Assessment of Prevalence and Causative Factors for Replacement of Composite and Amalgam Restorations: An Observational Study.

Aim: This study intends to evaluate the frequency and causes of replacement for failed amalgam and composite dental restorations. Methodology: A cross-sectional study comprising female patients with failed permanent composite and amalgam restorations aged 15-60 years old was carried out at the dental clinics of Qassim University. Using a self-structured proforma, demographic data and causes for restoration failure were recorded. The effectiveness of the restorations was assessed by using the Ryge criteria after performing clinical and radiographic examinations. The Statistical Package for Social Science was used for the statistical analysis. Results: It is found that 84.6% of the 299 unsuccessful restorations examined were composite, and 15.4% were amalgam. The main reason for dental failure for both amalgam (95.6%) and composite (93.28%) restorations was secondary caries. Failure of amalgam restoration was largely caused by poor marginal adaptation. With varied incidences between amalgam and composite restorations, typical complaints included discomfort, sensitivity, pain, and food impaction with soreness. The main justification for replacement in amalgam restorations was sensitivity. Repair and replacement rates were similar for amalgam, composite, and mandibular/maxillary restorations. Moreover, 21.1% of individuals overall reported no symptoms, with 8.7% in the amalgam group and 23.3% in the composite group with significant differences (χ2 = 34.28, P = 0.001). Conclusion: According to the current study, secondary caries was found to be the main reason for both amalgam and composite restoration failure. The main problems reported were sensitivity, discomfort, and pain with amalgam showing more sensitivity-related failures.

The Effect of Calcium Hydroxide, Triple Antibiotic Paste and Chlorhexidine on Pain in Teeth with Symptomatic Apical Periodontitis: A Randomised Controlled Trial.

BACKGROUND: One of the main reasons for post endodontic pain is the polymicrobial intracanal flora that may survive the initial disinfection. A single antimicrobial agent might not provide adequate disinfection, and an antimicrobial combination such as triple antibiotic paste was tested to achieve this goal. AIM: The study aimed to assess the efficacy of three intra-canal medicaments on post root canal preparation pain. MATERIALS AND METHODS: Eighty patients with single-rooted necrotic teeth and symptomatic apical periodontitis were randomly assigned to four treatment groups (n = 20). Their preoperative pain was recorded on Wong-Baker's FACES pain rating scale. After chemo-mechanical canal preparation, intracanal medications were applied to the groups (Group 1 (20% calcium hydroxide), Group 2 (2% chlorhexidine), Group 3 (tri-antibiotic paste), Group 4 (no medication (Control group)). Patients were instructed to record pain on the Wong-Baker FACES pain rating scale at 4, 48, 72 and 96 hrs, postoperatively. Pain scores were analyzed using a one-way ANOVA test and Tukey's post hoc test and, if significant, Dunn's test was used for pair-wise comparisons. The significance level was set at a p-value ≤ 0.05. RESULTS: Tukey's post hoc test revealed significantly lower pain scores in Group 3 compared with other groups at all follow up intervals. Dunnett's test showed significantly lower pain in Group 3 compared with the Control group at 48, 72 and 96 hrs, postoperatively. CONCLUSIONS: Triple-antibiotic paste showed effective pain control as an intracanal medication on necrotic teeth with symptomatic apical periodontitis.

The Relationship of Orofacial Pain and Dental Health Status and Oral Health Behaviours in Facial Burn Patients.

This study aims to examine the association of orofacial pain and oral health status and oral health behaviours in facial burn patients. The participants in this cross-sectional study were randomly recruited from the Burn Care Center, Institute of Medical Sciences, Islamabad, Pakistan. An intraoral evaluation was carried out to record the DMFT and OHI-S. A self-administered questionnaire was used to collect information on sociodemographic status, brushing frequency, and dental visits. Orofacial pain during mandibular movement was assessed using the Visual Analogue Scale (VAS). Psychological status was assessed using the Generalized Anxiety Disorder Scale and Impact of Events Scale. ANOVA and simple and multiple linear regression tests were used to analyse the data. From the 90 facial burn patients included, the majority were below 34 years of age, female, single or divorced, and unemployed. The mean DMFT was 10.7, and 71% had poor oral hygiene. 56% of the participants had moderate-to-severe anxiety, and 68% had posttraumatic stress disorder. 53% of the participants had moderate-to-severe pain during mouth opening or moving the mandible with a mean score of 41.5. Analyses showed that orofacial pain was associated with less frequent brushing, irregular dental visits, greater DMFT score, and more plaque accumulation (OHI-S). It was also associated with employment status, the severity of a burn, anxiety, and stress. The treatment and management of dental and oral conditions in burn patients need judicious balance in controlling and accurate assessment of the pain and improving psychological problems in burn patients.

Actions Speak Louder Than Words: Impact Of Kinesics On Undergraduate Medical Education.

BACKGROUND: Nonverbal communication constitutes significant proportion of human communication besides spoken words. This study explored teacher's perceptions about impact of kinesics (facial expressions, gestures, head movements and postures) on undergraduate medical education within a classroom setting. METHODS: A survey-based exploratory research was carried out from July-August 2020. Medical teachers from two private dental colleges of Islamabad were included in the sampling frame. The survey questions were validated and approved by all authors before execution. Frequencies and percentages of closed-ended questions were calculated while thematic analysis for open-ended questions was done by all authors to get consensus on themes, hence ensuring analytical triangulation. RESULTS: Forty-six teachers responded to the survey. The most frequently shown facial expressions were 'happiness and enthusiasm' (76.1%) creating friendly, conducive, and motivating learning environment. 'Smile' was considered powerful communicative signal (95.7%) whereas 'anger' was thought to be communication barrier leading to stressful and demotivating learning environment. Neutral expressions were considered helpful to maintain class decorum. 'OK sign with raised thumb' (50%) was found helpful to develop special teacher-student connection and 'head nod' (84.8%) was encouraging students to continue giving answers. Standing posture (81%) exhibited teacher's commitment towards teaching and produced active learning environment. CONCLUSIONS: Teachers should start lecture with welcoming facial expressions, i.e., smile to build rapport with students. Anger should be avoided as it demotivates students by making learning environment stressful. We need to train faculty regarding effective use of nonverbal communication strategies to improve student's learning experience and to create positive learning environment.

Traumatic injuries of the permanent maxillory incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad: a retrospective study.

BACKGROUND: The study aims to ascertain the prevalence of traumatic dental injures of the maxillary permanent incisors at Dental Department, Pakistan Institute of Medical Sciences Islamabad during the years 2003-2005. Information concerning age, sex, cause, type of tooth, number of injured teeth and patterns of tooth injury were recorded retrospectively from 336 patients aged between 8-40 years, comprising 498 traumatized teeth. METHODS: The dental records of all the patients presenting with dental trauma were examined for collection of data relating to age, sex, cause, number of injured teeth, type of tooth and type of tooth trauma. Type of tooth trauma was recorded according to the Andreason classification. The data was subsequently processed and analyzed using the SPSS statistical software programme. The statistical significance level was set at 5%. RESULTS: Of the 336 patients, 227 were males (67.6%) and 109 were females (32.4%). The gender difference was statistically significant (p < 0.0001). The patients had a total of 498 traumatized teeth. A large number of dental trauma occurred in patients aged between 9-11 years. Most injuries involved one tooth in 227 patients (67.6%). However two teeth in 90 patients (26.7%), three teeth in 11 patients (3.2%) and only in 8 patients (2.3%) four teeth were involved. Fractures in enamel only occurred in 74 teeth (14.6%). Uncomplicated crown fractures in 208 teeth (41.9%) were the most commonly encountered dental trauma. 137 teeth (27.6%) suffered complicated crown fractures, 44 teeth (8.9%) uncomplicated crown-root fractures, 19 teeth (3.8%) complicated crown-root fractures and avulsion in 16 teeth (3.2%) only. The main causes were falls in 225 patients (66.9%), collision with objects in 40 patients (11.9%), road traffic accident in31 patients (9.2%) violence in 21 patients (6.2%), and sports in 19 patients (5.6%). The maxillary central incisor was traumatized in 384 teeth showing a high percentage of 77%. CONCLUSION: Raising public dental awareness regarding the serious outcome of traumatic dental injuries is mandatory to improve the prognosis of dental trauma and to avoid complications.