World No Tobacco Day 2018 Celebrated at BPKIHS - WNTD 2018 : Tobacco and Heart Disease

World No Tobacco Day 2018, just as in the previous years was marked and celebrated by organizing a Cartoon Poster Competition for the undergraduate students and Extempore Speech Competition for Post Graduate Students at College of Dental Surgery, BPKIHS, Dharan, Nepal. The program was Co-organized by Department of Oral Medicine and Radiology and Department of Public Health Dentistry, CODS, BPKIHS.

The theme for this year's World No Tobacco Day was " Tobacco and Heart Disease".
The Winners and runner - ups for the poster competition were Anumesh Dahal, Dimpal Thapa Magar and Smriti Chaudhary. Similarly, winners and runner-ups for the extempore speech competition were Dr. Sagar Adhikari (Department of Oral Medicine and Radiology), Dr. Shashikant Chaudhary (Department of Periodontology and Oral Implantology), and Dr. Abhinaya Luitel (Department of Oral Medicine and Radiology).

 Here are the posters that participated in the program.

MCQs on Mandibular Fractures and Middle Third of Face Fractures - Oral and Maxillofacial Surgery

# Which is the immediate danger to a patient with severe facial injuries?
A. Bleeding
B. Associated fracture spine
C. Infection
D. Respiratory Obstruction

# Craniofacial dysjunction is seen in:
A. LeFort III fracture
B. Guerrin's fracture
C. High LeFort I fracture
D. None of the above

# The 'hanging drop appearance' in the maxillary sinus radiograph indicates:
A. a nasal polyp
B. a blowout fracture of the orbit
C. a radiograph artefact
D. an antrolith

# Suturing in facial wound injuries should be done within:
A. 2 hours
B. 4 hours
C. 6 hours
D. 8 hours

# Diplopia is most common with:
A. Mandibular fracture
B. Craniofacial dysjunction
C. Nasal fractures
D. Zygomaticomaxillary complex fracture

# Paresthesia is seen with which of the following types of fractures?
A. Subcondylar
B. Zygomatico maxillary
C. Coronoid process
D. Symphyseal

# Forceps used for maxillary fracture disimpaction:
A. Rowe's
B. Bristows
C. Ashs
D. Walshams

# A patient is in shock with gross comminuted fracture. Immediate treatment is to give:
A. Normal saline
B. Ringer's lactate solution
C. Whole blood
D. Plasma expanders

# Walsham's forceps are used to:
A. remove teeth
B. remove root
C. clamp blood vessels
D. Reduce nasal bone fractures

# 'Panda facies' is commonly seen after:
A. Le Fort I fractures
B. Le Fort II fractures
C. Mandible fractures
D. None of the above

# A fracture of eye by a ping pong ball is:
A. Blow out fracture
B. Orbital fracture
C. Blow in fracture
D. Compound fracture

# Guerin fracture is :
A. Maxillary fracture
B. Maxillary and zygomatic fracture
C. Maxillary and nasal bone fracture
D. only nasal bone fracture

# Gillis approach for reduction of zygomatic fractures is done through:
A. Temporal fossa
B. Infratemporal fossa
C. Infraorbital fossa
D. All of the above

# Which of the following is not a feature of Le Fort II fracture?
A. Enophthalmos
B. Malocclusion
C. Paresthesia
D. CSF rhinorrhea

# The first step in management of head injury is:
A. Secure airway
B. i.v. mannitol
C. i.v. dexamethasone
D. Blood transfusion

# After fracture of middle cranial foramen, there is epiphora, this is due to damage of:
A. Ciliary ganglion
B. Greater palatine nerve
C. Infraorbital nerve
D. None of the above

# The most common complication of CSF rhinorrhea is:
A. Brain herniation
B. Blindness
C. Ascending meningitis
D. Cavernous sinus thrombosis

# A 35 year old man with Le fort III fracture complains of blood tinged watery discharge from his nose 2 days after the trauma. CT scan confirms NOE fracture as well. What investigation is most confirmatory for detecting CSF leak?
A. CT scan
B. MRI scan
C. Presence of glucose in the fluid
D. presence of Transferrin Beta

# CSF rhinorrhea is found in:
A. Frontal bone fracture
B. Zygomaticomaxillary fracture
C. Nasoethmoidal fracture
D. Condylar fracture

# Which of the following is not included in the Glasgow coma scale?
A. Eye opening
B. Motor response
C. Verbal response
D. Pupil size

# Le fort III fracture is the same as:
A. Craniofacial dysjunction
B. Guerrin's fracture
C. Pyramidal fracture
D. None of the above

# Compression osteosynthesis heals fracture mandible by:
A. Primary union without callus formation
B. Secondary union without callus formation
C. Compression union
D. All of the above

# The treatment for a mandibular fracture between the incisors is:
A. Risdon wiring
B. Essig wiring
C. Cap splint with circum-mandibular wiring
D. Transosseous wiring

# Green stick fracture are most common with:
A. Older people
B. Adult
C. Children
D. Soldiers

# Lower lip paresthesia occurs in:
A. Body fracture
B. Symphysis fracture
C. Coronoid fracture
D. Condyle fracture

# Eburnation is seen in:
A. Malunion
B. Non union
C. Osteomyelitis
D. Osteoradionecrosis

# Primary healing of mandibular fracture is seen following fixation with ?
A. Gunning Splints
B. Compression plates
C. Transosseous wires
D. Clampy plates

# A fractured mandibular condyle is displaced forward and medially by the action of the following muscle:
A. Temporalis
B. External Pterygoid
C. Internal Pterygoid
D. Masseter

# Bucket handle type of fractures are seen in:
A. Children
B. Soldiers
C. Edentulous persons
D. Young adults

# A patient with unfavourable fracture of the angle of mandible is best treated by:
A. Closed reduction with intermaxillary fixation
B. Closed reduction with cap splints
C. Open reduction with interosseous wiring
D. Open reduction with rigid bone fixation

# The most common site of fracture of the mandible is the:
A. Body
B. Angle
C. Symphysis
D. Condyle

# A fracture of the mandible in the canine region in a 6 year old child should be managed by:
A. Cap splint fixation
B. Intermaxillary fixation
C. Risdon wiring
D. Transosseous wiring

# A displaced mandibular fracture in a child should be managed by:
A. Circum mandibular wiring
B. Early mobilization
C. Intermaxillary fixation
D. Transosseous wiring

# The proximal segment of mandibular angle fracture is usually displaced in which direction?
A. Anterior and superior
B. Posterior and Interior
C. Interior only
D. Posterior and Superior

# The fracture of the tooth bearing segment of the mandible is :
A. Simple
B. Complex
C. Compound
D. Comminuted

# In cases of subcondylar fracture, the condyle moves in :
A. anterior lateral direction
B. posterior medial direction
C. posterior lateral direction
D. anterior medial direction

# Most common complication of condylar injuries in children:
A. Pain
B. Ankylosis
C. Osteoarthritis
D. Fracture of glenoid fossa

# A fracture mandible should beimmpbilized for an average of:
A. 3 weeks
B. 6 weeks
C. 9 weeks
D. 12 weeks

# A 7 year old boy presented with fracture of left sub condylar region with occlusion undisturbed, the treatment would be:
A. Immobilization for 7 days
B. Immobilization for 14 days with intermittent active opening
C. No immobilization with restricted mouth opening for 10 days
D. No immobilization and active treatment

# The ideal treatment for fracture of the angle of mandible is:
A. Transosseous wiring
B. Intermaxillary fixation
C. Plating on the lateral side of the body of the mandible
D. Plating at the inferior border of the mandible

# All are true regarding fracture of mandible EXCEPT:
A. Fractures of the mandible are common at the angle of the mandible
B. Fractures of the mandible are effected bythe muscle pull
C. Fractures of the mandible are usually characterised by sublingual hematoma
D. CSF rhinorrhea is a common finding

Some Vitamin Deficiencies - General Manifestations and Oral Manifestations

Vitamin General Manifestations of deficiency Oral manifestations of Deficiency
Vitamin A
  • Night blindness
  • Xerophthalmia characterized by dryness in conjunctiva and cornea
  • Bitot Spots in forms of triangular plaques in conjunctiva
  • if xerophthalmia persists, destruction of cornea occurs, causing total blindness. This condition is known as keratomalacia.
  • Keratinizing metaplasia of epithelium resulting in increased keratin formation
  • Occlusion of salivary gland ducts with keratin
  • Enamel hypoplasia, atypical dentin formation and epithelial invasion of pulpal tissue are characteristic features.
  • Enamel is more severely affected than dentine
  • Delayed eruption of teeth
Vitamin D (Anti rachitic vitamin)
  • Rickets in children
  • Osteomalacia in adults
  • Pigeon chest is one of the important features of rickets.
  • Renal rickets or renal osteodystrophy is seen in patients with chronic renal failure. Renal rickets is mainly due to decreased synthesis of calcitriol in kidney.
  • In rickets, the plasma calcitriol is decreased and alkaline phosphatase activity is elevated.
  • Delayed eruption of primary and permanent teeth
  • Malalignment of the teeth in the jaws
  • Developmental anomalies of dentin and enamel . The teeth shows wide predentin zone with much interglobular dentin.
  • The pulp horns are elongated and extend high , reaching the dentinoenamel junction
Vitamin E (anti -sterility vitamin)
  • Decreased male fertility
  • Impaired fetal maternal vascular relationships
  • Encephalomalacia
  • Nutritional muscular dystrophy
Vitamin K (Coagulation vitamin)
  • Deficiency is uncommon
  • Brings about post translational modification of clotting factors II, VII, IX and X, particularly prothrombin. So, deficiency may result in prolonged clotting time.
Prothrombin levels below 35% results in gingival bleeding after toothbrushing
Spontaneous gingival hemorrhages occur, when the prothrombin levels fall below 20%. 
Vitamin General Manifestations of deficiency Oral manifestations of Deficiency
Vitamin C (Ascorbic acid)
  • Deficiency may result in Scurvy. It is characterized by spongy and sore gums, loose teeth, anemia, swollen joints, delayed wound healing, hemorrhage, osteoporosis, etc.
  • Defective collagen synthesis
  • 'Cork-screw' hair pattern, 'Woody legs' with large spontaneous bruises in lower extremities
  • 'Trummer field zone' is the characteristic histologic picture of bone in Scurvy.
The pathognomic sign is the swollen and spongy gums, particularly the interdental papillae is involved producing the appearance of scurvy buds.
In severe cases, hemorrhages to periodontal membranes followed by loss of bone and loosening of teeth occurs.
Vitamin B1 (anti beri-beri or anti neuritic vitamin)
  • Vit B1 deficiency is seen in populations consuming polished rice as staple food.
  • Dry beri-beri or peripheral neuritis; Wet berl-beri or cardiac manifestations, and cerebral or Wernickes encephalopathy  with Korsakoff's psychosis are features of vit. B1 deficiency
Vitamin B2 (Riboflavin)
  • Riboflavin deficiency is common in children who do not drink milk.
  • Nasolabial seborrhea or dyssabacea.
  • Vascularisation of cornea
  • Scrotal dermatitis
  • Glossitis: The filiform papillae become atrophic while the fungiform papillae become engorged and mushroom shaped, resulting in magenta colored tongue.
  • Cheilosis, ocular lesions. (Non-specific bilateral angular cheilosis may be seen in association with faulty dentures or in patients with reduced vertical dimension due to attrition.)
  • Pellagra (the symptoms of pellagra are referred to as three D's i.e., dermatitis, diarrhoea, dementia and if not treated may lead 4th 'D' i.e, death)

  • Bald tongue of Sandwith
  • 'Raw beefy tongue' 
  • The mucosa becomes fiery red and painful
  • Salivation is profuse.
Vitamin B5 (pantothenic acid or chick anti dermatitis factor)
  • Burning feet syndrome : Pain and numbness in the toes, sleeplessness and fatigue are features
  • Pantothenic acid is one of the water-soluble vitamins that is synthesized in the body.
Vitamin B6 (Pyridoxine)
  • Peripheral neuropathy (due to decreased synthesis of serotonin catecholamines) and demyelination of neurons.
  • Isoniazid (drug used in treatment of TB) is a antagonist of Vitamin B6.
Biotin (Anti egg white injury factor)
  • Biotin deficiency is uncommon since it is well distributed to foods and also supplied by the intestinal bacteria.
  • also known as Vitamin B7 or Vitamin H
Folic acid
  • Macrocytic anemia, glossitis.
  • Aminopterin and methotrexate are structural analogues of folic acid used in treatment of many cancers including leukemia. These drugs block the formation of THF and hence DNA synthesis is impaired.
  • GLOSSITIS: The filiform papillae disappear first, but in advanced cases the fungiform papillae are lost and tongue becomes smooth and fiery red in color.
Vitamin B12 (anti pernicious vitamin or extrinsic factor of Castle)
  • Neurological manifestations due to degeneration of posterior and lateral tracts of spinal cord.
  • Degeneration of myelin sheath and peripheral nerves also occur.
  • Beefy red tongue with glossopyrosis, glossitis and glossodynia.
  • Hunter's glossitis or Moeller's glossitis, which is similar to 'bald tongue of Sandwith' seen in pellagra

Some Facts About FDI (Federation Dentaire Internationale)

1. Define 'Oral Health' according to FDI.
Oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.

2. Theme of FDI World Dental Congress 2018 Buenos Aires, Argentina : A Passion for many, A commitment for all.

3. Chief elements of FDI Vision 2020:

  • Meet the increasing need and demand for oral healthcare.
  • Expand the role of existing oral healthcare professionals.
  • Shape a responsive educational model.
  • Mitigate the impacts of socio-economic dynamics.
  • Foster fundamental and translational research and technology.

#HealthForAll is a campaign to promote universal health coverage (UHC) by 2030 - our aim is to support policy-makers, civil society organizations, individuals and media in the journey to bring universal health coverage to your country. Something all countries committed to when they agreed the Sustainable Development Goals (SDGs) in 2015.

The World Health Organization (WHO) will maintain a high-profile focus on universal health coverage via a series of events, starting on World Health Day, 7 April 2018, with global and local conversations about ways to achieve Health for All.

6. How does FDI manage its funding?
- FDI offers different types of Corporate Partenerships to generate funds which are:
i) Exclusive Partnerships - FDI and its Corporate Partner would identify a common topic of interest and build together a custom-made project. Eg. FDI-Unilever Brush Day and Night Partnership started in 2004

ii) Non - compete Partnerships - multiple non-competing partners to fund a global project, eg. Flagship Partnership - World Oral Health Day with global partners Henry Schein, Unilever and Philips Sonicare

iii) Multi-partnership projects - Certain initiatives are open to multiple partners. eg. Vision 2020 launched in 2013

7. Is FDI directly involved in formulation of policies or it acts as a regulating body for other national bodies ?
 - Although it has its own constituiton for its working model, it acts as a regulating body for other national bodies. 

8. How FDI is in contact with government of each country ?

Bleaching of Discolored Tooth - Bleaching Agents in Dentistry

Bleaching is a procedure which involves the lightening of the color of the tooth through the application of a chemical agent to oxidize the organic pigmentation of the tooth.

Properties of an ideal bleaching agent

An ideal bleaching agent should:

  • be easy to apply on the teeth
  • have a neutral pH
  • lighten the teeth efficiently
  • remain in contact with oral soft tissues for short periods
  • be required in minimum quantity to achieve desired results
  • not irritate or dehydrate the oral tissues
  • not cause damage to the teeth
  • be well controlled by the dentist to customize the treatment of patient needs.
Bleaching Techniques: 
a) For Vital Teeth
- Home bleaching technique / Night guard vital bleaching / Matrix bleaching
- In office bleaching
    * Thermocatalytic
    * Non Thermocatalytic
    * Microabrasion

b) For non vital teeth
- Thermocatalytic in-office bleaching
- Walking bleach / Intracoronal bleaching
- Inside / Outside bleaching
- Closed chamber bleaching / extracoronal bleaching

c) Laser assisted bleaching

Bleaching Agents:
A. Carbamide Peroxide : It is a bifunctional derivative of carbonic acid. It is available as:
- For Home bleaching:
 i) 5% carbamide peroxide
ii) 10% carbamide peroxide
iii) 15% carbamide peroxide
iv) 20% carbamide peroxide

- In-office bleaching
i) 35% solution of carbamide peroxide

Nolla's Stages of Tooth Development

Nolla in 1952 described the various stages of tooth development which are as follows:

Stage 0 - Absence of crypt
Stage 1 - Presence of crypt
Stage 2 - Initial calcification
Stage 3 - 1/3rd of crown completed
Stage 4 - 2/3rd of crown completed
Stage 5 - Crown almost completed
Stage 6 - Crown completed
Stage 7 - 1/3rd of root completed
Stage 8 - 2/3rd of root completed
Stage 9 - Root completed, apex open
Stage 10 - Apical end of root completed, apical foramen closed

Nolla's stages of Tooth Development