White Pearl Dental Magazine Vol 1

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CONTENTS

who are we ?!

2 Who are we ?! 3-4 Oman Dental College (ODC) 5 Oral Hygien Instructions 6 -7 This is me .. 8 Once Upon a time in ODC 9 Childreen and Teeth Health 10 Food and Oral Health 11 Dental Composite 12 Infiction Control 13 Referances

White pearl voluntary

White Pearl Dental Magazine Family : Head of the magazine: Duaa Mohammad Rashid Editor in-cheif : Khamis Mohammad AlHassani Writers : Raya Hamdan AlBarashdi Safa’a Khalfan AlQarni Zinab Mohammad Aljabri Intisar Al Harthi Designer: Almuhalab Alrawahi

team

White pearl voluntary team (WPVT) is the first voluntary team representing dental students in Oman. Creating such a team was a dream for me. Such an idea has been shared with some colleagues in ODC and it has been welcomed. The team have gained the full national country membership from the International Association of Dental Student (IADS) by 4/8/2014. The team’s first event held at Alqurm Park in Muscat-Oman in March/2014 synchronized with GCC week of Oral Health. The event included Oral Hygiene Instructions, Free Dental Checkup, games and plays for kids beside a section of dental health for adults. The team have received positive feedback from the audience. Our coming events inshallah will be better and we will work hard to spread the dental awareness among our community.


OMAN DENTAL COLLEGE

Oman Dental College located in Muscat the capital of This has been verified sultanate of Oman is the first and currently the only and endorsed by the International Advisory dental college in the Sultanate of Oman. The college Panel which includes was founded in 2006\2007 and has already graduated experts from both India and the UK three batches in the past 3 years. amongst others. The Following the words of his majesty the sultan Qaboos intention is for the BDS bin said ( sultan of Oman ) and to play an active and curriculum at ODC to be contemporary and informed role in achieving his long sighted vision when to evolve in keeping he said “We live in the age of science and success and with international arena. However, the progress in all areas, knowing for certain that we need ODC curriculum has to strengthen our knowledge and hard work both also been adapted to together with our means to meet the challenges of local conditions and is therefore an original this era and build a strong and prosperous renaissance and unique curriculum on the basis of Islamic and cultural values ‘, 09/11/1986 specifically designed to suit the needs of AD the college has built the place not only to benefit the Sultanate of Oman the citizens but the residence as well . and its students. Every Oman dental college consists of an outpatient dental year the students get to see and learn not only clinical facility with multiple dental chairs, X-ray about dentistry but facilities, and laboratories, a Central Sterile Supply about medicine as well. Department, an operating theatre and a research In BDS 1 the basic medical science Centre together with the requisite academic facilities subjects are taught and in the College. These facilities are equipped to the human structure and function, which include highest standards using the latest technology currently available. The BDS curriculum at ODC is based on a blend of British and Indian BDS curricula and is designed to meet the respective academic and professional standards of both as specified by the UK General Dental Council (GDC) and the 3Dental Council of India (DCI).

biochemistry, general Anatomy & histology and physiology, are addressed fully. There is further detailed teaching in head & neck anatomy, embryology &genetics and a detailed course in biostatistics is also provided. Meanwhile in BDS2, the focus is on general pathology & microbiology, pharmacology, the dental sciences specifically oral biology and dental biomaterials science. Dental theory will also be learnt and training in clinical skills practiced on patient simulators in the clinical skills laboratory to prepare each student for clinics. For BDS3 Under close supervision, students will begin to treat patients. Students

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OMAN DENTAL COLLEGE

will learn to perform a wide variety of dental procedures applying theory to practice. Students will also learn how to apply preventive measures and motivate patients to maintain a high standard of oral health. During this year students will also take courses in human disease and oral pathology & microbiology. Finally when students come to BDS4 &5 and as clinical experience is gained, dental skills will be further developed and students will learn and under supervision perform more complex methods of treatment so that by the end of the fifth year they are ready and prepared for independent dental practice. Throughout the BDS clinical programme there is emphasis on the interrelationship between the different dental specialties, horizontal and

vertical integration of knowledge and skills which enable diagnosis and treatment planning with a view to providing total patient care and appreciation of continuing professional development. If you’re interested in studying dentistry then Oman dental college is one of the well recommended dental school to study because at ODC, you will be guided as an aspiring dental surgeon working towards your dental degree by an excellent faculty led by dynamic dentists, with many years of teaching and clinical experience and living in Muscat With its high standard of

living with its reasonable cost with its warm and friendly environment and unspoiled natural beauty which makes Muscat the best setting for studying, enjoyment and living.

All the information reserved by Oman Dental College official website: www.omandentalcollege.org


ORAL HYGIENE INSTRUCTIONS Oral cavity is a complex environment since it contains teeth, tongue and gum which serve different actions. Maintaining good oral health is mandatory in order to perform normal actions in proper ways. Ignoring oral health leads to diseases such as dental caries which require dentists’ intervention. Good Oral health can be obtained by the use of toothbrushes, toothpastes, floss, interdental brushes. A soft toothbrush is recommended for individuals to clean their teeth with the use of fluoridated toothpaste for a sufficient period of time. Do not rinse your mouth with water directly after brushing neither eating directly after and that is to give sufficient time for fluoride to strengthen the teeth. Toothbrush should be replaced every three months. Brushing twice a day especially before sleeping as saliva will be less produced; reduce the chance of bacteria metabolism. Dental floss is an aid tool that is used as a daily routine to clean between teeth since the toothbrush cannot be inserted in between. The dental floss is a sterilized thread that can be found over-the-counter in the pharmacies used in pull and push action. Careful should be kept in mind not to damage the gum while using the floss. General practitioners recommend that regular dental checkup and professional dental cleaning should be done twice a year in order to review any changes or development of new abnormalities. Brushing teeth after eating or drinking -especially acidic meals and beverages- immediately is bad habit evidence based. Bacteria have the ability to convert sugar into acids during five minutes; these acids lead to weaken the outer layer of tooth, so with brushing the outer layer will be eroded. After 30 – 45 minutes people can brush their teeth as the saliva will neutralize the acidity in the oral cavity. Chewing sugar-free gum can increase the pace of neutralization of the oral environment. Safa’a Khalifa Alqarni

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THIS IS ME ... Can you please introduce yourself to the readers ? Nutayla bint Said bin Amran Al Harthy, my family is from Ibra, but I have always lived in Muscat. My schooling was almost entirely in The Sultan’s School, Alhamdu Lillah, I am mother of wonderful twin boys, Ammar and Omeir, who will turn 14 years old in December In Sha Allah. They have truly enriched my life in unimaginable ways. I believe that I would have never achieved or accomplished my dreams without Allah’s blessings and my family’s constant support, encouragement and words of wisdom whenever the road got tough, Alhamdu Lillah. Can you tell us about your educational journey starting from school? Well, it is hard to track back into memory lane and remember the details. To keep it simple, Alhamdu Lillah I was an ‘all rounder’. I had a passion for sports, drama, and always set my academic goals high. With Allah’s grace, Alhamdu Lillah, my name was always in the Honours List. I joined The Sultan’s School from Grade 3. Subhan Allah, I remember receiving the Best Citizenship Award in Grade 5, never even knowing what it meant to be a good citizen. Ever since, that was my standard annual award at school. I loved anything to do with running at school, be it short

distance or long distance….I was so competitive and just had to win every 100m and cross country race. My 100m record remained for several years after graduating from school. My favourite team sport was Netball. After graduating from The Sultan’s School, I joined Ayr College (Scotland, UK) for one year. That was where I prepared for the Scottish Highers which were a requirement to get into a Dental School in the UK in those days. Alhamdu Lillah, I got the grades to enter the University of Glasgow Dental School (Scotland, UK), which was my first choice amongst the UK dental schools. In my first year, I was elected as the Class Representative and maintained my duties as a Rep throughout dental school. In my 4th year at dental school, I got the First Prize from the Medical Insurance Agency Elective Award to undertake a comparative research on cleft lip and palate patients between Scotland and Houston (Texas, USA). Alhamdu Lillah, during dental school I also managed to collect 6 Merit Awards and graduated with Commendation and the James Whitelow Prize for Clinical Dentistry. Dental school was not all hard work, I also used to participate in the Christmas Pantomimes as we collected money for charity. I then decided to enter the General Professional Training where I worked in different

hospital rotations and in family National Health Service practice for a year. This was extremely exciting for me and it helped me decide what career path I wanted to take. Having decided to enter into academia, I then started with my PhD as soon as my boys were born (they were only 8 weeks old). My research was mainly focused on investigating the effects of dental erosion on teeth. I simultaneously did my specialist training in Restorative Dentistry while doing my PhD, in addition to academic duties (lecturing/ teaching undergraduates and postgraduates). During the years I was undertaking my PhD, I was again elected as the Postgraduate Student Representative. In addition, I decided to carry out a small research project on prions during my PhD and received the first prize for that postgraduate project. Why dentistry? , was it a dream come true? It is amazing how we plan and Allah plans for us! When I was 11 years old, I was only interested in joining the Air Force as I wanted to fly jets. My parents were wonderful, and really knew how to manage me well.


Dr. nutayla alharthy They took me for every Air Force exhibition and air show in town, they bought me the books I needed to read and they totally encouraged me. Two years later, I changed my mind, after having spent 1 week at a dental clinic when my youngest brother traumatized his incisors. It was a struggle for me to go and face my very supportive parents and tell them I had changed my mind. I eventually expressed my interest in dentistry, to discover how relieved my parents were that I chose a profession they totally approved of, as their ‘strategy’ worked! They knew me too well, if they hadn’t supported me earlier I would have probably been in the Air Force now! Would you recommend this major for others? Most definitely, I find this fulfilling in many ways from patients to students. Being in a caring profession and to be able to teach in such a setting is very uplifting. Most of all, is returning to serve my country after being abroad for over 17 years. I have taught in many foreign institutions before moving back home(University of Glasgow, University of Dundee, and the National University of Singapore), but teaching in my own country has definitely been the highlight of my academic role, Alhamdu Lillah.

Studying advice you would like to give and is there any techniques of studying you love to share with the readers? 1. Don’t procrastinate. 2. Use ‘Mind Mapping’! I applied its principles before knowing what Mind Mapping was! 3. Always read around the subject, but be sure of the source. 4. Always prepare for lectures and clinical sessions, that way you will constantly reinforce your knowledge. Who is Nutayla outside the clinics? Ultimately a quiet family person…..Having been away for so many years, I cherish ‘quality’ family weekend time. Ma Sha Allah, my boys are very active and I love joining them in their excursions such as water sports, rock climbing, hiking, abseiling and wild water rafting. The only time they don’t want me around them is when they go with my dad and brothers fishing. Do you have a dream list yet to achieve? , could you share any of those dreams with us? Just working in Oman’s first dental college is a dream come true for me. Being abroad for many years, you have good days and bad days….Whenever I faced challenges, I used to reassure myself that what I was doing was for a good cause, it was to go home, serve my country so other Omani young girls didn’t have to leave their families at such a young age and make the sacrifices I

made…..Alhamdu Lillah, this has materialized. I am currently planning and actively organizing one of the very first items I had in my professional ‘dream list’! If all goes well, we plan to take a group of ODC dental student volunteers on a dental charity event to Zanzibar (Tanzania). I really am hoping it will be successful so that we can continue with this charity event on an annual basis. Finally, is to see the ODC students and Alumni constantly working together to move dentistry in Oman forward. For us to put Oman and ODC in the dental map internationally….. This dream of mine can only materialize by us working as a team. If you could change one thing in Oman regarding dentistry, what would it be ? Increased public awareness and appreciation of achieving high standards of oral health care from an early age. Final advice you would give all dental students and dentists out there? Your are Oman’s Ambassadors You are ODC’s ambassadors Dream big and live your dreams.

interviewed by: Raya Hamdan AlBarashdi

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once upon a time at odc

The doctor saw that one of the students wasn’t wearing mask during the treatment, so she went to the student to tell her that, but she was shocked that the student wasn’t even wearing gloves while treating the patient, so she said: “ Why aren’t you wearing gloves!!!“. The student replied “My patient is clean; she had a shower this morning”.

One of the most shocking moments that one of the doctors has went through in ODC, is that one time when he went to check in one of the patients and that patient had periodical periodontitis. So the doctor asked the student that was treating that patient “What is the reason of the Periapical lesion?? “Because the patient is a smoker and the lesion occurred due to the heat “The student replied.

Professional Dental Cleaning or as dentist call it “Scaling”, can be very painful procedure for the patients sometimes. During such a treatment for a male doctor, the male patient didn’t complain or say anything. Then the doctor asked the female assistant to go and call the supervisor. Once the assistant was gone, the patient said: “Can I cry a bit “…

After passing the gateways, students would start clinical practice on each other before start taking patients. So during periodontal examination, the supervisor was showing the students how BPE is done, then she asked some students to try doing it. In one of the student turns, the patient gum started bleeding and the student panic that she would have done something wrong. Now that student is aiming to be a maxiofacial surgeon.

During ODC’s gateway, the student has been preparing for the Impression test. He prepared everything and started the exam. He was very nervous. He started mixing the component in the bowel so hard and with passion that he hasn’t noticed that there is no alginate within the bowel, only water!!!!

- Susan Sarada Clinical services supervisor at Oman Dental College - Khamis Mohammad AlHassani


CHILDREN AND TEETH HEALTH Dentation is an important period of any kid’s life and once the first tooth erupts, which is usually the lower central incisors at the age of 6 months and a half (1), brushing and a good oral care are required. Since kids in this age cannot take the responsibility of watching over their own teeth, it is their parent’s responsibility to take up that duty. According to a dermatological study that has been done in England in which 54,000 child were examined. 12% of the subjects had tooth decays. A good sample of the children showed a condition referred as “Nursing/Bottle caries “(2). It is characterized by the appearance of lots of tooth decay usually the upper central teeth. The main reason is due to a high sugar consumption. In babies who still consuming mothers’ milk which contains lactose, such a phenomena results nursing caries. Since kids drink milk and go to sleep, the saliva flow is low and cannot reach to the front teeth to wash sugar, so sugar stays the whole night and with time decays will appear, moving to occupy the rest of the teeth gradually if the parent’s had lack of knowledge about the ways of preventing it (3). In addition to the pain and the bad appearance of the teeth, the effect may reflect on the development of the permanent dentation. As the decay spreads to the root of the decayed primary tooth, it might get in contact with the underlying developing permanent teeth. Such a consequence result in a condition known “Turner’s hypoplasia “. The premolars are the most commonly affected, and they can appear in normal color to yellowish, containing white spots or even brown ones. In some cases it can appear in a severely defected appearance (4).

be once in the morning and another time before sleeping. For infants, you can clean the teeth using small piece of gauze or you can buy a soft small head tooth brush (5). You might find in the markets a small tooth brush for infant’s that you can place in your figure and clean your baby’s teeth with, you can use it as well but make sure it meets the requirements of the ideal baby’s tooth brush.

It’s important to concentrate on the point of restricting the toothpaste usage according to the fluoride concentration to each age. For all kids below 3 years old, It’s recommended to use fluoride free toothpaste or smeared toothpaste which contains 1000 ppm of fluoride.(3) while , a 1350-1500 ppm fluoride concentration in the toothpaste ideal for kids above 3 years old (3). In addition supervising the kids during brushing is a must in order to prevent the swallowing of the toothpaste. As it can lead to toxicity, especially if the kid keeps eating the toothpaste without his parents knowledge. Moreover, access fluoride affects the permanent teeth development, giving rise to a dental anomaly termed “Fluorosis”. As teeth would have defected appearance according of the severity of the fluorosis. Teeth can appear in normal color with white spots, up to the severity that teeth would appear brown and break easily (4). Till the age of 7, parents should supervise their kids during brushing, to guide them and as well to prevent the swallowing of the toothpaste (2). Brushing should take 2 minutes and you should tell your kids to spit In order to prevent such anomalies from accruing the toothpaste after brushing instead of rinsing so to your child, a low sugary diet a long with a proper the teeth can benefit from the fluoride (3). knowledge of how to take care of your kid teeth are A good dental health starts from childhood. Brushing must. A regular visit to the pediatrician is a good along with your child motivates him to brush, as you step to start with in order to check on your kid teeth are the first idol in your kid’s life. and to give you a feedback about how effective you are in cleaning the teeth. Tooth brushing in kids is Duaa Mohammad Rashid as important as brushing in adults. And it should

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FOOD AND ORAL HEALTH

The mouth is a complex environment that contains varies structures and performs different functions. Since the mouth is the first place where food would be inserted and ingested, food uptake would be reflected on the oral health. Unbalance diet contributes to the occurrences of dental caries, tooth wear as well as periodontal diseases. Moreover, Halitosis is expressed either due to bad oral health or a reflation of internal problem (1).

On the other hand, increasing the amount of food containing nutrients helps in maintaining the strength of the teeth and the periodontal health, such calcium vitamins and iron.

Balanced diet, contributes in the improvement of the oral and general health. Food pyramid can be a useful tool to help individual’s building a healthy one. High frequency of water and proper knowledge of Beverage has influence on the oral health status. Ex- healthy choices provide disease free individuals. ceeding the beneficial amount of any required nutrient such as carbohydrates alters the oral condition Zainab Mohammad Aljabri and contributes in the progression of dental diseases since bacteria able to turn carbohydrate into acidity. Drinks such as Soft and energy drinks contain high amount of fermentable carbohydrates and considered as one of the main factors of tooth wear phenomena in the teeth due to its acidic nature. Moreover, long term exposure to Coffee and tea; contribute in the teeth staining in. High cariogenic diets -usually in young adults- contribute in the development of high amount of carious lesions termed as “Rampant caries�. It would be initiated as a sugar rinse is induced; the oral ph drops below the critical ph and put the teeth under the threat of demineralization. Normally the saliva works to neutralize the environment and reverse this drop within 60 minutes. The pace of the process would be reduced by the usage of sugar free gum which reduces the time the acidic attack. However, a frequent sugar exposure inhibits the ability of restoring the normal ph causing the many caries lesions development (2).


DENTAL COMPOSITE Dental caries is the most wild spread disease in the world. It is irreversible in late stages which might require dental interventions. And despite the fact that most of individuals do not visit dentists regularly unless there is pain which is in most cases is irreversible. The dental interventions are basically removal of the cause; distract structure, and replacing it with a material similar to the tooth structure in terms of aesthetics, function and form. In dentistry, synthesizing a material resembling the tooth structure has been considered a challenge. At the first half of the 20th century, silicate has been used as a filling to restore the teeth. Although it had the property of releasing fluoride, it has been replaced by PMMA by the end of 1940s despite the fact that it erodes quickly. PMMA had a good aesthetics and low cost but it have failed to tolerate the occlusal load and showed a high wearing pace in addition to the high shrinkage after sitting which eventually leads to micro leakage. In order to solve this problem, quartz has been added. Although the coefficient of thermal expansion and contraction has been reduced, Mechanical failure occurred as the PMMA do not bond to the fillers. (1) By the year 1961, PMMA was replaced with resin based monomers. Resin Composite basically made of: (1) (2) (3) 1) Matrix 2) Coupling agent 3) Fillersv 1) Matrix The matrix of the modern composite composes of resin monomers which can be in different types. BisGMA (Bisphenol A glycidyl methacrylate), UDMA (urethane Dimethacrylate) and TEGDMA (Tri-ethylene glycol dimethacrylate).(2) Methacrylate have been used as it increases the cross linking of the monomers and increases the rigidity of the composite, however Dimethalacrelate is used more often as it causes extensive cross linking in three dimensional structure and increases the rigidity of resin therefore it become more resistance to wear.(1) (3) Bis-GMA is the most popularly used resin monomer (3) which is characterized by having a high molecular weight and long chains of monomers, which make it more viscose. The advantage basically that it has a less

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shrinkage after polymerization comparing to TEGDMA which has short chains, therefore more polymerization shrinkage. (2) (1) In order to overcome the issues of void trapping and difficulty of manipulating Bis-GMA, (1) (2) TEGDMA have been added in the ratio of 25 % of its weight to each 75 % of Bis-GMA weight. (1)(3) 2) Coupling agent It’s an agent which is essential in order to bond the filler particles to the resin matrix. Y-methacryloxypropyl tlrirnethoxysilane (y-MPTS) is the commonest coupling agent used although titdilates and zirconates are available options (1) (2). These orgdno-silanes form a siloxane bond as the water hydrolizes the siliconal group in the resin then it bonds to a silanol group in the filler surface. Once the coupling process is completed, a covalent bond formation accrues between the orgdno-silanes and the resin as it polymerized. (1) 3) Filler particles Filler particles mainly added in order to decrease the wear under occlusal load, strengthen the material, reduce the shrinkage, increase the radiopacity of the restoration and reduces the water sorption1). A Wide option of materials available in order to be used, as fillers can be made of Quartz, Barium, Silicate or strontium glass derivatives (2). The shape and size of the filler particles influence the composite physical properties, aesthetics and wear resistance. A farther more information would be discussed in the next edition.

Duaa Mohammad Rashid


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iNFICTION cONTROL Infection control can be defined as the formal policies and procedures that are required to be followed in all healthcare facilities, including dental workplaces, to reduce the risk of spreading infections. In oral health-care practice, the objective is to protect patients, dental personal, and others who may expose to the environment of the clinics. Health services facilities must be placed for cure and prevention, not for dissemination of disease due to inadequate precautionary measures and habits of the professional personnel. The first responsibility of the entire dental team is to organize and maintain a system for the sterilization, disinfection and care of instruments and equipment. The second step is to develop and maintain work practices for all appointments that will prevent direct or indirect cross infection between dental personnel and patients and from one patient to another. Basic cross infection control 1) Hand hygiene: Washing hands with soap and water is the best way to reduce the number of microbes. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs. Hand sanitizers are not as effective when hands are visibly dirty or greasy.

2) Personal protective equipment (PPE): PPE includes face and eye protection (mask, protective eyewear), gloves and apron. Clinical and decontamination clothing should not be worn outside the clinic. 3) Surface and equipment decontamination: All dental practices should have a policy outlining cleaning schedules and maintenance of simple records on decontamination. Cleaning staff should also be briefed specifically on cleaning patient care areas and decontamination rooms. Wipe down the decontamination area after each decontamination cycle or after each patient. 4) Instruments decontamination: Clinicians must use sterile instruments which can be single use sterilized devices, reusable sterilized devices. Keeping clean environment is a must in order to eliminate the chances of infection to spread since most infections spreads through ventilation.

Intisar Al Harthi Dental Hygienist ROP Hospital


rEFERENCES

Children and teeth health:

Dental Composite:

(1) Oral Anatomy, Histology and Embryology, Fourth Edition. (2) http://www.dentalrepublic.co.uk/smile/news/ article/tooth-decay-affects-12-per-cent-of-threeyear-olds--says-survey (3) Pickard’s Manual of Operative Dentistry, Ninth Edition (4) Cawson’s essentials of oral pathology and oral medicine, Eighth edition. (5) http://www.babycentre.co.uk/a554806/caring-for-your-babys-teeth

(1) Philips Science of Dental Materials, Eleventh Edition. (2) Pickard’s Manual of Operative Dentistry, Ninth Edition. (3) http://www.dentallearning.org/course/Composites/Dental_Composites.pdf .

Food and oral health: (1)http://www.hkmj.org/article_pdfs/hkm0412p414. pdf?origin=publicationDetail (2) Pickard’s Manual of Operative Dentistry, Ninth Edition

Infiction Control: Textbook of Dental nurse, Dental Hygienist 9th edition. Pickard’s Manual of Operative Dentistry, 9th edition

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