JOURNAL OF KHYBER COLLEGE OF DENTISTRY

COSMETIC DENTISTRY TRENDS: BALANCING AESTHETICS AND FUNCTIONALITY

Dr. Farhad Ali — 2025-03-18

Cosmetic dentistry is rapidly evolving, driven by increasing patient demand for aesthetically pleasing yet functionally sound dental treatments. Modern advancements such as digital smile design, minimally invasive veneers, and biomimetic restorations have revolutionized the field, allowing practitioners to enhance smiles while preserving natural tooth structure. The rise of clear aligners and teeth-whitening innovations has further expanded accessibility, offering patients personalized, non-invasive solutions. However, in the pursuit of perfect smiles, it is crucial for dental professionals to maintain a balance between aesthetics and functionality, ensuring that treatments do not compromise oral health and long-term stability.

While cosmetic procedures significantly boost self-confidence and patient satisfaction, ethical considerations and evidence-based practices must guide their application. Over-aggressive enamel reduction, excessive bleaching, and ill-planned restorations can lead to irreversible damage and long-term complications. As we embrace cutting-edge techniques, the emphasis should remain on holistic treatment planning that integrates esthetics with occlusal harmony and periodontal health. The future of cosmetic dentistry lies in a multidisciplinary approach, combining artistry with scientific precision to achieve sustainable, natural-looking results that enhance both form and function.

ASSOCIATION OF STRESS WITH ACADEMIC PERFORMANCE AFFECTING SELF-EFFICACY OF DENTAL UNDERGRADUATE STUDENTS IN PAKISTAN

Afifa Ehsan — 2025-03-18

Objectives: To determine the association concerning stress and academic achievement affecting self efficacy in dental undergraduate students.
Materials and Methods: This cross-sectional study was carried out from July 01, 2020, to June 31, 2021, both in the private and public sectors in Punjab and the Federal areas in Pakistan. The study comprised 310 students and a validated questionnaire was shared with them. Response from all forms was analyzed and the relationship between stress and academic performance was assessed. Descriptive analysis was done for gender and years of study while the relationship between stress and academic performance was analyzed by Chi-square test.
Results: Results indicated that 86.1% of students were stressed and significant associations were seen in gender from academic overload in exams (p ≤ 0.001), too many tasks (p ≤ 0.05), and poor relation with peers (p ≤ 0.001). Likewise, stress of competitiveness (p ≤ 0.008), and becoming a dentist (p ≤ 0.001) were also found to be strongly correlated amongst all years of study. Furthermore, stress from academic overload, family pressure, interaction with peers, and future perspectives were all found to be intensely associated with the effect on academic performance.
Conclusion: The research shows high amount of stress in dental students which is linked to poor academic performance, emphasizing the need for institutions to implement effective stress management strategies to support student well-being and enhance academic outcomes.

MEAN VALUE OF THE ANGLE AMONG THE THREE VARIANTS OF ALATRAGUS LINE AND OCCLUSAL PLANE IN DENTATE SUBJECTS

Faryal Saeed — 2025-03-18

Objectives: To determine the mean value of angle among the three variants of ala-tragus line (ATL) and OP in dentate individuals and to identify which among the three variants is parallel to OP.
Materials and Methods: This descriptive cross-sectional study included 190 subjects of both gender with age range 20-40 years fulfi lling the inclusion criteria. Left Profi le photograph of the participant was taken with a digital camera (Canon 600D) in natural head position holding Fox OP between teeth. Image was analyzed using Adobe Photoshop CS6 software and most parallel relationship determined between the 3 variants of ala- tragus line and arm of the fox OP. Statistical analysis of the data was done using SPSS version 20.
Results: Out of 190 participants, males formed 53.7% whereas females formed 46.3%. The mean age was 29.5±5.35 (SD) yrs. A total of 109 patients fell within the 20-30 years. The three variants of ATL were found to be at a considerable angle to OP. Angle ≤ 5° was considered to be parallel for this study. Inferior variant of ATL (ATL-I) was found to have least angle with OP (mean value 3.56° ± 1.17). The relationship between the OP and three variants of ATL was stratifi ed among age and gender and was found to be non-significant.
Conclusion: In maximum subjects, the ATL-I was found to be parallel to be the OP suggesting inferior border of the tragus to be the reference point for the ATL.

ORAL HEALTH KNOWLEDGE AND ATTITUDE AMONG CAREGIVERS OF SPECIAL HEALTH CARE NEEDS CHILDREN AT SPECIAL EDUCATION SCHOOLS IN PESHAWAR: A CROSS-SECTIONAL STUDY

Omer Ali — 2025-03-18

Objectives: To assess the oral hygiene knowledge, practice and attitude among the caregivers of the special health care need children in Peshawar.
Materials and Methods: About 128 participants took part in this study. A validated self-administered questionnaire was used to evaluate and record the oral health knowledge and attitude of caregivers (Parents and Teachers) of the special children. The questionnaire contained a total of 22 questions, each correct question was scored 1 and incorrect was scored 0. The caregivers then were ranked according to their score achieved. The exclusion criteria of caregivers are those who did not want to participate in the study and an experience of less than 2 years. The inclusion criteria for the caregivers having at least primary school education for the parents and bachelor’s degree for the school teachers.
Results: Our study result showed that the association between child relation and knowledge level was statistically significant (P = 0.003). Regarding gender, no significant association was observed between gender and knowledge level (P = 0.672). Concerning age, no significant association was found between age and knowledge level (P = 0.473). A significant association was observed between qualification and knowledge level (P = 0.003). Pearson’s correlation test was used to analyze the data collected.
Conclusion: Association between the child relationship and knowledge levels were statistically significant. No significant association was found between age and gender with knowledge levels. A significant association was observed between qualification of the caregivers and oral health knowledge.

SATISFACTION OF PATIENTS VISITING SELECTED DENTAL TEACHING HOSPITALS IN ISLAMABAD: A CROSS-SECTIONAL STUDY

Rana Saad Bin Sohail — 2025-03-18

Objectives: To determine patient satisfaction with their visits to dental teaching hospitals in Islamabad, where multiple hospitals offer affordable and standard treatment.
Materials and Methods: This cross-sectional study involved 200 consenting patients who completed a customized satisfaction questionnaire using a fi ve-point Likert scale. Data were analyzed using IBM SPSS ver.23, with descriptive statistics, including mean, standard deviation, and frequency distribution, to determine satisfaction scores.
Results: The mean satisfaction scores for administration and advocacy, facilities, and dental professionalism were 4.197 (SD = 0.549), 3.721 (SD = 0.606), and 4.382 (SD = 0.578), respectively. Corresponding satisfaction percentages were 84%, 74%, and 88%. The overall satisfaction score for the visit to a dental hospital in Islamabad was 4.10 (SD = 0.72), with a satisfaction percentage of 82%. The highest-rated factors were receptionist courtesy (Mean = 4.45, SD = 0.663, 89% satisfaction) and dentist-patient communication (Mean= 4.45, SD = 0.807, 89% satisfaction). The lowest-rated aspects included hospital aff ordability (Mean = 3.64, SD = 1.333, 73% satisfaction) and availability of a pharmacy (Mean = 3.00, SD = 1.468, 60% satisfaction).
Conclusion: Most patients were satisfied with dentist-patient communication, administrative services, and the overall hospital environment. However, concerns were noted regarding treatment costs, long wait times, and the lack of an on-site pharmacy. Enhancing affordability and accessibility could further improve patient satisfaction.

FREQUENCY OF ENDODONTIC FLARE UP ACCORDING TO PULPAL AND PERIRADICULAR DIAGNOSIS AT REHMAT MEMORIAL HOSPITAL ABBOTTABAD

Maham Shafique — 2025-03-18

Objectives: To determine the frequency of endodontic flareup and its association with pulpal and peri radicular diagnosis in teeth receiving root canal therapy.
Materials and Methods: From June 10, 2021, to March 15, 2022, 101 patients aged 10 to 60 years were included in a descriptive case series.The sample size was determined using WHO software with a confidence level of 95%, an expected proportion of endodontic flare-up of 7%, and absolute precision of 5%. Non-probability consecutive Sampling technique was used for data collection. The study was conducted at the Restorative department of Rehmat memorial dental teaching hospital, Abbottabad, to determine the frequency of endodontic fl are-ups based on pulpal and peri radicular diagnoses.
Results: The study participant’s mean age was 33.62±11.57 years. Of the total 101 participants, 42 (41.58%) were females and 59 (58.42%) were males. Irreversible pulpitis, which aff ected 57 patients (56.44%), was the most requent diagnosis of teeth requiring root canal therapy while pulp necrosis, which aff ected 14 patients (13.86%), was the east common diagnosis . Pulp necrosis (6.93%) was the most frequent diagnosis associated with endodontic flare-ups out of total 14 reported cases, followed by irreversible pulpitis (3.96%), and, least frequent diagnosis associated with flare up was periapical pathology (2.97%).
Conclusion: In our set-up, the frequency of endodontic fl are-ups (13.86%) is signifi cantly higher. Irreversible pulpitis, peri-apical pathology, and pulp necrosis are the major diagnoses associated with endodontic flare-ups.

CLINICAL PRESENTATION AND BACTERIOLOGICAL PROFILE OF ICU ADMITTED PATIENTS WITH VENTILATOR ASSOCIATED PNEUMONIA IN KHYBER TEACHING HOSPITAL PESHAWAR

Mohammad Haroon — 2025-03-18

Objectives: To determine bacteriological profile of ICU admitted patients with ventilator associated pneumonia.
Materials and Methods: A descriptive cross-sectional study was conducted from July 2018 to April 2020 at department of Medical ICU. A total of 172 patients were observed for clinical presentation and bacteriological profile in ventilator associated pneumonia. Data were presented in form of frequency and percentages.The p-value less than 0.05 were considered as statistically significant.
Results: Out of 172 patients, 24 (13.71%) and 18 (10.2%) were having Diabetes Mellitus (DM) and Hypertension (HTN), respectively. Patients who received mechanical ventilation for 0-5 days had a relatively low recovery rate of 8.8%, with the majority (91%) unfortunately expiring. In the 6–10-day category, there was a slightly higher recovery rate of 14.8%, but still, the majority (85%) of patients did not survive. Patients with >16 days of ventilation, show higher recovery rate (35.2%). The highest number of bacteria was isolated from the patients with 0-5 day’s ventilation while there was a lowest growth of bacteria in 6-10 days ventilated patients. In antibiotics susceptibility, there are variations in antibiotic eff ectiveness across different bacterial strains and antibiotics. Fosfomycin and Tigecycline show highest eff ect against all bacteria except Acinobacter baumannii while Colistin was effective against all the bacteria except Pseudomonas.
Conclusion: Patients on mechanical ventilation had lower chances of recovery in the early days, but those who were ventilated longer showed better outcomes. Diabetes Mellitus and Hypertension were common comorbidities. Bacterial growth was highest in the early days of ventilation. Antibiotics like Fosfomycin and Tigecycline show highest eff ect against all bacteria except Acinobacter baumannii whereas Colistin was also eff ective against all, except for Pseudomonas.

IN-VIVO ANALYSIS OF OXIDATIVE STRESS IN AESTHETIC COATED ORTHODONTIC ARCH-WIRES & BRACKETS

Iffat Batool Syed — 2025-03-18

Objectives: To assess in vivo the oxidative damage that aesthetic coated arch-wires causes by measuring 8OHdG (8-hydroxydeoxyguanosine ) as an oxidative marker to detect the level of oxidative stress generation.
Materials and Methods: About 80 patients of ages 15-30 years enrolled in the study having fi xed orthodontic treatment were divided into control (patients with NiTi wire) and experimental groups including patients with wires coated in PTFE, epoxy resin, and rhodium. Saliva samples were collected with an unstimulated saliva collection method at two intervals. The first sample was collected before the bonding process and insertion of the arch-wires and the second sample was collected four weeks after the insertion of arch-wires. The samples were kept in storage at -80°C, and the amounts of 8-OHdG were measured by ELISA analysis.
Results: The salivary 8-OhdG level in all groups was measured at day 0 and the end of week 4. At day 0, It was 1.60±43 ng/ml in the NiTi group,1.60±0.52 ng/ml in the epoxy resin group, 1.70±0.12 ng/ml in the rhodium group and 1.63±0.40 ng/ml in PTFE group. After 4 weeks, it was 3.6810.47 ng/ml in the NiTi group, 3.50±0.77 ng/ml in the epoxy resin group, 3.06±0.70 ng/ml in the rhodium group and 2.75±0.72 ng/ml in PTFE group, p = 0.812) This demonstrated that while there was no noteworthy variation in the groups' mean 8-OHdG levels at day 0, there was at week 4. Post hoc Tukey test revealed that PTFE-coated arch-wires and Rhodium group had significantly lower 8-OHdG levels compared to NiTi and Epoxy resin-coated arch-wire. Salivary 8-OHdG levels increased significantly after 4 weeks of arch-wire use in all groups.
Conclusion: This study suggests that PTFE-coated arch-wires are the most biocompatible among the coated arch-wires studied.

CORRELATION BETWEEN NUMBER OF MISSING TEETH AND ORAL HEALTH RELATED QUALITY OF LIFE. A CROSS-SECTIONAL STUDY

Shafi Ullah Khan — 2025-03-18

Objectives: To determine correlation between number of missing teeth and Oral Health Related Quality of Life.
Materials and Methods: This study was carried out in the department of Prosthodontic, Khyber College of Dentistry, Peshawar. A non-probability consecutive sampling technique was used. A total of 177 partially edentulous patients were selected following strict inclusion and exclusion criteria. Data were collected using the method of interview. General Oral Health Assessment Index questionnaire was used as a tool for measurement of Oral Health Related Quality of Life. Number of missing teeth was determined through intra-oral examination. Pearson’s correlation and Linear Regression analysis was used to determine correlation and strength of association between number of missing teeth and General Oral Health Assessment Index score. A P < 0.05 was considered statistically significant.
Results: Out of 177 patients 49.7% were males and 50.3% were females. Means age of the patients was 35.8 (± 5.83). Average General Oral Health Assessment Index score for Oral Health Related Quality of Life was 47.82. Number of missing teeth was strongly related negatively with General Oral Health Assessment Index score, r= −0.53, p=<0.001. Linear regression analysis showed beta coefficient of −1.02 [CI = 95% (−1.24 to −0.79)].
Conclusion: Increase in number of missing teeth was strongly correlated negatively with Oral Health related Quality of life.

HYPERTRIGLYCERIDEMIA AS A RISK FACTOR FOR NON–ALCOHOLIC FATTY LIVER DISEASE

Sarwat Abbasi — 2025-03-18

Objectives: To determine increased triglyceride levels as a potential cause of development of non–alcoholic fatty liver disease.
Materials and Methods: This cross sectional study was conducted at Ayub Medical Institute, Abbottabad. A well designed questionnaire was designed. Subjects between 40–60 years age group were selected after informed consent and all the data was saved confi dentiality. Data accumulated and examined with the help SPSS version 22.
Results: Among patients with hepatic steatosis 28 (56.0%) have normal serum triglyceride levels while 22 (44.0%) have high triglyceride levels. Among individuals with no fatty infi ltration 41 (82.0%) have normal triglyceride level while only 9 (18.0%) have elevated serum triglyceride levels. 27 (54.0%) obese patients and 17 (34.0%) overweight individuals have fatty liver disease hence giving a outstanding p-value of ˂0.001 with chi-square test between NAFLD and BMI.
Conclusion: Hypertriglyceridemia was found as a risk factor for non–alcoholic fatty liver disease (NAFLD).

KNOWLEDGE ABOUT ROLE OF HPV AS A RISK FACTOR OF ORAL SQUAMOUS CELL CARCINOMA AMONG DENTISTS IN ASIA. A SYSTEMIC REVIEW

Maria Ilyas — 2025-03-18

Objectives: To assess the awareness and the knowledge among dentists of Asia about the Human Papillo mavirus (HPV) as a risk factor in oral squamous cell carcinoma (OSSC).
Materials and Methods: This systemic review was conducted on cross-sectional and observational research to assess dentists knowledge of HPV as a risk factor for OSCC in Asia. Up until August 9, 2024, databases including PubMed, Web of Science, Scopus, and Google Scholar were searched for relevant studies. Studies applying dentists as participants carried out in Asian nations met the eligibility requirements. The Joanne Briggs Institute (JBI) criteria for analytical cross-sectional research was used to assess the quality of the investigations.
Results: Studies from Asian countries, including Saudi Arabia, Turkey, Malaysia, Indonesia, and Pakistan, met the inclusion criteria. The fi ndings revealed signifi cant disparities in knowledge across regions. In Indonesia, 98% of dentists demonstrated a high understanding of HPV’s role in OSCC, while in Pakistan and Malaysia, many dentists were unaware of this association. Gender and education level infl uenced awareness, with male students showing more knowledge about HPV's link to oropharyngeal cancer, while female students were better informed about HPV vaccination. These results highlight the need for enhanced education and training programs to address these gaps.
Conclusion: Asian nations have an increased incidence of oral squamous cell carcinoma (OSCC), with tobacco use, alcohol intake, and chewing betel quid as major risk factors. There is growing evidence that HPV, specifically subtypes HPV-16 and HPV-18, plays a major role in the development of OSCC. In Asia, dentists are still mostly unaware of the role HPV plays in OSCC risk factor education and early diagnosis, despite their critical role in this respect.

Amir Khan — 2025-03-19