JOURNAL OF KHYBER COLLEGE OF DENTISTRY

THE SILENT EPIDEMIC – ADDRESSING BURNOUT IN THE DENTAL COMMUNITY

Farhad Ali Khattak — 2025-06-23

Burnout among dental professionals is a growing concern worldwide, but in regions like Pakistan and particularly Khyber Pakhtunkhwa, it remains largely underrecognized and underreported. The dental profession demands high levels of concentration, manual dexterity, and continuous patient interaction, often in resource-limited and high-stress environments. In KP’s public and teaching hospitals, dentists face large patient loads, outdated equipment, and administrative burdens that significantly contribute to emotional exhaustion and depersonalization key hallmarks of professional burnout. Coupled with the stigma around mental health and limited institutional support, this silent crisis continues to erode the wellbeing of our dental workforce.

The implications of burnout go beyond individual suffering. Studies have shown that it directly impacts quality of care, patient safety, and even academic productivity in teaching institutions. In the context of Khyber Pakhtunkhwa, where dental services are stretched thin across urban and rural divides, the consequences of an overburdened and disengaged dental workforce could lead to long-term public health repercussions. Young dentists, house officers, and postgraduates in particular often face unrealistic expectations, poor mentorship, and job insecurity all of which increase susceptibility to early career burnout.

It is imperative that academic institutions, hospital administrators, and policymakers prioritize the mental health of dental professionals. Preventive strategies such as workload redistribution, mental health literacy programs, institutional counselling support, and protected academic time must be urgently introduced. Furthermore, integrating burnout screening and resilience training into dental curricula could empower future professionals to recognize and manage stress proactively. If left unaddressed, burnout will continue to undermine not only the profession but also the trust and care we owe our communities.

CORRELATION BETWEEN MOTORCYCLE RIDING BEHAVIORS AND SEVERITY OF MAXILLOFACIAL INJURIES IN PESHAWAR, KHYBER PUKHTUNKHWA

Basheer Rehman — 2025-06-23

Objective: The objective of this study is to determine the correlation between riding behavior score of motorcyclists and maxillofacial injuries severity score.

Methodology: This co relational Cross sectional study was conducted in the Department of Oral & Maxillofacial Surgery at Khyber College of Dentistry Peshawar from June 2022 to December 2024 on 264 patients who suffered Oral & Maxillofacial injuries as a result of motorcycle riding. Data was collected on a pre-validated Modified Motorcycle Rider Behavior Questionnaire & Facial Injury Severity Score. Categorical variables such as pattern of fracture (injury type), Educational Level, SES, addiction, registration status, accidents in the past, occupation and driving experience were expressed in terms of frequency and percentage while continuous variables such as age, MRBQ score and FISS was expressed as mean ± standard deviation (SD). Mean MRBQ score and Mean FISS were correlated using Pearson correlation. P<0.05 was considered statistically significant.

Results: The Facial Injury Severity Score had a mean of 1.89 ± 0.69 SD while Motorcycle Riding Behaviour Score had a mean of 1.97 ± 0.65 SD, showed a strong positive Pearson correlation of 0.847, statistically significant at the p < 0.001 level. The motorcycle riding behaviour score was strongly and positively correlated with both traffic errors score (r = 0.83) and facial injury severity score (r = 0.83). Stunts score showed a moderate positive correlation with the motorcycle riding behaviour score (r = 0.33) and facial injury severity score (r = 0.38. Control error score demonstrated moderate negative correlations with both the motorcycle riding behaviour score (r = –0.29) and facial injury severity score (r = –0.36. The number of accidents in the past had a weak-to-moderate positive association with stunts score (r = 0.56) and facial injury severity score (r = 0.35).

Conclusion: These findings underscore the urgent need for targeted interventions focused on young motorcyclists, including road safety education, strict enforcement of traffic laws, and promotion of helmet use to reduce the incidence and severity of maxillofacial injuries.

EFFECTIVENESS OF VARIOUS DISINFECTANTS ON ALGINATE IMPRESSION MATERIAL: IN-VITRO EXPERIMENTAL STUDY

Fawad Fayyaz — 2025-06-23

Objectives:

The objective of the study was to highlight a disinfectant which dentists can use to decontaminate alginate impressions in hospitals and clinics before sending it to laboratory.

Materials and Methods:

This In-vitro experimental study was conducted at the Department of Prosthodontics, Sardar Begum Dental College & Hospital, Peshawar. After Ethical approval Microbiological analysis were carried out at Research Centre Gandhara University, Peshawar. Consent was taken from Male dentate individuals fulfi lling the inclusion criteria and maxillary impressions were achieved from them. Palatal portion each impression was divided into four section. Specimens of control group 1 were left unwashed and
untreated whereas; Specimens of experimental group 2 were sprayed with simple tap water, specimens of experimental group 3 were washed with 0.5% hypochlorite solution and specimens of experimental group 4 were treated with 1% chlorohexidine solution. These specimen were then arranged on blood agar petriplates stitched with S.mutans and results were collected. For dimensional stability specimen were made from alginate impression materials and were tested according to ADA specification no 19.

Results:

The control group (untreated) exhibited the highest mean microbial colony count (63.6 ± 15.1 CFU), while disinfection with 1% chlorhexidine resulted in the lowest (1.27 ± 1.53 CFU), refl ecting a 98% reduction in microbial load (p < 0.001). Treatment with 0.5% sodium hypochlorite also showed a signifi cant reduction (2.2 ± 1.90 CFU; p < 0.001, 96.5% reduction), whereas rinsing with tap water (19.87 ± 6.78 CFU) achieved only a 68.8% reduction (p < 0.001). In terms of dimensional stability, untreated impressions showed a 10%
reduction in dimensions after 1 hour (from 20 mm to 18 mm). In contrast, the 1% chlorhexidine group maintained dimensional stability with only a 2.5% change (20 mm to 19.5 mm), followed by 0.5% hypochlorite (4.5%) and tap water (4%). All changes were statistically significant (p < 0.05), with 1% chlorhexidine showing the most favorable balance of antimicrobial effi cacy and minimal dimensional distortion.

Conclusion:

Chlorohexidine 1% is proved to be a potent disinfectant as compared to tap water and 0.5% sodium hypochlorite for irreversible hydrocolloid alginate impression material.

FREQUENCY AND CLINICORADIOGRAPHIC PATTERN OF GIANT CELL LESIONS AFFECTING ORAL AND MAXILLOFACIAL REGION

Hira bibi — 2025-06-23

Objectives: To determine the frequency, clinical and radiographic features of diff erent types of giant cell lesions of the oral & maxillofacial region reported to Khyber College of Dentistry Peshawar.
Materials and Methods: This descriptive cross sectional study was conducted in the department of oral and maxillofacial surgery, Khyber College of Dentistry Peshawar from November 2019 to April 2021. Total of 239 patients with histopathologically confirmed reports of giant cell lesions were included in the study. Data about patient age, gender, clinical and radiographic features were obtained through a structured proforma and was analyzed for results.
Results: Out of total 239 patients, 145 (60.7%) were female. The most common age group was 11-20 years comprising (34.7%). Among diff erent types of giant cells lesion, central giant cell (60.7%) was the most common followed by peripheral giant cell granuloma (31%). There was no pain in 72% patients. Bicortical swelling was observed in 65.7% cases. The Mandible was the most commonly involved site (65.7%), with anterior mandible aff ected in 46.9% cases. Tooth mobility was observed in 67.8% cases. Radiographically, 94.6% cases were radiolucent and 54.8% were multilocular.
Conclusion: It is concluded from this study that Giant cell lesions are frequently encountered during 2nd decade of life and more common in females, involving anterior mandible. Central giant cell granuloma is the most frequent among the other types of giant cell lesions. Clinically, the majority of patients presented without pain, exhibited tooth mobility and had biocritical swelling. adiographically, most of the lesions appeared radiolucent and multilocular.

EFFECT OF FIBER BUNDLE POSTS USED IN DIFFERENT THICKNESSES ON FRACTURE RESISTANCE

Elif YILDIZ — 2025-06-23

Objectives: To evaluate in vitro the effect of three different thicknesses of traditional fibre posts and a novel canal post (bundle post) on the fracture resistance of restored teeth.
Materials and Methods: Ninety-two extracted single-rooted, single-canaled upper incisors were selected and prepared for endodontic treatment. The specimens were divided into six experimental groups (n=14 each) based on post type and thickness: Group I (Bundle Post 0.8 mm), Group II (Bundle Post 1 mm), Group III (Bundle Post 1.2 mm), Group IV (Fibre Post 0.8 mm), Group V (Fibre Post 1 mm), and Group VI (Fibre Post 1.2 mm). Additionally, two control groups were included: a negative control group (n=4, untreated healthy teeth) and a positive control group (n=4, canal prepared but unrestored). Fracture resistance was tested using an Instron device, and results were analyzed statistically.
Results: The negative control group showed the highest fracture resistance (2133.21 ± 317.42 N), significantly greater than the positive control group (1436.08 ± 334.31 N; p < 0.05). Among experimental groups, no statistically significant differences were observed based on post type or thickness (p > 0.05). For 0.8 mm posts, fracture resistance was 1211.14 ± 396.85 N (bundle) and 1276.42 ± 339.02 N (fibre); for 1 mm posts, 1355.49 ± 282.45 N (bundle) vs. 1271.86 ± 323.46 N (fi bre); and for 1.2 mm posts, 1122.74 ± 311.50 N (bundle) vs. 1062.49 ± 163.10 N (fibre), all with p > 0.05.
Conclusion: The fracture resistance of teeth restored with bundle fibre posts of varying thicknesses was comparable to those restored with conventional fibre posts.

IMMUNOREACTIVITY OF MMP-9 IN TISSUE SAMPLES OF ORAL POTENTIALLY MALIGNANT DISORDERS AND NORMAL ORAL MUCOSA

Fiza Shafiq — 2025-06-23

Objectives: This study's objective is to evaluate the immunoreactivity of MMP-9 in tissue samples from diagnosed cases of oral precancerous conditions and from normal oral mucosa.
Materials and Methods: This study evaluated MMP-9 immunoreactivity in normal oral mucosa and oral potentially malignant disorders (OPMDs). Tissue samples were collected from surgical procedures and departmental archives, with H&E and immuno-histochemical staining performed following standard protocols. Immunoreactivity was assessed based on staining intensity and positive cell percentage, using spleen tissue as a positive control. Statistical analysis showed signifi cant differences in age between normal mucosa and OPMD cases (p < 0.05).
Results: MMP-9 expression was high in OPMDS patients than in normal oral mucosa. While comparing the degree of MMP-9 expression among OPMDs and normal oral mucosa , a statistically significant relationship was found.
Conclusion: MMP-9 expression was shown to be higher in OPMDs than in normal oral mucosa. Evaluation of MMP-9 biomarker may be clinically significant in OPMDs and may be utilized as a diagnostic indicator for OPMDs.

CLINICOPATHOLOGICAL ANALYSIS AND CD44 EXPRESSION IN ORAL AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMA

Rehana Ramzan — 2025-06-23

Objectives: To assess the relationship between CD44 expression in malignant cells, clinicopathological findings, and prognostic outcomes in oral squamous cell carcinoma.
Materials and Methods: This was a retrospective comparative study utilized excisional and incisional biopsy specimens from oral and oropharynx, collected at Akbar Niazi Teaching Hospital, Islamabad, between September 2022 and September 2024. Among 40 specimens, 13 were well-differentiated, 19 were moderate, and 8 were poor squamous cell carcinomas, with or without nodes metastasis. These specimens were randomly selected for CD44 immunohistochemical staining.
Results: The majority of patients were between 50 and 75 years old (mean was 62.5±7.2 years), and males were 77.5%. The mean tumor depth was 0.7±0.4 mm. T1 tumors were the most common (55%), with the majority exhibiting N0 nodal status (62.5%). Grade 2 tumors were the most frequent (47.5%), while stage I tumors had the highest prevalence (40%). Strong CD44 expression was detected in 72.5% cases, with basal cell invasion present in 55%. Lesions were most frequently located on the tongue (30%) and vocal cords (25%). Insignificant difference was observed in age, gender, tumor size, nodal status, or basal cell invasion across expression levels (p > 0.05). A notable variation in tumor grades was identified across different expression levels (p = 0.022).
Conclusion: Reduced CD44 expression in aggressive OSCC, characterized by poor differentiation and lymphnode involvement, indicates a potential association with disease progression. CD44 may help preserve tissue structure, and its loss could serve as a potential marker of poor prognosis.

PATTERNS OF ORAL & MAXILLOFACIAL INJURIES IN PEDIATRIC PATIENTS: A RETROSPECTIVE CHART REVIEW

Riaz Khan — 2025-06-23

Objectives: To determine the frequency distribution of patterns of maxillofacial injuries in pediatric patients.
Materials and Methods: A retrospective study was carried out in the department of Oral & Maxillofacial Surgery, Lady Reading hospital Peshawar from June 2023 to June 2024. A total of 178 patients were selected in this study of both genders. And two groups were allocated from 0-6 years and 7-12 years aged group. Panorama or Computed tomographic scan was used for diagnosis of facial fractures. Data was analyzed using SPSS version 23.0. The level of signifi cance was kept at p<0.05.
Results: The age presentation was 6.35 (5.82-6.87) years. Males were predominant than female with ratio 1.4:1. Overall the dentoalveolar fracture was the most common injury seen in pediatric patients with 81(42.1%).Mandible was the most common facial bone fracture 30(16.85%) in 0-6 years aged group and 36(20.22%) in 7-12 years aged group. Perioral area was seen most frequent in these patients, 20(11.23%) in 0-6 years aged group and 29(16.29%) in 7-12 years aged group. The most common etiology of maxillofacial injuries seen were fall, 50(67.57%) in 0-6 years aged group and 41(39.42%) in 7-12 years aged group.
Conclusion: The most common cause of maxillofacial injury was fall, injury was dentoalevolar and site of facial fracture was mandible with male predominance.

COMPARISON OF CLINICAL EFFECTIVENESS OF HYDROCHLORIC ACID AND SODIUM HYPOCHLORITE IN MICROABRASION TECHNIQUE FOR THE TREATMENT OF DENTAL FLUOROSIS: A RANDOMIZED CONTROL TRIAL

Hareem Abdul Sattar — 2025-06-23

Objectives: The aim of this study is to compare the clinical effectiveness of hydrochloric acid-pumice compound and sodium hypochlorite-pumice compound in treating dental fluorosis using micro abrasion technique.
Materials and Methods: A Randomized Clinical Trial were carried out in Fatima Jinnah Dental College & Hospital, Karachi, from 1st November 2019 to 30th April 2020. Total 30 patients in each group were included. Preoperatively shade was checked. The mixture was applied 10 times or more during the same session. Total treatment time was around 30 minutes. Every patient received entire micro abrasion treatment. At the end of the treatment, neutral sodium fluoride gel was applied. Then changes in shade were checked.
Descriptive statistics were calculated. Chi square test was applied to compare effectiveness of both groups. P-value <0.05 as significant.
Results: There were 53.3% male and 46.7% female patients in Group-A (hydrochloric acid–pumice compound) and 60% male and 40% female patients in Group-B (sodium hypochlorite–pumice compound). Mean pre-operative shade in group-A and group-B was .53±0.50 and 4.66±0.47 respectively. Mean post-operative shade in group-A and group-B was 2.90±0.75 and 3.96±0.99 respectively. Effectiveness was found 90% in group-A and 53.3% in group-B. The results showed significant association of effectiveness with study groups.
Conclusion: Effectiveness was 90% with hydrochloric acid-pumice compound and 53.3% with sodium hypochlorite-pumice compound. The enamel micro abrasion is efficient and effective for producing esthetic improvements.

ASCERTAINMENT OF MAXILLARY BICUSPID ROOT AND ROOT CANAL MORPHOLOGY USING CONE BEAM COMPUTED TOMOGRAPHY, AMONG PATIENTS OF KHYBER PAKHTUNKHWA

Maryam Arbab — 2025-06-23

Objectives: To determine the most common root canal configuration in maxillary fi rst bicuspid (MFB) teeth using Vertucci’s classification among patients visiting a tertiary care hospital.
Materials and Methods: This descriptive cross-sectional study was conducted from August 2023 to August 2024. CBCT images were obtained from the radiology department using a SCANORA 3DX scanner, with a 50x50 mm field of view and 200 µm resolution. Patients aged 12–40 years who met the inclusion criteria were enrolled. Data analysis was performed using SPSS version 22. Chi-square or Fisher’s exact test was applied to assess statistical differences in Vertucci canal types between genders.
Results: A total of 246 patients were evaluated with a male-to-female ratio of 1:1.2 and a mean age of 28.02 ± 11.63 years. The revalence of two-rooted MFBs was 54.3% on the left side and 59.9% on the right. Vertucci’s Type IV canal configuration was the most common, observed in 72.2% of cases on both sides of the arch. The association between canal configuration and gender was statistically non-significant (p = 1.000).
Conclusion: Maxillary first bicuspids demonstrated bilateral symmetry in root number, with Vertucci’s Type IV being the most prevalent canal configuration in both male and female patients.

RELATIONSHIP BETWEEN SAGITTAL POSITION OF LOWER INCISORS AND FACIAL PROFILE ESTHETICS WITH REFERENCE TO VERTICAL FACIAL DIVERGENCE

Mehak Hassan — 2025-06-23

Objectives: To compare the sagittal position of the lower incisors and facial profile esthetics among sagittal and vertical pattern.
Materials and Methods: This comparative study on 229 participants at deparment of Orthodontics, Armed Forcers Institute of Dentistry, Combined Military Hospital, Rawalpindi. Patients aged 20–30 years with no history of orthodontic treatment and a complete dentition up to the second permanent molars were included, while those with dental anomalies, craniofacial deformities, or a history of head and neck trauma or surgery were excluded. Pretreatment lateral cephalograms were obtained, and age and gender were recorded from patient files. Facial growth patterns were assessed using the SN-MP angle, facial profile convexity using Merrifield’s Z-angle, and lower incisor inclination using the IMPA. Student t-test and ANOVA were used to compare lower incisor inclination and facial profile among vertical and sagittal patterns.
Results: Males were 95 (41.5%). IMPA was significantly higher in the high-angle (100± 9.9) than in the low-angle group (94.8±15.320) (p = 0.004), while the Z angle was significantly lower in the high-angle (66.02±7.880) than in the low-angle group (72.07 ± 11.35) (p < 0.001). Signifi cant diff erences in IMPA and Z angle across skeletal classes (p < 0.001), with Class II showing the highest IMPA (108.68 ± 5.54) and lowest Z angle (64.59 ± 7.510), while Class III had the lowest IMPA (66.88 ± 6.630) and highest Z angle (90.12 ± 5.970).
Conclusion: High-angle participants had more proclined lower incisors and a retrusive profile, while Class II showed the most proclined incisors and flattest profile.

2025-06-23