Kamis Gaballah

Evaluation of trigeminal nerve injuries in relation to third molar surgery in a prospective patient cohort. Recommendations for prevention.

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by mandibular third molar (M3M) surgery. 120 patients with nerve injury following M3M surgery were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. 53 (44.2%) inferior alveolar nerve (IAN) injury cases and 67 (55.8%) lingual nerve injury (LNI) cases were caused by third molar surgery (TMS). Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain), allodynia and hyperalgesia. Pain was one of the presenting signs and symptoms in 70% of all cases. Significantly more females had IAN injuries and LNIs (p<0.05). The mean ages of the two groups of patients were similar. Speech and eating were significantly more problematic for patients with LNIs. In conclusion, chronic pain is often a symptom after TMS-related nerve injury, resulting in significant functional problems. Better dissemination of good practice in TMS will significantly minimize these complex nerve injuries and prevent unnecessary suffering.

Molecular markers for diagnosis and prognosis

A plethora of aberrations are associated with progress and outcome for head and neck cancer patients and some have been shown to provide prognostic information independent of the TNM staging system. These findings justify future studies that will harness recent advances in technologies to refine the range of molecular markers available. Important lessons have been learnt during the last two decades, particularly the need to perform multivariate analysis and to combine information derived from several molecular markers. At present the overall evidence is insufficient to alter clinical practice or to consider restricting clinical trials of new adjuvant to subsets of patients, identified on the basis of the use of molecular markers. However, a number of key prospective clinical studies are in progress and we can be optimistic that in the near future clinical research incorporating specific markers may provide new criteria for defining risk of relapse or of developing a new primary tumour, and guide the choice of optimal adjuvant treatment after surgery. The only way to truly validate a marker is to incorporate it into large clinical trials, and it is anticipated that the new treatment options that are on the horizon, that are likely to be an improvement on radiotherapy alone, will provide opportunities to help translate this laboratory research into clinical practice.

Tissue engineering of oral dysplasia.

Keratinocytes and fibroblasts isolated from dysplastic oral lesions were combined to provide a renewable source of epithelia. A dysplasia‐scoring index was devised to compare the architectural and cytological features and used together with robust immunophenotyping to show that the engineered epithelia showed most of the characteriztics of the clinical lesions. The strains of dysplastic oral keratinocytes with an extended or immortal lifespan provided a reproducible resource of epithelia showing mild (DOK), moderate (POE9n) or severe (D20) dysplasia when maintained under defined conditions. The dysplasia score was influenced by growth conditions, with KGF polarizing proliferation to the basal layer and reducing the severity of dysplasia. When compared to the normal counterparts, dysplasia‐associated fibroblasts expressed MMP9, secreted more HGF, increased the dysplasia score for epithelia generated with mortal dysplastic keratinocytes and induced morphological changes in normal keratinocytes, highlighting the role of the microenvironment in determining the phenotype of dysplastic epithelia. Copyright

Oral cancer in the UAE: a multicenter, retrospective study

Aim To determine the prevalence of various malignant oral lesions in the UAE and correlate cases of squamous cell carcinomas with age, gender, site, grade, clinical presentations at the time of diagnosis, and the prevalence of neck metastasis. Materials and methods A multicenter, retrospective study was conducted at four major hospitals in the UAE. The study was based on histopathology reports of biopsies of oral tissues. Results Of the 992 oral biopsy reports retrieved, 147 cases of malignant tumors were found which accounted for 14.9% of the total biopsies. Fifteen different types of malignant lesions were diagnosed, of which oral squamous cell carcinoma (OSCC) was the most prevalent and made up 11.4% of the overall oral biopsies retrieved. The commonest presentation of cancer was ulceration (31.17%), followed by lumps and white lesions. The most common site where the lesions were diagnosed was the tongue (51.9%), followed by the cheeks and lips. OSCC accounted for 77% of all malignancies reported. Neck dissections were conducted in only 20.8% of all OSCC cases diagnosed at Mafraq and Tawam hospitals, of which 43.75% showed evidence of neck metastasis. Conclusion Oral cancer is not an uncommon disease in the UAE. This may mandate more awareness campaigning, including screening procedures for early detection of cancerous lesions and other potentially malignant oral diseases. Elective neck dissections to detect lymph node metastasis should be more routinely performed, in particular for tongue carcinomas because of the early neck involvement potential.Aim To determine the prevalence of various malignant oral lesions in the UAE and correlate cases of squamous cell carcinomas with age, gender, site, grade, clinical presentations at the time of diagnosis, and the prevalence of neck metastasis. Materials and methods A multicenter, retrospective study was conducted at four major hospitals in the UAE. The study was based on histopathology reports of biopsies of oral tissues. Results Of the 992 oral biopsy reports retrieved, 147 cases of malignant tumors were found which accounted for 14.9% of the total biopsies. Fifteen different types of malignant lesions were diagnosed, of which oral squamous cell carcinoma (OSCC) was the most prevalent and made up 11.4% of the overall oral biopsies retrieved. The commonest presentation of cancer was ulceration (31.17%), followed by lumps and white lesions. The most common site where the lesions were diagnosed was the tongue (51.9%), followed by the cheeks and lips. OSCC accounted for 77% of all malignancies reported. Neck dissections were conducted in only 20.8% of all OSCC cases diagnosed at Mafraq and Tawam hospitals, of which 43.75% showed evidence of neck metastasis. Conclusion Oral cancer is not an uncommon disease in the UAE. This may mandate more awareness campaigning, including screening procedures for early detection of cancerous lesions and other potentially malignant oral diseases. Elective neck dissections to detect lymph node metastasis should be more routinely performed, in particular for tongue carcinomas because of the early neck involvement potential.

Needle stick injuries among dental students: risk factors and recommendations for prevention

Aim : To evaluate the risk factors of needle stick injuries (NSIs) sustained by undergraduate dental students and nurse students at the Kings College London (KCL) Dental Institute. Materials and methods : A retrospective study evaluated the incident reports relating to NSIs reported over a period of 2 years. Factors including the dental department, study year, and when the injury took place during administration of local anaesthesia (LA) and recapping conventional syringe or clearing work surface or during disposal. Results : This report showed that students are at the highest risk of NSIs at the fourth year of their 5-year BDS course. About one-third of injuries were reported among this group of students followed by year 5 students (25%). Oral surgery clinics were the major source of incident reporting when compared with other specialised dental clinics within the institute. The left hands of the students were the most frequently affected by such injuries and then the right hands of student dental nurses. The attempt of needle recapping of conventional syringes was the least reported mechanism of injuries and constituted only 15% of the total injuries and mainly occurred in third year students. The most frequent injuries among student nurses were during disposal of the needle. Conclusion : Less NSIs occur when using safety syringes. A non-recapping policy with immediate disposal of either the conventional or safety syringe systems after injection would prevent all clearance-related NSIs sustained by nurses. To avoid NSIs, education plays a vital role particularly with effective implementation of the change to safety syringes with appropriate training.

Lysis of Dysplastic but not Normal Oral Keratinocytes and Tissue-Engineered Epithelia with Conditionally Replicating Adenoviruses

There is no effective medical treatment for oral precancer, and surgery to remove these lesions is imprecise because abnormal mucosa extends beyond the visible lesion. Development of vectors for tumor-selective viral replication has been a significant advance, and viral lysis is well suited to destruction of oral precancerous mucosa. To facilitate evaluation of new treatments, we engineered dysplastic oral epithelium using keratinocytes isolated from dysplastic lesions. We show that these model systems recapitulate the key characteristics of the clinical lesions closely, and that topical delivery of the conditionally replicating adenovirus (CRAd) dl922-947 can lyse tissue-engineered epithelia that show mild, moderate, or severe dysplasia, but normal oral epithelia are very resistant to this treatment. The lytic effect is determined by various factors, including the grade and proliferation index of the dysplastic epithelia. The presence of suprabasal cycling cells, expression of the coxsackie adenovirus receptor (CAR), the transcription cofactor p300, and other aberrations that affect the regulation of the cell cycle or apoptosis and promote viral replication may also be important. The ability of dl922-947 to destroy engineered oral dysplasia was significantly greater than that observed using wild-type adenovirus, d/1520, or viruses modified to bypass cell entry dependent on the presence of CAR. Evidence of infection in clinical dysplastic lesions was also shown ex vivo using tissue explants. We conclude that dl922-947 may provide an efficient molecular cytotoxic to dissolve oral dysplastic lesions.

The Knowledge and Attitude of Practicing Dentists towards the Antibiotic Prescription: A Regional Study

This work was carried out in collaboration between all authors. Author KG designed the study, wrote the protocol, and wrote the first draft of the manuscript. Authors AAB and AS managed the questionnaire handling and performed the statistical analysis. Author NAMH assisted in the preparation of the study protocol and the revision and correction of the manuscript. All authors read and approved the final manuscript.

The antiangiogenic agent ZD4190 prevents tumour outgrowth in a model of minimal residual carcinoma in deep tissues

Background:Tumour cells may persist at the operative site after seemingly adequate surgery. Radiotherapy is often given in an attempt to prevent repopulation, but this modality cannot be relied upon to prevent locoregional recurrence. An alternative strategy is to take advantage of the requirement of tumour cells to develop an independent blood supply and block this process to prevent recurrence.Methods:In this study, we evaluate the effect of the angiogenesis inhibitor, ZD4190, using a rodent model of residual carcinoma in deep tissues, mimicking the clinical scenario where low numbers of malignant cells persist at the operative site.Results:The tumour burden that could be eliminated was dependent on the site where the cells were implanted. Immediate treatment with ZD4190 prevented outgrowth of up to 2.5 × 105 cells in the rectus muscle and 1 × 105 in the gastrocnemius, whereas control animals developed large tumours. When more than 2.5 × 106 cells were implanted into the rectus or 1 × 106 into the gastrocnemius and treatment was maintained for 3 weeks, the carcinomas that developed in ZD4190-treated animals showed a reduced microvessel density and increased necrosis when compared with the vehicle-treated controls, but an infiltrative growth pattern was common.Conclusion:These findings suggest that antiangiogenic agents have a role to play in preventing outgrowth of residual carcinoma and are likely to be most effective when the tumour burden is minimal.

Arab dentists’ refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools

Abstract Objective: To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention. Materials and methods: In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients. Results: The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54). Conclusions: One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.

MINIMIZING THE INJURY OF INFERIOR DENTAL NERVE DURING REMOVAL OF LOWER THIRD MOLAR: A SYSTEMATIC APPROACH

Introduction: Temporomandibular disorders (TMDs) are chronic musculoskeletal pain conditions. Clinical manifestation of pain is related to the use of the joint stiffness during first motions after prolonged rest and limited joint range of motion can cause significant pain and disability. There is little evidence that physical therapy methods of management cause long-lasting reductions in signs and symptoms. Exercise programs designed to improve physical fitness have beneficial effects on chronic pain and disability of the musculoskeletal system.A smile is a very powerful social instrument. A better quality of working life, together with the promotion of employment and entrepreneurship, requests beauty and time savings. Today, patients come to Dental office and expect quick, good quality, long-term smile and absolutely, and always with no pain or other complications during or after the treatment. The successful Dentist is the one to be able to prepare and finish dental procedure; having happy patient at theand! Pharmaceutics could help a lot, but specific knowledge is needed.Study Design & Methods: A group of 29 children suffering from JRA age 7 to 15 are included in this prospective study. Healthy control group is consisted of 29 school children. Assessment of oral health awareness questionnaire was distributed to the parents/guardians. Oral examination was performed to determine scores for gingival index (GI), plaque index (PI) and dmft/DMFT index. Conventional orthopantomographic (OPT) images are done to examine the condition of the temporomandibular joint (TMJ) and to identify potential dental/oral focuses. In older children, age 8 and above the overall health status was measured using Stanford Health Assessment Questionnaire (HAQ).Endodontic therapy or root canal therapy: is a sequence of treatment for the pulp of a tooth which results in the elimination of infection and the protection of the decontaminated tooth from future microbial invasion. Root canals and their associated pulp chamber are the physical hollows within a tooth that are naturally inhabited by nerve tissue, blood vessels and other cellular entities which together constitute the dental pulp. Endodontic therapy involves the removalof these structures, the subsequent shaping, cleaning, and decontamination of the hollows with small files and irrigating solutions and the obturation (filling) of the decontaminated canals with an inert filling such as gutta-percha and typically a eugenol-based cement. Epoxy resin, -which may or may not contain Bisphenol Ais employed to bind gutta-perchain some root canal procedures.Methods: This intervention study was conducted on 117 female elementary school students in 1391-92. Random and clustered sampling was done from 4 groups of grade 3 in elementary school data selection was through a questionnaire, so that knowledge, attitude and practice of students were evaluated and compared before and after administration of methods. Data were analyzed using SPSS17 software through T-test and ANOVA.Out of the 33 forms received, 22 faculty members were fellows of College of Physicians and Surgeons of Pakistan or Royal College of Surgeons UK. Oral Surgeons were reported to be responsible for teaching by 19 of the faculty. In majority of the dental colleges, Implantology was introduced after the year 2005. Out of the 23 respondents who placed implants, 17 reported that they frequently allowed students to observe implant surgeries. Lectures (64%) are the mainstay of teaching Implantology at undergraduate institutions.Results: The findings of our study demonstrated that children aged 10-15-year-old living in the urban areas had higher prevalence of caries than those in rural areas. The average and standard deviation of DMFT in children from urban areas was 2.8 and 2.1, respectively the average and standard deviation of DMFT was 2.4 and 1.7, for children from rural areas. OHI-S index, on the other hand, showed an average 1.4.Background: Extensive caries, short clinical crown, traumatic injury, or severe para-functional habits may limit the amount of tooth structure available to properly restore an affected tooth. The restoration of an adequate biological width and the creation of an adequate space for proper placement of crowns prosthetic margins on a compromised tooth can be achieved surgically (crown lengthening procedure) or orthodontically (forced eruption), or by a combination of both.