Ashish Shrestha

The Histopathological Spectrum of Pyogenic Granuloma: A Case Series

Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i) cellular phase, (ii) capillary phase/vascular phase, and (iii) involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH) and non-lobular capillary hemangioma (non-LCH). Case Presentation. In this series, four cases (varied age groups and both genders) of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification.

Dentigerous Cystic Changes in the Follicles Associated with Radiographically Normal Impacted Mandibular Third Molars

Objective To assess the incidence of dentigerous cystic changes in the follicles of radiographically normal impacted mandibular third molars. Methods One hundred and thirteen follicles obtained after surgical removal of impacted mandibular third molars with radiolucency of less than 2.5 mm in the radiograph were sent for histopathologic evaluation to evaluate pathologic changes. Results The incidence of dentigerous cystic changes observed was 15.9%, that is, 18 out of 113 patients (51 males and 62 females), with the maximum incidence of cystic changes seen in the follicular space size of 0.5 mm. The mean age of the patients included was 27.8 ± 8.1. The most common indication for extraction among the patients in this study was recurrent pericoronitis (95%). There were no statistically significant differences in occurrence of cystic changes based on age, gender, angulation, relation to ramus, depth, side of impaction, and follicle size (P > 0.05). Conclusion Dental follicles obtained from surgically removed impacted mandibular third molars should be submitted for histopathologic examination irrespective of the radiographic size of the follicle.

Effectiveness of a Mass Media Campaign on Oral Carcinogens and Their Effects on the Oral Cavity

Objective: To develop a mass media campaign on oral carcinogens and their effects on the oral cavity in order to increase awareness among the general population. Methods: Documentary and public service announcements highlighting the effects of tobacco and its products were designed and developed based on principles of behavior change. A questionnaire, designed to determine the knowledge, attitude and practice of people regarding oral carcinogens, was used to conduct a baseline survey at various sites in eastern Nepal. Local television channels and radio stations broadcasted the documentary and public service announcements. An evaluation survey was then performed to assess the effectiveness of the campaign. Results: Baseline and evaluation surveys covered 1,972 and 2,140 individuals, respectively. A third of the baseline population consumed quid, 22% chewing tobacco, 16% gutka (commercial preparation of arecanut, tobacco, lime and chemicals) and 25% cigarettes. Tobacco consumption differed significantly between 3 ecologic regions with greater use in the Terai region. The knowledge prevalence regarding the oral carcinogens quid (70%), chewing tobacco (82%), gutka (58%) and cigarettes (93%) significantly increased in the evaluation population. Females were more aware about the various tobacco products and their effects on health. More people knew about the harmful effects of tobacco on their health and oral cavity, and had their mouth examined and the frequency of consumption of these products reduced significantly after the campaign. Attitudes towards production, sale and advertisements of tobacco also improved significantly. Conclusions: The mass media campaign was an effective tool for increasing awareness among the population.

Evaluation of Oral Hygiene Practice, Knowledge and Attitude among (10-15 Yrs) School Children in Dharan, Nepal- A Cross- Sectional Study

Background: The study is aimed to evaluate oral hygiene practice, knowledge and attitude among (10-15 yr) school children in Dharan. Materials and Methods: This is a cross sectional study which included 200 school students of age group (10-15 years) from five different schools of Dharan. The school and the students were selected by random sampling method. The consent for the participation of school children were obtained from the head of the school verbally. A pretested closeended questionnaire was used for the study which was adopted from different conducted research. The questions were in English language. Results: The result of this study show that only 15% of the students knew that gum bleeding means gingivitis. 83% reported that use of fluoride strengthens teeth and 81% knew that healthy teeth is strong and caries free teeth. 64.5% participant reported the reason for dental visit was general dental check up while 36% visited dentist only when dental pain and 76% felt the necessity of regular dental visit. 96% of the respondents used toothbrush and toothpaste as their brushing material and 83% of them brushed twice a day. Among all the students surveyed 80.5% had the habit of rinsing their mouth after eating. Results of this study prove that oral hygiene habits, oral health awareness and knowledge level among school children in Dharan is satisfactory. The participants had conducive oral health behavior, sufficient knowledge, positive attitude and practice regarding oral health.

Introduction of problem-based learning in undergraduate dentistry program in Nepal.

Context: Problem-based learning (PBL) is a methodology widely used in medical education and is growing in dental education. Initiation of new ideas and teaching methods requires a change in perception from faculty and institute management. Student-centered education is a need of the day and PBL provides the best outlet to it. Aim: To introduce PBL, assess feasibility and challenges in undergraduate dentistry program and evaluate the impact on their learning. Settings and Design: PBL was used as a teaching methodology on 37 students in 2nd year BDS program. The PBL was duplicated as that of MBBS program. PBL was spread over 5 days. Pre- and post-test questions along with different questionnaires were designed for the students and tutors/faculty to be administered after PBL session. Subjects and Methods: Case with temporomandibular joint and muscles of mastication and occlusion was designed as a module with five triggers given to students who were divided into five groups over two tutorials facilitated by tutor. Resource sessions were held by involved departments (Oral Biology, Oral Pathology, Oral Medicine and Radiology, Orthodontics, and Oral Surgery). Students were allotted time for search, research and discover to search literature. Statistical Analysis Used: Descriptive statistics. Results: Pre and post-test comparison showed that the knowledge increased immensely following PBL sessions. Students’ assessment by tutors following two PBL tutorials showed a mean score of 34.9 ± 4.01 and 35.5 ± 3.86, respectively. Students’ feedback showed that most of them preferred PBL because they found it interactive, collaborative, goal and research oriented. Students were motivated to learn new topic because learning objectives were formulated by themselves and they developed self-directed learning skills. The tutors learned to design cases. Conclusions: PBL encouraged students to use more interactive methods of learning which possibly will make them lifelong learners.