) patients. DESIGN: Cross-sectional study on nonsyndromic CL±P and noncleft patients. SETTING: Reconstructive clinic and outpatient dental clinic, Hospital Universiti Sains, Malaysia. PATIENTS: Blood samples of 96 nonsyndromic CL±P and 96 noncleft subjects. MAIN OUTCOME MEASURE: Prevalence and association of mutations in TGFß3 and Jagged2 genes with nonsyndromic CL±P. RESULTS: Most of the nonsyndromic CL±P patients (53.1%) had left unilateral CLP. There were slightly more females (56.6%) compared with males. The prevalence of the mutations in the TGFß3 gene was 17.7 (95% confidence interval [CI]: 9.5, 24.5) and in the Jagged2 gene was 12.5% (95% CI: 5.5, 18.5), which was higher compared with the noncleft group. For the TGFß3 gene, there was no mutation in the coding region in either of the groups. All variants were single nucleotide polymorphisms located within the intronic flanking region. Two variants were identified (g.15812T>G and g.15966A>G) in both nonsyndromic CL±P and noncleft patients. However, the association was not significant (P > .05). Three variants (g.19779C>T, g.19547G>A, and g.19712C>T) were identified in the Jagged2 gene among nonsyndromic CL±P and noncleft patients. Only g.19712C>T showed a significant association with nonsyndromic CL±P patients (P = .039). CONCLUSION: g.19712C>T might play a crucial role in the development of cleft lip and palate. To the best of our knowledge, this is the first report of the mutation found within intron 13 of the Jagged2 gene among nonsyndromic CL±P Malay patients.

The impact of children with disabilities on parent health-related quality of life and family functioning in Kelantan and its associated factors.

OBJECTIVES: Caring for children with disabilities brings about a significant impact on the parents and families. The purposes of this study were to determine the impact of having children with disabilities on parents' health-related quality of life (HRQOL), family functioning, and total family impact and to identify the associated factors. METHOD: A total of 425 parents/caregivers of children with disabilities who were registered to community-based rehabilitation centers in 5 districts in Kelantan, Malaysia, participated in this study. The Malay version of PedsQL Family Impact Module was used as research instrument. General linear regression was applied to analyze the association between family impact scores (Total Impact, Parent HRQOL Summary, and Family Functioning Summary) and study factors using Stata/SE 11 software. RESULTS: The mean (SD) Total Impact Score and Parent HRQOL Summary Score of the parents/caregivers was 75.1 (16.85) and 75.0 (18.74) respectively, and the median (IQR) of Family Functioning Summary Score was 84.4 (28.13). Mothers, non-Malays, and widowed parents/caregivers, parents/caregivers having male children with disabilities, and children with more complex disability had significantly lower parent HRQOL and family functioning. CONCLUSIONS: Both parents/caregivers' characteristics and children's characteristics contributed to family impact in local setting. Results of this study emphasize the importance of the whole family involvement as the focus of services and supports by health care providers.

The effect of mild hearing loss on academic performance in primary school children.

OBJECTIVES: To determine the prevalence of mild hearing loss and its association with academic performance among primary school children. PATIENTS AND METHODS: A comparative cross sectional study was conducted on standard (grade) five school children in a state in Malaysia. Five schools were selected by using simple random sampling. There were three classes (A, B and C) of standard five in each school. Student's selection into these classes was made by respective school administration based on their final term examination in standard four. Class A was for the best academic achievers while class C was for the poorest. Ear examinations were done followed by pure tone audiometry for confirmation of the hearing status. In this study, mild hearing loss was defined as an average threshold of 20-39 dB at 0.5, 1, 2 and 4 kHz. Data analysis was done using SPSS Version 12.0 software. Chi-square test was used to determine the association between mild hearing loss and academic performance. The significant level was set at p=0.05. RESULTS: From a total of 257 students, 234 have completed the examinations (response rate=91.0%). Fifty-three percent of them were boys while 47% were girls. A hundred and forty-nine (63.7%) of them were from class A while 85 (36.3%) were from class C. The prevalence of hearing loss in our school population was 15% (95% CI: 11.0-20.0%). Thirty-two (88.9%) of them were having conductive type. Out of the total, 38.9% were having problems in both ears. The students who have poor academic performance have been shown to be significantly associated with mild hearing loss (p<0.001). CONCLUSIONS: There was a high prevalence of mild hearing loss among primary school children. This problem could affect their academic performance. Therefore, hearing assessment is highly recommended to be done on every child especially to those who have poor academic achievement.