JOURNAL OF KHYBER COLLEGE OF DENTISTRY

GREEN DENTISTRY: A SUSTAINABLE FUTURE FOR ORAL HEALTH CARE

Shazia Liaqat — 2024-09-30

The dental public health profession, like many others, is becoming increasingly aware of its environmental impact and the urgent need to adopt more sustainable practices. Green dentistry, also known as eco-friendly dentistry, is a growing movement that focuses on reducing waste, conserving energy, and minimizing pollution while maintaining high standards of patient care. By integrating environmentally conscious choices into daily practices—such as using digital technologies, reducing water consumption, and choosing biodegradable or recyclable materials—dentists can significantly contribute to environmental preservation without compromising the quality of their services.

One of the core tenets of green dentistry is the shift towards digital dentistry. Traditional methods of record-keeping and patient management involve a considerable amount of paper and plastic waste. By adopting digital x-rays, patient records, and appointment scheduling systems, dental practices can dramatically reduce their paper use, lower radiation exposure, and decrease the need for disposable materials. Additionally, using energy-efficient equipment and eco-friendly sterilization techniques can help reduce the carbon footprint of dental offices, aligning with global sustainability goals.

As the dental community moves towards greener practices, there is an opportunity for education and advocacy in dental public health. Dental schools and professional organizations play a crucial role in promoting awareness of sustainable practices among both practitioners and patients. By fostering a culture of environmental responsibility within the field, we not only contribute to a healthier planet but also inspire the next generation of dentists to prioritize sustainability in their professional lives. Green dentistry represents a vital step towards a more sustainable future for both the profession and the world at large.

Amir Khan — 2024-09-30

FREQUENCY OF DRY SOCKET POST-IMPACTED MANDIBULAR THIRD MOLAR EXTRACTION AND ITS ASSOCIATION WITH SURGICAL DIFFICULTY

Rafay Manan Mian — 2024-09-30

Objectives: To determine the frequency of dry socket following impacted mandibular third molar
extraction and its relationship with surgical complexity.
Materials and Methods: The cross-sectional study enrolled 125 patients from the oral and maxillofacial surgery department of De. Montmorency College of Dentistry, Lahore from November 2022 to April 2023. Patients aged 18 years and above, who had undergone surgical extraction of impacted mandibular third molars with complete clinical records. The primary outcome measure was the incidence of dry socket, with secondary outcome measures including Paderson Difficulty Index score. Data analysis was performed using IBM SPSS, version 27.0.
Results: In this study, 125 participants were enrolled, with males comprising 51.2% (n=64) and
females 48.8% (n=61). The age range was 15 to 59 years, with a mean age of 33.5±10.44 years.
Left-sided mandibular third molar impaction was noted in 52.8% (n=66) of cases, while right-sided impaction was seen in 47.2% (n=59). Based on Pederson’s diffi culty index, the majority fell
into the moderately difficult category (54.4%, n=68), followed by less difficult (29.6%, n=37)
and very difficult (16.0%, n=20) cases. The prevalence of dry socket post-extraction was 21.6%.
Conclusion: Our study reveals a notable frequency of dry socket following impacted mandibular
third molar extraction, with 21.6% of cases experiencing this complication with a significant
association observed between the occurrence of dry socket and the surgical difficulty assessed
by Pederson's difficulty index.

COMPARISON OF IMMUNOHISTOCHEMICAL EXPRESSION OF INSULIN LIKE GROWTH FACTOR 1 RECEPTOR (IGF-1R) IN BENIGN AND MALIGNANT SALIVARY GLAND TUMORS

Mehreen Malik — 2024-09-30

Objectives: To evaluate the difference in immunohistochemical expression of insulin-like growth
factor-1 receptor (IGF-1R) in diagnosed cases of benign and malignant salivary gland tumors.
Materials and Methods: This Comparative Cross-Sectional Study was conducted at the department of Pathology, Peshawar Medical and Dental College, Peshawar. A total of 100 Salivary Gland Tumors from 56 male and 44 female patients were included in the study, with an average age of 43.50 ± 15.21. The Immunohistochemical Expression of Insulin-like Growth Factor 1 Receptor was determined on both benign and malignant salivary gland tumors using the Bio SB Polyclonal IGF-1R antibody (rabbit, BT-AP04398). The collected data were analyzed using SPSS version 25.
Results: For the immunohistochemical expression of IGF-1R on benign and malignant salivary
gland tumors, the Allred Scoring method was utilized. P value of <0.05 was considered significant,
but no positive signifi cance was found between the expression of IGF-1R and salivary gland tumors.
Conclusion: IGF1R expression was positive in various SGTs but no statistically significant difference was seen in multiple histopathological types of benign and malignant SGT

EFFECT OF HIGH-FLUORIDE TOOTHPASTE AND MOUTH RINSE ON THE PREVENTION OF DEMINERALIZED LESIONS DURING ORTHODONTIC TREATMENT

Haider Zahid — 2024-09-30

Objectives: To evaluate the impact of using high-fl uoride toothpaste and mouth rinse in preventing demineralized lesions (DLs) during orthodontic therapy.
Materials and Methods: This randomized controlled trial included 250 patients of both gender
and were divided into three groups (A=FMR, B=HFT and C=FT). The FMR group, which received a 0.2% sodium fl uoride (NaF) mouth rinse in addition to 1450 ppm fl uoride (F) toothpaste; the HFT group, which used a 5000 ppm F toothpaste; and the Control (CTR) group, which utilized 1450 ppm F toothpaste. Non-probability purposive sampling was used for the recruitment of patients. A blinded healthcare professional evaluated digital images obtained before and after treatment to determine the percentage of individuals with at least one new demineralized lesion. SPSS version 25 was used for analysis.
Results: A total of 250 patients with a mean age of 16.82±2.21 years participated, comprising 95 males (38.0%) and 155 females (62.0%). Group A (n=83) had a mean age of 17.01±2.17 years, Group B (n=84) 16.46±2.19 years, and Group C (n=83) 17.00±2.26 years. Health status varied,
with Group A having 73.5% with no disease, Group B 83.3%, and Group C 90.4%. the study presents unadjusted relative risks for increases in demineralized lesions (≥1, ≥2, ≥3) in all teeth
and the aesthetic zone, comparing High-Fluoride Toothpaste (HFT) vs. Control (CTR), Fluoride Mouth Rinse (FMR) vs. CTR, and FMR vs. HFT. Pretreatment, white spot lesions (WSL) were
distributed across groups, with Group A and B showing diff erent prevalence rates. Post-treatment, Group A had 30.1% with 0 lesions, Group B 33.3%, and Group C 20.5%. Statistically significant differences were observed for increases in ≥1 WSL post-treatment (p=0.01), but not for ≥2 WSL (p=0.50) or ≥3 WSL (p=0.11).
Conclusion: It has been shown that using high fl uoride toothpaste and mouthwash can help prevent dental caries on canines, lateral incisors, and central incisors when undergoing orthodontic treatment. A mouthwash and toothpaste with high fl uoride content may be advised to prevent DL in the aesthetic zone.

KNOWLEDGE & ATTITUDE OF GENERAL DENTIST, REGARDING PERIODONTAL DISEASE DIAGNOSIS, TREATMENT PROTOCOL AND PERIODONTAL SPECIALIST REFERRAL

Mahirah Iqbal — 2024-09-30

Objectives: To assess the knowledge, attitudes, and practices of general dentists regarding periodontal disease diagnosis, treatment strategies, and referrals to specialists.
Materials and Methods: A cross-sectional survey was conducted among 185 dentists in Peshawar, utilizing a pre-customized, closed-ended questionnaire through convenience sampling technique. The survey included practitioners from dental government and private teaching hospitals as well as independent clinics, encompassing both genders and any age. Informed consent was incorporated into the questionnaire. Exclusion criteria were undergraduate students, house surgeons, and periodontists. Data were collected using the questionnaire based on participants' understanding of periodontal diseases, diagnostic frequency, referral practices, and treatment approaches.
Results: Most dentists favored scaling as the primary treatment for bleeding on probing (n=149, 80.54%) and identifi ed loss of attachment as the cause of tooth mobility (n=158, 85.41%). The study revealed a significant association between years of experience and various aspects of periodontal care, including referral practices (p=0.047), diagnostic accuracy (p=0.018), and treatment strategies (p=0.05). Despite a recognized link between poor oral hygiene and periodontal diseases, the referral rate to periodontists was notably low (10.27%).

Conclusion: General dentists exhibit defi ciencies in knowledge concerning the causes, referral processes, and the importance of specialized care in periodontology.

BARRIERS TO INITIATE INSULIN THERAPY AND ITS ASSOCIATION WITH DURATION OF DIABETES MELITIS AND DEMOGRAPHIC FACTORS IN UNCONTROLLED TYPE 2 DIABETIC PATIENTS, A CROSS SECTIONAL STUDY

Imran ullah — 2024-09-30

Objectives: To determine different barriers to initiate insulin therapy and association of duration of diabetes mellitus and demographic factors with barriers in initiation of insulin therapy in Uncontrolled type 2 diabetic patients.
Materials and Methods: We conducted a cross sectional study conducted among patients with type 2 diabetic patients presenting to endocrinology outpatient clinics in two Tertiary care hospitals of Peshawar ie. Khyber Teaching hospital and hayatabad medical complex Peshawar. The duration of study was 03 months after approval of synopsis. The sample size was 257.The study population was selected by consecutive non probability sampling technique. The data was collected by pre designed questionnaire. All the included patients were interviewed on pre designed questionnaire. Data was processed in SPSS version 22.
Results: In study we found that patients face different barriers to initiate insulin therapy. In our study, side effects of insulin was the barrier for 97(37.7%) of the patient, difficulty in carrying insulin was barrier for 128(49.8%) patients , dose adjustment of insulin was barrier for 90(35%) patients, fear if insulin needle was barrier for 89 (34.6%) patients, self administration of insulin was barrier for 98(38.1%) patients , affordability of insulin was barrier accounting for 114(44%) patients , frightened about insulin therapy by someone was barrier for116 (45.1%) patients. The association between economic status of patient and the barrier that they are frightened by someone was statistically significant. Chi-square test was also run between duration of diabetes with all barriers in which one association was found nearly signifi cant i.e. the association of duration of diabetes with difficulty in carrying insulin with the p value of 0.064.
Conclusion: The most common barrier in insulin therapy initiation of patients in the study was difficulty in carrying insulin. We found that there is near to signifi cant association between duration of diabetes and difficulty in carrying insulin. There is significant association between economic status of patient and frightened by someone. The lower the economic status the more frightened about Insulin use.

EFFECT OF INTRACANAL CRYOTHERAPY ON THE POST ENDODONTIC PAIN IN TEETH WITH SYMPTOMATIC APICAL PERIODONTITIS

Ahsan Ali — 2024-09-30

Objectives: To compare the effect of cryotherapy, room temperature saline and no saline as final root canal irrigants on post-endodontic pain in patients with symptomatic apical periodontitis.
Materials and Methods: An observational study was done at the Endodontics Department of Rehman College of Dentistry, Peshawar from August 2023 to January 2024. Ninety patients were selected via purposive sampling technique and underwent root canal treatment. After root canal preparation, patients were equally divided into three groups using the lottery method: Cryotherapy group, room temperature saline group and no saline group. Pain on percussion was recorded pre-operatively and 24hours post-operatively for every patient using the visual analogue scale. Wilcoxon Signed ranks test was used to assess the signifi cant difference between mean pre-endodontic and post-endodontic pain levels. Post hoc analysis was used to compare the significant difference (p value<0.05) between each group.
Results: At 24 hour post-operatively, the mean post-endodontic pain scores on visual analogue scale were 2.50± 1.253 for cryotherapy group, 2.70±2.261 for room temperature saline group and 3.63±1.938 for no saline group. The result shows that the post-endodontic pain reduces signifi cantly in all the three groups(p<0.05). However, cryotherapy as the final irrigant was found to be significantly more eff ective in reducing the post-endodontic pain than no saline as the final irrigant (p value 0.029). No significant difference was found in between the cryotherapy group and the room temperature saline groups (p value 0.964).
Conclusion: Cryotherapy as the final root canal irrigant is the most effective method of reducing post-endodontic pain as compared to when no saline was used as the final irrigant. Room temperature saline is also as useful as cryotherapy in reducing post-endodontic pain. The findings of the study will be helpful for the dentists to minimize post-endodontic pain.

EVALUATING THE DENTAL LEARNING ENVIRONMENT: A STUDENT-CENTRIC PRESPECTIVE ACROSS PRECLINICAL AND CLINICAL YEARS USING DUNDEE READY EDUCATION ENVIRONMENT MEASURE (DREEM) TOOL

Waqar-Un-Nisa — 2024-09-30

Objectives: The learning environment has a profound role in students learning and success. It also has an integral role in the development of the curriculum. The aim of this study to evaluate the learning environment and compare dental students' perception of the learning environment of pre-clinical and clinical years.

Materials and Methods: This cross-sectional study was conducted from October 2023 to April 2024. A total of 170 both male and female BDS students from all four years at the Bacha Khan College of Denistry were included in the study. A stratified random Sampling Method was used. Students migrated from other colleges in the middle of the sessions and students currently working as interns or house officers were excluded from the study. Dundee Ready Education Environment Measure (DREEM), a 50-item questionnaire that uses a 5-point Likert scale (4 = strongly agree to 0 = strongly disagree) was used to measure strength of agreement with statements on five domains of learning. Learning (L), Teaching (T), Academic self-perception (ASP), Atmosphere (A) and Social self-perception (SSP). Frequency distributions and descriptive statistics were tabulated in IBM SPSS (version 21). Mean scores for each dimension of learning were used for analysis. Comparative analysis was done using independent sample t test.

Results: The DREEM questionnaire was completed by 147 students, 78 1st and 2nd year students (preclinical training phase) while 69 3rd and 4th year students. 34.6% of the participants were male and 66.6% were female. The mean age of the participants was 21.4 years (SD=1.72). Tukey's post hoc analysis within the participants revealed a significantly lower DREEM score of the Final year compared with the 1st year (p < .003), and 3rd year (p< 0.031). The items within each domain with the biggest signifi cant differences (p ≤ 0.05) was between Pre-Clinical Training Phase and Clinical training.

Conclusion: This study examined the educational setting in our institution. The students of Bacha Khan College of Dentistry showed a predominantly satisfaction with their educational environment. The primary results indicated that students in the early stages of their studies, namely those in their pre-clinical years had positive opinions across all aspects of their learning environment. Overall, the findings from the study highlight the importance of understanding how students perceive their educational environment throughout diff erent stages of their dental training. By delving deeper into these differences and correlations, educators and administrators can make informed decisions to enhance the curriculum and ultimately improve the learning experience for students. This implies that a more tailored and effective approach to dental education could lead to better outcomes and preparedness for future dental professionals.

LAYPEOPLE PERCEPTION OF ATTRACTIVENESS OF THE ORTHODONTIC APPLIANCES – A CROSS SECTIONAL SURVEY

Aneela Nausheen — 2024-09-30

Objectives: To assess the perception of adult laypeople regarding the attractiveness of various orthodontic appliances.
Materials and Methods: A total of 195 participants, aged 18 to 40 years, with at least an intermediate level of schooling, non-dental education, and no history of orthodontic treatment, were included in the study. Participants evaluated the attractiveness of nine different orthodontic appliances through a questionnaire designed using frontal oral smiling photographs. The appliances included metal brackets with colorless elastomeric ligatures, self-ligating brackets made of stainless steel, clear aligner trays, hybrid brackets, ceramic brackets, self-ligating ceramic
brackets, metal brackets with colored elastomeric ligatures, no appliance (simulating lingual brackets), and shaped brackets. Scores were given on a Visual analogue scale. Attractiveness scores were stratified based on gender and occupation using one-way ANOVA.
Results: The results showed the mean age of 25.90±5.49 years among the participants, with the majority being female (53.85%) and students (36.41%). The "CAT" bracket type was rated as the most attractive (8.37 ± 1.35), while the "Shaped brackets"and"SLB" types received lower attractiveness scores (5.54 ± 1.96and 5.90 ± 1.85, respectively). Significant differences were observed among the diff erent bracket types (p<0.001). Lingual brackets and CAT brackets was perceived as highly attractive in both genders, with statistically signifi cant diff erences (p<0.001)
between genders.
Conclusion: The study concludes that adult laypeople preferred orthodontic appliances with minimal visibility and clear materials, while increased metal visibility was associated with decreased perceived attractiveness.

EXPRESSION OF CD34 IN AMELOBLASTOMA AND ODONTOGENIC KERATOCYST

Maria Hanif — 2024-09-30

Objectives: To evaluate the expression of CD34 in Ameloblastoma and Odontogenic keratocyst (OKC) in various age groups and to determine the difference in the biological behavior of the lesions according to CD 34 expression.
Materials and Methods: This was a comparative cross sectional study of total 80 cases, 40 each of ameloblastoma and OKC which were retrieved from histopathology lab of Peshawar Medical College, Peshawar (PMC) and Pakistan Institute of Medical Sciences, Islamabad (PIMS). The study was conducted at the laboratory of Peshawar Medical College & Peshawar dental college. Mean vascular density was determined. A descriptive analysis was done using SPSS version 21.
Results: Mean microvessel density was significantly higher in ameloblastoma as compared to odontogenic keratocyst. Relationship between CD34 expression in ameloblastoma and odontogenic keratocyst was statistically significant (p-value 0.01).
Conclusion: This study concludes that CD34 expression is higher in ameloblastoma than odontogenic keratocyst. This is suggestive of more aggressive behavior of ameloblastoma as compared to odontogenic keratocyst and treatment may be modified according to CD34 evaluation. This study also concludes that in case of Ameloblastoma CD34 expression is dependent on different age groups.

COMPARISON OF HISTOPATHOLOGICAL FEATURES BETWEEN PRIMARY AND RECURRENT ORAL SQUAMOUS CELL CARCINOMAS: IMPLICATIONS FOR MANAGEMENT STRATEGIES

Syed Umer Farooq — 2024-09-30

Objectives: To assess clinical and histopathological characteristics of primary and recurrent OSCC about the tumor site, grade, stage, lymph node involvement, and tobacco habits, which determine the prognosis and recurrence.
Materials and Methods: Our cross-sectional study recruited 80 consecutive participants i-e 40 patients with primary tumors and 40 patients with secondary/recurrent tumors. The study was conducted in Bacha Khan College of Dentistry in a time of 5 years. The participants were divided into two groups i-e primary tumors (without recurrence) (n=40) and secondary tumors (with recurrence) (n=40). The participant’s age, gender, history of tobacco use, tumor location, management, grade, stage, presence or absence of recurrence, and survival rates were collected from the clinical records and tumor registers. OSCC slides (both primary and recurrent) were collected from the department of pathology Bacha Khan College of Dentistry to confirm the diagnosis of the primary and secondary tumors. The recurrent tumor sites were identifi ed as local, secondary, or distant sites. The recurrence of the tumor was confirmed histologically and was considered in patients with advancement of the disease and had no cure to treatment. The second primary tumors within the site were also considered recurrent tumors. Tumor grading was performed according to the WHO classifications and survival analysis was performed using the Kaplan-Meier and Cox proportional hazards regression to determine effects of these features on overall survival and cancer-specific survival. Results: The Kaplan-Meier estimator test established differences in survival characteristics of primary and recurrent tumors, with tobacco use significantly present. In this study, a history of tobacco use was associated with a poorer overall survival of patients (p=0.04), as well as cancer-specific survival (p=0.04). However, clinically, tobacco use has been shown not only to be an independent risk factor for OSCC but also a signifi cant factor for tumor recurrence and poor survival, which demands an effective control in smokers. We also noted that primary tumor site inflenced survival: patients with tumor in the buccal mucosa had worst survival rates (p = 0.04). Furthermore, lymphatic infiltration was identified as an independent predictor of poor prognosis and hazardous for both OS and cancer-related survival (p = 0.006). These imply the need for closer follow-up and assertive intervention on patients who exhibit lymphatic spread and particular anatomic site manifestation.
Conclusion: Continued tobacco use, buccal mucosa tumors, and patients with lymphatic infiltration were found to have poor survival rates which indicated that such patients require more intense treatment modalities. These results underscore the need for the inclusion of the factors in the management of care especially on smoking cessation, targeted therapies, and frequent follow-up of patients with unfavorable molecular profiles. However, due to its single-institution design and low number of cases included, the generalization of our findings is restrained; therefore, more extensive investigations should be conducted in the future to validate and further develop our
findings in OSCC prognosis.