i

MOH/K/GIG/27.2010(RR)

Oral Health Division Ministry of Health Malaysia

October 2010

A Compendium of Abstracts 2009 ResearchProjectsandPublicationsofOralHealthPersonnel,MinistryofHealthMalaysia

ii

iii

TABLEOFCONTENTS

COMPENDIUMOFABSTRACTS2009ForewordbythePrincipalDirectorofOralHealth xiMinistryofHealthMalaysiaEditor’sNote xiiAcknowledgement xiiiRESEARCHINPROGRAMMEEVALUATION

1 CRITICALEVALUATIONOFTHEPRESENTSTRATEGYFORORALHEALTHOF 3

PRESCHOOLCHILDRENINMALAYSIA RoslindaAS

2 EFFECTIVENESSOFORGANISEDSCHOOLDENTALSERVICEINMALAYSIA 4

JamaliahAR

3 THEEFFECTOFEXTENDINGRECALLVISITINSECONDARYSCHOOLSWITH 5

HIGHPERCENTAGEOFCARIES‐FREECHILDRENANDLOWCARIESINCREMENTINJOHORBAHRUDISTRICT–APROGRESSREPORT(PHASE1) JamaliahAR,NoridahA

4 TOINCREASETHEPERCENTAGEOFCARIES‐FREE12‐YEAR‐OLD 6

SCHOOLCHILDRENINBANDARMAHARANIDENTALCLINIC,MUAR WongPY,SalianaAA,TiuSH

5 INCREASINGTHECOVERAGEOFANTENATALMOTHERSSEENATDENTAL 7

CLINICS–THEKOTATINGGIEXPERIENCE Muz`iniM,NorhamimahA

6 EVALUATIONOFATRAININGPROGRAMMEFORHEALTHCAREWORKERS 8 ASORALHEALTHEDUCATORSINTHEDISTRICTOFHULUPERAK

BibiSaerahAK,NoorlizaMasturaI

7 THEUTILISATIONOFAUXILIARIESINTHEDELIVERYOFORALHEALTHSERVICES 9

INPERAK NoorRohanaK,MenonRPP,WardatiAM,PalaniasamyM,SyedNasirSA,LawCH,BibiSaerahAK

iv

8 ALONGITUDINALSTUDYOFTHESCHOOL‐BASEDFISSURESEALANT 10PROGRAMMEINTHEDISTRICTOFMANJUNG,PERAKSyedNasirSA,HizanMS,AriahshahD,WardatiAM,NorinaB

9 FISSURESEALANTEVALUATIONAMONGPRIMARYSCHOOLCHILDRENIN 11

KELANTAN AsmaniAR,HabesahS,AzizahM

10 COSTINGDENTALRESTORATIONSINPUBLICSECTORDENTALCLINICS 12

KhairiyahAM,IshakAR,Raja‐LatifahRJ,TanBS,NorainAT,NoorAliyahI,NatifahCS,RauziI

RESEARCHINEPIDEMIOLOGY11 THEPREVALENCEOFVICTIMSINVOLVEDINMOTORVEHICLEACCIDENTS 15

ATTENDEDTOATBATUPAHATDENTALCLINICIN2008 MaisarahZA,AzlitaN,NurulZatilAI

12 PHYCHOSOCIALIMPACTOFORO‐FACIALPAINANDDISCOMFORTAMONG 16

FORMFIVESCHOOLCHILDREN DoreyatJ

13 NATIONALORALHEALTHSURVEYOF5‐YEAR‐OLDPRESCHOOLCHILDREN2005 17

(NOHPS2005)PERAKREPORTORALHEALTHSTATUSANDTREATMENTNEEDS

BibiSaerahAK,NoorRohanaK,LawCH,RokiahM

14 ORALHEALTHSTATUSOF5‐YEAR‐OLDPRESCHOOLCHILDRENINJOHOR 18

TanEH,RamalingamSR,WanMohammadNasirWO,AbdulHamidM,KhairiyahAM

15 CARIESIN5‐YEAR‐OLDSINMALAYSIA 19

KhairiyahAM,WanMohd.NasirWO,TanBS,NatifahCS,NorainAT

16 DEVELOPMENTOFJOHORGERIATRICORALHEALTH‐RELATEDQUALITYOF 20

LIFEINDEXMuz’iniM,NoridahA,HabibahY

RESEARCHINHEALTHANDSAFETY

17 ANEVALUATIONOFTHEEFFICACYANDEFFECTIVENESSOFAPREVENTIVE 23

MAINTENANCEPROTOCOLONTHEQUALITYOFWATERFROMDENTALUNITWATERLINESANDDENTALSUCTIONSYSTEMS–APILOTSTUDYMuz’iniM,RamalingamSR

18 STERILISATIONPRACTICESINSCHOOLMOBILEDENTALTEAMS,MINISTRYOF 24

HEALTHMALAYSIA BadariahTC,TanBS,AhmadBahrainO,RohanaAK,NorizanO,AhmadTermiziZ,MohdRashidB,SararaksS

v

19 COMPLIANCETOINFECTIONCONTROLPROCEDURESINMOBILEDENTAL 25TEAMSINKUALAKANGSARDISTRICT,PERAKDARULRIDZUAN SuhailizaS,NoorRohanaK,Nur`AdilahAO

RESEARCHINBEHAVIOURALASPECTSINRELATIONTOORALHEALTH20 ASURVEYOFORALHEALTHKNOWLEDGE,PERCEPTION,UTILISATION OF 29

DENTALSERVICES,ORALHYGIENEPRACTICESANDDIETARYHABITSAMONGTHECARIESGROUPOFSCHOOLCHILDRENAGED9TO11YEARSOLDINTHEDISTRICTOFMUAR,JOHORHabibahY,WongPY,SalianaAA

21 PRESCHOOLCHILDREN`SDRINKINGANDSNACKINGPATTERNINGOVERNMENT30

KINDERGARTENS SabarinaO

22 A5‐YEARRETROSPECTIVESTUDYONNEWATTENDANCESOFANTENATAL 31

MOTHERSTOGOVERNMENTDENTALCLINICSINPONTIANDISTRICT IrnaI,RoslindaAS

23 LEVELOFAWARENESSONTHEIMPORTANCEOFPRIMARYDENTITIONAMONG 32MOTHERSWITHTODDLERSATTENDINGTHEMATERNALANDCHILDHEALTHCLINIC(MCH)INRAUBMohamadKhairulHafizanMN,NoraziahMZ,RozitaB

24 CORRELATIONOFORALHEALTHPERCEPTIONANDORALCAREPRACTICES 33

WITHCARIESEXPERIENCEAMONGSCHOOLCHILDRENINRURALAREASOFJERANTUT,PAHANGSiaJY,KalsomI,NorhafizahMH

25 LEVELOFKNOWLEDGE,ATTITUDEANDPRACTICERELATEDTOTOOTHWEAR 34

AMONG16‐YEAR‐OLDSCHOOLCHILDREN BibiSaerahAK,NoorlizaMasturaI,NaingL,AbdulRashidI

26 PERCEPTIONOFSCHOOLCHILDRENONDENTALNURSESINSARAWAK:A 35

COMPARISONBETWEENTHERESULTSOFTHE2003AND2007SURVEYS ChenCJA,LingKS,EddyA,FatimahI,HongSL

27 TOOTHWEAR:THEINFLUENCEOFDIETARYINTAKEAMONG16‐YEAR‐OLD 36

SCHOOLCHILDREN BibiSaerahAK,NoorlizaMasturaI,NaingL,AbdulRashidI

28 FLUORIDETOOTHPASTEUTILISATIONBEHAVIOURAMONGPRESCHOOL 37

CHILDRENINPERLIS,MALAYSIA TayHL,IntanSharizaZ,NasrudinJ

vi

RESEARCHINCLIENTSATISFACTION29 TODECREASETHEWAITINGLISTTIMEFORDENTURETREATMENT 41

RohanaAB,SitiZurainiM,WahidahMJ,SitiHariyanaM,JulailaS,SuzitaS,MariamA

30 TOREDUCETHEWAITINGTIMEFOROUTPATIENTCLINICATTAMANUNGKU 42

TUNAMINAHDENTALCLINIC NoraziyahAA,MarianaM,NoorHassiahK

31 AREYOUMAKINGTHERIGHTCAREERCHOICE? 43

WanMariamWAR

32 TOINCREASETHEPERCENTAGEOFPATIENTSSEENBYDENTISTWITHIN30 44

MINUTESAFTERREGISTRATIONATKOTATINGGIDENTALCLINICTO50%HalizaT,RamalingamSR,NorAzmahB

33 ASTUDYONPATIENTS`WAITINGTIMEINTHEDENTALCLINICSINTHE 45

DISTRICTOFKUALAKANGSAR,PERAK Nur`AdilahAO,NoorRohanaK,SuhailizaS

34 STUDYONPATIENTSATISFACTIONONISSUEDCOMPLETEDENTURESIN 46

TEMERLOH&BERAGOVERNMENTDENTALCLINIC MimiBaizuraZ,FarhanaMZ,AbdulRazakI,NorulAkmaA,NorhaslindaT,NorainiY

RESEARCHINORALSURGERY,ORALPATHOLOGYANDORALMEDICINE

35 APPROPRIATENESSOFREFERRALSFORSURGICALREMOVALOFIMPACTED 49

MANDIBULARTHIRDMOLARSBYDENTALOFFICERS JeyaRamanJS,KanagaratnamSS,LimYC,SuppiahP

36 AFIVE‐YEARRETROSPECTIVESTUDYOFDENTOFACIALINJURIESAMONG 50

PRESCHOOLCHILDRENINMALACCA,MALAYSIA RoyanSJ,EePS,RajahGunarajahD

37 INFECTIVEENDOCARDITISAFTERTOOTHEXTRACTION:ACASEREPORT 51

KokTC

38 MANAGINGPATIENTSONANTICOAGULANTS–TENGKUAMPUANRAHIMAH 52

HOSPITAL,KLANGEXPERIENCE NurulAdhaI,AbrahamMT

39 EMERGINGTRENDSOFEXTRAPULMONARYTUBERCULOSIS– CASESERIES 53

ThangavaluL,AbrahamMT

40 MAXILLOFACIALTRAUMAATTENGKUAMPUANRAHIMAHHOSPITAL, KLANG 54

–A4‐YEARREVIEW(2005–2008)TiuSL,AngKT,YongPY,TahGM,AbrahamMT

vii

41 INCREASINGPATIENTREGISTRATIONATTHECOUNTERREGISTRATION 55CENTRE(CRC)BEFOREATTENDINGTHEMAXILLOFACIALSPECIALISTCLINIC,SULTANISMAILHOSPITAL,JOHORBAHRUMazlinaMN,WongTC,SuhileeA,MohdFaizalR

42 AUDITOFORALSQUAMOUSCELLCARCINOMAATORALSURGERYCLINIC, 56

SULTANAHAMINAHHOSPITAL,JOHORBAHRU,JOHOR MdAradJ,MaBC

43 ARETROSPECTIVESTUDYOFMAXILLARYFRACTURESATORALSURGERY 57

CLINIC,SULTANAHAMINAHHOSPITAL,JOHORBAHRU RosniMA

44 PATTERNOFREFERRALFORMINORORALSURGERYONIMPACTEDTHIRD 58

MOLARCASESFROMDISTRICTDENTALCLINICINNORTHERNJOHORTOORALANDMAXILLOFACIALSURGERYDEPARTMENTINSULTANAHFATIMAHSPECIALISTHOSPITAL,MUAR NurlizaAR,RohanaS

45 DISLOCATIONANDIMPACTIONOFMANDIBULARCONDYLEFOLLOWING 59

MANDIBULARFRACTURESRohanaS,AkmalR

46 THEOUTCOMESOFNON‐SURGICALTREATMENTFORCONDYLARFRACTURES 60

(MANDIBULARDEVIATIONANDOCCLUSALRELATION)INSULTANAHFATIMAHSPECIALISTHOSPITAL,MUAR:ARETROSPECTIVESTUDY RohanaS,NurlizaAR

47 OSTEOGENICSARCOMASOFTHEJAWBONES:A40‐YEARREVIEWOF61CASES 61

AjuraAJ,LauSH

48 ANAUDITOF500CONSECUTIVECASESOFSURGICALREMOVALOFIMPACTED 62 LOWERTHIRDMOLARS

DionysiusDD,LimLW,RoyanSJ

49 TOOTHFRAGMENTEMBEDDEDINTHELOWERLIPAFTERDENTALTRAUMA: 63

ACASEREPORT NuriahM,RoyanSJ

50 CALCIFYINGEPITHELIALODONTOGENICTUMOURINMANDIBLE 64

NormaJ

51 AUDITON`REJECTED’SPECIMENSSENTTOSTOMATOLOGYUNIT,INSTITUTE 65

FORMEDICALRESEARCHFORYEAR2007 AjuraAJ,LauSH

viii

52 THEPATTERNOFMAXILLOFACIALFRACTURESINMINISTRYOFHEALTH 66HOSPITALSMALAYSIA WanMahadzhirM,TayKK,ChelvanayagamPI,KhairiyahAM,Md.YusoffN,AbdulRahmanR,MaBC,YuenKM,RoyanSJ,JesuVC,VincentC,RusdiAR

53 CHROMOSOMEABERRATIONTESTFORHYDROXYAPATITEINHUMAN 68

OSTEOBLASTCELLLINE ChangCS,KannanTP

54 GENEEXPRESSIONANALYSISOFOSTEOBLASTSSEEDEDINCORALSCAFFOLD 69

FooLLH,SuzinaSAH,KannanTP,AzlinaA

55 SHEDFROMPRIMARYMOLARS 70

YapWY,SitiNoorFazliahMN,SaidiJ

56 PERIOPERATIVEORALANTIBIOTICSINTHIRDMOLARSURGERY:DOTHEY 71

MAKEADIFFERENCE? RoyanSJ,KamsinahO,ZuhaibahM

57 BASEMENTMEMBRANEPROFILEOFKERATOCYSTICODONTOGENICTUMOUR 72

HartinieM

58 EXPRESSIONOFCYCLIND1ANDp27INORALSQUAMOUSCELLCARCINOMA 73

NorNazalizaB

59 THEINTERCANTHALANDINTERPUPILLARYDISTANCESOFTHREEMAJOR 74

ETHNICGROUPSINMALAYSIA SharifahTahirahAJ,NgeowWC

60 BISPHOSPHONATESANDOSTEONECROSISOFTHEJAW:AHIGHLIGHT 75 KanagaratnamSS,JeyaRamanJS

61 CRANIOFACIALANTHROPOMETRY:ACOMPARISONBETWEENMALAYAND 76

ORANGASLIKUALA RoslizaP

RESEARCHINPAEDIATRICDENTISTRY

62 ARETROSPECTIVEANALYSISOFTRAUMACASESSEENINTHEPAEDIATRIC 79

DENTALSPECIALISTCLINIC,SULTANAHAMINAHHOSPITAL MohdRidzuanMR,SockalingamG

63 ARETROSPECTIVESTUDYOFTHEINCIDENCEOFMISSEDAPPOINTMENTS 80

WITHTHEDENTALNURSEATTHEPAEDIATRICDENTALSPECIALISTCLINIC,SULTANAHAMINAHHOSPITAL,JOHORBAHRU NoormadiyaY,MohdRidzuanMR,SockalingamG

ix

64 DELAYEDERUPTIONOFUPPERPERMANENTINCISOR:ACASEREPORT 81JamilahO

65 ARETROSPECTIVECLINICO‐STATISTICALANALYSISOFLIPMUCOCELE 82

OCCURRENCEINCHILDRENBELOW16YEARSSEENATTHEPAEDIATRICDENTALSPECIALISTCLINIC,SULTANAHAMINAHHOSPITAL,JOHORBAHRU SockalingamG

66 FACIALCELLULITISOFODONTOGENICORIGININCHILDREN 83

SarimahMM,Nor`AdlinA,AhmadFaisalI

67 CLINICALREVIEWONFACIALSOFTTISSUEINJURYAMONGCHILDREN 84

ATTENDINGPAEDIATRICDENTALSPECIALISTCLINICINSULTANAHNURZAHIRAHHOSPITAL,TERENGGANU FarahNatashaM,YushainiA

RESEARCHINORTHODONTICS68 THEFREQUENCYOFSKELETALPROBLEMSAMONGORTHODONTICPATIENTS 87

ATTHEMUARORTHODONTICSPECIALISTCLINIC,JOHORNorizanA

69 THEFREQUENCYOFSKELETALPROBLEMSAMONGREFERRALPATIENTSTO 88

THEORTHODONTICSPECIALISTCLINICWanZurainiWAZ

70 ASTUDYONTHEPREVALENCEOFMALOCCLUSIONAMONGCLEFTLIPAND 89

PALATEPATIENTSATTHEORTHODONTICSPECIALISTCLINICINJOHORFarizaT

71 PROBLEMSENCOUNTEREDBYPATIENTSWEARINGTHEREMOVABLE 90

APPLIANCE MuniandyPL

72 CRANIOFACIALMORPHOLOGYOFCLASSIIDIVISION1MALOCCLUSIONIN 91

MALAYETHNICGROUPINMALAYSIA RozaimahMS

73 NORMATIVEANDPERCEIVEDNEEDFORORTHODONTICTREATMENTAMONG 92

SCHOOLCHILDRENSitiZurianaMZ,RashidahE,IshakAR

74 CEPHALOMETRICANALYSISOFUNILATERALCLEFTLIPANDPALATEPATIENTS 93

EbinL@E

75 EFFECTOFLIGHTTIPANGULATIONONTHESHEARBONDSTRENGTHOFAN 94

ORTHODONTICADHESIVE UmmuAimanY

x

76 ANINTERCEPTIVEORTHODONTICPACKAGEFORDENTALOFFICERS– 95 EVALUATINGTHEINITIATIONOFITSIMPLEMENTATION

CheFatimahA,RashidahB,NorlianD,RafeaahAK,ZainatulAkmarK,GereMJ

77 EVALUATIONOFORTHODONTICTREATMENTOUTCOME:ASELF‐AUDIT 96

USINGTHEPEERASSESSMENTRATING(PAR)INDEX LokeST78 PERCEPTIONSANDIMPLEMENTATIONOFORTHODONTICCLINICALPRACTICE 97

GUIDELINES(CPG)BYDENTALOFFICERSANDORTHODONTISTSINMALAYSIA LokeST,AngLC

RESEARCHINPERIODONTOLOGY79 PROFILEOFPATIENTSSEENINAJOINTDENTALMULTI‐DISCIPLINARYCLINIC 101

ChanYK,ZainatulAkmarK,MaBC

80 THEHEALTHSTATUSOFPATIENTSATTHEPERIODONTICSPECIALISTCLINIC, 102

JOHORBAHRURunayatiR@M,ChanYK

81 PERIODONTALSCREENINGANDPRACTICESAMONGGOVERNMENTDENTISTS 103

INMALAYSIA VaithilingamRD,RamanR,SiowYY,WanNurAzreenaWH

RESEARCHINRESTORATIVEDENTISTRY

82 ANTIMICROBIALEVALUATIONOFSODIUMHYPOCHLORITEANDOZONATED 107

WATERONE.FAECALISBIOFILM NurZianaI

83 ENDODONTICTREATMENTOFAMAXILLARYCENTRALINCISOR(11)WITH 108

ARRESTEDROOTDEVELOPMENT:ACASEREPORT WanAzmilA,RossuhaimiAR,JuannaB

84 COMPLICATIONSOFINJECTIONOFSODIUMHYPOCHLORITEBEYONDTHE 109

ROOTAPEX MaBC,ChanYK

85 THEEFFECTOFDENTUREADHESIVEONFOODOCCLUSION 110

MarlyndaA,DayangFadzlinaAI,NurhafizahH,NatasyaAT,KamarulHishamK

86 MASTICATORYEFFICACYANDBITEFORCEINCOMPLETEDENTURES:ASTUDY 111

OFDENTUREADHESIVE NatasyaAT,MuhdTermiziB,MuhdDellTaufikM,MarlyndaA,KamarulHishamK

87 MANDIBULARALVEOLARBONERESORPTIONINSELECTEDCOMPLETE 112

DENTUREPATIENTS SabarinaB

xi

FOREWORDBYTHEPRINCIPALDIRECTOROFORALHEALTHMINISTRYOFHEALTHMALAYSIAItgivesmegreatpleasuretowritetheforewordforthis12thpublicationofCompendiumofAbstracts.AshasbeenthepracticeofthisDivision,oralhealthpersonneloftheMinistryofHealthwhoconductresearchareacknowledged inthis annualpublication. It isourhopeandaspirationtobuildastrongresearch‐orientedcultureamongouroralhealthpersonnel.Thus, I would like to urge all top level management in the states to give their fullestsupport and commitment to realise this aspiration. State anddistrictmanagersmust setthepacebylayingthefoundationforresearchtoflourishandcreatesuitableenvironmentandopportunitiestoenableprogressivedevelopmentinresearch.This compilation showcases 87 works of research abstracts with 6 being dissertations,32presented at scientific conferences and 23exhibited asposters. Thismakesa total of55presentationsatbothlocalandinternational levels.Howeveronly6werepublishedinjournals and I would like to challenge and exhort all researchers to work towardspublication of their articles. It is indeed heartening to note that 13 articles had theinvolvementofdentalauxiliariesasresearchmembers.Itismyhopethatstateanddistrictoralhealthmanagementwillcontinuetogivesupporttosuchefforts.I wish to extend my warm and sincere appreciation to all officers whose works arefeatured in this Compendium and last but not least, to all others who have contributedenormouslytoputtogetherthisCompendium. Icongratulateallofyouforprovidingthisvaluablereferencebookforboththeoralhealthandresearchcommunity.

DATO’DR.NORAINBINTIABUTALIBPrincipalDirectorOralHealthDivisionMinistryofHealthMalaysia

xii

EDITOR’SNOTEThisCompendiumofAbstracts2009isacompilationofresearchabstractsthatwerereportedto the Oral Health Division, Ministry of Health in year 2009. These were research outputsgatheredfromhealthsystems researchprojects,oralandposterpresentationsatboth localand international scientific meetings, dissertations, submissions to the Director‐General ofHealth,MinistryofHealthMalaysia forapproval forpublication, scientificpaperspublishedandotherresearchworksoforalhealthpersonnel.TheOralHealthDivisionreservestherightanddiscretiontoeditandmodifytheseabstractsforgrammar,lengthandclarityandtostandardiseformatsincompliancetotherequirementsofthispublication.In general, the usual convention of abbreviating names of authors shall be used with thesurnameinfull,followedbyinitialsofthefirstandmiddlenameswhereasMuslimnamesareabbreviatedwiththefirstnameinfullfollowedbyinitialsoffather’sname.Researchofpublichealth interest conductedbySpecialists is includedunder the respectiveclinicalspecialtyresearchcategories.TheDivisionregretstheexclusionofanyresearchworkorpresentationthatwasnotreportedtothisDivisionin2009.TheEditorCompendiumofAbstracts2009OralHealthDivisionMinistryofHealthMalaysiaOctober2010

xiii

ACKNOWLEDGEMENT

TheOralHealthDivisionacknowledgesthefollowinginthepreparationofthisdocument:

• Dr.ChengLaiChooforcompilingandeditingtheabstractsandotherportionsofthe

document

• Dr.YawSiewLianandDr.Khairiyahbt.Abd.Muttalibfor theirvaluableadviceandidentifyingabstractsforinclusion

• Dr.ChewYokeYuenforproof‐readingthedocument

• MsKungSiewGaik,MsHaziahbt.HassanandMsRoslidabt.Zinforpreparationofall

graphicsandforprocessesinvolvedinthepublication

• Ms Zatun Nakia bt. Mahmud for secretarial assistance in preparation of thisdocument

xiv

1

RESEARCHIN

PROGRAMMEEVALUATION

2

3

CRITICAL EVALUATION OF THE PRESENT STRATEGY FOR ORAL HEALTH OF PRESCHOOLCHILDRENINMALAYSIARoslindaASIntroduction: Dental caries remains a significant public health problem amongst preschoolchildren inMalaysia. Although there has been some improvement in oral health status, asignificant number of preschool children still suffer from dental caries. This is despite thepresence of fluoridated water supply and a well planned dental care system in Malaysia.Objective:Theaimofthisstudywastoreviewthecurrentoralhealthstrategiesforpreschoolchildren in Malaysia and to make recommendations to improve them. Methodology: Acomprehensive review of the treatment and preventive programmes in Malaysia wasundertaken.Acriticalreviewofevidence‐basedtreatmentandpreventiveactivitiesrevealedlimitationsofthecurrentpreschoolprogrammeinMalaysia.SystematicreviewfromMedline&Pubmedwasdone.Results:Even thoughMalaysiahas itsownpreventiveand treatmentprogrammes,dental caries inourpreschool children is still adebatable issue. This ismostprobably because the programme is not adopted fully especially in remote and non‐fluoridated areas. Conclusion: Future action to promote oral health needs by adoptingevidence‐based public health approach, for example, the implementation of healthy schoolprogrammetothepreschool setting,wouldhaveasignificant impacttoachievesustainableimprovementinoralhealth.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.RoslindaAbdulSamadPontianDentalClinicJohor

4

EFFECTIVENESSOFORGANISEDSCHOOLDENTALSERVICEINMALAYSIAJamaliahARObjectives: The aim of this study is to evaluate the effectiveness of organised dental careprogrammeforschoolchildreninthedistrictofJohorBahru. Theobjectivesare1.Toassesstrends in dental caries increments for three consecutive years (2002, 2003, 2004) in thedistrictof JohorBahru. 2. To suggestwaysof improvingthe implementationofdental careandpreventiveprogrammes.Methodology:Data collectedroutinelyduringtheexaminationof schoolchildren in the school dental service were used to analyse trends in dental cariesincrementsofschoolchildrenin47selectedschools.TheschoolswererankedaccordingtoitslevelofDMFXat13years,withthe lowestDMFXscore rankedasnumber47.Basedontheincrements,suggestionsforimprovingtheimplementationoftheschooldentalserviceweremade.Results: The levelsofmeanDMFXand caries incrementswere low inall 47 schools.Morethan50%ofschoolchildreninthe47schoolswerecaries‐free.Cariesincrementsfollowtrend lines. In Johor Bahru, bending of the trend line did not occur which showed lack ofpreventive and oral health promotion programmes. Conclusion: Based on the results andconstraintsofresourcesinJohorBahru,thepolicyofannualexaminationofallschoolchildrenin Johor Bahru needs to be re‐examined. Consideration should be given to fissure sealantprogrammesinschoolswithhighDMFX.Theconceptofhealth‐promotingschoolsshouldbeexplored.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.JamaliahAbdulRahmanKotaTinggiDentalClinicJohor

5

THEEFFECTOFEXTENDINGRECALLVISITINSECONDARYSCHOOLSWITHHIGHPERCENTAGEOF CARIES‐FREE CHILDRENAND LOWCARIES INCREMENT IN JOHOR BAHRUDISTRICT – APROGRESSREPORT(PHASE1)JamaliahAR,NoridahAIntroduction:With the high percentage of schoolchildren being caries‐free in Johor Bahru,much time is actually spenton screening in theSchool Programme.Due to thehigh schoolpopulation,appropriate strategies shouldbe identified so that timeand resources couldberedirected to those with higher disease level. Longer examination intervals could saveresources. Objectives: To assess the effect of extending recall interval between dentalexaminations in selected secondary schools in Johor Bahru district and to recommend anextended recallof18‐24monthsbasedon caries incrementand trend.Methodology:Datafrom 2007 were used to select 6 schoolswith high percentage of caries‐free children, lowmean DMFX and low caries increment. The schoolchildren in these schools were notexamined in 2008. Another 6 schools with almost similar caries status were selected ascontrols. These children were examined in 2008. In 2009, all schoolchildren will be givenannualexaminationasusual.Datafrom2007and2009wereanalysedandcompared.Results:ThemeanDMFXin2007inthe6schoolsrangedfrom0.44to0.67,whilstin2009themeanDMFXwasfrom0.34to0.86.Caries incrementforthe13,14and15‐year‐olds in2007whoturned 15, 16 and 17 years respectively in 2009, were low, that is ‐0.03 to 0.23. The % ofchildrenwithNo Treatment Required (NTR) were also high in 2009 in these schools; from79.8%to92.5%.Conclusion:Withthe lowcaries incrementandhigh%ofNTRchildren,theextended recalldental examination canbe considered for implementation in these schools.FurtheranalysiswillbedoneincludingthoseofthecontrolgroupinPhase2ofthestudy.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.JamaliahAbdulRahmanKotaTinggiDentalClinicJohorDr.NoridahDato’AdnanAbdSamadRoadDentalClinicJohorBahruJohor

6

TO INCREASE THE PERCENTAGE OF CARIES‐FREE 12‐YEAR‐OLD SCHOOLCHILDREN INBANDARMAHARANIDENTALCLINIC,MUARWongPY,SalianaAA,TiuSHRecords of incremental dental care programme show that only 57.1% (2002) and 58.9%(2003)of12‐year‐old schoolchildren inBandarMaharani DentalClinicwere caries‐free.Thelow percentage of caries‐free 12‐year‐old schoolchildren leads to increased work load fordental personnel and reflects inadequate caries prevention provided by our dental service.Dental caries among schoolchildren is preventable by increasing their awareness andknowledgeondentalhealthaswellasreinforcementofpreventivemeasureswithemphasisonhigh caries risk individualsand schools.Aprospective studywas conducted. Informationwas gathered from Health Management Information System (HMIS) records. The level ofknowledge and practice regarding oral healthcare and dietary habits among primaryschoolchildren who were of moderate to high caries risk (DMFX=2 and above) were alsoevaluated using questionnaires. Analysis of the questionnaires concluded that the majorcontributing factors for high caries levels among the respondents are low socioeconomicbackground, inadequate knowledge and low awareness on oral healthcare among therespondents and their caregivers. The short‐term strategy to change includes improvingpreventive measures through dental health education to students from schools with highcariesprevalence, increasingthenumberof fissure sealantsappliedandconductingtrainingoncaries calibration fornewdentalofficersandnurses. The long‐termstrategy focusesontoddlersandpreschool childrenby increasing toddler coverageand thenumberof visits tokindergartens,aswellasincreasingtheattendanceofantenatalmotherstodentalclinic.Thepercentageofcaries‐free12‐year‐oldschoolchildrenincreasedfrom58.9%in2003to74.8%in2008. This performance level met the standards of the District Specific Approach forMuar(70%)andOralHealthGoal2010(60%).Futureactionliesincontinuingthecurrentpreventiveprogrammes to maintain the caries‐free status with closemonitoring yearly. Toddlers andpreschoolchildrenwillbethenexttargetgroupstoensurelong‐termsuccess.Keywords:caries‐free,schoolchildren,preventivemeasures,toddlerPoster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital, JohorBahruandat6thNationalHealthConference on28–30September2009atUniversiti SainsMalaysia,KubangKerian,Kelantan

Dr.WongPikYongDr.SalianaA.AzizDr.TiuSzuHuiAllofBandarMaharaniDentalClinicMuarJohor

7

INCREASING THE COVERAGE OF ANTENATAL MOTHERS SEEN AT DENTAL CLINICS – THEKOTATINGGIEXPERIENCEMuz’iniM,NorhamimahAIntroduction:Oralhealth interventionprogrammebeginswithantenatalmotherstoensurethattheywillimpartknowledgeandbehaviourpracticestotheirchildren.Reducingtheriskofdeveloping tooth decay at an early age will ultimately contribute to healthy caries‐freeschoolchildren. This programme complements the programme in the maternal and childhealth clinics.Objective: To increase the proportion of antenatalmothers attending dentalclinics for oral health education and screening to meet the standard set in the QualityAssurance Programme (Johor State Indicator).Methodology: A cross‐sectional study wasdoneonattendancesofantenatalmothers intendentalclinics inKotaTinggidistrict intheyear 2007. Both oral healthcare andmaternal healthcare personnel reviewed processes inreferralofantenatalmotherstodentalclinics.Results:Afterremedialmeasures,coverageofantenatalmothers seenatdental clinics inKotaTinggidistrict increasedfrom20.8% inyear2005to75.4%inyear2007.Conclusion:Properplanningofvisitstoclinicswithoutpermanentdentalofficersandaproperappointment systemcontribute to the increase in coverageofantenatalmothersseeninalldentalclinicsinKotaTinggidistrict.Keywords:antenatalmothers,appointmentsystem,properplanningProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.Muz’iniMohammadDr.NorhamimahAbdullahBothofKotaTinggiDentalClinicJohor

8

EVALUATIONOFATRAININGPROGRAMMEFORHEALTHCAREWORKERSASORALHEALTHEDUCATORSINTHEDISTRICTOFHULUPERAKBibiSaerahAK,NoorlizaMasturaIThe objectives of this study were to determine and compare the level of oral healthknowledgeamongHealthcareWorkers(HCW)intheDistrictofHuluPerakandKualaKangsarandtoevaluatetheeffectivenessoftheinterventionprogrammesintermsofincreasingoralhealth knowledge amongHCWs in theDistrict of Hulu Perak. This is an intervention studywhich involved42 randomly selectedparticipants fromHuluPerakasa studygroupand49participants from Kuala Kangsar as control group. Self‐administered questionnaires weregiventobothgroupstocapturethegeneralinformationregardingprofileofparticipantsandoral health‐related knowledge. A one‐day oral heath seminar was conducted for the studygroupwhichincluded lecturesandanexhibition.Approximatelythreeweekslater,thesamequestionnairewasdistributedtobothstudyandcontrolgroups.DatawasanalysedusingSPSSversion15.RepeatedMeasureAnovawasperformedtomeasurethetime*groupeffect.Themeanscore(SD)oforalhealthknowledgewas51.0(SD=6.56)and44.3(SD=5.30)forHCWsinKuala Kangsar and Hulu Perak respectively and the score was significantly different(independent t‐test,p<0.001). Therewas significant improvement inoralhealthknowledgeamongHCWs inHulu Perakafter the seminar (p<0.001) compared to controls. Therefore itcan be concluded that the intervention programmewas effective in influencing oral healthknowledgeamongtheHCWs.Keywords:healthcareworkers,intervention,oralhealthknowledgePaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.BibiSaerahAbd.KarimTaipingDentalClinicPerakDr.NoorlizaMasturaIsmailUniversitiSainsMalaysiaKubangKerianKelantan

9

THEUTILISATIONOFAUXILIARIESINTHEDELIVERYOFORALHEALTHSERVICESINPERAKNoorRohanaK,MenonRPP,WardatiAM,PalaniasamyM,SyedNasirSA,LawCH,BibiSaerahAK

Thechangingdiseasepatterns in the last fewdecadeshave resulted in theneed to reviewdentalservicedelivery,includingdecisionsontheappropriateutilisationofdentalpersonnelintheworkforce,andthetypeofskillmixrequiredinthedentalteam.Theaimofthisprojectis to study the possibility of empowering personnel to assume more responsibilities andownershipofworkprocessesbyextendingandexpandingtheirrolesandresponsibilities.Thiswasacross‐sectionalqualitativestudyusingtheNominalGroupTechnique(NGT)conductedinthedistrictsofLarutMatang,SelamaandKualaKangsar.Thecategoriesofdentalauxiliariesselected were dental nurses, dental technologists, dental surgery assistants and dentalattendants.Itwasfoundthatthemostacceptedextendedandexpandedroleofdentalnurseswas being tutor to other dental personnel. However, an increase in age limits forschoolchildrentreatableandprovidingtreatmentstoadultswerepoorlyaccepted.Asforthedentaltechnologists, trimming issueddenturesas requestedbypatientsandtakingprimaryimpressionswerebeingpractisedbythiscategoryofauxiliary.Castingdentures,doingsimpledentureworkandgivingdentalhealth education talks to schoolchildren,antenatalmothersand adults were the extended and expanded roles highly accepted by the dental surgeryassistants(DSA).Finally,thehighestlevelofacceptanceofextendedandexpandedrolesforthedental attendantswere conducting toothbrushdrills andgivingdentalhealtheducationtalks to children. Changes in the global disease pattern which is also observed inMalaysiarequire a change in strategy in the delivery of dental services. A team approach should beadopted with the dentist taking the role of team leader andmaintaining responsibility foroveralltreatmentplanningandqualityassurance.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.NoorRohanaKamaruddinDr.RaghunandananPPMenonDr.WardatiAbdulMalekDr.MalligaPalaniasamyDr.SyedNasirSyedAlwiDr.LawChaiHoonDr.BibiSaerahAbd.KarimAllofOralHealthDivisionPerak

10

A LONGITUDINAL STUDY OF THE SCHOOL‐BASED FISSURE SEALANT PROGRAMME IN THEDISTRICTOFMANJUNG,PERAKSyedNasirSA,HizanMS,AriahshahD,WardatiAM,NorinaB This is a prospective 5‐year longitudinal study using simple random sampling technique. Itinvolved a cohort group of 8‐year‐old schoolchildren, rendered fissure sealants in the year2003bydentalnurses.MaterialsusedwereGlass IonomerCement (GIC)and resin sealants.Theaim is toevaluate the school‐based integrated fissure sealantprogramme, looking intotheretentionrateofthesealantsintermsofupperandlowermolarsandmaterialsused,andalso to look into the caries outcome of the teeth. The sealantswere reviewed yearly from2004 to2007. Fourhundredandonechildrenwitha totalof620 fissure‐sealed teethwereinvolved inthestudy.Atotalof268teethweresealedwithGICwhile352weresealedwithresin‐basedfissuresealants.Resultsfromthestudydemonstratedthatretentionrateofresin‐basedsealantsisbetterthanGICsealants,whereby,attheendofthe5‐yearstudy,55.4%ofresin sealants were found to remain completely intact while for GIC only 3.8% remainedintact. About 18% and 11% respectively of the GIC‐sealed and resin‐sealed teeth becamecariousat the endof the study.Of the cariousor restoredmolars,morewere found in thelowermolarsthanintheuppermolars,14.3%and11.4%respectively.Cariesriskassessmentis an important component in case selection and in clinical decision‐making. As the resinsealants aremore durable they are generally preferred, whileGIC should be used in caseswheremoisturecontrolisdifficult,e.g. ineruptingornewly‐eruptedteeth,especiallyamonghigh caries risk individuals and in settings where control of moisture is difficult. This isparticularlyso,inthemobileschool‐basedsetting.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.SyedNasirSyedAlwiHizanMohdSaidDr.AriahshahDahDr.WardatiAbd.MalekDr.NorinaBadaruddinAllofOralHealthDivisionPerak

11

FISSURESEALANTEVALUATIONAMONGPRIMARYSCHOOLCHILDRENINKELANTANAsmaniAR,HabesahS,AzizahMIntroduction:Dentalcariesisachronicdiseasewhichposessignificantpublichealthproblemsall over the world. The use of fissure sealants is a cost‐effective tool for occlusal cariesprevention.Objective:Thisstudyexploredfissuresealantretentionandtheassociatedfactorsofsealantfailureamongschoolchildren inKelantan.Methodology:A longitudinalstudywasconducted involving420StandardTwoschoolchildren inKelantan.The schoolchildrenwererendered initialapplicationof fissure sealant intheyear2003andwere reviewedyearlytilltheyear2007.Datapertainingtosocio‐demographiccharacteristics,facilities,materialsusedand fissure sealant status were captured usingAppendix 2: Format for oral examinationofEvaluationof theSchool‐based IntegratedFissureSealant Programme:A longitudinal study.DatawasenteredandanalysedusingSPSSversion12.Descriptivestatisticswerepresentedbyfrequencyandpercentagewhileassociatedfactorsoffissuresealantfailureweredeterminedusing chi‐square test.Results: Of420 schoolchildren,310 (74%)were followedup till 2007.Twohundredandeightschoolchildren (67.1%)werefromKotaBharuand102 (32.9%)fromPasirMas.Themajoritywerefemales (55.2%)andMalays (281,90.6%).Mostofthemwererenderedtreatmentbymobileteam (229,73.6%).Ofthe310students,480firstpermanentmolarteethwere sealed.Themajoritywere lowerfirstpermanentmolars (440,91.7%)andmostwere sealedwithGIC (292,60.8%). The sealant retention ratedecreaseddramaticallyfrom36.4%inthe secondyeartoonly2.9%inthe5thyear.Sealantfailurewas significantlyhigher in treatment renderedbymobile team (148,41.9%) compared to thosedone in thedental clinic (18.9%; p <0.001). The failure rate with GIC was also higher (126, 43.2%)compared to resin (24.5%; p<0.001). Conclusion: Fissure sealant retention among cohortschoolchildren inKelantanwas low.Thiswasassociatedwithtypeof facilitiesandmaterialsused.Keywords:fissuresealantretention,cariespreventionPaperpresentedat6thNationalHealthConferenceon28–30September2009atUniversitiSainsMalaysia,KubangKerian,Kelantan

Dr.AsmaniAbdRazakPasirPutehDentalClinicKelantanDr.HabesahSulaimanKelantanStateHealthDepartmentKelantanDr.AzizahMatTumpatDentalClinicKelantan

12

COSTINGDENTALRESTORATIONSINPUBLICSECTORDENTALCLINICS

KhairiyahAM,IshakAR,RajaLatifahRJ,TanBS,NorainAT,NoorAliyahI,NatifahCS,RauziI

Theobjectiveofthisstudyistosharecost‐analysismethodologyandtoobtaincostestimatesforposteriorrestorationsinpublicsectordentalclinics.Twourbanand2ruraldentalclinicsinSelangorstatewereselected.Onlycasesof1posteriorrestorationpervisitbydentalofficersover a 6‐month period were included. One capsulated amalgam type, 1 capsulated tooth‐colored,and1non‐capsulatedtooth‐coloredmaterialwereselected.Aclinicalpathwayform

was formulated to collect data for each patient. Annual capital andrecurrent expenditureswere collectedforeveryclinic.ThemeancostofanamalgamrestorationwasRM30.96 (SDRM7.86);andthatfortooth‐coloredrestorationsrangedfromRM33.00(SDRM8.43)toRM41.10(SDRM10.61).[Wherein1USD=RM2.8].Restorationcostswere35%to55%higherinclinicsinruralareascomparedtourbanareas.Thefindingsdemonstrateeconomyofscaleforclinic operation and restoration costs with higher patient load. Costs per restorationwerehigher in rural than in urban dental clinics.More studiesare recommended to address thedearthofdentalcostsdatainMalaysia.

Keywords:costs,dentalrestorations,publicsector,Malaysia

Publication: Asia-Pacific Journal of Public Health. 2009, Vol. 21, No. 2, 184-195

Dr.KhairiyahAbdulMuttalibDr.TanBeeSiewDato’Dr.NorainAbuTalibDr.NatifahCheSallehAllofOralHealthDivisionMinistryofHealthMalaysiaF.T.PutrajayaDato’Dr.IshakAbdulRazakDr.RajaLatifahRajaJallaludinBothofDepartmentofCommunityDentistryFacultyofDentistryUniversityofMalayaKualaLumpurDr.NoorAliyahIsmailDr.RauziIsmailBothofOralHealthDivisionSelangor

13

RESEARCHIN

EPIDEMIOLOGY

14

15

THEPREVALENCEOFVICTIMSINVOLVEDINMOTORVEHICLEACCIDENTSATTENDEDTOATBATUPAHATDENTALCLINICIN2008MaisarahZA,AzlitaN,NurulZatilAIObjectives:Thisretrospectivestudyaimstodocumenttheprevalenceofvictims involved inmotorvehicleaccidents (MVA)andpatternofmaxillofacial injuries sustained; todeterminedemographicand injurycharacteristics;aswellasthe immediatetreatmentprovidedtothevictims.Methodology:Patient records from January2008 toDecember2008were selectedand reviewed. Data associated with demographics, aetiology of injury, types of injurieswhether soft tissue or hard tissue and treatment modalities were collected. DescriptiveanalysiswasdoneusingMicrosoftExcelWindowsversion2007.Results:Atotalof139MVAvictims were reviewed by dental officers in Batu Pahat Dental Clinic during the one‐yearperiod.MostofthepatientsseenwereMalaymales(105,76%)whosustainedmoreinjuriescomparedtowomen(34,24%)withratioof3.1:1.Theoccurrenceofinjurieswasmostlyseenamongtheagegroupof11‐20years(49,35%).Thehighestnumber(17,12.3%)ofMVAcaseswere reported in the month of August, occurring mostly on weekdays (106, 76%) andinvolvingmotorbikes (85,49%).Softtissue injuries(131,94.2%)arethemostcommon.Themandiblewasthemostcommonbonetofracture(86,61.9%)withtheparasymphysisbeingthe most common site. Toilet and suturing (50, 30%) of the wound was the commonestimmediatetreatmentprovidedtothevictims.Conclusion:MVAarethemostcommoncauseformaxillofacial injury.Theseresults indicatethehigh incidenceofdentalandfacialtrauma,and suggest the importance of adopting appropriate prevention protocols and effectivetherapeuticmethods.PaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.MaisarahZainalAbidinDr.AzlitaNasranDr.NurulZatilAmaliIbrahimAllofBatuPahatDentalClinicJohor

16

PSYCHOSOCIAL IMPACT OF ORO‐FACIAL PAIN AND DISCOMFORT AMONG FORM FIVESCHOOLCHILDRENDoreyatJObjectives:Theobjectivesofthissurveyaretocomparetheprevalenceoforo‐facialpain inrelationtootherbodilypain,todeterminethetype,severityandcausesoforo‐facialpainanddiscomfortandalsotodeterminethepsychosocial impactoforo‐facialpainanddiscomfort.Methodology: This is a cross‐sectional study where 4 secondary schools were selected bysimple random sampling. All the form five schoolchildren from the selected schools wereinvolved in this study. Subjective data on oro‐facial pain were collected through a self‐administeredquestionnaire.Results:About42%ofsubjectsreportedsufferingfromoro‐facialpain in the previous 4 weeks. Oro‐facial pain was the third most common pain conditionaffectingschoolchildrenafterheadache(46.3%)andstomachache(44.4%).Theprevalenceofreportedoro‐facialpainand/discomfortinthepast4weekswasabout66.1%.Thethreemostcommonself‐reportedoro‐facialpainwas sensitivity tohot/cold (34.9%),ulcer (30.1%)andpain in the jaw while chewing (13.8%). However themajority felt that it was only of mild(65%)ormoderateintensity(29.2%).Hence,themajority(67.9%)didnotdoanythingaboutit.Ofthosewhohadpainanddiscomfortoverthepast4weeks,themost common impactreportedwerefeltworried(31.7%),felttension(21.9%),andinterruptedsleep(21.3%).Intheoverall sample,1 in10students saidthattheir concentration instudieswasaffectedbytheoro‐facialpainanddiscomfort.Conclusion:Itisconcludedthatoro‐facialpainanddiscomforthas a significant psychosocial impact. Emphasising the impact of oro‐facial pain anddiscomfortwillcreategreateroralhealthawarenessandthepublic’sperceptionofthevalueoforalhealth.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.DoreyatJemunDentalClinicKluangHospitalJohor

17

NATIONAL ORAL HEALTH SURVEY OF 5‐YEAR‐OLD PRESCHOOL CHILDREN 2005 (NOHPS2005)PERAKREPORTORALHEALTHSTATUSANDTREATMENTNEEDSBibiSaerahAK,NoorRohanaK,LawCH,RokiahMThis cross‐sectional survey data was extracted from the National Oral Health Survey ofPreschoolChildrenin2005.Itinvolved1,355randomlyselected5‐year‐oldpreschoolchildrenfromvariouscategoriesofkindergartensinPerak.Theaimwastodeterminetheiroralhealthstatusand treatmentneeds.The cariesprevalencewas66.1%,beingalmost similar inboththe boys (67%) and the girls (65%). The percentage of children with caries‐free mouth(dmft=0, DMFT=0) was 33.9%. The highest proportion of treatment need for two‐surfacerestorations was on upper and lower deciduous molars. The highest treatment need forupper centraldeciduous incisorswasextraction.Asymptomatic cariousposteriorteethwereretained as ‘space maintainers’. Only 0.91% of 1,423 erupted permanent teeth requiredrestoration.Theprevalenceandseverityofdentalcarieswasstillhighamong5‐years‐oldsinPerak. It is therefore recommended that priority should be given to restore all cariousdeciduousmolarstoreducetheirearlyloss.Painlesspreventivedentalproceduressuchastheapplicationoffluoridevarnishshouldbere‐emphasisedfor5‐year‐olds.Keywords:oralhealthstatus,treatmentneeds,5‐year‐oldpreschoolProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.BibiSaerahAbd.KarimDr.LawChaiHoonBothofTaipingDentalClinicPerakDr.NoorRohanaKamaruddinKualaKangsarDentalClinicPerakDr.RokiahMamikuttyBatuGajahDentalClinicPerak

18

ORALHEALTHSTATUSOF5‐YEAR‐OLDPRESCHOOLCHILDRENINJOHORTanEH,RamalingamSR,WanMohammadNasirWO,AbdulHamidM,KhairiyahAMObjective: This report describes the oral health status and treatment need of 5‐year‐oldchildreninJohorintheyear2005.Itwasgeneratedfromasub‐setofdatafromtheNationalOralHealthSurveyofPreschoolChildren(NOHPS)2005.Methodology:Across‐sectionalandmultiple‐stage stratified random sampling method was used. Clinical examinations wereperformedbytwotrainedandcalibratedexaminersaccordingtotheWHObasicmethodsfordental caries and treatment needs assessment. BASCD criteria were used to assess oralhygienestatus.Results:Ofthe1,929childrenexamined,61.0%wereaffectedbydentalcariesbutdistributionofdentalcariesexperiencewashighlyskewed.Meancariesexperiencewas3.46 dmft (decayed, missing and filled teeth), with decayed teeth (3.27) being the highestcomponent.Meandecayedpermanentteethwas0.01withnofilledandmissingpermanentteeth.About72.1%ofchildrenwerefoundtohavecleanteeth,25.9%had littleplaqueand2.2% had substantial plaque. As for treatment needs in deciduous dentition, 783 (40.6%)subjects needed some type of treatment, 753 (39%) needed restorations and 90 (4.7%)needed dental extraction. For permanent dentition, 447 subjects had erupted permanentdentition and of these, 10 subjects needed restorations. Significant differences in cariesprevalence(p=0.000)andcariesexperience(p=0.000)werefoundamongtheethnicgroups,withMalays recording the highest level of dental decay. Similarly, significant differences indental caries prevalence (p=0.001) and caries experience (p=0.000) were found betweenurban and rural preschool children with rural children having poorer oral health status. Nosignificantdifferences indental cariesprevalence (p=0.376)andcariesexperience(p=0.134)wereseenbetweengenders.Theincidenceofcleftlipandcleftpalatewas1:964.Conclusion:Theprevalenceofdentalcariesin5‐year‐oldpreschoolchildreninJohorwashigh(61%)withameandmftof3.46.Thedistributionofdentalcarieswashighlyskewed.Thereweresignificantdifferences incariesprevalenceandcariesseverityamongethnicgroupsandbetweenurbanand rural children. High unmet treatment needs were observed. Oral health promotiontargetedatparents/caregiversneedtobestartedasearlyaspossible.Oralhealthstrategiesneedtobereorientedtoreduceoralhealthinequalities.Publication:JohorTechnicalReport2005;59‐70

Dr.TanEeHongMuarDentalClinicJohorDr.SheilaRaniRamalingamPontianDentalClinicJohorDato’Dr.WanMohammadNasirWanOthmanDr.AbdulHamidMohamadDr.KhairiyahAbd.MuttalibAllofOralHealthDivisionMinistryofHealthMalaysiaF.T.Putrajaya

19

CARIESIN5‐YEAR‐OLDSINMALAYSIA

KhairiyahAM,WanMohd.NasirWO,TanBS,NatifahCS,NorainAT

Objective: TheMalaysianoralhealth surveyon5‐year‐olds in2005 (NOHPS2005)assessedcaries prevalence and severity for the country's oral health profile.Methodology: A cross‐sectional two‐stage systematic sampling design stratified by location was used, withprobabilityproportionatetosize.Atotalof16,192childrenwererecruited;datawasweightedforanestimated573,000population.Results:Males comprised50.9%,withthemajorityofpopulation (60.4%) in urban areas. Themajor ethnic groups wereMalays (59.8%), Chinese(20.7%), and Indian/Pakistani (5.0%). Caries prevalence was 75.7% (95% CI 74.14‐77.22).Meandmftwas5.57(95%CI5.36‐5.79),withdisparitybylocation(urban4.52;95%CI4.25‐4.79;rural6.91;95%CI6.91‐7.51)andbyethnicgroup–best inthe Indian/Pakistani group(mean dmft 1.82; 95%CI 1.52‐2.12) and worst in theMalays (6.10; 95%CI 5.89‐6.31) andIndigenousgroups(8.07;95%CI7.69‐8.44).Decayedteethwerelargelyunrestored(mean‘d'5.2;95%CI5.04‐5.45);withmean‘f'at0.21(95%CI0.16‐0.26).Themajority(61.2%)haddmft>3,with 24.8% having dmft >10. About 27% had permanent teeth (mean 3.2, range 1‐12),4.6% with DMFT>0. Conclusion: Caries control in young children continues to be a majorchallenge, and there is slight improvement from baseline 1995 data despite a preschoolpreventiveprogramme.Malaysia grappleswithappropriatepopulationapproaches for veryyoungchildren,weighingpragmaticdental care for thedentitionagainst thewiderneed toensurechildren'scontinuedlong‐termacceptanceofsuchcare.

Keywords:caries,children,5‐year‐olds

Posterpresentationatthe9thWorldCongressonPreventiveDentistry,7‐10Sept2009inPhuket,ThailandDr.KhairiyahAbd.MuttalibDr.TanBeeSiewDr.NatifahCheSallehDato’Dr.NorainAbuTalibAllofOralHealthDivisionMinistryofHealthMalaysiaF.T.Putrajaya Dato’Dr.WanMohd.NasirWanOthmanUniversitiSainsIslamMalaysiaKualaLumpur

20

DEVELOPMENTOFJOHORGERIATRICORALHEALTH‐RELATEDQUALITYOFLIFEINDEXMuz’iniM,NoridahA,HabibahYObjective:Todevelopanoralhealth‐relatedqualityoflifemeasurefortheelderlypopulationinJohorandtovalidateitonasampleofelderlysubjectsaged60andabove.Methodology:Physical, social and mental well‐being health dimensions were incorporated in aquestionnaire. The scale had 5 scoring points. Field testing was conducted among 30respondents aged 60 years and above from the Sri Kenangan Institution for the elderly inJohorBahruandelderlypatientsfromBandarTenggaraandBukitBesarhealthclinicsinKotaTinggi. Results: Principal component analysis and factor analysis were used to deriveacceptablereliabilityandagoodconstructvalidityofthescaleforeachhealthdimension.Thefinal questionnaire contained 12 items, four for each dimension. Cronbach`s alpha forphysical,mentalandsocialwell‐beingdimensionswere0.918,0.935and0.921respectively.Conclusion:Thisprojectprovidesevidenceforthereliabilityandvalidityofthemeasures intheJohorgeriatricoral‐health‐relatedqualityoflifequestionnaire.Keywords:oralhealth‐relatedqualityoflife,reliability,validityPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.Muz’iniMohammadDentalOfficerDr.NoridahDato’HajiAdnanDentalOfficerBothofAbdulSamadRoadDentalClinicJohorBahruJohorDr.HabibahYaacobDentalOficerBandarMaharaniDentalClinicJohor

21

RESEARCHIN

HEALTHANDSAFETY

22

23

ANEVALUATIONOF THEEFFICACYAND EFFECTIVENESSOFAPREVENTIVEMAINTENANCEPROTOCOL ON THE QUALITY OF WATER FROM DENTAL UNIT WATERLINES AND DENTALSUCTIONSYSTEMS–APILOTSTUDYMuz’iniM,RamalingamSRObjective:To evaluate the efficacyand effectivenessofa PreventiveMaintenanceProtocol(PMP)tocontrolbacterialbiofilmindentalunitwaterlines(DUWL)anddentalsuctionsystems(DSS). The PMP intervention aimed to reduce the number of pathogenic living organismswhichposedahealthrisktoimmune‐suppressed/compromisedpatients.Methodology:Thiswasacross‐sectionalstudywhichinvolvedthreedentalunitsattheKotaTinggiMainDentalClinic. Eight sampling sites were selected per unit. The independent water reservoirswerestored inan invertedpositionand refilledwithfreshdistilledwaterthenextmorning.Timedependentflushingwascarriedoutfordentalunitwaterlines.PeriodicdisinfectionwasdoneforDSS.Microbiological examinationwasdone todetermine thenumberof colony‐formingunits(CFU)permillimeter(ml)ofwater.Results:AllwatersamplesfromDUWLswerewithinstandards of less than 200 colony‐forming units (CFU) perml water following intervention.Samples of dental suction system showed reduction in CFU following disinfection but notwithinthestandards required.Conclusion:ThePreventiveMaintenanceProtocolwasfoundto be effective inmaintainingmicrobiological quality of water within the standards of lessthan200CFUpermlindentalunitwater.PeriodicflushingofDSSalsoreducedthenumberofCFU in the biofilm matrix. Further research is necessary to determine effectiveness ofchemicaldisinfectiontoreducebacterialcontaminationofDSStoacceptablestandards.Keywords:dentalunitwaterlines,dentalsuctionsystems,preventivemaintenanceprotocolPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.Muz’iniMohammadDr.SheilaRaniRamalingamBothofOralHealthDivisionJohorStateHealthDepartmentJohor

24

STERILISATION PRACTICES IN SCHOOL MOBILE DENTAL TEAMS, MINISTRY OF HEALTHMALAYSIABadariahTC,TanBS,AhmadBahrainO,RohanaAK,NorizanO,AhmadTermiziZ,MohdRashidB,SararaksSObjective: This paper describes the use of autoclaves and other alternative sterilisationpracticesinmobiledentalteams,MinistryofHealthMalaysia.Methodology:Aquestionnairesurveywasconductedtogather informationonavailabilityanduseofautoclaves,packagingof sterilised instruments as well as use of alternative sterilisation methods in currentfunctioningmobiledentalteams inMinistryofHealthMalaysia intheyear2007.DatawereenteredintoEpiInfoVersion10andtransferredtoSPSSVersion13foranalysis.Results:Themeannumberofautoclavespermobiledentalteamwas0.95(rangedfrom0.06to2.5)withsevenstateshavingatleastoneautoclavepermobiledentalteam.Instrumentswerepackedinto sterilisation pouches (range from 21.1% ‐ 86.8%). Alternative sterilisation used wereeitherhotwatersteriliserorchemicalsolutionsespeciallyinremoteareassuchasinSarawak(112/115mobiledentalteams).Conclusion:Provisionofadequatenumberofautoclavesformobiledentalteamsisimperativetoimprovesterilisationpractices.Keywords:sterilisation,autoclaves,mobiledentalteamsPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.BadariahTambiChek

OralHealthDivision

KelantanStateHealthDepartmentKelantanDr.TanBeeSiew

Dr.MohdRashidBaharonBothofOralHealthDivision

MinistryofHealthMalaysiaF.T.PutrajayaDr.AhmadBadrainOthman,Dr.RohanaAbuKassimBothofOralHealthDivision

PahangStateHealthDepartmentPahangDr.NorizanOthmanOralHealthDivision

MalaccaStateHealthDepartmentMalaccaDr.AhmadTermiziZamzuri

TheChildren’sDentalCentreandDentalTrainingCollegeMalaysiaPenangDr.SondhiSararaksInstituteofHealthSystemsResearchMinistryofHealthMalaysiaKualaLumpur

25

COMPLIANCETOINFECTIONCONTROLPROCEDURESINMOBILEDENTALTEAMSINKUALAKANGSARDISTRICT,PERAKDARULRIDZUANSuhailizaS,NoorRohanaK,Nur’AdilahAO

Introduction:Themouthcarriesalargenumberofpotentiallyinfectivemicro‐organisms.Itisthereforeessentialthatdentalhealthcareworkersoperatecrossinfectioncontrolproceduresto minimise the risk of infection passing from patient to patient, from patient to teammembersorviceversa.Objective:ThisstudywascarriedouttoevaluatethecompliancetoinfectioncontrolprocedureswithintheMobileDentalTeamsinKualaKangsarDistrict,Perak.Methodology: In order to evaluate the extent of compliance to the infection controlprocedures,twoseparateauditswerecarriedoutonallMobileDentalTeamsinKualaKangsarDistrict.ThereweresixMobileDentalTeamsandtheauditswerecarriedoutby“cross‐audit”betweentheteams.Theextentofcompliancetoinfectioncontrolprocedureswasbasedonthe cumulative percentage score obtained from the nine categories in PK KKP 1B form.Results: During the first audit, it was found that Team 3 showed the highest level ofcompliance (94.1%). However, the other five teams also comply highly with the infectioncontrol procedures and scored in the range of 80.2% to 84.1%. All the teams showedimprovementsinthesecondauditrangingfrom0.8%to10.9%.Team3stillscoredthehighest(94.9%)withTeam2the lowest (83.6%).Team3wasobservedtohavethehighest levelofcompliance to infection control procedures in all the nine categories. The most dramaticimprovement especially in complying with storage procedure, work practice control andenvironmental infection control was found in Teams 1 and 5. However, Team 4 showed adecline in the level of compliance to elements of occupational exposure prevention andsterilisation and disinfection of patient care items. It was found that compliance tosterilisationprocedureandworkpracticecontrolwasnotsatisfactoryduringthesecondauditin Team 6. Infection control procedures must be followed diligently during any dentalprocedureregardlessoftheplacewheretheyareconducted.Conclusion:Thisstudyshowedthatthemobiledentalteamsarecapableofmaintaininghighlevelofcompliancetoinfectioncontrolprocedureseventhoughnot inan ideal clinicset‐up. Inthiseraofglobalisationandthe emergence of more virulent strains of organisms, it is imperative for every dentalpersonnel topractice standardprecautionsand effective infectioncontrolproceduresatalltimes. Auditing is a quality measure tomonitor compliance, identify weakness and ensurecontinuous improvement to infection control procedures. This would ensure that clientsreceivequalityoralhealthcareinasafeenvironmentforprovidersandclientsalike. ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.SuhailizaSaharudinDr.NoorRohanaKamaruddinDr.Nur’AdilahAhmadOthmanAllofOralHealthDivisionPerak

26

27

RESEARCHIN

BEHAVIOURALASPECTSINRELATION

TOORALHEALTH

28

29

ASURVEYOFORALHEALTHKNOWLEDGE,PERCEPTION,UTILISATIONOFDENTALSERVICES,ORALHYGIENEPRACTICESANDDIETARYHABITSAMONGTHECARIESGROUPOFSCHOOLCHILDRENAGED9TO11YEARSOLDINTHEDISTRICTOFMUAR,JOHORHabibahY,WongPY,SalianaAAObjectives: To assess the oral health knowledge, oral hygiene practices and dietary habitsamong 9 to 11‐year‐old schoolchildren in relation to their caries experience (DMFT), todeterminetheirperceptionandutilisationofdentalservicesandalsotoidentifythefoodsoldintheschool canteens.Methodology:Thiswasa cross‐sectionalstudy, involving400 schoolchildrenaged9to11yearsold,selectedrandomlyfromthecariesgroup.Datawascollectedusingastructuredquestionnaireandcariesexperience(DMFT)wasreviewedbasedontheirdentaltreatmentrecords.Results:Onlyonethird(34.5%)oftheselectedstudentshadahighleveloforalhealthknowledgeeven though97%of them admitted that they receiveyearlydentalexaminationandeducationfromthedentalpersonnel.About57%ofthemwereafraidof dental treatment and seek dental care only when pain occurred. Themajority of theseschoolchildren(86%)brushedtheirteethtwiceormoreperday,usingfluoridatedtoothpaste.More than 50% of the participants brought their food and drinks from home, the mostfrequentbeingfriedrice,bread,Miloandsyrup.Ahighproportionofparticipantshadsnacksbetween meals and the types of snacks taken were bread (75%), cakes (57.8%), biscuits(53.5%),chocolates(34%)andcarbonateddrinks(31.5%).Themostcommonfoodsoldinthecanteen was burgers and nuggets. Conclusion: This survey revealed that a thoroughassessment of schoolchildren`s snacking habits and their perception towards oral healthservicesincludingexaminationandoralhealtheducationarerequired.Keywords:oralhealthknowledge,dentalfear,oralhygienepracticesPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.HabibahYaacobDr.WongPikYongDr.SalianaA.AzizAllofBandarMaharaniDentalClinicBandarMaharaniPolyclinicMuarJohor

30

PRESCHOOL CHILDREN’S DRINKING AND SNACKING PATTERN IN GOVERNMENTKINDERGARTENSSabarinaOObjectives: The objectives of this study are to assess the baseline patterns of drinks andsnacksconsumptionamongstpreschoolchildreningovernmentkindergartensinJohorBahruDistrict, Johor, Malaysia by developing a questionnaire to assess the drinks and snacksconsumption and also to review the existing policy or guideline implementation of healthyeatinginkindergartens.Methodology:Itwasacross‐sectionalstudyinvolving52governmentkindergartens in Johor Bahru. A self‐administered questionnaire was used in this study.Results: This study showed that 94% of the kindergartens involved provided Milo drinksfollowedbypowderedmilk(82.7%).Thefavoritesnacksprovidedarebiscuits,82.7%followedbybreadwithbutterat53.3%.Mostofthekindergartens/parentsprovidedunhealthy,non‐nutritious foodandhigh sugar‐content foodanddrinksduring specialoccasionswith74.3%providingbirthdaycakesfollowedbyBriyani rice51.4%andsweetsandchocolates (78.1%).Eightysevenpercentofkindergartenshavenorestrictionsonfoodsanddrinksbroughtfromhome.Outof51kindergartens,88%reportedhavingaverbalandwrittenpolicybut37%ofthese do not know who prepared the policy. However, 55.6% said they followed KEMASguidelines.Ninetytwopercentofkindergartensreportednoparentinvolvementinpolicybut63.5%claimedparentscouldreadthepolicy inkindergartens. Inmostkindergartensthereislittle evidenceofanypolicyonhealthy eatingand therewasambiguity in the guidelineonfoodanddrinksprepared.Conclusion:Mostofthesnacksanddrinksbroughtfromhomeareunhealthy.The results showed that there isnotmuchdifference regardlessofwhether thekindergartenshaveapolicyonhealthyeatingornot.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.SabarinaOmarAbdulSamadRoadDentalClinicJohorBahruJohor

31

A 5‐YEAR RETROSPECTIVE STUDY ON NEW ATTENDANCES OF ANTENATAL MOTHERS TOGOVERNMENTDENTALCLINICSINPONTIANDISTRICTIrnaI,RoslindaASObjective: This study aims to identify the trend of new attendances of antenatal mothersfrom2004to2008anditscontributingfactorsinPontianDistrict.Methodology:Aconvenientsampleofantenatalmotherswasused inthisstudy.Datawascollectedfromquestionnairesdistributedtoa convenientsampleof190mothers,aswellasannualreportsandworkloadreturns.Results: An increasing trend of new attendances of antenatal mothers was notedfrom5.5% (2004),39.8%(2005),68.4% (2006),78.3% (2007)to86.3% in2008. Fourfactorswereidentifiedthatcontributetothetrend,whichareMotherandChildHealthClinic(MCH),operator,facilitiesandpatient’sfactors.Remedialactionsweretakenin2008basedonthesefactors. Active participation from the Health Department and MCH Clinic in referring newattendances of antenatal mothers to dental clinics increased the new attendances of ante‐natalmothers.Scheduledvisitswereplanned involvingalldentalofficers includingfirst‐yeardental officers (FYDOs) with approval from Senior Dental Officer. Oral health talks forpregnant mothers were also carried out in MCH Clinic to increase antenatal mothers’awareness. Monthly visits to facilities without dental officers were carried out by dentalofficersfromthenearestdentalclinics.Antenatalmotherswerealsogivenpriorityforcheck‐ups in dental clinics and fast‐lanes were created for them at all counters. The newattendances of antenatal mothers increased from 78.3% in 2007 to 86.3% in 2008 whichexceededthetargetsetofmorethan85%.Conclusion:Thisstudyindicatedthatmanyfactorscontributed to the new attendances of antenatal mothers in dental clinics. Activeparticipation from all parties is required to ensure that antenatal mothers utilise dentalfacilitiesfully.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.IrnaIsmailDr.RoslindaAbdulSamadBothofPontianDentalClinicJohor

32

LEVELOFAWARENESSON THE IMPORTANCE OF PRIMARYDENTITIONAMONGMOTHERSWITHTODDLERSATTENDINGTHEMATERNALANDCHILDHEALTHCLINIC(MCH)INRAUBMohamadKhairulHafizanMN,NoraziahMZ,RozitaBTheNationalOralHealthPlanfor2010targets30%ofall6‐year‐oldswithcaries‐freedentitionby 2010. In order to achieve this target, early prevention especially at the toddler stage isneeded.Theauthorswouldliketofocusonthe levelofawarenessonthe importanceoftheprimarydentitionamongmotherswithtoddlersinthedistrictofRaub.Across‐sectionalstudywas conductedfor2months. Self‐administered questionnairesweredistributedamongthe7 MCH in the district of Raub after obtaining necessary approvals. Respondents wereMalaysian mothers and sampling was done in which every 2nd mother was chosen as arespondent. The levelofawarenesswas calculatedbyproxy from responses in sectionBofthequestionnaireandwasexpressedinpercentages.DatawereanalysedbySPSSversion15.The mean level of awareness among respondents is 73.1%. Maternal level of education,occupationofthemotherandthemanner inwhichthemotherwasexposedtooralhealthinformationwere significantlyassociatedwith the levelofawareness. Statements regardingfunctions of primary dentition had poor responses while statements regarding primarydentition care scores highly. Exposure to oral health information via mass media has nosignificantcorrelationwithlevelofawareness.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.MohamadKhairulHafizanMohamadNohNoraziahMdZainRozitaBasranAllofOralHealthDivisionPahang

33

CORRELATION OF ORAL HEALTH PERCEPTION AND ORAL CARE PRACTICES WITH CARIESEXPERIENCEAMONGSCHOOLCHILDRENINRURALAREASOFJERANTUT,PAHANGSiaJY,KalsomI,NorhafizahMHIntroduction:Oralhealthmeansmore than good teeth; it is integral to generalhealthandessential for well‐being. The key challenges of dental health in rural or remote areas areensuring access for people in need and providing people,wherever they live, with optionswhichsuittheirparticularcircumstances.Objectives:Tocorrelateoralhealthperceptionandoral care practices with caries experience among primary schoolchildren inUlu Tembeling,Jerantutandtocorrelateinterestofprofessionwithcariesexperience.Methodology:Cross‐sectionalsurveyusingaguidedquestionnairewasconducted.Universalsamplingof5schoolsin Ulu Tembeling with 70 study subjects and their annual dental records (card LP8) wereretrievedtoassessdentalcaries.Results:Aroundhalfofthestudysubjects(49%)havegoodoralhealthperceptionand37%havegoodoralcarepractices.Amajorityof96%ofthemhaveDMFTanddftlessthan3.Seventypercentofthemwereunsurewhethertheyareinterestedin the dental profession. Conclusion: No statistically significant correlations between oralhealth perception, oral care practices and interest with caries experience were found.Collaborative efforts involvingallparties to improveoral health for the community in ruralareasarerecommended.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

DrSiaJyeYenKalsomIbrahimNorhafizahMohamadHosainiAllofOralHealthDivisionPahang

34

LEVEL OF KNOWLEDGE, ATTITUDE AND PRACTICE RELATED TO TOOTH WEAR AMONG16‐YEAR‐OLDSCHOOLCHILDRENBibiSaerahAK,NoorlizaMasturaI,NaingL,AbdulRashidIObjectives:Tovalidatetheknowledge(K),attitude(A)andpractice(P)questionnaireandtodetermine and compare (KAP) scores on tooth wear among 16‐year‐old schoolchildren.Methodology:Thiscase‐controlstudyinvolved576(460casesand116controls)16‐year‐oldschoolchildren randomly selected from secondary schools in Kota Bharu, Kelantan. A self‐administeredquestionnairewasusedtocapturesocio‐demographicprofileofthefamily,KAPandassociatedvariables for toothwear. Thequestionnairewasdevelopedbasedonexpertopinionandwaspiloted twiceamong 16‐year‐old secondary schoolchildren.TheSmithandKnight Tooth Wear Index 1984, was used to record tooth wear during oral examination.Results:AllparticipantswereMalays. The itemanalysisofKAPquestionnaire showed fairlygood internalconsistencyreliabilityandconstructvalidity.TheK,AandPscoresvarywidelyfrom 0‐100% among cases and controls. However themean score differenceswere all lessthan1markbetweenthem.ComparisonofKAPscoresbyusingt‐testrevealednosignificantdifferencebetweenthetwogroups.Conclusion:TheKAPquestionnairewasvalidatedandthescoresvarywidelyamongtheparticipants.Howeverthescoreswerenotsignificantlydifferentbetweenthetwogroups.ThisstudyrevealedthatsomeoftheparticipantsstillhaveverypoorK, A and P scores regarding tooth wear. Therefore oral health education in schools shouldemphasisethismatter.Keywords:validity,knowledge,attitudeandpracticeProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.BibiSaerahAbd.KarimTaipingDentalClinicPerakDr.NoorlizaMasturaIsmailDr.LinNaingDr.AbdulRashidIsmailAllofUniversitiSainsMalaysiaKubangKerianKelantan

35

PERCEPTION OF SCHOOLCHILDREN ON DENTAL NURSES IN SARAWAK: A COMPARISONBETWEENTHERESULTSOFTHE2003AND2007SURVEYSChenCJA,LingKS,EddyA,FatimahI,HongSLOral healthcare for schoolchildren is a priority in Malaysia. In Sarawak, more than ninetypercentofprimaryschoolsarecoveredbydentalnurses.InthedeliveryoftheSchoolDentalService, the quality of oral healthcare provided is as important as the number of schoolscovered.ThisstudyaimstoprovidefeedbackontheperceptionofprimaryschoolchildrenondentalnursesinSarawakinthefollowingareas:thequalityoforalhealthservicesprovidedbythedentalnurses, theacceptabilityoforalhealthpromotionactivities carriedout, and theconducivenessoftheschooldentalclinic.Year6schoolchildrenfrom129primaryschoolsinSarawakwithaschooldentalclinicwere includedinthesamplingframe.Tenpercentoftheeligibleschoolchildrenwereselectedfromtheseschoolsusingsystematic randomsampling.A total of 1,692 schoolchildren participated in the 2003 survey,while 2,069 schoolchildrenparticipated in the 2007 survey. Data was collected using a self‐administered, structuredquestionnaire. Data analysis was done using EPI‐Info 2002. The findings from this studyindicatethatthedeliveryoforalhealthservicesinprimaryschoolshasimprovedoverthelastfour years. More schoolchildren felt that the dental nurses were friendly (94.0% in 2007against 91.3% in 2003), were gentle when carrying out dental treatment (89.5% in 2007against 87.7% in 2003) and spoke nicely to them, (95.5% in 2007 against 90.4% in 2003).Moreschoolchildrenwerehappywiththeschooldentalclinicand itssurroundings(92.1%in2007 against 90.5% in 2003). Overall, only 4.6% of the schoolchildren felt that the dentalnurseswere“notacceptable”,13.9%feltthedentalnurseswere“acceptable”and84.5%feltthenurseswere “highlyacceptable”. In general, a comparisonbetween the findingsof thisstudyandapreviousstudyin2003indicatethatthedeliveryoforalhealthservicesinprimaryschools has improved over the last four years. Efforts should bemade to ensure that thesuccessofthepresentSchoolDentalServiceremainssustainableinfutureyears.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.CatherineChenJeanAiDr.LingKwokSungDr.AndrewEddyFatimahIbrahimHongShiowLengAllofOralHealthDivisionSarawakStateHealthDepartmentSarawak

36

TOOTHWEAR:THEINFLUENCEOFDIETARYINTAKEAMONG16‐YEAR‐OLDSCHOOLCHILDRENBibiSaerahAK,NoorlizaMasturaI,NaingL,AbdulRashidIIntroduction:Toothweardescribes thenon‐cariouspathological lossof tooth tissue,whichresultsfromattrition,erosionandabrasionthatoccurssinglyorincombination.Objective:Toinvestigatedietaryintakepatternsinrelationtotoothwearandtodeterminetherelationshipbetweentoothwearanddietary intake.Methodology:Thiscase‐control study involved576randomly selected 16‐year‐old schoolchildren froma secondary school in Kota Bharu town.The Smith and Knight tooth wear index (1984) was used. Data were analysed using asimplifiedsoftwareprogram(Naing,2004)basedonthe indextoquantifypathologicaltoothwear.Controlsweresubjectswithnopathologicaltoothwear indicatedbyzeroscoresonalltoothsurfaces.Casesweresubjectswithpathologicaltoothwearhavingat leastonesurfacescoring1fortoothwear.Dataontherateandfrequencyofconsumptionofdrinks,foodsandfruitswereobtainedfromfoodfrequencyquestions intheself‐administeredquestionnaires.Results:Over95%ofthechildrenconsumedcarbonateddrinks.Lessthan5%ofthechildrenconsumedittwiceperday.Themethodofdrinkingwasnotsignificantlyrelatedtotoothwearbutthedurationofintakeofcarbonateddrinks,orangejuices,certainsportsandcarbonateddrinks and intake of dairy products were significantly associated with tooth wear (simplelogistic regression analysis with p value<0.05). Conclusion: Most children consumedcarbonateddrinksdailybutat low frequency. Therewere significant relationshipsbetweenparticulardrinksandfruitswiththeamountoftoothwear.Furtherinvestigationoftheerosivepotentialofthesedrinksandfruitisrequired.Keywords:toothwear,dietarypatterns,schoolchildren,SmithandKnightIndexPaperpresentedatthe15thFDI/MDAScientificConventionandTradeExhibition,25th–27thJanuary2008

Dr.BibiSaerahAbdulKarimDistrictDentalOfficerHuluPerakPerakDr.NoorlizaMasturaIsmailDr.LinNaingDr.AbdulRashidIsmailAllofSchoolofDentalSciencesUniversitiSainsMalaysiaKubangKerianKelantan

37

FLUORIDETOOTHPASTEUTILISATIONBEHAVIOURAMONGPRESCHOOLCHILDRENINPERLIS,MALAYSIATayHL,IntanSharizaZ,NasrudinJIntroduction:Verymildfluorosisisquiteprevalentinchildrenandoneofthesourcesmaybeattributed to poor fluoride toothpaste utilisation habits. Objectives: To investigate thefrequency of toothbrushing, parental supervision, the person who usually applied thetoothpaste, toothpaste swallowing and spitting habits, size of toothbrush and type oftoothpaste used and amount of toothpaste used by shape andweight.Methodology: Thiswasanobservationalcross‐sectionalstudyofarepresentativerandomsampleof373childrenaged 5‐6 years old. The children were interviewed using a structured close‐endedquestionnaire.Directobservationsweremadeontheirtoothpaste‐dispensinghabitduringatoothbrushing exercise. Results: All children reported practising toothbrushing with 90%practising itonadailybasis.Almostallusedfluoridatedtoothpaste (91.4%).Aboutone‐half(50.7%) reportedthattheirparentsneversupervisedthem.Morethanone‐thirdofchildrenusedadulttoothpasteand60.1%usedflavouredtoothpaste.Mostofthechildren(92%)usedtoothbrush meant for children. About 40% applied a pea‐sized amount of toothpaste.Themeanweightoftoothpasteappliedwas0.43g(SD±0.35g).Conclusion:Themajorityusedtherecommendedchild‐sizedtoothbrushandtoothpastethatcontainedfluoridebutlessthanone‐half of the parents supervised their children. Most children used flavoured children’stoothpastebutasizableproportionusedtoothpastesmeantforadults.Theamountappliedbyshapeandweightexceededtheamountrecommendedbyexperts.Keywords:fluoride,fluorosis,preschoolchildren,toothpastePaperpresentedatPerlisScientificConferenceatDewanWarisan,Kangar,Perlison27‐28Mac2008andpublishedinCommunityDentalHealth,Dec2009vol26Issue4pg211‐215.

Dr.TayHongLukDentalClinicKangarHealthClinicPerlisDr.IntanSharizaZainudinBeseriDentalClinicBerseriPerlisProfessorDr.NasrudinJaafarDepartmentofCommunityDentistryFacultyofDentistryUniversityofMalayaKualaLumpur

38

39

RESEARCHIN

CLIENTSATISFACTION

40

41

TODECREASETHEWAITINGLISTTIMEFORDENTURETREATMENTRohanaAB,SitiZurainiM,WahidahMJ,SitiHariyanaM,JulailaS,SuzitaS,MariamA

Lossofpermanentteethcancauseseriousimpacttopatients.Itcangivenegativeeffectstoaperson including difficulty during eating or speaking, feeling uncomfortable andembarrassment inperforminghis/herdailyactivity. Inorderto restorefunction,themissingteeth canbe replacedbydentures. The increase indemandfordentures ledtotheDentureWaiting List Bookbeingdeveloped.Datawas collected from theDentureWaiting List Bookandalso frompatients’ feedback.Action for improvementhasbeen takenwhich includesastrong commitment by the management and personnel, updating the waiting list,communicatingwiththepatientsandexpeditingthedenture‐makingprocess.DentureoutputbytheDentalTechnologistincreasedandasaresult,therewasareductioninthewaitinglistfor denture treatment. Most of the patients were satisfied with the service because thewaitingtimehadbeenshortenedtolessthan3months.Standardisationandmonitoringwasdone continuously at all the clinics in Kluang District from Jun 2005 to August 2005. As aresult,therewasnowaitinglistanymorefordenturetreatment.TheWaitingListforDentureTreatmentBookwasclosedofficiallyon1stSeptember2005.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.RohanaAbuBakarDr.SitiZurainiMominWahidahMd.JunapSitiHariyanaMasninJulailaSuparSuzitaSakirMariamAhmadAllofDentalClinicKluangHospitalJohor

42

TOREDUCETHEWAITINGTIMEFOROUTPATIENTCLINICATTAMANUNGKUTUNAMINAHDENTALCLINICNoraziyahAA,MarianaM,NoorHassiahK

Introduction:Outpatientserviceisoneofthe‘corebusinesses’ofthedentalserviceinTamanUngku Tun Aminah Dental Clinic. It encompasses dental check‐up, extraction, conservativetreatmentsuchasfillingandpreventivetreatmentsuchasscaling.Objective:InJanuary2009,the Waiting Time Study showed that 62.4% of outpatients received treatment within 60minutes after registration. This percentage needs to be increased because the QualityObjective of the Johor Dental Services has targeted that 85% of outpatients will receivetreatmentwithin60minutesafterregistration.ThisproblemhasanimpactonachievementoftheQuality Objective of Johor Dental Services and also on the Clients’ Charter agreement.Nevertheless, this problem can be overcome. Methodology: A retrospective study wasconductedattheverification levelandprospective studyafterthe improvementactionwastaken.ThisstudywasdoneontheoutpatientswhoattendedtheTamanUngkuTunAminahDentalClinic.ATriageSystemwasimplementedattheregistrationcounterandpatientsweredivided into 2 treatment stations namely treatment station and conservative station. Datawas analysed usingMicrosoft Excel. Percentage achievement for patient waiting time wasanalysed with the waiting time study. Results: An increment has been shown after theimplementationof the Triage System inFebruary2009.TheWaitingTimeStudy found that95% of the outpatients had received treatment within 60 minutes after registration.Conclusion:TheTriageSystemisimplementedattheTamanUngkuTunAminahDentalClinic.ClientsatisfactionofthepatientswhoattendedTamanUngkuTunAminahDentalClinichasincreasedduetotheimprovementaction.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.NoraziyahAbdulAzizMarianaMisronNoorHassiahKadirAllofTamanUngkuTunAminahDentalClinicJohorBahruJohor

43

AREYOUMAKINGTHERIGHTCAREERCHOICE?WanMariamWAR

Objectives: To identify the causesof lackof interestamongst staffmembers inMiri DentalClinic regardingtheir currentposts.Thisstudyalsoservedto identifythe causesthat ledtoaverageresponsebystaffofMiri comparedtostandardsetbystatefollowingthefeedbackfromtheinternalcustomersatisfactionsurveythatwasconductedin2007bytheOralHealthDivision,Sarawak.Methodology:Thestudywascarriedoutbydistributingself‐administeredquestionnaires to all staff members which included dental officers, dental nurses, dentaltechnologists,dentalsurgeryassistants,attendants,driversandclericalstaffatMiriDivision.Staffmembers fromMarudi were excluded. The questionnaire forms were distributed andcollectedonthesameday.Results:Outof78staff,51%confessedthattheircurrentpostisnottheirfirstchoice.Fortytwopercentappliedforthejobbecausetheydidnothaveotherchoices.Forty‐onepercentchosethepostbecausetheywouldliketocontributetheirservicesto the community. A total of 38% are not satisfied with their current posts. Thirty threepercentexperiencedstressfrequentlywhile42% rarelyexperiencedstress. Fiftypercentareproudthattheyareintheservicewhiletheotherhalffeelsthattheyarejustlikeanyothergovernmentstaff.Sixty‐twopercentofthestaffmemberswould liketochangecareergiventhe chance. Ironically, 68% would like to recommend their posts to other people. Thedissatisfaction was obvious amongst dental surgery assistants and drivers. Conclusion:Problems amongst personnel should be tackled from the beginning to avoid the conditionfrombecomingchronic.Motivationshouldbegiventostaffmembersearliertofosterinterestintheirjobsandencouragethemtotrytheirbest.Themanagementshouldbesensitivetothesituation in theworkplaceandorganisediscussion sessions so that staffmemberswill feeltheyarevalued.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.WanMariamWanAbdulRahmanOralHealthDivisionSarawak

44

TOINCREASETHEPERCENTAGEOFPATIENTSSEENBYDENTISTWITHIN30MINUTESAFTERREGISTRATIONATKOTATINGGIDENTALCLINICTO50%HalizaT,RamalingamSR,NorAzmahBThelongwaitinghoursfortreatmentatgovernmenthospital/cliniccancauseunsatisfactoryreaction from the customer or patient. The congested waiting room indirectly affects thequality of service and image of the department. For this, the Minister of Health YangBerhormatDato’SriLiowTiongLaiurgesallrelateddivisionstoimprovetheservicebytakingnecessaryactionsto improvethewaitingtimetowithin30minutesforalloutpatient clinicsandhospitals.(SuratPekelilingKetuaPengarahKesihatanMalaysiaBil.2/2008).FortheKotaTinggiDentalClinic(KTDC),insufficientoutpatientdaysandinsufficientdentalofficersondutywere identified as contributing factors. The measurement of the study is based on theimprovementofwaitingtimeforoutpatientsby increasingthe3daysaweekforoutpatientdaywith1officerondutyin2008,to5daysaweekforoutpatientdayin2009with2officersonduty.CollectionofdataandstudywasdoneontheoutpatientwaitingtimefromJanuaryuntil December 2008. Another collection of data was carried out after remedial action inJanuary until April 2009. All categories of outpatients (new and repeat) will fall under theinclusion criteria. Thiswill exclude all appointment patients. The increase in percentage ofpatients getting treatment within 30 minutes before and after remedial action wasdetermined.ThecollectionofdataafterremedialactionshowedimprovementfromJanuarytoApril2009.Theremedialactionsandmeasureswerefoundtobeeffectiveinachievingthetarget.Thestrategiesforchangeinclude1.AllstaffatKTDCincludingdentalofficers,first‐yeardentalofficers,dentalnurses,dental surgeryassistantsandattendantswerebriefedon thechanges. 2. Deployment of staff especially auxiliaries from Bandar Mas Dental Clinic.3.Evaluationofthecriteriaforpatientswhoneededappointments.4.Tostrengthentheuseofexpress counter forantenatalmothers. It ishighlyhoped thata significant improvementcan be further achieved by December 2009. The scope should be broadened to includeoutpatientdaytwiceaweekforBandarMas/SeningDentalClinic.PaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.HalizaTugemanDr.SheilaRaniRamalingamDr.NorAzmahBadriAllofKotaTinggiDentalClinicJohor

45

ASTUDYONPATIENTS’WAITINGTIMEINTHEDENTALCLINICSINTHEDISTRICTOFKUALAKANGSAR,PERAKNur’AdilahAO,NoorRohanaK,SuhailizaS

Clients’ Charterofdental clinics state thatpatients shouldbe registeredwithin15minutesandtreatmentwaitingtimeshouldnotbemorethan45minutes.Theobjectivesofthisstudyweretoevaluate compliancesto standardpatients’registrationtimeandtreatmentwaitingtimeinalldentalclinicsinKualaKangsar,todeterminenon‐conformancerateandtoidentifyremedial action to be taken to improve dental services. This observational cross‐sectionalstudy was conducted in January till August 2007. Monitoring from treatment cards (LP8),registration book (PG 101 Pin 3/04) and PKPP‐BK 32/ Pin 00 form showed that 100% ofpatients were registered within 15 minutes and 95.3% patients were treated within 45minutes.Atotalof3.5%ofpatientswaitedformorethan45minutesbut lessthan1hour.Only1.3%patientswaitedmorethan1hourtogetdentaltreatment.Sg.SiputDentalClinicshowed the highest rate of non‐conformance in the district where 10.1% patients waitedbetween45minutesto60minutesand2.9%morethan60minutes. Thiswasbecauseonlyonedentalofficerwasondutyduringoutpatientday.Remedialaction inhavingtwodentalofficersondutyduringoutpatientdaymayresolvethisproblem.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.Nur’AdilahAhmadOthmanDr.NoorRohanaKamaruddinDr.SuhailizaSaharudinAllofOralHealthDivisionPerak

46

STUDYONPATIENTSATISFACTIONONISSUEDCOMPLETEDENTURESINTEMERLOH&BERAGOVERNMENTDENTALCLINICMimiBaizuraZ,FarhanaMZ,AbdulRazakI,NorulAkmaA,NorhaslindaT,NorainiYIntroduction:TheincreasingdemandforfulldenturesisrelatedtotheconsistentincreaseintheelderlypopulationinMalaysia.Dissatisfactioncausesdisappointmentinbothpatientanddental practitioner.Objective: The purpose of this study is tomeasure patient satisfactiontowards dentures issued in Temerloh and BeraGovernmentDental clinic by describing thesocio‐demographicfactorsandfactorsofdenturequalityinfluencingit.Methodology:Thisisa cross‐sectional study involving 100 patients who completed treatment for full dentures.Questionnairesonsocio‐demographicfactorsandfactorsinfluencingpatientstowardtheirfulldenturesweredistributedduringthesurvey.PASWversion17wasusedtoanalyzethedata.Results:Atotalof85%respondentsweresatisfiedwiththeirfulldentures.Factorsaffectingpatient’s satisfaction were gender, comfort, pain, aesthetics, retention, mastication andspeech (P< 0.001). Post‐operative instructions given also relate to patients’ satisfaction(p<0.034). Factors that do not influence patients’ satisfactionwere age, level of education,monthly income, pre‐operative instructions and dietary advice after issuing the completedenture. Conclusion: Good quality of complete dentures, gender and post‐operativeinstructionsaffectthelevelofpatientsatisfaction.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.MimiBaizuraZulkafliDr.FarhanaMd.ZinAbdulRazakIbrahimNorulAkmaAbdullahNorhaslindaTambunNorainiYusofAllofOralHealthDivisionPahang

47

RESEARCHIN

ORALSURGERY,ORALPATHOLOGYAND

ORALMEDICINE

48

49

APPROPRIATENESS OF REFERRALS FOR SURGICAL REMOVAL OF IMPACTEDMANDIBULARTHIRDMOLARSBYDENTALOFFICERSJeyaRamanJS,KanagaratnamSS,LimYC,SuppiahP

Objective:Toassesswhetherdentalofficers(DO)whoreferredpatientsforsurgicalremovalofimpactedmandibularthirdmolarstoOralSurgeryDepartment,AmpangHospital (OSDAH)were following the current Ministry of Health Malaysia Clinical Practice Guideline (CPG).Methodology: A retrospective study was conducted on all patients who were referred toOSDAH for surgical removal of impactedmandibular thirdmolars from government dentalclinics.PatientswhowerereferredfromJanuary2008untilMarch2009wereincludedinthestudy. Demographics, concordance of diagnosis and concordance in exact indication forsurgical removal of impacted mandibular third molar between DO in government dentalclinicsandDO/SpecialistinOSDAHandmanagementofthereferredpatientswerereviewed.Alldatawerecollectedinacustomisedworksheetanddescriptivelyanalysed.Results:Atotalof270recordswere reviewed.Theconcordanceofdiagnosisof referredcasesbetweenDOfromgovernmentdentalclinicsandDO/Specialist inOSDAHwas71.5%.Surgicalremovalsofimpacted mandibular third molars were done in 208 cases (77.0%) of which 72.6% hadconcordance in exact indication for surgical removal. Pericoronitis was the highest referralreason for removal (41.5%) whereas unrestorable caries and pulpal pathology were thecommonestreasonsforsurgicalremovalat55.8%.Itwasnotedthat17.8%ofthecaseswereinappropriate referrals. Conclusion: The majority of cases were appropriately referred,howeverimprovementispossiblebyunderstandingandadheringtotheCPG.Keywords:impactedmandibularthirdmolar,appropriatenessofreferrals,surgicalremovalPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.J.SureinthirenJeyaRamanDr.SivakamaSunthariKanagaratnamDr.LimYeeChinDr.PremaSuppiahAllofOralSurgeryDepartmentAmpangHospitalSelangor

50

A FIVE‐YEAR RETROSPECTIVE STUDY OF DENTOFACIAL INJURIES AMONG PRESCHOOLCHILDRENINMALACCA,MALAYSIARoyanSJ,EePS,RajahGunarajahDObjective:Todeterminethepatternofdentofacialinjuriesseenamongpreschoolchildrenina public hospital dental service in Malacca, Malaysia. Methodology: The study wasretrospectiveandbasedonrecordsofchildrenaged0to6yearswithdentofacialinjurieswhowereseeninMalaccaHospitalbetween1January2002and31December2006.Results:Overthefive‐yearperiod,268preschoolchildrenwereseenandtheymadeup8.69%ofthetotalnumberofdentofacial injuries seen in thehospitalduring thatperiod.Malesoutnumberedfemalesbyaratioof1.8:1.Fallsaccountedfor83%oftheinjuries.Softtissueinjurieswerethemost common injury encountered (94%) with the lips being the commonest site of injury.Dentalinjurieswereseenin37%andbonefracturesin3%ofthechildren.Conclusion: Inthedentofacialarea,softtissuesarethemostcommonlyinjuredinyoungchildren.Dentistsmustbeadeptatmanagingsofttissue injuries inthis group.Thefindingsofthisstudydiffered insome ways from those conducted in other countries. The findings are useful for resourceplanningandpreventionstrategies.Keywords:dentofacialinjuries,preschoolchildren,epidemiology,Malaysia,facialtraumaPosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.StephenJosephRoyanDr.EePei‐ShanDr.DharmindraRajahGunarajahAllofDepartmentofOralSurgeryMalaccaHospitalMalacca

51

INFECTIVEENDOCARDITISAFTERTOOTHEXTRACTION:ACASEREPORTKokTC

Infectiveendocarditisisararebutpotentiallyfataldisease.Antibioticprophylaxisforinfectiveendocarditispreventionafterinvasivedentalprocedureshaslongbeenpractised.Recently,in2008,theNationalInstituteforHealthandClinicalExcellence(NICE)guidelinerecommendedthat antibiotic prophylaxis is no longer needed for prevention of infective endocarditis fordentalprocedures.Thishascreatedsomeconfusionandcontroversyinmanagementofsuchcases in theMalaysian setting.A case reportof infective endocarditisoccurringafter toothextraction in a patient with prosthetic heart valve is presented. This case occurred afterextraction without antibiotic prophylaxis. The patient subsequently developed a mycoticaneurysm,ararebutfatalcomplicationofinfectiveendocarditis.Areviewofthecaseandtheantibioticguidelineisdiscussed.Keywords:infectiveendocardities,toothextraction,guidelinesPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.KokTuckChoonOralSurgeryDepartmentSg.BulohHospitalSelangor

52

MANAGING PATIENTS ON ANTICOAGULANTS – TENGKU AMPUAN RAHIMAH HOSPITAL,KLANGEXPERIENCENurulAdhaI,AbrahamMTDentalprofessionalsareseeingagreaternumberofpatientswithmedicalproblems.Commonamongthemarepatientsonanticoagulants.Anticoagulantsandantiplateletmedicationsarebeing prescribed for numerous conditions such as atrial fibrillation, venous thrombo‐embolism episodes, following valve replacements or as prophylaxis against myocardialinfarction episodes. These drugs alter homeostasis and thereby increase the risk ofpostoperativebleeding. Inordertopreventsuchcomplications,one is forcedtomodifytheanticoagulantsandalsothedentaltreatmentgiventothepatient.Thesemodificationsarenotwithoutrisktothepatientandinthispresentationwelookattheclassicalwaywetreatthesepatients. We also look at our experience ofmanaging these patients on anticoagulants atTengkuAmpuanRahimahHospital,Klang.Keywords:anticoagulants,warfarin,bleedingPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.NurulAdhaIsmailDentalOfficerDr.MannilThomasAbrahamOralSurgeonBothofOralSurgeryDepartmentTengkuAmpuanRahimahHospitalSelangor

53

EMERGINGTRENDSOFEXTRAPULMONARYTUBERCULOSIS–CASESERIESThangavaluL,AbrahamMTObjective: The objective of this presentation is to increase awareness among dentalhealthcare professionals about the increasing trend of extrapulmonary tuberculosis.Methodology: Recordsof threepatientsdiagnosedwithextrapulmonary tuberculosis in theOral and Maxillofacial Surgery Clinic of Tengku Ampuan Rahimah Hospital, Klang werereviewed. Results: In this presentation, we highlight two cases who presented at theDepartmentofOralandMaxillofacialSurgeryClinicatTengkuAmpuanRahimahHospitalwithsubmandibular lymphadenopathy and submental lymphadenopathy respectively. We alsopresent a third case which presented with ulceration in themouth. In all three cases, thepatientsdidnotpresentanyclassicalsymptomsoftuberculosis like low‐gradefever,weightloss, night sweat or cough. Even routine investigations for pulmonary tuberculosis wereequivocal.Ahighdegreeofsuspicion is required inorder tocometoanaccuratediagnosis.Conclusion: With the increased influx of migrant population from neighbouring countries,Malaysia is seeing an increased incidence of tuberculosis, especially the extrapulmonaryvariety. As dental healthcare professionals, it is important that we realise the increasedincidenceof this infectiousdiseaseandpractiseproper infection control aswell aseducateourauxiliarystafftoensuretheytoopractiseproperinfectioncontrolprocedures.Keywords:extrapulmonarytuberculosis,diagnosis,infectioncontrolPaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.LogesvariThangavaluDentalOfficerDr.MannilThomasAbrahamOralSurgeonBothofOralSurgeryDepartmentTengkuAmpuanRahimahHospitalSelangor

54

MAXILLOFACIAL TRAUMA AT TENGKU AMPUAN RAHIMAH HOSPITAL, KLANG – A 4‐YEARREVIEW(2005–2008)TiuSL,AngKT,YongPY,TahGM,AbrahamMTObjective:Theobjectiveofthispaperistohighlightthe incidenceofmaxillofacialtraumainKlangandtolookatthereasonswhythereisanincreasedincidenceofmaxillofacialtrauma.Methodology:AllthepatientsseenattheOralSurgery(OS)DepartmentofTengkuAmpuanRahimah Hospital (TARH) from year 2005‐2008 are included in this study. The exclusioncriteriaareincompleterecordsandpatientsbelow16yearsoldwhoareseenatthePaediatricDentistryDepartment,TARHandwerenotreferredtotheOSDepartment.Thedentalcardsarethesourceofinformation.Adatacollectionformwaspreparedtorecordallthenecessarydata. The results were analysed using SPSS version 14.0.Results:On an average, over 600casesareseenyearlyattheOralSurgeryDepartmentofTARH.Themajorityofthesecasesareasaresultofroadtrafficaccidents.Ofthese,mostpatientsareMalaymalesoftheagerange18‐30years.Mostpatientssustainedsofttissueinjuries,followedbymandibularandmaxillafractures.Agoodnumberofpatientsareforeigners.Afterroadtrafficaccidents,interpersonalviolenceisthesecondcommonestcauseoftrauma.Conclusion:Roadtrafficaccident(RTA)isthemajorcauseofmaxillofacialtraumainKlangandisontherise.Youngadultsarethemostprevalent group to be involved in RTA. Road safety education should be reinforced andtargeted at this group. Interpersonal violence also plays an important role inmaxillofacialtrauma due to increasing crime rate. The high number of maxillofacial trauma involvingforeignersisbecomingaburdentolocalpublichealthservice.Keywords:maxillofacialtrauma,fracturemaxilla,fracturemandiblePaperpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.TiuSuLengDentalOfficerDr.TahGeokMoiDentalOfficerDr.MannilThomasAbrahamOralSurgeonAllofOralSurgeryDepartmentTengkuAmpuanRahimahHospitalKlangSelangorDr.AngKokTiongDentalOfficerSungaiBesarDentalClinicSelangorDr.YongPohYinDentalOfficerTanjungKarangDentalClinicSelangor

55

INCREASING PATIENT REGISTRATION AT THE COUNTER REGISTRATION CENTRE (CRC)BEFORE ATTENDING THE MAXILLOFACIAL SPECIALIST CLINIC, SULTAN ISMAIL HOSPITAL,JOHORBAHRUMazlinaMN,WongTC,SuhileeA,MohdFaizalR

Registration for patients attending the maxillofacial specialist clinic at the Sultan IsmailHospitalisdoneusingtheTotalHealthInformationSystem(THIS).AllpatientswhohadbeengivenappointmentsatthespecialistclinicneedtoberegisteredattheCRCbeforeattendingthe specialist clinic.A consultationchargeofRM5 ispaidduring registration.Somepatientswith appointments at theMaxillofacial Specialist Clinic do not register at the CRC. Instead,they go straight to the clinic for treatment. However, treatment cannot be given if thepatients have not been registered at the CRC. Therefore, they have to go to the CRC toregister and by then, the CRC counter is usually busy. As a result, patients will receivetreatment later than the appointment time. A prospective study was conducted at theverificationlevelandalsoaftertheimprovementaction.Attheverificationlevel,thenumberofpatientswhodidnotregisterattheCRCwassummedandtheirreasonfornotregisteringattheCRCwasnoted.Inaddition,datawasalsoobtainedfromthequestionnaireformswhichwere distributed to all patients who attended the Maxillofacial Specialist Clinic forappointment to identify the source of problems. After improvement action was taken, thenumber of patients who still failed to register at the CRC counter was summed. Data wasanalysedusingMicrosoftExcelandMicrosoftWord.Atotalof25from205patientswhohadbeengivenanappointmentattheMaxillofacialSpecialistClinic failedto registerattheCRCcounter.Fromthequestionnaire,afewfactorswereidentified.Aftertheimprovementaction,only1.4%ofpatientsfailedtoregisterattheCRCcounter.Thefollowingactivitiesweretakenbasedonthefactors identified: (1)Distributing information lettertoall theDentalClinics inJohorBahruandallDepartmentsatSultanIsmailHospital(2)AttachingremindernotestotheappointmentcardsofpatientswhoattendedtheMaxillofacialSpecialistClinic(3)Emphasisingtothepersonatthecountertogiveclearinformationtopatients(4)Changingthelocationofinformationtoanappropriateplacewhichismorestrategicandclear.Aftertheimprovementactions, the number of patients who did not register at the CRC counter decreased from12.2%to1.4%.ImprovementactionisdonecontinuouslytoincreasetheservicequalityattheMaxillofacialSpecialistClinic.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.MazlinaMohdNoorWongTohChienSuhileeArifMohdFaizalRomliAllofMaxillofacialSpecialistClinicSultanIsmailHospitalJohorBahruJohor

56

AUDIT OF ORAL SQUAMOUS CELL CARCINOMA AT ORAL SURGERY CLINIC, SULTANAHAMINAHHOSPITAL,JOHORBAHRU,JOHORMdAradJ,MaBCObjective: This study evaluates the pattern of oral squamous cell carcinoma seen andmanaged at the Oral Surgery Department, Sultanah Aminah Hospital, Johor Bahru.Methodology:Thiswasadescriptive studyofalloral squamous cell carcinomas cases. Therecords of patients diagnosed with oral squamous cell carcinoma in 2007 and 2008 werereviewed. Data analysed included age, gender, ethnic group, stage of cancer, and types oftreatmentdone.Results:Atotalof29casesoforalsquamouscellcarcinomawererecordedbetween2007and2008.Themeanagewas60.7years‐old.Genderwise,malesandfemaleswerealmostequallyaffected.TheIndianethnicgroupmadeup44.8%ofthecases,followedbyMalays(24.1%),Chinese(24.1%)andothers(7.0%).Themajorityofpatients(48.3%)haveno risk factors. Betel quid chewing habit was found to be higher among the Indian ethnicgroup. The buccal mucosa was the most common site of oral squamous cell carcinoma(41.1%), followed by the tongue.Most of the cases presented at stage IV (62.1%) and themajorityof thepatientsneededprimary radiotherapy.Outof29patients,9were still aliveand9patientshaddied.Therewere11patientsofwhichtheirstatuswereunknownduetolossoffollowup.Conclusion:ThemajorityofcasesseenatthiscentrepresentedatstageIV.Oral cancer screening especially for the high‐risk group should be carried out for earlydetectionoforalsquamouscellcarcinoma.PaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.MdAradJelonDr.MaBeeChaiBothofOralSurgeryDepartmentSultanahAminahHospitalJohorBahruJohor

57

ARETROSPECTIVESTUDYOFMAXILLARYFRACTURESATORALSURGERYCLINIC,SULTANAHAMINAHHOSPITAL,JOHORBAHRURosniMAObjective: The aim of this study was to determine the incidence, aetiology, type,demography,treatmentandcomplicationsofmaxillaryfracturesmanagedattheOralSurgeryClinic, Sultanah Aminah Hospital, Johor Bahru, Johor, during a 4‐year period from 2003 –2006.Methodology: Treatment cards of patients treated for maxillofacial injuries for theyears2003‐2006werereviewed.Onlypatientswithmaxillaryfractureswereselectedforthisstudy. All data including age, gender, ethnic group, type of maxillary injuries, aetiology,treatment methods and complications were entered into questionnaire forms for analysis.Results:Therewere148patients(10.1%)whohadmaxillaryfracturesoverthe4‐yearperiod.TheMalayethnicgrouphadthehighestincidenceofmaxillaryfractures(73%)ascomparedtoother ethnic groups. Themajority of maxillary fractures were seen inmale patients (92%),agedbetween21‐30years(47.3%).Motorvehicleaccidentswerethemaincauseofmaxillaryfractures(88.5%).Themostcommonmaxillaryfracture,wasLeFortIIfracture(101),followedbyLeFort I (31), LeFort III (25)anddentoalveolar (23).Morethanhalfofall cases(56.8%)weretreatedbyopenreductionandinternalfixation(ORIF).Complicationsoccurredin11.5%ofpatients.Conclusion:Thefindingsofthisstudyweresimilartootherreportedstudies,thatmotorvehicleaccidentswerethemajorcauseofmaxillaryfractures.Strictenforcementandroadsafetyeducationshouldbeimplemented,especiallyforyoungadultsastheyformedthehighestnumbersinvolvedinroadtrafficaccidents.PaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

RosniMohdAliOralSurgeryDepartmentSultanahAminahHospitalJohorBahruJohor

58

PATTERN OF REFERRAL FORMINOR ORAL SURGERY ON IMPACTED THIRDMOLAR CASESFROM DISTRICT DENTAL CLINIC IN NORTHERN JOHOR TO ORAL AND MAXILLOFACIALSURGERYDEPARTMENTINSULTANAHFATIMAHSPECIALISTHOSPITAL,MUARNurlizaAR,RohanaSObjectives:1)Toassessthelevelofconfidenceandtoevaluatethelevelofknowledgeamongdentalofficers indiagnosingandclassifying impactedthirdmolars.2)Toassessthereasonsfor referral of impacted third molar cases to Oral and Maxillofacial Surgery (OMFS)Department, Sultanah Fatimah Specialist Hospital (SFSH) Muar. Methodology: This cross‐sectionalstudywascarriedoutamongdentalofficersworkinginthedentalclinicsofNorthernJohor district (Segamat, Muar, Ledang and Batu Pahat). Dental officers attached to OMFSdepartment, dental specialist officers (public health and orthodontist) and administrativeofficers were excluded. The questionnaire was formulated and distributed among thesubjects.Results:Atotalof31dentalofficersparticipated inthestudy.Eightyfourpercenthadreferredminororalsurgerycasesoverthepast6monthstoOMFSdepartmentinSFSH.Amongthem,77.4%performedminororalsurgeryprocedures intheirdaily clinicalwork. Itwas found that 32.4% were very confident in diagnosing impacted third molar cases and16.1% were very confident when classifying the impacted third molar cases. Meanwhile,58.1%ratethemselvesatscale4forthe levelofknowledgetoperformtheprocedure.Themost common reasons for referral were the degree of difficulty anticipated in treating theimpaction (77.4%)and lackof confidence inperforming theprocedure (41.9%).Conclusion:ThemajorityofdentalofficersfromdistrictdentalclinicsreferredimpactedthirdmolarcasestoOMFS department even though they had the knowledge to diagnose and to classify thecases. Reasons for referring include the difficulty of the cases and lack of confidence incarrying out the procedure. Use of Clinical Practice Guidelines and continuing dentaleducation regarding management of impacted third molar should be practised by dentalofficersindistrictdentalclinics.Keywords:impactedthirdmolar,minororalsurgery,dentalofficersPaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.NurlizaAbdRazakDr.RohanaSujakBothofDepartmentofOralandMaxillofacialSurgerySultanahFatimahSpecialistHospitalMuarJohor

59

DISLOCATION AND IMPACTION OF MANDIBULAR CONDYLE FOLLOWING MANDIBULARFRACTURESRohanaS,AkmalR

Traumaticdislocationofmandibularcondylesthatwent intomiddle cranial fossa,superiorlyor superolaterally, have been reported previously. This case report described the rareconditionofdislocationandimpactionofmandibularcondyleina19‐year‐oldgentlemanwhowas involved in a road traffic accident and sustained open fractures of the mandibularsymphysisandparasymphysis. Initialclinicalpresentationnotedtheocclusiononthesideofthe affected condyle had posterior premature contact but normal occlusal relation on thecontra‐lateral side. The plain orthopantomogram did not reveal a significant difference ofmandibularcondyles.Intraoperativemanipulationoftheaffectedcondylewasunsuccessfulinreducingtheopenfracturesandobtainingcorrectocclusion.Computedtomography(CT)scanimagingwasthenundertakentoinvestigatefurther.The3Dimagesclearlydemonstratedthecondylepositionwhichwasdislocatedanddisplacedintosuperiorandmedialofthetemporalspaces. The following operation was performed via hemi‐coronal approach (Al‐Kayat andBramley) to gainaccess.Coronoidectomywasdoneand0.5cmosteotomyof the zygomaticarchfailedtorepositionthecondyleintheglenoidfossa.Thefibrosisofthedisplacedmusclesdue to the delay of operation prevented themanoeuvre. Condylectomywas then done tobringtheocclusion intoanacceptablerelation.Thiscasereporthighlightsthe importanceofadvanced imaging modalities such as CT in diagnosing the condition. Proper planning andmanagementappeartoimprovetheprognosis.Keywords:dislocation,impaction,mandibularcondylePosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenangandatQuality Initiatives&1st JohorOralHealthResearchConference,10‐11 June2009atSultanIsmailHospital,JohorBahru

Dr.RohanaSujakDr.AkmalRailBothofOralSurgeryDepartmentSultanahFatimahSpecialistHospitalMuarJohor

60

THEOUTCOMESOFNON‐SURGICALTREATMENTFORCONDYLARFRACTURES(MANDIBULARDEVIATION AND OCCLUSAL RELATION) IN SULTANAH FATIMAH SPECIALIST HOSPITAL,MUAR:ARETROSPECTIVESTUDYRohanaS,NurlizaAR

Objective: To evaluate the occlusal relation andmandibular deviation among patients whohadnon‐surgicaltreatmentforcondylarfractures.Methodology:Thisretrospectivestudywascarriedouton68patientswhosustainedcondylarfracturesfromJanuary2000toDecember2005.Thedemographiccharacteristics,causesoffractures,typeofcondylarfracturesanditsassociated fractures and period of intermaxillary fixation (IMF) were taken from patientrecords.Theassessmentonmandibulardeviationandocclusalrelationshipwasdoneduringrecallassessment.Results:Twentyeightoutof68patientsattendedtherecallassessment,23were males and 5 females. The condylar fractures were commonly associated withsymphysis/parasymphysisfractures(39.3%).Only85.7%ofpatientsreceivedtreatmentwhichinvolved32condylar sites. The treatment includedplacementofarchbars followedby IMFusingstainlesssteelwiresof0.05mmdiameterfordisplacedfracturesororthodonticelasticsof5/16” (7.9mm) forminimally‐displaced fractures. Themeandurationof IMFwas14dayswith89.35%ofpatientshaving satisfactoryocclusal relationshipbut46.4%hadmandibulardeviation during mouth opening. A longer duration of IMF, (>30days) was found to beassociated with limitedmouth opening (<40mm). Those who had IMF for 14 days showedsatisfactoryoutcomewithmouthopeningofmorethan40mm,andnoocclusalderangementormandibulardeviationwhileopening.Conclusion: Thenon‐surgicaltreatmentfor condylarfracturesseen inthiscentre showedsatisfactoryoutcomes.Howeverthere isstillaneedtorevisethecurrenttreatmentmodalityandthefollow‐uprehabilitationexercisetoensurethesuccessoftreatmentinfuture.Keywords:condylarfractures,occlusalderangement,mandibulardeviationsPosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenangandatQuality Initiatives&1st JohorOralHealthResearchConference,10‐11 June2009atSultanIsmailHospital,JohorBahru

Dr.RohanaSujakDr.NurlizaAbdRazakBothofOralSurgeryDepartmentSultanahFatimahSpecialistHospitalMuarJohor

61

OSTEOGENICSARCOMASOFTHEJAWBONES:A40‐YEARREVIEWOF61CASESAjuraAJ,LauSH

Objective: To determine the clinicopathological features of osteogenic sarcomas of themandible and maxilla. Methodology: A retrospective study was carried out on allosteosarcomacasesdiagnosedintheStomatologyUnit,InstituteforMedicalResearch,KualaLumpur from 1967 to 2008. All the data regarding the age of presentation, gender, race,clinicalpresentation,radiographicfindingsanddiagnoseswere retrievedfromcomputeriseddata.Results:Therewere61cases(38malesand23females)withagerangingfrom7to68years.Thepatientscomprisedof29Malays,16Chinese,3 Indiansand13ofotherethnicity.Therewere39casesinvolvingthemandible,19inthemaxillaandin3casesthesiteswerenotstated.Themaincomplaintwaspainlessbonyswelling.Ninecasespresentedasnumbnessofthe associated region. Four patients had history of prior radiotherapy and one patient hadosteosarcoma of the right leg. The radiographic findings which varied from radiolucent toradiopaque lesionswerementioned inonly31ofthecases.Conclusion:Osteogenicsarcomaof the jaws is a rare malignant bone tumour. Over the 40 years, there were 61 casesdiagnosedinourInstituteandtodate,thisisthefirststudyofjawosteosarcomasinMalaysia.Keywords:osteosarcoma,mandible,maxillaPosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.AjuraAbdulJalilDr.LauShinHinBothofStomatologyUnitInstituteforMedicalResearchKualaLumpur

62

AN AUDIT OF 500 CONSECUTIVE CASES OF SURGICAL REMOVAL OF IMPACTED LOWERTHIRDMOLARSDionysiusDD,LimLW,RoyanSJ

Objective: To investigate the occurrence of complications following surgical removal ofimpactedthirdmolars.Methodology:Fivehundredconsecutive casesofsurgicallyremovedimpacted lower third molars carried out at Malacca Hospital from 1st January 2005 wereevaluated. Information was obtained from patient records kept at Department of OralSurgery,MalaccaHospital. Informationrelatedtoage, gender,diagnosis, typeof impaction,modeofanaesthesiaandcomplicationswererecorded.Thosecaseswherethepatientfailedto attend post‐operatively were excluded from analysis. The rate of complications wascomparedtotheotherdatacollected.Results:Atotalof500caseswereaudited. Sixtyonepatients (12.2%) did not attend follow‐up. Complications were seen in 53 of the remaining439patients(12.1%). Infectionwasthemostcommoncomplication,seen in32cases(7.3%).Dry socket was noted in 16 cases (3.6%). Sensory deficit to the inferior dental and lingualnerveswas seen in5 (1.1%)and3 (0.7%) cases.A significantlyhigher rateof complicationswas noted amongst women as compared to men (14.1%, 9.6%, p=0.047). Pre‐existingpathologysuchaspericoronitis,cariesanditssequelaewerenotsignificantlyassociatedwithahigher rateofpost‐operativecomplications.Conclusion: Thecomplicationratefrom lowerthird molar surgery was 12.1%. Infection was the most frequently seen complication.Thefemale gender was significantly associated with increased incidence of post‐surgicalcomplications.Keywords:thirdmolarsurgery,complications,infectionPosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.DionetteDelittaDionysiusLimLiWoeiDr.StephenJosephRoyanAllofDepartmentofOralSurgeryMalaccaHospitalMalacca

63

TOOTHFRAGMENTEMBEDDEDINTHELOWERLIPAFTERDENTALTRAUMA:ACASEREPORTNuriahM,RoyanSJ

The presence of tooth fragments embedded in soft tissue following trauma is uncommon.Complications suchas infectionand foreignbody reactionmay resultwhen such fragmentsarenot removed. In this report, a case ispresentedwhereamissed tooth fragment in thelower lip resulted in chronic infection. This case describes a patient who was involved in amotorvehicleaccidentand sustaineda lacerationwound.Whilepalpating the tissueof thelower lip, we felt the presence of a foreign body. This was confirmed by a soft tissueradiographofthelowerlipthatshowedaradiopaquematerial,similartoatoothfragment.Itwassurgicallyremoved.Subsequentlythelowerlipwoundhealeduneventfully.Keywords:toothfragments,lowerlip,dentaltraumaPosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.NuriahMohamedDr.StephenJosephRoyanBothofDepartmentofOralSurgeryMalaccaHospitalMalacca

64

CALCIFYINGEPITHELIALODONTOGENICTUMOURINMANDIBLENormaJA case of calcifying epithelial odontogenic tumour in the mandible presented at the OralSurgeryDepartment,QueenElizabethHospital,KotaKinabalu,Sabah.Calcifyingodontogenictumour,alsoknownasPindborgtumour,israreandfewerthan200caseshavebeenreportedintheliterature.Itcommonlypresentsasapainless,slow‐growingswellinginthemandibleormaxilla. The tumour has bizarre microscopic features which can be mistaken for a poorlydifferentiated carcinomamicroscopically. Long‐term experience with this tumour is lackingand treatment varies from conservative curettage and enucleation to local resection. Arecurrencerateofabout14%hasbeenreportedandtumourstreatedbycurettagehavethehighestfrequencyofrecurrence.Thispaperpresentsa casewhichwastreatedbyresectionandreconstructedusingcancellousboneinatitaniummeshtray.Paperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.NormaJalilOralSurgeryDepartmentQueenElizabethHospitalKotaKinabaluSabah

65

AUDITON‘REJECTED’SPECIMENSSENTTOSTOMATOLOGYUNIT, INSTITUTEFORMEDICALRESEARCHFORYEAR2007AjuraAJ,LauSHIntroduction:TheStomatologyUnit,InstituteforMedicalResearch,KualaLumpuristhemainoralpathologydiagnosticlaboratoryintheMinistryofHealthMalaysia.Oralbiopsyspecimensarereceivedeachyearfromhospitalsanddentalclinicsofboththepublicandprivatesectorsinthe country.Objective:Aspartofqualityassuranceofahistopathology laboratory,afewinternal audits were carried out. One of the internal audits that were done in 2008 is todetermine the number of specimens received in 2007 that were supposed to be rejected(however processed) and to identify the cause of the ‘rejection’.Methodology: Rejected(however processed) letters (IMR/CaRC/STOMA/25/2511) which had been completed andreturned to the sender were analysed. Specimens are considered being ‘rejected’ if therequestform is incomplete,specimen isnotsubmitted in theproperfixativeorspecimen isnotproperly labelled.Results:Outof1,542specimensreceived,21(0.01%)specimenswereconsideredrejected;12specimenbottleswerenotlabelled,7specimenswerenotsubmittedin theproper fixative,1 request formwas incompleteand in1 case the specimenwasnotsubmittedinaproperfixativeandthebottlewasnotlabelledaswell.Forspecimenswithoutlabelling;3 caseswerefromMuar,2eachfromSibuandKuala LumpurHospitaland1eachfrom Paedodontic Johor, Kuala Terengganu, Kuching, Kluang and Paedodontic Ipoh. Out of7casesofwhichthespecimenswerenotsubmittedinaproperfixative,3werefromSeberangJaya, and 1 each from Paediatric Institute, Sibu, Kuala Terengganu and Johor Bharu.Conclusion:Althoughthenumberof specimensthatweresupposedtoberejected issmall,clinicians should be aware of the general procedure for submission of specimens forhistopathologicalexaminationandtheimplicationsifprocedureisnotmet.Paperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.AjuraAbdulJalilDr.LauShinHinBothofStomatologyUnitCancerResearchCentreInstituteforMedicalResearchKualaLumpur

66

THE PATTERN OF MAXILLOFACIAL FRACTURES IN MINISTRY OF HEALTH HOSPITALSMALAYSIAWanMahadzhirM, Tay KK,ChelvanayagamPI, KhairiyahAM,Md. YusoffN, Abdul RahmanR,MaBC, Yuen KM,RoyanSJ,JesuVC,VincentC,RusdiAR

Objective:Toassessthepatternoffacialfracturesat23Malaysianhospitals.Methodology:Aone‐yearprospectivestudywascarriedout.Thedatacollectedincludeage,gender,ethnicity,aetiology,sitesof fracturesandtreatment.Results:Atotalof2,101fractureswerefound in1,862patients.Mostfracturesoccurredintheagerange20to29yearsold(mean29.2,642cases,34.5%).Menweremore commonlyaffected (6males:1 female).Malays (62%)werethemost commonlyaffectedethnicgroupfollowedby Indians(14.4%),Chinese(14.1%)andforeigners (5.9%). Most fractures were caused by road traffic accidents (RTAs) (79.59%),assaults (7.62%) and falls (6.50%). The majority of RTA cases involved motorcyclists.The commonest bones involved were the mandible (51.2%), followed by zygoma (23.6%),maxilla (19.8%), isolated orbital (3.9%), nasoethmoidal (19, or 0.9%) and frontal bonefractures(15,0.7%).Thecommonestmethodoftreatmentusedwasconservativetreatment(33.2%), followed by open reduction and internal fixation (31.5%), and closed reduction(29.6%).However,4.7%ofthepatientsrefusedtreatment.Conclusion:MaxillofacialfracturesasaresultofRTAsarestillveryhighandareusuallyassociatedwithmotorcyclistsandpillionriders. Current preventive measures have little impact on the incidence of road trafficaccident‐relatedfacialfracturesinMalaysia.Keywords:maxillofacialinjuries,fracture,hospitals,facialbones,MalaysiaPaperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.WanMahadzhirMustafaDepartmentofOralSurgeryKualaLumpurHospitalKualaLumpurDr.TayKengKiongDepartmentofOralSurgeryKuchingGeneralHospitalSarawakDr.PeaceIndraniChelvanayagamDepartmentofOralSurgeryTengkuAmpuanRahimahHospitalKlangSelangorDr.KhairiyahAbd.MuttalibOralHealthDivisionMinistryofHealthMalaysiaF.T.PutrajayaDr.Md.YusoffNajardinDepartmentofOralSurgeryAlorSetarHospitalKedah

67

Dr.AbdulRahmanRazaliDepartmentofOralSurgerySeberangJayaHospitalPenangDr.MaBeeChaiDeparmentofOralSurgerySultanahAminahHospitalJohorBahruJohorDr.YuenKarMunDepartmentofOralSurgeryIpohHospitalPerakDr.StephenJosephRoyanDepartmentofOralsurgeryMalaccaHospitalMalaccaDr.VincentCelestineJesuDepartmentofOralSurgeryTengkuAmpuanAfzanHospitalKuantanPahangDr.ChristopherVincentDepartmentofOralSurgerySelayangHospitalSelangorDr.RusdiAbd.RahmanDepartmentofOralSurgeryKotaBharuHospitalKelantan

68

CHROMOSOME ABERRATION TEST FOR HYDROXYAPATITE IN HUMAN OSTEOBLAST CELLLINEChangCS,KannanTPObjective:Hydroxyapatiteisthemajorcomponentandanessentialingredientofnormalboneand teeth. Cell and tissue culture models make it possible for us to study the biologicalresponsesofcellstoawiderangeofstimuli invitro rightdowntothemolecular level.Thisstudyaimstofindthepossiblemutageniceffectofsynthetichydroxyapatite(manufacturedbyUniversiti Sains Malaysia, Penang) on chromosome of human osteoblast cell line.Methodology: Human osteoblast cell line (CRL 1543 – ATCC) was exposed to synthetichydroxyapatite (5 mg), distilled water and Mitomycin C both with and without metabolicactivation system at different time intervals. Colcemidwas added to arrest cell division atmetaphase. The cells were then washed in phosphate‐buffered saline and trypsinised,followedbyhypotonictreatmentandfixation.Thechromosomeswereprepared,stainedandanalysedforchromosomalaberrations.Results:Mean(SD)mitoticindicesof4.88(1.01)and4.11(0.99)percentwereobtainedforthetreatmentwithhydroxyapatitewithoutandwiths9for 6 hours respectively and 4.72 (1.13) and 4.96 (1.15) percent for direct treatment withhydroxyapatitefor24hoursand48hoursrespectively.Similarly,themean(SD)mitoticindiceswere 5.16 (1.85), 4.75 (1.16) and 2.47 (0.82) percent respectively for the treatment withdistilledwater (withandwithout s9)andMitomycinC (with s9) for6hours.Only cell linestreated with Mitomycin C exhibited chromosomal aberrations. Conclusion: Synthetichydroxyapatiteisnon‐cytotoxicanddoesnotproducechromosomalaberrationsinthehumanosteoblastcellline(CRL1543).Paperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.ChangChiewSinnSungaiBakapDentalClinicPenangDr.T.P.KannanSchoolofDentalSciencesUniversitiSainsMalaysiaPenang

69

GENEEXPRESSIONANALYSISOFOSTEOBLASTSSEEDEDINCORALSCAFFOLDFooLLH,SuzinaSAH,KannanTP,AzlinaAObjective: To examine the gene expression level of osteoblast specific genetic markers;RUNX2, osteopontin, ALP and osteocalcin from osteoblasts seeded in coral scaffold.Methodology: Processed coral scaffold were cut into 30mm in diameter disc. OsteoblastswereinoculatedontothecoralinDulbeccoMinimumEssentialMedia(GIBCO,USA).ThecellsweretrypsinisedonDay1,7,14,18,and21;addedwithRNALaterforpreservationofRNAincells and kept frozen at‐80o until used. The RNA was extracted using RNA extraction kit,PureLink micro‐to‐midi (Invitrogen, Germany). The respective genes were amplified usingRT‐PCRkit(Qiagen,Germany)andanalysedqualitativelyon1.5%agarosegel.Theexpressionswere evaluatedbasedon the intensityofband fordifferentperiodof cellharvest.Results:RUNX2/Cbfa 1, osteopontin, ALP were expressed constantly from day 7 till day 21 byosteoblasts seeded in coral. Osteocalcin was expressed on day 14 and day 18.Conclusion:Increased expressions of the RUNX2/Cfba 1, osteopontin, ALP and osteocalcin genes provethat coral is a favorable carrier for osteogenetically‐competent cells to attach and remainviable.Paperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.LenieFooLeanHeongTamanEhsanDentalClinicGombakDistrictSelangorDr.SuzinaSheikhAbdulHamidDr.T.PKannanMs.AzlinaAhmadAllofSchoolofDentalSciencesUniversitiSainsMalaysiaPenang

70

SHEDFROMPRIMARYMOLARSYapWY,SitiNoorFazliahMN,SaidiJObjective: Stem cells fromhuman exfoliateddeciduous teeth (SHED)werediscoveredbyagroupofresearchersin2003.Theyexhibitedanabilitytogrowmuchfasteranddoubledtheirpopulation in culture at a greater rate, suggesting SHEDmay be in amore immature statethan adult stem cells. The objective was to isolate stem cells from dental pulp of primarymolarswhichcanbeusedasapossiblesourcefortissueengineering.Methodology:Humanprimary molars were collected from subjects aged 4‐7 years old under standardisedprocedures.Within24hours,thetoothwascutatthecemento‐enameljunctionusingahardmaterial cutter. The sectioned tooth was briefly immersed in 75% ethanol and soaked inPhosphate Buffer Saline. The pulp was separated from the crown and then digested in asolution of 3 mg/ml collagenase type I (Worthington Biochem, Freehold, NJ) and 4mg/mldispase(BoehringerMannheim)for1hourat37oC.Single‐cellsuspensionswereobtainedbypassing the cells througha70‐umstrainer (Falcon)and culturedwithalphamodificationofEagle’s medium supplemented with 20% Fetal Bovine Serum, 100 µM L‐ascorbic acid2‐phosphate, 2 mM L‐glutamine, 100 units/ml penicillin, 100 µg/ml streptomycin,and incubated at 37oC in 5% CO2. The culture was observed daily under microscope.Immunohistochemistry confirmationwasdoneusingCD105andCD166.Proliferativeactivityof SHED was determined using alamarBlueTM kit. Results: The cell changes its shape fromrounded to fibroblastic‐like. Tooth pulp‐derived progenitor cells were found positive forCD105andCD166(mesenchymal lineagemarkers),whichareconsistentwiththefindingforhumanmesenchymalstemcells (HMSC).ProliferativeactivityofSHEDishighercomparedtoHMSC.Conclusion:Aclonogeniccellpopulationwasisolatedfromdentalpulptissuesandhashigh proliferative activity. Stem cells from dental pulp can be a possible source for tissueengineeringinthefuture.Paperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.YapWaiYingOralHealthDivisionPenangDr.SitiNoorFazliahMohdNoorDr.SaidiJaafarBothofSchoolofDentalSciencesUniversitiSainsMalaysiaPenang

71

PERIOPERATIVE ORAL ANTIBIOTICS IN THIRD MOLAR SURGERY: DO THEY MAKE ADIFFERENCE?RoyanSJ,KamsinahO,ZuhaibahMObjective:Toevaluatetheusefulnessofantibiotics inpreventingpost‐operative infection inthirdmolar surgery.Methodology: The study was retrospective with information obtainedfrompatientrecords.Theoperationscarriedoutbytwosurgeons inthecourseoftwoyearswere studied. In2002,SurgeonA routinelyprescribedOralMetronidazole400mgtdspost‐operativelyforfivedays(GroupA02)whereasSurgeonBprescribedOralMetronidazole800mgpre‐operativelyand2dosesof400mgpost‐operatively(GroupB02). In2003,antibioticswere not routinely prescribed by either surgeon (Group A03 and B03). The proportion ofpost‐operative infectionsseen inGroupsA02andA03andthatinGroupsB02andB03werecompared.Results:Thenumberof infections inGroupA02wasoneoutof35and inGroupA03,twooutof43.Outof36patients inGroupB02,therewerenoinfectionsand inGroupB03, it was three out of 43. However, using Fisher’s exact test, there was no statisticallysignificant difference between the infections seen in Groups A02 and A03 (p=1.000) andGroups B02 and B03 (p=0.109) respectively. Conclusion: No significant benefit could bedemonstrated by administering perioperative oral antibiotics to prevent post‐operativeinfectioninthirdmolarsurgery.Keywords:thirdmolarsurgery,perioperativeantibiotics,prophylaxis,post‐operativeinfectionPublication:MalaysianJournalofOral&MaxillofacialSurgery.2007;5:6‐9

Dr.StephenJosephRoyanDr.KamsinahOthmanDr.ZuhaibahMustaphaAllofDepartmentofOralSurgeryMalaccaHospitalMalacca

72

BASEMENTMEMBRANEPROFILEOFKERATOCYSTICODONTOGENICTUMOURHartinieM

Introduction: Keratocystic Odontogenic Tumour (KCOT) is formerly known as odontogenickeratocyst (OKC).Thehighrecurrencerate isauniquecharacteristicofKCOT.Objective:Thepresent study was aimed at determining the presence of Collagen IV, Laminin 5, MatrixMetalloproteinase‐ 2 (MMP‐2) and Matrix Metalloproteinase‐ 9 (MMP‐9) in the basementmembrane(BM)zoneofKCOTinordertogainabetterunderstandingoftheroletheymightplay in the high recurrence rate in KCOTs.Methodology: Haematoxylin and eosin‐stainedsections of 26 KCOT cases were grouped into I). Twelve primary KCOT cases whichhad not recurred (KCOTnR) (n=12), II). Seven primary KCOT cases which had recurred(KCOTwR) (n=7) and III). Seven recurrence KCOT (ReKCOT) (n=7). These were prepared forimmunohistochemical staining forCollagen IV, Laminin5,MMP‐2andMMP‐9with suitablepositive and negative controls.Results: Primary KCOTnR showed Collagen IV expression inhigh percentage (75.0% cases) followed by those found in KCOTwR (28.6% cases). Theexpressions of Collagen IV, Laminin 5, MMP‐2 and MMP‐9 at the BM zone were notsignificantlydifferentbetween theprimary KCOTnRandprimary KCOTwRbutadecrease inthenumberofimmunopositivecasesoftheCollagenIVintheprimaryKCOTnRtotheprimaryKCOTwRandtheReKCOTwasseen.ImmunopositivityforLaminin5,MMP‐2andMMP‐9werealsofound inthebasalandsuprabasalepithelialcells.MMP‐2andMMP‐9 immunoreactivitywerealsodetected inthefibroblastsoftheconnectivetissuestroma.Conclusion:TherewasnostatisticallysignificantdifferenceintheexpressionsofCollagenIV,Laminin5,MMP2andMMP9 at the BM zone between the primary KCOTnR and primary KCOTwR. Collagen IV,Laminin 5, MMP‐2 and MMP‐9 may be involved in the modulation of KCOTs’ basementmembraneintegritybutmaynotbeusedasapredictablemarkerfortherecurrenceofKCOT.This research report is submitted in partial fulfillment of the requirements for the degree of Master of ClinicalDentistry(OralPathology&OralMedicine)

Dr.HartinieMuhamadOralHealthDivisionSelangor

73

EXPRESSIONOFCYCLIND1ANDp27INORALSQUAMOUSCELLCARCINOMA

NorNazalizaB

Introduction:CyclinD1regulates cellcycleprogressionbyforminga complexwithdifferentcyclin‐dependantkinases.p27isan inhibitorofcyclindependantkinaseandactsasnegativeregulatorsofthecellcycle.DeregulationofcyclinD1andp27canresultinlossofnormalcellgrowthandtumourdevelopment. Increasedexpressionof cyclinD1andunderexpressionofp27havealsobeencorrelatedwithpoorprognosisinavarietyofhumantumours.Objective:The aim of the present study was to describe the expression of cyclin D1 and p27 in oralsquamous cell carcinoma (OSCC) of buccal and alveolar mucosa and also to investigatewhetherthereisanyassociationbetweentheexpressionsofcyclinD1andp27withselectedclinicopathologicalparameters (habit,Broders’ tumour grading, tumour size, tumourdepth,patternofinvasion,lymphnodemetastasisandpTNMstaging).Methodology:Thesamplesofthe studyweretakenfromsurgical specimensof31patientswhohadbeendiagnosedwithOSCCofbuccalandalveolarmucosa.Thesurgicalspecimenswereobtainedfromthearchivesof the Oral Pathology Diagnostic Laboratory. The sociodemographic and clinical data wereobtained from theMalaysianOral CancerTumourandDatabase Systemat theOral CancerResearchandCoordinatingCentre (OCRCC).Of the31patients, 25 (81%)were femalesand6 (19%)weremales.Overall age ranged from41 to86yearswithameanageof62 ±9.93years. TheOSCCpatients consistedof24 (78%) Indians,6 (19%)Malaysand1(3%) Chinese.TheexpressionsofcyclinD1andp27weredemonstratedwith immunohistochemistryusingtheEnvisionsystem.ImmunoreactivityevaluationofcyclinD1andp27wasperformedusingthe image analyzer. For analysis of cyclin D1 and p27 expressions, positive staining wasconsidered when there is more than 5% and 10% of nuclear reactivity in the selected cellpopulationobservedrespectively.StatisticalcorrelationsbetweencyclinD1orp27expressionandcertainclinicopathologicalparametersofOSCCwereanalyzedusingchisquareorFisher’sexacttest.Results:CyclinD1positivityandreducedexpressionofp27wasdetected in74%and 87% of the cases respectively. The distribution of cyclin D1 immunoreactivity wasobservedmainlyattheperipheryofthetumour islandsattheinvasivefrontwithdecreasingimmunoreactivity towards the centre. No immunoreactivity was seen within the keratinpearls.Thedistributionofp27expressionappearedtobeoppositetothecyclinD1expressionwhereabsentandlowimmunoreactivitywasobservedmainlyattheperipheryofthetumourislandsattheinvasivefront.ThepresentstudyfoundsignificantcorrelationbetweencyclinD1positivitywith larger tumour greatestdimension (T3andT4) (p =0.012), tumourdepth>8mm (p = 0.043), non cohesive pattern of invasion (p = 0.001) and advanced pathologicaltumourstage(III‐IV)(p=0.003).Reducedp27expressionwassignificantlyassociatedwithnoncohesive pattern of invasion (p = 0.043). Conclusion: The present findings showedoverexpressionof cyclin D1andunderexpressionofp27 inOSCCof thebuccal andalveolarmucosa. These findings support other findings that cyclin D1 and p27 are involved in oralcarcinogenesis. There is a significant correlation between overexpression of cyclin D1 andunderexpression of p27 with some clinicopathological parameters which are knownindependentprognostic indicators. Thus, these results suggest thatoverexpressionof cyclinD1andunderexpressionofp27maybeusedasprognosticmarkers forOSCCofbuccal andalveolarmucosa.

This research report is submitted in partial fulfillment of the requirements for the degree of Master of ClinicalDentistry(OralPathology&OralMedicine)

Dr.NorNazalizaBasriOralHealthDivision,Selangor

74

THEINTERCANTHALANDINTERPUPILLARYDISTANCESOFTHREEMAJORETHNICGROUPSINMALAYSIASharifahTahirahAJ,NgeowWCThe normal range of intercanthal distance (ICD) and interpupillary distance (IPD) have onlybeen reported in one minor ethnic group in Malaysia, the KadazanDusun. The aim of thisstudywastoestablishthe ICDand IPD inthethreemajorethnicstocks inMalaysia,namelytheMalays,Chineseand Indian.Atotalof300samplesconsistingof50adultmalesand50adult females of each ethnic stock were recruited from the campus of the University ofMalaya. ICDwasmeasuredbetweenthemidpointsofthepupils.Measurementsweredonetwicetothenearest0.5mmbyoneresearcherusingacalliperandametalruler.Ameanwastakenoutofthesetwomeasurements.Ifthereweremajordiscrepancies,athirdreadingwastakenandthetwoclosest‐measurementswereaccepted.InICDmeasurement,themeansofallthreegroupswerehighlysignificantlydifferentfromeachother.Thewidestspacebetweeninner canthus was recorded in both sexes of the Indians. Gender variation is statisticallysignificantwherethemalestendtohaveawiderintercanthaldistancecomparedtofemalesinall threeethnicgroups.TherewasnosignificantdifferencebetweenthemeanIPDvaluesamong the three ethnic groups. However highly statistically significant difference(independentt‐test<0.001)wasseenwhencomparingthetwosexes;themalegenerallyhadawiderIPDtothefemaleinalltheraces.TheICDandIPDinthisstudywerewithintherangeofthoseintheKadazanDusun,whites,blackandmixedpopulations.Keywords:intercanthaldistance,inter‐pupillarydistance,anthropometry,ethnicPublication:MalaysianJournalofOral&MaxillofacialSurgery.2007;5:3‐5

Dr.SharifahTahirahAlJunidClinicalSpecialistinOralSurgerySerembanHospitalNegeriSembilanAssociateProfessorNgeowWaiCheongDepartmentofOralandMaxillofacialSurgeryFacultyofDentistryUniversityofMalayaKualaLumpur

75

BISPHOSPHONATESANDOSTEONECROSISOFTHEJAW:AHIGHLIGHTKanagaratnamSS,JeyaRamanJSReportsofBisphosphonate‐inducedOsteonecrosisofJaw(BONJ)areincreasinglatelyanditsdevelopment isassociatedwithoralhealth.ExactpathogenesisofBONJ remains ill‐defined.Complexinterplayofmultipleriskfactors,especiallydentalsurgery,alteredbonemetabolismsecondarytoBisphosphonate(BP)therapyanddurationofexposureofanindividualtoBPareassociatedwiththepathologicalpresentation.Clinicalsignsandsymptomsmayvaryforeachpatient. Adherence to recommended dental treatmentmay reduce risk of development ofBONJ.AimoftreatmentofBONJcurrentlyistocontrolthepathologyanddiscontinuationofBPtherapyattheonsetofBONJisdebatable.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.SivakamaSunthariKanagaratnamConsultantOralSurgeonOralSurgeryDepartmentAmpangHospitalSelangorDr.J.SureinthirenJeyaRamanDentalOfficerOralSurgeryDepartmentAmpangHospitalSelangor

76

CRANIOFACIAL ANTHROPOMETRY: A COMPARISON BETWEEN MALAY AND ORANG ASLIKUALA RoslizaP

Introduction: Direct craniofacial anthropometry is a simple and non‐invasivemethod that isuseful togather informationon the facialprofileof variousethnicgroups for thepurposeofphysicalanthropology study,ergonomicstudyandtheplanningof craniofacial reconstructivesurgery.Objective: Theaimof this cross‐sectional studywas todetermine thedifferences incraniofacial morphology between the Malay and Orang Asli Kuala in Peninsular Malaysia.Methodology: A series of 21 direct anthropometric craniofacial measurements wereperformedon120healthysubjectsofbothethnicgroups.Therewere30femalesand30malesbetween 18 to 45 years of age who were recruited into each group. Subjects of mixedparentagewereexcluded. StandardanthropometrymethodasoutlinedbyFarkas(1994)wasused.Seventeenproportion indiceswerederivedfromthemeasurementsobtained.Thedatawerecomparedusingindependentt‐testwiththesignificantvaluesetat95%(p<0.05).Results:Comparisons between both groups showed several similarities and differences in theircraniofacial features. Almost all the significant differences were found in the verticalmeasurements (v‐n, v‐gn,n‐gn,n‐sto, sto‐gn,ps‐pi,n‐sn)while thehorizontalmeasurements(eu‐eu, g‐op, zy‐zy, go‐go, en‐en, en‐ex, ch‐ch) remained almost equal. Our findings showedthat both ethnic groups shared the samemesocephalic head (mediumwide‐long type), longleptoprosopface(long‐narrowfacetype),similar intercanthaldistanceandeyefissurelength,similarnasaltipprotrusionheightandalmostidenticalorolabialdimensions.However,becauseof the differences in vertical dimensions, some distinguished features were obvious in4regions,namelythehead,face,orbitandnose.TheOrangAsliKualahadlongerhead,shortermidfacebutlongermandibleheightandsmallereyefissureheight.Theyalsopresentedwithachamerrhin nose type (broad; wide alar and short nose) while theMalay presented with amesorrhine (medium width) nose type. This typical Negroid nose type is the most strikingdistinguishingfeaturefortheOrangAsliKuala.Conclusion:ThisstudysuggeststhattheOrangAsliKualamanifestsfacial featuresthatareamixtureoftheAfrican (Negroid)andtheMalayandChinese,bothofwhomareofMongoloid stock.However, the findingof this small scalestudyneeds tobe confirmedbya larger scale, randomisedandpreferably stratified study.Amulti‐researcher calibrated re‐collectionofdatawith standard instrumentsandmethodologyor even by using more sophisticated technology ofmeasurementmay be helpful to ensuremoreaccurateandreliableoutcomesinthefuture.This research report is submitted in partial fulfillment of the requirements for the degree of Master of ClinicalDentistry (Oral & Maxillofacial Surgery) and presented at Quality Initiatives & 1st Johor Oral Health ResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.RoslizaParumoOralHealthDivisionJohor

77

RESEARCHIN

PAEDIATRICDENTISTRY

78

79

A RETROSPECTIVE ANALYSIS OF TRAUMA CASES SEEN IN THE PAEDIATRIC DENTALSPECIALISTCLINIC,SULTANAHAMINAHHOSPITALMohdRidzuanMR,SockalingamGIntroduction:ThePaediatricDental SpecialistClinic,SultanahAminahHospital, JohorBahru,Johor is a tertiary referral centre for paediatric dental / maxillofacial cases in the southernregion of Peninsular Malaysia. The clinic receives referrals for themanagement of a widespectrumofconditionsincludingmaxillofacialtraumaanddentalinjury.Objective:Theaimofthisstudyistoreporttheoccurrence,aetiology,demographicandclinicalfeatures,treatmentmodalities,patternandtimeofreferraloftraumacasesseeninoursetting.Methodology:Aretrospectivereviewwasconductedon67dentalrecords(yellowcards)ofchildrenreferredto the clinic formanagement ofmaxillofacial and dental trauma throughout 2008.Results:Outof1,030newcasesseenoverthestudyperiod,6.5%patientspresentedwithmaxillofacialand/ordentaltrauma.Themeanagewas5.9±3.4years.Femaletomaleratiowas1:2.35.Malayscomprisedthemajority (82.1%)followedbyChinese (13.4%)and Indians(4.5%).Fallwas themost common aetiology. Fifty three cases presentedwith soft tissue injuries. Fiftysevenpercentofthesubjectssustaineddentalinjurywhileonly11.9%ofcasessufferedbasalbonefracture. Localanaesthesiawith sedationwasthepreferredmodeofanaesthesia.Themajority of the cases were referred from Accidents & Emergency Department and slightlymore than half were seen during office hours. Conclusion: Soft tissue injury is the mostcommonpresentationintraumacasesinpaediatricdentalpatients.Keywords:paediatric,trauma,clinicalpatternPaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.MohdRidzuanMohdRaziDr.GanasalingamSockalingamBothofPaediatricDentalSpecialistClinicSultanahAminahHospitalJohorBahruJohor

80

ARETROSPECTIVESTUDYOFTHEINCIDENCEOFMISSEDAPPOINTMENTSWITHTHEDENTALNURSE AT THE PAEDIATRIC DENTAL SPECIALIST CLINIC, SULTANAH AMINAH HOSPITALJOHORBAHRUNoormadiyaY,Mohd.RidzuanMR,SockalingamGIntroduction:ThePaediatricDentalSpecialistClinic,SultanahAminahHospital isoneofthetwo referral centres for paediatric dental and maxillofacial cases for the state of Johor.Consultationandtreatmentaregivenbyappointmentexceptforemergencycases.Onetimeslot isusuallybooked for eachpatient.Whenpatientsdonot turnup for theappointmentthen the slot is not utilised. Missed appointments present a significant problem in theeffectiveandefficient runningofthe clinic.Objective:Theaimofthisstudy istodeterminethe percentage of failed appointments with the dental nurse over a period of 1 year fromJanuary2008–December2008.Methodology:Aretrospectivereviewwasconductedonthedental nurse’s appointment book for the year 2008. Attendances were assigned to threegroups: attended appointment, missed appointment with notice and missed appointmentwithoutnotice.Results:Outofatotalof795casesseeninyear2008,24.5%failedtoattendtheirappointments.Malayscomprisedthemajority(65.2%)followedby Indians(14.4%)andChinese (18.9%). Female to male ratio was 1:1.2. Primary schoolchildren were the largestgroupofpatientswhofailedtoattendappointments.ItwasalsonotedthatthehighestperiodforfailedappointmentsoccurredfromJulytoSeptember.Conclusion:Missedappointmentscancauseadisruptionofclinicaltimemanagementandalsodelaytreatmentforthepatients.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.NoormadiyaYusoffDr.MohdRidzuanMohdRaziDr.GanasalingamSockalingamAllofPaediatricDentalSpecialistClinicSultanahAminahHospitalJohorBahruJohor

81

DELAYEDERUPTIONOFUPPERPERMANENTINCISOR:ACASEREPORTJamilahOFailure of eruption of incisors can cause problems in the adult dentition. There aremanyfactorsleadingtodelayedorfailederuption.Localfactorsliketrauma,ectopiccryptposition,cystic change in the follicle, thickenedmucosa,presence of supernumeraryandodontomesmay prevent eruption of a permanent incisor. Systemic factors may include Cleidocranialdysplasia, Gardner syndrome or some endocrine disorder. Early diagnosis is vital and anumber of options are available for treatment. This clinical case report describe themanagement of a 13‐year‐old Chinese schoolgirl presenting with delayed eruption of herupperright incisortooth.Surgical removaloftheobstructionthathasdelayedtheeruptionledtothespontaneouseruptionoftheupperrightincisorintotheoralcavity.Timingandthesequenceofpermanent teeth eruptionwill influence the integrationof thedentition.Earlydiagnosisisessentialasitincreasesthechancesofasuccessfuloutcomeandthechancesoftheuneruptedincisoreruptingwithoutthenecessityforappliancetherapy.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.JamilahOmarDepartmentofPaediatricDentalSurgerySultanIsmailHospitalJohorBahruJohor

82

A RETROSPECTIVE CLINICO‐STATISTICAL ANALYSIS OF LIP MUCOCELE OCCURRENCE INCHILDREN BELOW 16 YEARS SEEN AT THE PAEDIATRIC DENTAL SPECIALIST CLINIC,SULTANAHAMINAHHOSPITAL,JOHORBAHRUSockalingamG

Objective:Theobjectiveof this study is to report theoccurrenceandclinical findingsof lipmucocelesinchildren.Methodology:Theperiodofstudywas3yearsbeginning2003to2005.Treatmentcards(L.P8‐2Pin.7/97andL.P8‐Pin.6/89)ofallpatientsseenattheclinic intheyears2003,2004and2005wereretrieved.Allcardsofpatientsinwhomaclinicaldiagnosisoflipmucocelewasmadewere then selected.Requireddatawas recordedand subsequentlyanalysed.Results:Outof1,407newcasesseenovertheperiodofstudy,17 (1.2%)patientspresented with lip mucoceles. All lesions occurred in the lower lip. There was no sex orracial predilection. The average duration of the lesion prior to seeking treatment was2.8±2.8months.Mostpatients(76.5%)firstsawamedicalpractitionerfortheproblem.Nospontaneousresolutionofthelesionsinanyofthepatientswasnoted.Thepreferredmethodof treatment of lower lip mucoceles in children is surgical excision of the involved minorsalivary glands.Conclusion: Salivary glandmucoceles in children predominantly involve thelowerlipandcanbetreatedsuccessfullybycompleteremovaloftheinvolvedandassociatedminorsalivaryglands.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.GanasalingamSockalingamPaediatricDentalSpecialistSultanahAminahHospitalJohorBahruJohor

83

FACIALCELLULITISOFODONTOGENICORIGININCHILDRENSarimahMM,Nor‘AdlinA,AhmadFaisalIObjective:ThepurposeofthisstudywastoinvestigatetheclinicalhistoryandcharacteristicsoffacialcellulitisofodontogenicorigininchildrenreferredtothePaediatricDentalSpecialistClinic, RajaPerempuanZainab IIHospital, Kota Bharu.Methodology:Allpatientswhowerediagnosed with this condition from January 2008 until August 2009 were included in thisstudy.Thepersonaldata, clinicalhistoryandcharacteristicsof the conditionwere recordedfrom the casenotes, location, symptomsof cellulitis, the lengthofhospitalisation,modeoftreatment,historyof visit to thedentist, caries experienceandmanagementof thepatientwerenoted.Descriptiveanalysiswasused toanalyse the datausingWindowsSPSSversion13.0.Results:Thirtyninesampleswere collected;22or56.4%weremalesand17or43.6%werefemales.Themeanagewas6.69±3.50.Itwasfoundthat94.5%hadtoothachepriortoswellingand 51.3%had fever.A totalof74.1%hadmore than6 teeth cariouswhile61.5%required hospitalisation and the mean length of stay in hospital was 2.94 ± 3.43 days. Amajority of 71.4% were treated under local anaesthesia while 28.6% were treated undergeneralanaesthesia.Conclusion:Facialcellulitisisverydebilitatingtopatients.The lowlevelofdentalcarewasevidentwheremanypatientswerehighlyaffectedbydentaldiseasesandmostwereneverbroughttoseethedentistbeforedevelopingthecellulitis.Theimplicationoffacialcellulitisonhealthcarecostcanbeappreciatedbytheamountofcareneededoncethechildrendevelopthedisease.Some requiredadmission intohospitalandtheuseof generalanaesthesia. Since dental caries is a preventable disease, it is important that prevention ofcaries at the community level, particularly in Kelantan, is revised and strengthened. Facialcellulitisofodontogenicorigin implyanunnecessaryincrease inhealthcareserviceburden intermsofpersonnel,timeandcost.Paperpresentedat6thNationalHealthConferenceon28–30September2009atUniversitiSainsMalaysia,KubangKerianKelantan

Dr.SarimahMohd.MokhtarDr.Nor‘AdlinAbdullahDr.AhmadFaisalIsmailAllofDepartmentofPaediatricDentalSurgeryRajaPerempuanZainabIIHospitalKelantan

84

CLINICAL REVIEW ON FACIAL SOFT TISSUE INJURY AMONG CHILDREN ATTENDINGPAEDIATRIC DENTAL SPECIALIST CLINIC IN SULTANAH NUR ZAHIRAH HOSPITAL,TERENGGANUFarahNatashaM,YushainiAObjectives: 1) To determine the age of patients frequently involved with facial soft tissueinjury 2) To investigate the location of facial soft tissue injury 3) To assess the time ofmanagement of soft tissue injury 4) To evaluate the outcome of treatment of soft tissueinjury.Methodology:DatawascollectedretrospectivelyfrompatientfoldersinthePaediatricDental Specialist Clinic, Sultanah Nur Zahirah Hospital, Kuala Terengganu. The samples arepatientswho sustained soft tissue injury from the period of January 2006 until June 2008.There were 267 patients involved. These data were processed using SPSS version 13.0.Results:Childrenfromtheageof3to16arefrequentlyinvolvedwithsofttissueinjuries(30%in 7‐12 age group, 29% in 13‐16 age group and 25% in 3‐6 age group). Themost commonlocation for facial soft tissue injury was at the lower third of the face (59%) followed bymultiplelocations(29%).Atotalof92%ofthepatientshadimmediatetreatmentwhileothersweretreatedmorethan1day later.Mostofthemanagement carriedoutwastoiletingandsuturingunderlocalanesthesia(70%)followedbyobservationonly(30%).Amajorityof76%of thepatientsweregivenbothanalgesicsandantibiotics formedication.On review,morethan90%patientshadnopain,noinfectionandnormalmouthopening.Conclusion:Childrenagedbetween7‐12yearsoldaremoreprone to soft tissue injuries thanotherage groups.Most injuries occurred in the lower third of the face. Commonly, immediate toileting andsuturing, analgesics and antibioticwere given as themanagement. The overall outcome ofsofttissueinjurymanagementwasgood.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.FarahNatashaMohammadMarangDentalClinicTerengganuDr.YushainiAhmadPaediatricDentalSpecialistSultanahNurZahirahHospitalKualaTerengganuTerengganu

85

RESEARCHIN

ORTHODONTICS

86

87

THEFREQUENCYOFSKELETALPROBLEMSAMONGORTHODONTICPATIENTSATTHEMUARORTHODONTICSPECIALISTCLINIC,JOHORNorizanA

Introduction:Therelationshipofskeletalfacialpatternhasbeenacriterionduringtheclinicalexaminationfororthodonticpatients.Thisskeletalevaluationisusefulfortheorthodontisttoprioritise and plan treatment for the patient.Objective: The purpose of this study was toassess the frequency of skeletal problems among orthodontic patients and to identify thefrequency of the problems according to their age, ethnicity, gender and type of treatmentthey have received.Methodology: The studywas done at theMuar Orthodontic SpecialistClinic, Johor. A retrospective study was conducted on a sample of 335 patients. A randomsampling was employed involving collection of data from the year 2000 to 2007. All theinformationcollectedfromtheLP7treatmentcardwasfilledinthedatacollectionform.Datawereanalyseddescriptively.Results:ThefrequencyofClassIIandClassIIIskeletalproblemsamongorthodonticpatientswashigh(62%)with46%ofthemhaveClassIIandtheremaining(16%) with Class III skeletal problem. Themost commonly affected age groupwith skeletalproblemwasbetween13‐17years‐old(69%).ThehighestfrequencyofskeletalproblemwasamongtheChinese(45%)whiletheMalayhadthesecondhighestofClassIIskeletalproblem(34%).ThefrequencyofClassIIandClassIIIskeletalproblemswashigheramongthefemales(70%)comparedtothemales(30%).Mostofthepatientswithskeletalproblems(94%)weretreatedwithfixedappliances.Conclusion:ThemostfrequentClassIIandIIIskeletalproblemswereamongtheChinese,agegroup13‐17yearsandfemales.Mostofthemweretreatedwithfixedappliances.Keywords:skeletalII,skeletalIII,frequencyofproblemProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.NorizanAlwiOrthodonticSpecialistClinicMeriamRoad MuarJohor

88

THE FREQUENCY OF SKELETAL PROBLEMS AMONG REFERRAL PATIENTS TO THEORTHODONTICSPECIALISTCLINICWanZurainiWAZ

Introduction: Skeletal problem is evaluated through 3 dimensions which are theanteroposterior, transverse and vertical dimensions. In the anteroposterior dimension,skeletalclassification iscategorised intoClass I,ClassIIandClass IIIskeletalwherebyClassIIandClass IIIaretheskeletalproblems.Inthetransversedimension,skeletalproblemalwaysinvolvethenarrowmaxillaproblem.Theverticaldimensioncancauseanterioropenbiteandanterior deep bite. Objective: This study was done to assess the frequency of skeletalproblems among patients who were referred to the Orthodontic Specialist Clinic, AbdulSamadRoad,JohorBahru.Methodology:Datacollectionwasbasedonreferralcaserecordsin2004.Thesamplesizewas275consistingofmalesandfemales,alsoincludingthe3majorethnic groupswhichareMalay,Chineseand Indian.Results: This studyhas shown that theClassI,ClassIIandClassIIIskeletalproblemswere53%,37%and12%respectively.Theresultsfor malocclusion were Class II Division I (65%), Class I (22%), Class III (12%) and Class IIDivisionII(1%).Fromthestudy,37%and10%ofthesampleshadClassIIandClassIIIskeletalproblem respectively and among those patients, 14.5% had been given early treatment.Conclusion: ItwasfoundthatthefrequencyofClassIIskeletalproblemwashighamongthe275patientswhohadbeenreferredtotheOrthodonticUnit,AbdulSamadRoadDentalClinic.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

WanZurainiWanAbdAzizOrthodonticSpecialistClinicAbdulSamadRoadJohorBahruJohor

89

A STUDY ON THE PREVALENCE OF MALOCCLUSION AMONG CLEFT LIP AND PALATEPATIENTSATTHEORTHODONTICSPECIALISTCLINICINJOHORFarizaT

Cleftisacongenitaldisorderwhichoccursduringcraniofacialgrowth.Cleftlipandpalate(CLP)patients may have other problems which include abnormality in the number of teeth,malformed teeth,malocclusion, and abnormality in the alignment ofmaxilla and occlusionrelationship.Membersof the cleft lipandpalate treatment teamusually include specialistsfrom various disciplines. For orthodontic treatment, the issues are more related to theaestheticandfunctionofteeth.ThisretrospectivestudywasdoneatOrthodonticSpecialistClinic, Johor.Theobjective istoassesstheprevalenceofmalocclusionamongcleftpatientsandthenumberofcleftpatientsaccordingtogenderandethnicgroup;typeofcleftandthetreatmentgiven.Thesubjectswerepatientswhowerereferredfromtheyear2000to2007.Data was collected for a total of 63 subjects from Johor Bahru, Kluang and Batu PahatOrthodonticSpecialistClinics.Fromthestudy,56(89%)hadClassIIImalocclusion,2(3%)hadClass IImalocclusionand5(8%)hadClass1malocclusion.CleftpatientswerehigheramongtheMalays(46%)followedbyChinese(43%)andIndian(11%).Unilateralcleftattheleftsidewas the highest (44.4%) followed by right unilateral cleft (22.2%). Twenty one patients(33.3%)hadbothcleftlipandpalate(BCLP).Orthodontictreatmentinmixedandpermanentdentition for the cleft patients included wearing of quadhelix or upper/lower removableappliance (URA) for arcus development, fixed appliance or combination of both. AlveolarimplanttreatmentwasdonebythePlasticSurgeonorOralSurgeon.Keywords:prevalence,ClassIImalocclusion,ClassIIImalocclusionProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

FarizaTalibAbdulSamadRoadDentalClinicJohorBahruJohor

90

PROBLEMSENCOUNTEREDBYPATIENTSWEARINGTHEREMOVABLEAPPLIANCEMuniandyPL

Introduction: Orthodontic treatment can be done bymoving the teeth with removable orfixedappliances.Activeappliancesworkbysimpletippingmovementswherebytheretainerisapassiveappliancewhichisusedasretentionaftertreatmentwithfixedappliance.Objective:To identify problems encountered by orthodontic patients in the wearing of removableappliancesattheOrthodonticClinic,AbdulSamadRoad,JohorBahru.Methodology:Thisisacross‐sectionalstudy involving80patientsusingremovableappliances.Results: Itwasfoundthat 25 patients were wearing upper/lower removable appliances (URA), 29 patients hadpassive retainers and 26 patients were using functional appliances (Twin Block/ Bionator).Speechproblemswereencounteredby32%ofthepatients,29%feltdiscomfort,followedbybroken appliances (22%), not suitable (13%) and loss of the appliance (4%). Conclusion:Speech problems were the most frequent problems encountered by patients wearing theremovableappliance. ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia PremaLataMuniandyAbdulSamadRoadDentalClinicJohorBahruJohor

91

CRANIOFACIALMORPHOLOGYOF CLASS II DIVISION 1MALOCCLUSION INMALAY ETHNICGROUPINMALAYSIARozaimahMSObjective:ToevaluatecraniofacialfeaturesofClassIIdivision1malocclusionofMalayethnicgroup inMalaysia.Methodology: This study involved fifty one (26males and 25 females)pretreatment lateral cephalometric radiographs of Malay patients with Class II division 1malocclusion selected from the files of Orthodontic Clinic, Dental Faculty of UniversitiKebangsaanMalaysiaandfromtheGovernmentOrthodonticClinic,Bangsar,Kuala Lumpur.The craniofacial features of the Class II samples were compared with Class I controls ofapproximately similarageandnumber. Independentsamplet‐testwasusedtoevaluatethedifferencesbetween sexandbetweenClass IIdivision1andClasss Imalocclusion.Results:Widevariationswereobservedformostofthemeasurements.Class II subjectshave longermaxilla, more convex facial profile, retrognathic mandible and shorter mandibular bodycomparedtoClassIsubjects.Sexdifferencesrelatedonlytosizewheremalesgenerallyhavelarger or longer skeletal features compared to females. Conclusion: The findings haveimportant clinical implicationsregardingtreatmentdecisionsforMalaypatientswithClass IIdivision 1 malocclusion. In addition, this study provides a foundation for further studiespertainingtoClassIIdivision1malocclusionintheMalayethnicgroupinMalaysia.Keywords:ClassIIdivision1,Class1malocclusion,craniofacialfeaturePaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.RozaimahMatShafieiOrthodonticSpecialistClinicMeriamRoadMuarJohor

92

NORMATIVE AND PERCEIVED NEED FOR ORTHODONTIC TREATMENT AMONGSCHOOLCHILDREN

SitiZurianaMZ,RashidahE,IshakAR

Introduction:Thedecisionfororthodonticcareismostoftendeterminedbynormativeneed.However, a person's decision to seek orthodontic treatment is often based on multiplefactors.Objective: To compare the orthodontic treatment need amongst 13 ‐ 14 year‐oldschoolchildrenusing theDentalHealthComponent (DHC) andAestheticComponent (AC)ofthe Index of Orthodontic Treatment Need (IOTN) with the children's perceived need fororthodontic treatment. Methodology: A cross‐sectional study was conducted on 700schoolchildrenattending8secondary schools inJempolDistrict.Amulti‐stageandstratifiedrandomsamplingwasemployed.Children'snormativeneedwasassessedusingtheDHCandACofthe IOTNbyatrained researcherwhiletheirperceivedneedswerematchedbyusingthe photographs on the AC scale.Results: The normative need according to the DHC was27.1%asindicatedbytheneedtreatmentcategorywhiletheACindicated21.9%.About97%oftheschoolchildrenagreedwiththedentistthattheydidnotrequiretreatment.Incontrast,only12.4%agreedwith thedentist that theyneed treatmentbasedon theirAC scores.Nosignificant difference was found between gender or ethnicitywith the children's perceivedneed(p>0.05).BasedonbothDHCandACbydentist, theChinesehadthehighestneedfortreatmentfollowedbytheMalaysandIndians(p>0.05).Conclusion:Perceivedneedamongschoolchildren in certain population is low compared to the normative need. Therefore,evaluationofperceivedneedisusefulinanytreatmentpriorityassessmentindecisionmakingfororthodonticservices.Keywords:IOTN,normativeneed,perceivedneedPaper presented at 22nd International Association for Dental Research (SEA Division) & 19th South East AsiaAssociationforDentalEducationonOctober8‐10,2008inManila,Phillipines

Dr.SitiZurianaMohdZamzuriOralHealthDivisionMinistryofHealthMalaysiaF.T.PutrajayaAssociateProfessorDatinDr.RashidahEsaProfessorDato’Dr.IshakAbdulRazakBothofDepartmentofCommunityDentistryFacultyofDentistryUniversityofMalayaKualaLumpur

93

CEPHALOMETRICANALYSISOFUNILATERALCLEFTLIPANDPALATEPATIENTSEbinL@E

The aim of this cross‐sectional study was to establish a descriptive summary of thecraniofacialmorphologyfortheMalayunilateralcleftlipandpalate(UCLP)patientsandalsoto document the possible craniofacial morphology differences between the Malay UCLPchildrenand‘normal’MalaychildrenwithnoUCLP(control).Inaddition,MalayUCLPwasalsocompared to the Caucasian UCLP for possible differences in their craniofacial morphology.Twenty UCLP children (12 boys, 8 girls) with a mean age of 10.5 years (SD ± 1.79) werecomparedwith20controlchildren(12girls,8boys)whowerematchedforage(mean=9.72years, SD±1.70)and sex. TheMalayUCLPwasalso comparedwith the CaucasianUCLPofmatchedagefromthestudyofSembG.(1991).Thirtyonelinearandangularvariablesweremeasuredfromlateralcephalometricradiographswherethelandmarksweredirectlydigitisedwith Dolphin Imaging Software Version 10.0 (Dolphin Imaging, Chatsworth, CA). The datawere analysed with Mann‐Whitney test and the level of significance was set at p < 0.05.Compared with the control group, theMalay UCLP demonstrated amore retrognathic andshortermaxillabutwithnormalmandible.Thecranialbaseangulationwassmallerandmoreacute in Malay UCLP. There was also a bimaxillary retroclination of the upper and lowerincisorswhich led to increasedangulationof the interincisal angle. The soft tissuewas lessconvexwithobtusenasolabialangleandthinnerupperlip.Therewerenosignificantfindingsin theverticalmeasurementof facialheightandmaxillomandibularplaneangle. TheMalayUCLPshowedatendencyforClassIIIskeletalpatterncomparedtoCaucasianUCLPduetoasmaller and acute cranial base angulation and more forward position of the mandible. Inconclusion,themostsignificantdifferencewasfound inthemaxillamorphology,wherethemaxillaoftheMalayUCLPwasmoreretrusiveandshorterthanthecontrolgroupbutwassetmoreforwardwhencomparedtotheCaucasianUCLP.ThisresearchreportissubmittedinpartialfulfillmentoftherequirementsforthedegreeofMasterofOrthodontics

Dr.Lillybia@EmilyEbinOralHealthDivisionSabah

94

EFFECTOFLIGHTTIPANGULATIONONTHESHEARBONDSTRENGTHOFANORTHODONTICADHESIVEUmmuAimanY

Anumberofstudieshavebeendoneinrelationtotheeffectsofdifferentfactorsaffectingtheshear bond strength of orthodontic adhesives. At present there are no studies that haveevaluated the effectof light tipangulationwhile curingorthodonticadhesiveson the shearbond strength. The purpose of this study was to investigate the effect of light curing tipangulationontheshearbondstrengthofanorthodonticadhesive.Ninetyhumanpremolarswith brackets bonded in a standardised manner using the light‐cure orthodontic adhesive,Transbond XT,werepolymerisedusingablue LED light curingunit for40 secondsat threedifferent angulations of 0 degree, 45 degrees and 90 degrees at a standardised 3 mmdistance.TheInstronUniversalTestingMachinewasusedtomeasurethemaximumforcefordebonding. The Adhesive Remnant Index (ARI) and evaluation under Scanning ElectronMicroscope (SEM) were done to evaluate the site of bond failure on tooth and bracketsurface,respectively.SPSSversion12.0wasusedtoanalysethedata.TheKruskal‐Wallistestwasemployedtocomparetheshearbondstrengthofallgroups.Fromtheresults,themeanshearbond strengthvalues forGroupA (0degree),GroupB (45degrees)andGroupC (90degrees)were4.15,4.56and 6.66MPa, respectively. The highestmean rankwas 46.98 forgroupC.Thestatisticalanalysisofthestudyshowednosignificantdifference (p=0.286)oftheshearbondstrengthoforthodonticadhesiveswhencuredatthreedifferentangulationsof the light curing tip. However, the highest shear bond strength was at 90 degreesangulationsofthelightcuringtipanditsvaluewaswithintheoptimalorthodonticforce.ResearchreportsubmittedaspartialfulfillmentoftherequirementfortheDegreeofMasterofOrthodontics

Dr.UmmuAimanYusoffOralHealthDivisionSelangor

95

AN INTERCEPTIVE ORTHODONTIC PACKAGE FOR DENTAL OFFICERS – EVALUATING THEINITIATIONOFITSIMPLEMENTATIONCheFatimahA,RashidahB,NorlianD,RafeaahAK,ZainatulAkmarK,GereMJIntroduction: The increasingdemand fororthodontic treatmenthashighlighted the chronicwaitinglistsituationinthepublicserviceundertheMinistryofHealthMalaysia,whichcanbeaslongas3‐4years.Thisposesproblemsassomeinterceptiveorthodonticcasesthatcouldbetreated with simple removable appliances during adolescence can be missed out.Involvement of dental officers in the management of selected interceptive cases isappropriate as they had undergone basic orthodontic training under their undergraduatecurriculumand can improveorthodontic servicedelivery.Objectives:Theaimsof the studyweretodeterminetheeffectivenessoftheinterventionpackagetoenabledentalofficerstomanage interceptiveorthodonticcasesundersupervisionandto identifyproblemsfacedbythem during its implementation. Methodology: A non‐randomised interventional studyinvolving 15 dental officers (intervention group) and 6 orthodontists (control group) wascarried out in 4 states. The study startedwith central level training for dental officers and16dentaltechnologistswhowereattachedtothe control groupusingpre‐designedtrainingmodules.Altogether403patientswere involved in the study. For comparisonof treatmentoutcome,237prospectivesamplesweretakenforthedentalofficersand166 retrospectivesamplesfortheorthodontists.Clinicalmanagementofcaseswascarriedoutin2phases,first6 months of handholding followed by a period of independent management with regularmonitoring by the orthodontists (control). A set of validated and pre‐tested questionnaireswasalsousedto identifyproblemsfacedbydentalofficersduringtheconductofthestudy.DatacollectedwereanalysedstatisticallyusingSPSSVersion15.Outcomesachievedbybothgroupswerecompared.PooledanalysisbymetaanalysisusingRandomEffectModelAnalysistoanalysesuccessratewascarriedoutusingSTATA/SEversion10.Results:Thisstudyshowednostatisticaldifference insuccessfultreatmentoutcome, reduction in IndexOfOrthodonticTreatment Need (IOTN) grade and patient’s compliance between the two groups. Fewproblems were encountered by dental officers during the study and themajority of themagreed that interceptive orthodontics has a role in improving service delivery and jobsatisfaction.Conclusion:Dentalofficersshouldbeabletomanageselectedinterceptivecasessuccessfullywithtrainingandguidance. It istherefore recommendedthatthe roleofdentalofficers be expanded to includemanagement of interceptive orthodontic cases following acourseoftrainingwiththisproposedinterventionpackage.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.Hjh.CheFatimahHj.AwangDr.RashidahDato’BurhanuddinDr.NorlianHj.DaudDr.RafeaahAyatKhanDr.ZainatulAkmarKhalilDr.MariaJiromGereAllofOralHealthDivisionKualaLumpur

96

EVALUATION OF ORTHODONTIC TREATMENT OUTCOME: A SELF‐AUDIT USING THE PEERASSESSMENTRATING(PAR)INDEXLokeSTIntroduction: The peer assessment rating (PAR) index was used to self‐audit 4 years ofcompleted preadjusted edgewise appliance cases treated by a single orthodontist in agovernment clinic. Objectives: The objectives of this study were to evaluate orthodontictreatment standards and factors which may influence treatment outcomes and treatmenttime.Methodology:Preandpost‐treatmentstudymodelswerescoredusingthePARindexbytheauthor.Seventeenmodelswerere‐examinedforintra‐examinerreliabilityusingintraclasscorrelationcoefficient(ICC).ICCwasexcellentforpre‐treatment(0.96),post‐treatment(0.98)and reduction inPAR (0.96) scores.Results:Therewere173cases (51males;122 females)withmeanage17.6 (SD5.75) years.Mean treatment timewas18.6 (SD6.47)monthswithrange between 5‐40 months. There was no statistically significant difference betweenone‐archandtwo‐archcasesandbetweenroutineandcompromisedcases.Treatmenttimeinextraction cases (mean 19.5, SD 6.17) was significantly different (p=0.000) compared withnon‐extractioncases (mean11.6,SD4.10)althoughthisaccountedfor15%ofthevariationonly (r=0.388). A total of 76.3% cases were ‘greatly improved’, 22.0% ‘improved’ and1.7% ‘worse/nodifferent’.Meanpre‐treatment,post‐treatmentand reduction in PAR scorewas34.1(SD9.68),6.4(SD6.84)and27.9(SD9.69)respectively.MeanpercentagePARscorereduction was 82.0% (SD 1.96). Pre‐treatment (p=0.000), post‐treatment (p=0.000) andreduction (p=0.489) in PAR scores was significantly different between routine andcompromised cases. There was significant difference (p=0.000) between category ofimprovement and pre‐treatment scores but not with treatment time. Conclusion: A highstandardoftreatmentoutcomewasachieved.Severemalocclusionshad largerreduction inPARscoresandrequiredlongertreatmenttime.Extractioncasestooklongertocompleteandroutinecaseshadbetteroutcomesthancompromisedcaseswithsevereskeletaldiscrepancy.Keywords:PARindex,preadjustededgewiseappliance,self‐auditProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.LokeShuetTohTelukWanjahDentalClinicAlorSetarKedah

97

PERCEPTIONS AND IMPLEMENTATION OF ORTHODONTIC CLINICAL PRACTICE GUIDELINES(CPG)BYDENTALOFFICERSANDORTHODONTISTSINMALAYSIALokeST,AngLCThis survey elucidated the perceptions and implementation of orthodontic Clinical PracticeGuidelines (CPGs)byallorthodontistsanddentalofficers intheMinistryofHealthMalaysia(MOH). Two different sets of self‐administered questionnaires were targeted at first‐yeardentalofficers(FYDO),dentalofficers(DO)andadministrativeSeniorDentalOfficers(SDO)inone group and orthodontists in another group. Only 30% responded from a total of 1,327MOHdentalofficers,withnoparticipationfromthree states. Themajority (89%)ofofficershaveheardofCPGsalthoughsomewereunsureoftheirpurposeandusage.About69%haveread the orthodontic CPG of whom 87% have read otherMOH dental CPGs. About 78.6%found CPGs ‘good to excellent’ but 16.0% did not answer this question. Some commentsreceived included: language was confusing, inadequate details and pictures, needimprovement, irrelevant,needCPGsforotherorthodonticproblems,needmoreknowledgefirst and request formore copies. Only 27.7% used themoften, 53% occasionally and 15%hardlyfollowCPGs.About82%feltthattheywereencouragedtouseCPGsintheirworkplaceandthemajority (86%)knewwheretheywerekeptespeciallySDOsandDOs.About90%intheorthodontistgrouphavereceivedhardcopiesoforthodonticCPGsbutthemajority(76%)havenot seen themon thewebsite.Althoughall felt thatCPGswereuseful toofficersandencouragedtheiruse,only62.5%haveintroducedCPGstotheirofficers.Therewasgenerallymore awareness and usage of CPGs among SDOs compared with DOs and FYDOs.The dissemination and availability of orthodontic CPGs is reasonably good. However, theimplementation by orthodontists and administrative officers can be improved for betterawareness,understandingandusagebydentalofficers,especiallyFYDOs.Keywords:Clinicalpracticeguidelines,orthodontics,perceptionPublication:MalaysianJournalofPublicHealthMedicine.2007,Vol.7(2):35‐41

Dr.LokeShuetTohOrthodonticSpecialistClinicTelukWanjahDentalClinicAlorSetarKedahDr.AngLaiChoonSungaiPetaniDentalClinicKedah

98

99

RESEARCHIN

PERIODONTOLOGY

100

101

PROFILEOFPATIENTSSEENINAJOINTDENTALMULTI‐DISCIPLINARYCLINICChanYK,ZainatulAkmarK,MaBCIntroduction:Thejointdentalmulti‐disciplinaryclinicinvolvesthespecialitiesoforthodontics,oralsurgeryandperiodontics.Twoconsultantorthodontists,oneconsultantoralsurgeonandoneconsultantperiodontistwereattachedtothisclinic.Objective:Theaimofthestudywastoanalysetheprofileofpatientsseen inajointdentalmulti‐disciplinaryclinicin2007 inthestateofJohor,Malaysia.Methodology:Aretrospectivesurveywasconductedusingnationalrecordsfromthejointclinic.Results:Atotalof59patientswereseenintheclinicin2007.ThemajorityofthepatientswereethnicMalay(50.8%)followedbyChinese(39.0%)andIndians(10.2%). There were slightlymore female patients (57.6%) compared tomale (42.4%). Themajority of the patients required joint consultation and management by the speciality oforthodontic‐oral surgery (74.6%), followed by orthodontic‐periodontic (18.6%). The threemostcommontreatmentplanswereorthognathicconsultationandsurgery(37.3%)followedby orthodontic treatment (18.6%) and dental implants (13.6%).Most of the referrals werefromthespecialityoforthodontics (88.1%)andperiodontics (8.5%).Conclusion:Theoverallprofile of patients showed that complex dental and dentofacial anomalies often require amulti‐disciplinaryapproachintheirmanagement.Poster presentation at Quality Initiatives& 1st JohorOral Health Research Conference, 10‐11 June 2009 at SultanIsmailHospital,JohorBahru

Dr.ChanYoongKianPeriodontalSpecialistClinicMahmoodiahRoadDentalClinicJohorBahruJohorDr.ZainatulAkmarKhalilOrthodonticSpecialistClinicAbdulSamadRoadDentalClinicJohorBahruJohorDr.MaBeeChaiDepartmentofOralSurgerySultanahAminahHospitalJohorBahruJohor

102

THEHEALTHSTATUSOFPATIENTSATTHEPERIODONTICSPECIALISTCLINIC,JOHORBAHRURunayatiR@M,ChanYK

Introduction: Thepatient’shealthproblemscanaffectdentaltreatment.A recentstudyhasdemonstratedthatabout42%ofdentalpatientshadatleastonehealthproblem.Objective:ThisstudyaimedtoinvestigatethehealthproblemsofpatientswhocametothePeriodonticSpecialist Clinic in Johor Bahru. Methodology: This retrospective study was done at thePeriodonticSpecialistClinic,MahmoodiahRoad, JohorBharu.AllnewpatientsfromJanuary2004untilOctober2006were involved in this study.Dataonpatient’shealthproblemwascollected from themedical history column of the periodontal treatment card (LP12). Sociodemography data was collected and health problems were classified into 9 categories.Results:Threehundredandfiftysix(356)patientswere involved inthisstudy.Amongthesepatients, 26.1% of them have at least one health problem. Most of these patients hadcardiovascular disease (56.5%), followed by endocrine problem (24.2%) and bleedingtendency(0.8%).Thehighestnumberofpatientswithhealthproblemwasfromtheoldestagegroup ofmore than 65 years.Conclusion: It will therefore be important to investigate thehealthproblemsofpatientbeforeprovidinganydentaltreatmenttoavoidanyunnecessaryincidents.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.RunayatiRobani@MaarofMuarDentalClinicBandarMaharaniCommunityPolyclinicMuarJohorDr.ChanYoongKian

MahmoodiahRoadDentalClinicJohorBahruJohor

103

PERIODONTALSCREENINGANDPRACTICESAMONGGOVERNMENTDENTISTSINMALAYSIAVaithilingamRD,RamanR,SiowYY,WanNurAzreenaWH

Objective: This studyaims to identify frequencyofperiodontal screeningandknowledgeofBasic Periodontal Examination (BPE) as well as management of periodontal diseases (PDs)among government dentists in the states of Negeri Sembilan dan Penang, Malaysia.Methodology: The study was carried out using a self‐administered questionnaire whichwasposted to 120 governmentdentists in these states.A totalof117questionnaireswerereturned. Results: A majority of 82.1% respondents were females as compared to 17.9%males.Questionsaskedwereabout frequencyofperiodontal screening, knowledgeofBPE,management of periodontal abscesses and referrals to the periodontist. Findings showed55.6%dentists screenforPDsroutinely,35.9%whentheyhavethetimeand8.5%neverorvery rarely screen. A total of 62.4% of the subjects were very familiar with BPE.Of these,10.9% use it frequently while 67.12% use it when necessary. There was a significantassociation between knowledge of BPE and years since graduation (p<0.05). To manageperiodontal abscesses, 83.8% would do deep scaling on affected teeth, 62.4% takeradiographs and 88.9% prescribe antibiotics. Use of radiographs showed significantassociationwithyearsofgraduation(p<0.05).Withinthepast6months,43.6%respondentsmade referralstoperiodontists.Ofthese,82.35% referredpatientsfortreatmentof chronicperiodontitis,43.14%foraggressiveperiodontitisand50.98%forPDssecondaryto systemicconditions. However, 56.92% respondents who did not refer were able tomanage the PD.Conclusion: In this study,more than 50%of government dentists routinely screen for PDs.Younger graduateshadbetter BPEknowledgeandweremore likely to take radiographs forperiodontal abscesses as compared to their seniors. Antibiotics are widely prescribed bydentists to treat periodontal abscesses. Themajority of referrals to periodontists were forchronicperodontitis.ProjectreportedtotheOralHealthDivision,MinistryofHealthMalaysia

Dr.RatnaDeviVaithilingamSeniorLecturerDepartmentofOralPathology,OralMedicine&PeriodontologyFacultyofDentistryUniversityofMalayaKualaLumpurDr.RajeswaryRamanPeriodontistPeriodontalSpecialistClinicPerakRoadDentalClinicPenangDr.SiowYonYinSeniorDentalOfficerKualaPilahDentalClinicNegeriSembilanDr.WanNurAzreenaWanHassanDepartmentofChildren’sDentistry&OrthodonticsFacultyofDentistryUniversityofMalayaKualaLumpur

104

105

RESEARCHIN

RESTORATIVEDENTISTRY

106

107

ANTIMICROBIAL EVALUATION OF SODIUM HYPOCHLORITE AND OZONATED WATER ONE.FAECALISBIOFILMNurZianaIObjective: To evaluate antimicrobial efficacy of sodiumhypochlorite (NaOCI) and ozonatedwateras irrigantsagainstEnterococcifaecalisgrownasbiofilm.Methodology:AgardiffusiontestwerecarriedouttodeterminethebaselineconcentrationofNaOCIandozonatedwaterinPartOneofthisstudy.Celluloseacetatemembranefilterswereusedasbiofilmmodel insecondpartofthestudywhereminimumbiofilmeradicationconcentration(MBEC)ofNaOCIwasdetermined.ThebacterialbiofilmwasexposedtotwoconcentrationofNaOCI,2.62%&1.31%and0.1ppmofozonatedwateroverarangeoftimeperiods(1,2,4,8,15,30and60minutes).Theantimicrobialactivityoftheagentswasceasedandthepresenceofviablecellswas determined by inoculation onto BHI agar, incubation and enumeration of the colonyformingunits(CFU).Distilledwaterwasusedasacontrolagent.Theantimicrobialactivitywasalsotestedbycombiningthe1.31%NaOCIand0.1ppmozonatedwater.Allexperimentswererepeatedfourtimes (n=4). Therateofbacterialkillingandeffectivenessoftheagentswerecomparedusingnon‐parametricKruskal‐Wallistest.Results:Theresultsrevealedthat2.62%of NaOCI can completely kill the E. faecalis biofilm in 15minutes. However, 1.31% NaOCIrequired a longer time period to produce a similar effect (60minutes). From the findings,0.1ppmozonatedwaterseemednottopossessanyantimicrobialeffectwithintheperiodoftime tested. However, combination of 1.31% NaOCI and 0.1ppm ozonated water showantimicrobial activityafter 30minutesof exposure time.Whencomparedbetween the testagents,2.62%NaOCIwassignificantlydifferent(p<0.05)fromtheotheragentsintermsofitsantimicrobial effectiveness. Conclusion: From this study, it can be concluded that 0.1ppmozonatedwaterwasnot comparablewith2.62%and1.31%NaOCI inantimicrobial efficacyagainstE.faecalisbiofilm.The0.1ppmozonatedwater isthereforenotasuitableirrigantforrootcanaltreatmentanditisnotrecommendedassuch.PaperpresentedatQualityInitiatives&1stJohorOralHealthResearchConference,10‐11June2009atSultanIsmailHospital,JohorBahru

Dr.NurZianaIbrahimRestorativeDentalSpecialistClinicAbdulSamadRoadJohorBahruJohor

108

ENDODONTICTREATMENTOFAMAXILLARYCENTRALINCISOR(11)WITHARRESTEDROOTDEVELOPMENT:ACASEREPORTWanAzmilA,RossuhaimiAR,JuannaB

Arrested root development of permanent teeth can occur due to local factors such asinfection and trauma or general factors such as radiation and odontodysplasia. This casereport presents tooth 11 with arrested root development requiring endodontic treatment.Followingobturationwithmineraltrioxideaggregate (MTA),aminorsurgicalprocedurewasperformedtoremoveperiapicalpathologictissue.Thetoothhadremainedasymptomaticatthe6‐monthreviewandthecasewillbefollowed‐upforatleast2yearstoensurecompletehealing.Keywords:arrestedrootdevelopment,endodontictreatment,mineraltrioxideaggregatePosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

Dr.WanAzmilAnnuarDr.RossuhaimiAbdulRahmanBothofMalaysianArmedForcesDentalServicesKuchingSarawakDr.JuannaBahadunDentalSpecialistClinicSarawakGeneralHospitalKuchingSarawak

109

COMPLICATIONSOFINJECTIONOFSODIUMHYPOCHLORITEBEYONDTHEROOTAPEXMaBC,ChanYK

Irrigantsareusedtosupplementmechanicalpreparationofrootcanalsduetothecomplexityof the root canal system. Sodium hypochlorite remains one of the most commonly usedirrigantsolutioninendodontics. Improperuseofsodiumhypochloriteduringirrigationcouldresultinseverecomplicationsfromtheinjectionofthesolutionbeyondtherootapex.Thisisacasereportofcomplicationsinthreepatients.Treatmentoptionsandpreventivemeasurestoavoidsuchincidentsarediscussed.Paperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.MaBeeChaiOralSurgeonDentalSpecialistClinicSultanahAminahHospitalJohorBahruJohorDr.ChanYoongKianConsultantPeriodontistMahmoodiahRoadDentalClinicJohorBahruJohor

110

THEEFFECTOFDENTUREADHESIVEONFOODOCCLUSIONMarlyndaA,DayangFadzlinaAI,NurhafizahH,NatasyaAT,KamarulHishamK

Objective: Tocomparetheweightofretrievedfoodaccumulatedunderdenturebaseswithand without denture adhesive treatment.Methodology: The study was conducted in twoparts which involved food occlusion and questionnaire. For the food occlusion study,accumulated peanuts under the denture base with and without denture adhesive werecollected,dried,measuredandcomparedusingpairedt‐test.Thetwo‐sectionquestionnairefor patient’s feedback was administered after 7 days of using denture adhesive (reviewappointment).Results:Theinvestigationfoundstatisticallysignificant(t=2.945,df=31,p<0.05)decreasesinthemeanweightoffoodimpactionunderdenturebaseswhendentureadhesivewasapplied;regardlessofwhetheritwasamaxillaryormandibulardenture.Themajorityofthe subjects reported increasedconfidenceandcomfortofdentureuseafterusingdentureadhesive. Conclusion: Denture adhesive effectively reduces the amount of food particleimpactionbeneathdentures,thus increasing confidenceand improvingthequalityof lifeofdenturewearers.Keywords:foodocclusion,dentureadhesive,qualityoflifePosterpresentedat66thMDAAGM&MDA/FDIScientificConvention&TradeExhibitionon25June2009atSerinditRoom,EquatorialHotelPenang

MarlyndaAhmadDayangFadzlinaAbangIbrahimNurhafizahHazmiDr.NatasyaAhmadTaribAllofFacultyofDentistryUniversitiKebangsaanMalaysiaKualaLumpurDr.KamarulHishamKamarudinPutrajayaDentalClinicF.T.Putrajaya

111

MASTICATORYEFFICACYANDBITEFORCEINCOMPLETEDENTURES:ASTUDYOFDENTUREADHESIVENatasyaAT,MuhdTermiziB,MuhdDellTaufikM,MarlyndaA,KamarulHishamKObjective:Themainobjectiveofthisstudy isto comparemaximumbiteforceuntildenturedislodgement(BFDD)aswellasmasticatoryefficacy(ME)ofcompletedentures,withoutandwithdentureadhesive,basedonModifiedKapurIndexScale(MKIS).Methodology:Completedentures that complied with MKIS were tested with BFDD and ME, using disposablegnathometerandconsumingaquarterofappletoassessdislodgementofcompletedenturesrespectively.Bothtestsweredonewithoutandwithdentureadhesiveapplication.Theeaseand comfort level of mastication were assessed to compare between without and withdenture adhesive. Results: BFDD improved in 17 (58.6%) samples with denture adhesiveapplication (p=0.0001).Numberof chewing cyclesuntil firstdenturedislodgement forbothmaxillaryandmandibularcompletedenturesincreasedwithdentureadhesiveapplication.Allsamplesagreedthateaseandcomfort levelofmasticationincreasedwithdentureadhesive.ThemagnitudesofcorrelationcoefficientbetweenMKIStoBFDDwithoutandwithdentureadhesivewereweak (r=0.081, r=0.057).Conclusion:Bite forceandchewing cycle increasedwith denture adhesive application. Patients were satisfied with denture adhesive formasticationthatmadethemmorecomfortableinchewing.Keywords:biteforce,masticatoryefficacy,dentureadhesive,ModifiedKapurIndexScalePaperpresentedat16thFDI/MDAScientificConvention&TradeExhibition2009,17‐18January2009atHotelIstana,KualaLumpur

Dr.NatasyaAhmadTaribMuhdTermiziBakarMuhdDellTaufikMuratMarlyndaAhmadAllofFacultyofDentistryUniversitiKebangsaanMalaysiaKualaLumpurDr.KamarulHishamKamarudinPutrajayaDentalClinicF.T.Putrajaya

112

MANDIBULARALVEOLARBONERESORPTIONINSELECTEDCOMPLETEDENTUREPATIENTSSabarinaBObjective: This study investigated the effects of systemic and local factors on resorptionof the posterior mandibular residual ridge under conventional complete dentures.Methodology: Proportional area measurements of the posterior mandible were made onpanoramic radiographs of 87 edentulous patients who requested replacement completedenturesattheFacultyofDentistry,UniversityofMalaya.Theamountofalveolarbonelosswasexpressedasaproportionofthepredictedoriginalheightofthemandibleintheareaofthementalforamen,priortotoothlossandanyalveolarboneresorption.Theresorptionwasclassified as minimal and severe resorption. The use of proportions rather than actualmeasurements minimised errors related to magnification and distortion of the panoramicradiographs. Results: A total of 67% of the subjects studied had severe bone resorption.Femalesubjectsabove50yearsshowedahigher riskforgreaterresorption.Thenumberofyearsapatienthadbeenedentulouswasalsoasignificantfactor.Otherfactorslikeageofthesubjects, reasons for tooth loss and systemic medical conditions, except the statisticallysignificant effect of endocrine disorder, failed to show an association with the degree ofresorptionoftheresidualposteriormandibularridge.Conclusion:Thisstudyshowsthatolderfemale subjectsmay be at a greater risk of severe resorption of themandibular ridge as aresultofwearingcompletedentures.Yearsofedentulousnessalsohassignificantassociationwith the severity of bone resorption. Endocrine (thyroid disease) also has significantassociationwiththeseverityofboneresorption.This research report is submitted in partial fulfillment of the requirements for the degree of Master of ClinicalDentistry(RestorativeDentistry)

Dr.SabarinaHj.BujangOralHealthDivisionSabah