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White Pearl Voluntry 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 have been shared with some colleagues in ODC and it have been welcomed. And by the hard work, we 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.
Mohammed AlMammri
|||||| Ahmed Bin Majid School Visit As a part of the school visits activities, the white pearl voluntary team visited Ahmed bin Majid School on the 23rd of November 2014.
The different sections of the event were presented in the form of different train stations, each one aiming to deliver a separate aspect of how to take care of teeth in a way that best suits children. The first station was a reception that gave the pupils a general introduction to what they were going to see and learn about. The next station was a puppet show showing both bad habits that can lead to teeth decay, and how to avoid them. The third station provided given oral hygiene instructions via a demonstration of brushing and flossing techniques using plastic models. In order to show the pupils what plaque is and why we need to brush, they were asked to rinse with a colouring agent. They were then shown their teeth in a mirror with the agent highlighting plaque stains. Additionally, there was a station set up as a market where the children had to identify healthy and unhealthy foods. The body parts section constituted the following station, and here the pupils were given the opportunity to identify different parts of the body including the teeth, and given some advice about how to stay healthy. The journey 2 | DESIGN MGZ 6 ended at a station for drawing, coloring and face painting just to add more fun for the participants.
White Pearl Dental Magazine The head of the magazine: Duaa Mohmmad Rashid
Editor in-chief: Khamis Mohammed Alhassani
Writers: Dr. Sanjay Saraf Dr. Ayida Alwahaibi Noura Alghafri Juhaina Albalushi Suhail Alsumri Rayia Alburashdi Fatma Alfarsi AlAzwar Alkhalasi Amal Alwadi Muneer Alsalmi Sharifa Algahdami Omar Alhanshi Safa’a AlQarni
Cover Designer: AlAzwar Alkhalasi
Designer: Suhail AlSumri AlMuhalab AlRawahi
Grammer and Spelling Check: ODC English Department
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CONTENT
Aphthous Ulcer
14-15 Gummy Smile What Is Tooth Enamel?
6-7
The Effect Of Dental Caries In Teeth And Life Quality
8-9
Custom Cast Post System In Endodontically Treated Teeth Dr.Salwa AlHabsi “I Don’t Like Copying Other People, Wanted To Be Different And Unique ...” Necrotizing Ulcerative Periodontal Disease, The Causes And Management
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10-11 12-13 16-18
20-23
Cementoma ... “These Tumors Are Not Cancerous, But Can Grow To Cause Dental Distortion Or Pain ...”
32-33 ODC student’s achievements on 2015 Dubai AEEDEC Conference
Interview with Dr. Noor AlSaadi
34-35 19
“ God Have Created Us Differently With
Frankincense In Medicine
24-25
General Anesthesia In Brief
26-27
Assessment Of Salivary Flow Rates
uniquenss
28-29
In Each
Oral Manifestation Of Behcet's Disease
30-31
The References
36-37
an element of
And Every One ”
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What Is Dental Enamel ?
By Noora AlGhafri
We might wonder what makes our teeth so strong that they are able to grind food easily and withstand such strong forces. People with no scientific knowledge in this field may think that a tooth is just a bone inside the oral cavity. However teeth are a very unique structures composed of 2 main parts according to the visibility. The crown of the tooth and the root of the tooth. The crown of a tooth, which is the visible part in the oral cavity (2), is covered by a highly mineralized tissue called enamel. Beside the enamel, the tooth consists of dentine, cementum and dental pulp. Enamel originates from ectoderm, while dentin, cementum and pulp are of ectomesenchymal origin. In order to maintain its function, which is chewing and grinding food, enamel is highly mineralized and it is the hardest biological tissue (1). It is harder than bone and other mineralized structures. The physical proprieties of enamel enhance its function. It is thick over the cusps and incisal edges and thin at cervical margins (1) . Overall, the enamel can-
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not undergo repair or replacement. It has low tensile strength and can be described as a brittle tissue that it is supported by dentine. A brittle structure like enamel cannot withstand mastication forces without fracturing unless there is a support from other tissues like dentin. Dentin has a high tensile strength and it is a more resilient tissue (2). It will give the enamel the ability to withstand such occlusal forces. In clinical scenarios, if the tooth becomes carious, the enamel will not fracture and no cavity will appear until the caries reaches the middle third dentine(3). This is because enamel has lost its support. The surface enamel, which comes in contact with food, is harder, denser and has less porosity than the subsurface enamel (1 As
it is mentioned before, the enamel is a highly mineralized tissue.
Tooth Structure
“Every Tooth In A Man’s Head Is More Valuable Than A Diamond”
97% of its composition is inorganic material in the form of hydroxyapatite crystals. 3 % of enamel is water and organic matrix. Organic matrix is mainly the enamel proteins which can be classified into 2 groups: amelogenins and nonamelogenins. In addition to proteins, enamel organic matrix contains a small amount of lipids(1). The best way to describe enamel is as composite ceramic with crystallites. The basic unit of enamel is an enamel prism or enamel rod. The enamel between rods is called interrod or interprismatic enamel. There is no different between the composition of rods and interrod enamel, but their orientation is different(1). The rods run in different patterns from the enamel dentin junction to the surface. The most common pattern is “the keyhole pattern”, where the enamel prisms are arranged in such a way that a tail lies between two heads in the next row(1). In addition to prismatic enamel there is also non-prismatic or prismless enamel. The outer layer enamel is usually non-prismatic. Surface enamel is harder and more mineralized due to the lack of prism boundaries,
which are the areas where the proteins or the organic matrix are located(1). Non-prismatic enamel is also present in a very thin layer in first formed enamel at enamel dentin junction (1). The boundary between enamel and dentin is less mineralized compared to the enamel and dentin, and it is termed enamel-dentin junction. In conclusion, enamel is a very unique structure whose composition, strength and physical properties do not resemble any other dental materials. Although enamel is very strong, with ageing and due to masticatory forces, it starts wearing off. Good oral hygiene, fluoride usage and regular dental visits are essential to maintain the health of teeth in general and enamel in particular.
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Effect of Dental Caries on Teeth and Quality of Life By Juhaina AlBalushi
Dental Cariesis one of the world’s most ancient and widespread conditions. It has been reported that about 92% of adults (20-64 years old) have had dental caries in their permanent teeth and about 42% of children (2-11 years old) have had dental caries in their primary teeth(3). This condition causes permanent damage to dental tissue resulting in a negative effect on the quality of life. It is known to be a multifactorial progressive disease initiated by the action of numerous bacteria specifically streptococci mutans, which are a part of normally occurring oral human flora. This overgrowth may be considered to be a laboratorial marker for caries upon fermentable carbohydrates in the black biofilm on the tooth surface leading to a drop in oral pH below a critical point. The bacteria’s metabolic activity produces proteolysis acid which prompts a dynamic process in the absence of protective factors such as healthy saliva and fluoride, known as demineralization of the organic constituents of dental tissue(1). The early 8 | DESIGN MGZ 6
manifestation of the caries process is non-cavitated, white spots or lesions on the surface of enamel, including other indications such as bleeding, halitosis, and presence of a black biofilm known as plaque. A longer exposure to reduced pH causes the initial histological changes within the enamel. . In addition, demineralization of enamel crystals results in micro porosities within the enamel prisms. It starts in the subsurface enamel and if not arrested, continues to develop to the more softer and sensitive part of the tooth structure. If an active lesion is allowed to progress, the weakened part of enamel collapses to form a cavity under the occlusal load (4). Clinical manifestations in this stage display a variable size cavity. The cavity has been classified into 3 main histological zones. The exposed necrotic dark brown zone, described clinically as a wet and mushy layer on dentine, is referred to as caries infected dentine. The second zone, which is paler brown and harder dentine located directly under the first one, is caries affected dentine. The last zone
is the sound part of the dentin. It has a very low bacterial load. The last zone is the sound part of the dentin. It has a very low bacterial load. The presence of these zones is variable according to the stage of the caries diagnosis. Studies in this field show that dental decay affects normal social life. For instance, the necrotic dental tissue with bacteria may release a repulsive odor and cause bad breath. In addition, constant pain may be experienced. The constant pain affect one’s appetite, study, work, sleep or even general health. Dental caries might also cause periodontal disease due to leakage of bacteria and necrotic cells through the apex of the root to the surrounding periodontal tissue. In advanced carious stages, tooth extraction would be indicated as the tooth is unrestorable. In addition to the esthetic concern, the empty space may lead to adjacent teeth drifting and supra eruption of the opposing ones. Studies have shown that primary dentition caries is a matter of concern as it leads to loss of appetite and weight as a result of pain. Treating them would increase growth rate and improve their quality of life(2). In conclusion, early caries lesion can be reversible by optimal control of the risk factors while in cavitated lesions minimal invasive surgery is required to restore the destroyed structure of tooth surface(4).
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Custom Made Post & Core By Suhail AlSumri
Custom cast posts and core can be used in any situation with no need for additional preparation of the canal space as in a prefabricated post.
metal. The simplest method for the fabrication of a post and core is direct fabrication using the lost wax technique(2). Custom cast posts and core can be used in any situation with no need for additional preparation of the canal space as in a prefabricated post. However, this technique requires additional appointments and is much A post and core is a dental restoration more expensive compared to other posts used to sufficiently build-up tooth struc- (2). A cast post and core will be needed ture for future restoration i.e. crown in clinical situations (e.g. anterior maxilwhen there is not enough tooth struclary teeth) where it is necessary to modture to properly retain the crown. ify the angle of the core in relation to the A post is placed within the body of the root(1). root of a tooth that has already treated with root canal treatment. Traditionally, gold alloy was used. HowThe core is the part of the restoration ever, silver-palladium and base metal that shows out in the mouth that help alloys have been suggested as alternaanchor crown. tive material and have become the most A post can be fabricated from metal commonly used metals because they are (gold, titanium, stainless steel), ceramic easier to adjust chairside and show acor fibre-reinforced resin(1) . ceptable casting accuracies (2). Cast metCustom cast posts and core have been al post and cores are fabricated either considered to be the standard of care directly or indirectly. The resin pattern when endodontically-treated teeth are of the post and core is made directly restored, and are described as the treat- in the prepared tooth. A final impresment of choice. sion of the canal and remaining coronal Historically they have been made of 10 | DESIGN MGZ 6
tooth structure can be taken so that a wax pattern can be made indirectly on a gypsum cast(2). Direct fabrication technique: Several methods have been described for intraoral fabrication of an acrylic resin pattern for a direct post and core. Prefabricated plastic patterns are commonly used and relined with autopolymerising acrylic resin to fit the post space(2). The coronal adaptation is completed using the same type of resin and the core is contoured intraorally to the desired form.The only disadvantages of this technique are the amount of chairside time needed to fabricate the pattern intraorally and the addition appointments required for fitting and cementation. Indirect fabrication technique: This technique is used to fabricate more than three cast posts in one visit and when we cannot access a direct technique(2). The post spaces are prepared to the desired depth, and final tooth preparation is completed with finish lines. This method saves chair time because fabrication of the pattern is carried out by a dental technician. The success of this technique depends on the accu racy of the impression in replicating the internal surface of the post and on the skills of the dental technician(2). An elastomeric impression material is used
to make an accurate impression of the prepared root canal. Distortion must be prevented during removal of the impression(2) Several materials, such as orthodontic wire, paper clips or plastic pins, have been used to make the impression technique easier. Metal wire can be flexed on impression removal and will be permanently bent and distorted(2). Plastic posts should only be used when they are totally passive and do not bind.
To conclude, the use of posts was based on the concept that a post reinforces the tooth. Laboratory studies have shown that placement of a post and core either fails to increase the fracture resistance of endodontically-treated extracted teeth or decreases the fracture resistance of the tooth when a force is applied via a mechanical testing machine(2)... DESIGN MGZ 6 | 11
THIS IS
ME...
1) Introduce yourself to the readers. Salwa Abdullah Saleh Al-¬Habsi.
By Raiya AlBrashdi
3) Why have you chosen dentistry and not any other major? Through research, interviewing people 2) Can you tell us about your educational and reading helped me chose Dentistry. journey starting from school? Primary and Middle school: Al-Qurum 4) Is there a specific reason for specializPrivate School Secondary school: Ruwi Sec- ing in Pediatric dentistry? were you alondary school for girls.. Richmond College ways a fan of kids ? in London and British council during the Yes I love kids but Pediatric Dentistry summer holidays. Undergraduate school: was not my first choice as an undergradAyr college, Scotland , and Trinity College uate. When I worked as a general pracDublin. Postgraduate Education: - Eastman titioner I did not know what specialty to Dental Institute, University College London do. I thought about it a lot asked Allah for - Royal Australian College of Dental guidance, asked many people and felt I can Surgeons . make a difference in Pediatric Dentistry Education never ends and never stops it’s in Oman. Allah was great to me that he the air that I breathe in. I’m the happiest showed me the right path. I’m so blessed when I read or study. Alhamdulillah. 12 | DESIGN MGZ 6
5) Would you recommend this major \ specialty for others? Of course I recommend it
interview goes well we give an offer letter. This is the only Centre in Oman Dedicated to kids only, kids friendly. I don’t like copying other 6) Studying advice you people, wanted to be differwould like to give and is ent and unique. I wanted there any techniques of studying you love to share patients, Parents and even staff to be comfortable. It with the readers? took a long time, dedication Just be up to date with your studies and lectures do and patience. not leave it till last minute 8) What is your answer to because towards the end you will be very nervous to people whom tell you that study sometimes. So I study kids can be the hardest and most stubborn creatures everyday so I do not suffer that are there? later and have short notes Adults can be difficult and done from the beginning of the year so towards the ex- stubborn too. ams I can scan very quickly 9) What is your secret in on my notes without readhandling kids? ing everything. There is no secret if you 7) Tell us about your clinic have: Faith of Allah, Educate (day of opening, services yourself, Love what you do you provide, how do you and do what you are excelchoose your staff, how is lent in (not just good) you it different than the other can achieve anything. clinics in the Sultanate of Oman, how did you man10) Do you have a dream age to make your clinic list yet to achieve? , could kids friendly)? you share any of those Child Dental Centre opening hours and services dreams with us? I have aims and goals that I are on our website. I encourage you to visit it www. go through every 6 months and sometimes every year. I childdentalcentre.com . Choosing staff was like any cannot share them I believe they need to be kept secret other process. We receive CV’s and those who we like until I am able to achieve them. we interview and if the
11) If you could change one thing in Oman regarding dentistry, what would it be ? One thing to change in dentistry in Oman would be to start changing myself before I change anything. I would want to able to help others more and do my best to share knowledge and motivate young dentists and inspire others. I would want to create more jobs for dentists and nurses and provide the best dental service there is as much as I could. 12) Final advice you would give all dental students and dentists out there? I said this in other interviews before , you know that have the brains that’s what got you to do dentistry in the first place. So believe in your self and there is nothing that can stop you from achieving your dreams. Have faith. Focus , focus and focus . Be up to date with your studies and do not leave it to the last minute. Remind your self with your greater aim. May Allah Bless you and thank you for the interview.
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Gummy Smile
By Fatma AlFarsi
A person’s smile plays an important role in making a good first impression. Therefore, a smile assessment is considered an important part of the clinical examination since the first priority patients often have is a perfect smile. Gummy smile also known as “high smile line” or “gingival smile line” is a condition which is characterized by exposure of the maxillary gingiva during smiling (1), this is understood to mean exposure of more than 5 mm of gingiva above the neck of the centrals incisors (5). 10% of the population between the ages of 20 and 30 present a high smile line (2) though this is more frequent in females, 14%, compared to 7% (3) of the male population. As age increases, the rate of incidence decreases as a result of a dropping of the lips, which results in the reduction of maxillary incisors exposure
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and an increase of mandibular incisors exposure (2). The main etiologies of the excessive gingival display are plaque-/drug-induced gingival enlargement; the un-esthetics appearance is usually due to plaque, inflammation or as a result of some medication like cyclosporine, phenytoin or calcium channel blockers. In such cases, the treatment mainly focuses on oral hygiene reinforcement though periodontal surgeries might be indicated in severe cases (2). Another cause is altered/delayed passive eruption. Passive eruption is a normal condition in which the gingival margin migrates in an apical direction to the cementoenamel junction level after tooth eruption. APE is the name given when this fails to occur. Treatment options depend on the crevice depth: a gingi-
vectomy can be carried out to increase the crown length by up to 3mm, and this is indicated when the distance from the crest of the gingiva to the alveolar crest is 5mm and there is sufficient crevice depth with adequate band of kertatinized tissue. Apically repositioned flap is indicated when the crest of the gingiva to the bone is 3mm and there is insufficient gingival depth for gingivectomy. In such cases, a flap is elevated and the bone is re-contoured (2, 4). Anterior dento-alveolar extrusion is an overgrowth of maxillary incisors dento-gingival complex and occurs when the gingival margin moves more apically. These cases present where there is tooth wear in the anterior region, or with anterior deep bite. Treatment includes orthodontic intrusion and surgical periodontal correction with or without supportive restorative therapy (2) . Vertical maxillary excess occurs due to the over growth of the maxilla in a vertical dimension although it can also be one of the manifestations in Long Face Syndrome, where there would be an increase in lower face dimension and the occlusal plane is lower than normal, which results in an excessive gingival growth. Here the length of the upper lip is normal, but clinically appears short. Diagnosis confirmation requires the usage of cephalometric radiograph. The treatment varies depending on the gingival mucosal display, where orthodontic intrusion, periodontal intrusion and restorative therapy are the treatment options for display of 2-4 mm “degree I”, periodontal, restorative therapy and orthognathic surgery for display of 4-8 mm “degree II” and orthognathic surgery with or without supporting periodontal and restorative therapy for display of more than 8 mm(2) Hyperactive upper lip is an extreme
elevation of the upper lip due to hyper-function of elevator muscles. The treatment options varies from surgical lip repositioning and botulinum toxin injection to periodontal surgery with or without supportive restorative therapy because the aim is to decrease the amount of lip elevation on smiling and to reduce the height of the gingivolabial sulcus (2). There is an increased awareness of the importance of esthetics to patients, and correct diagnosis is crucial to solving a complex cosmetic concern. An interdisciplinary method is required in order to achieve satisfying results in the management of a gummy smile.
Correct
diagnosis is key to
solving a complex cosmetic concern
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Necrotizing Periodontal Diseases Subsequent to the international workshop in 1999 for the classification of periodontal diseases and conditions it was recommended that both necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis should be called necrotizing periodontal diseases. There are many stages of periodontal diseases such as Necrotizing gingivitis and necrotizing periodontitis. . The diagnosis for them is “acute “because they usually go through a cute phase (1). Usually the distinction between necrotizing gingivitis and necrotizing periodontitis is that the term necrotizing gingivitis is
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By AlAzwar AlKhalasi
so called in cases where no attachment loss has occurred. On the other hand, the term periodontitis is called in cases where the disease is combined with attachment loss. However, the progression of the disease beyond the mucogingival junction with necrosis is called necrotizing stomatitis (2). Etiology The etiology of necrotizing periodontal disease is still unknown. However, some factors are likely to be related to this disease for example some specific microrganisms (3) low or weakened immune defences play the major risk factor in cases of pathogenesis necrotizing periodontal diseases. It has been suggested that there is a pathogenetic role of bacteria such as Selenomonas sp, Treponema sp, Fuso-
necrotizing periodontal diseases . It had been noted that in necrotizing ulcerative disease, there is 95% probability that the T-lymphocyte count is below 200 cells /mm3 (3), therefore the frequent incidences of NUD in patients with HIV and Immunity disorders could be linked to the reduction of leukocytes account (leukaemia)(4). There is a study which indicates that change in profile of cytokine can barerium sp and prevotlla be verified in Nigerian children with necrotizintermedia in causing ing periodontitis. The necrotizing periodontal serum level of each IL-1, diseases. However, some IL-10, L-6, IL18, IL-8 was studies show it was possible to view the presence possible to show a clear of characteristic bacterial increase. However the cortisol level has shown flora of spirochetes and Fusobacteria in numerous slight reduction to the interferon (IFN) gamnecrotic lesions. Despite the fact their primary ae- ma concentration. That tiological role is not clear, means it could be related that predisposing factors it could be related to the (such as stress, smoking, secondary infection. malnutrition and alcohol abuse) can cause necrotizMany studies propose ing periodontal diseases that there is an associa(2) . Other predisposing tion between necrotizing periodontal diseases and factor is poor oral hygiene according to some studweakness of immune system for example, defect ies as a result of causing in mitogenic lymphocyte chronic gingival disease which can cause NUD(2). reaction , reduction of immunoglobulin expresAccording to epidemiosions,(5) and other disorder cases of immune sys- logical studies which show frequent occurrences of tem patients which have
necrotizing periodontal diseases in patients who are exposed to psychological stress(3). Clinical pattern Necrotizing gingivitis is destructive and inflammatory and is characterized by ulceration and narcotization of papillae. The ulceration is surrounded by white to greyish pseudomembranes. The content of the ualcer are fibrin and necrotic tissue as a primary composition. However, the secondary compostion of the ulcer are leukocytes, erythrocytes and large quantities of bacteria. If the membrane is removed, the place will be bleeding spontanously.The development of necrotic lesions is very quick and they are very painful. The necrosis is limited to the tip of the papillae initially, but usually in most of the cases the patient desires visiting the dentist in order to relieve the severe pain (3). So in the initial stage of the lesion, there is significant increase in the size and number of the lesion. Moreover, presence of bleeding either spontanously or any pressure put on the area.However, gingival necrosis develops quickly and it divides the affected papillae to afacial and lingual sections after DESIGN MGZ 6 | 17
few days. Helitosis is always associated with necrotizing periodontal diseases (3) . It is very easy to transmit necrotising gingivitis to necrotising periodontitis. Diagnosis Generally the diagnosis is based on the clinical pattern which has been discussed above. However, the diagnosis of necrotizing gingivitis can be misdiagnosed with the herpes simplex virus. Other predisposing factor is poor oral hygiene according to some studies as a result of causing chronic gingival disease which can cause NUD. (2) According to epidemiological studies which show frequent occurrences of necrotizing periodontal diseases in patients who are exposed to psychological stress. 3 Necrotizing periodontal disease Aetiology Age Site Symptoms Duration of disorder cure
Primary herpetic gingivastomatitis Viral (herpes simplex virus) Childhood Gingiva entire of oral mucosa Multiple small blisters
Bacterial 15 to 30 years Interdental papilla Ulcerations and necrotic tissue that is coated with pseudomembrane One to two days with treatment One to two weeks Irreversible periodontal destruc- Reversible gingival lesions tion
Treatment The treatment can be subdivided into acute and maintenance phase treatment. The objective of acute phase treatment is to relieve the pain and the quick elimination of disease. (Patients with necrotizing ulcerative disease should maintain a high standard of plaque control both mechanically and chemically. Therefore reinforcement of oral hygiene is essential in such patients. The prescription of hydrogen peroxide and oxygen releasing agents has a great advantage in such a clinical scenario as the usage of oxygen therapy for 15 minutes, 3 times per day for 10 days shows a great benefit in reducing the disease symptoms. It can be adjusted to the prescription of systemic Metranidazole and Coamoxiclave for better treatment results). (1)(2)(3)
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The most popular
One of the Oman dental college student’s achievements was on 2015 Dubai AEEDEC Conference. Where 4 students have participated in the poster presentation section.
1)Balarab AlSiyabi: “ Endodontic Mishaps: Etiology, 2)Khamis Mohammad AlHassani: “Discussion Boards And Forums – Do They Enhance Learning Prevention and Management” . Experience Of The Dentistry Students”.
3)Duaa Mohammad Rashid: “Role Of Antimicrobial Therapy In Periodontal Diseases- A Review”.
4)AlMuhalab Juma AlRawahi: “Evaluation Of The Root And Root Canal Anatomy Of Mandibular Second Premolars In Omani Population”.
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Recurrent Aphthous Stomatitis (RAS) Is the most common oral mucosal pathology of unknown etio¬logy characterized by occurrence of recurrent bouts of one or several, shallow, rounded or ovoid painful ulcers, that recur at intervals of few days to 2 to 3 months. It has been reported that recurrent aphthous stomatitis affects 20 percent of general population at any time with a peak age of onset during childhood. The prevalence rate among medical and dental students has been found to be 50 percent. It has also been found to occur more in chil¬dren and adults of high socioeconomic group. Recurrences are less milder and decrease with age. The recurrent aphthous stomatitis can be classified as simple aphthosis and complex aphthosis. The simple aphthosis is episodic, common and short-lived occurring in 20 to 50 percent of population especially in younger indi¬viduals. Complex aphthosis is uncommon, but persistent and chronic. It is associated with systemic diseases. The various associated conditions with complex aphthosis may be: 1.Ulcer vulvae acutum 2.Behçet’s disease 3.Mouth and genital ulcers with inflamed cartilage syndrome (MAGIC) 4.Fever, aphthosis, adenitis, pharyngitis syndrome 5.Aphthous-like ulcerations of HIV disease. 6.Hematinic deficiencies 20 | DESIGN MGZ 6
By Dr.Sanjay Saraf 7.Celiac disease 8.Inflammatory bowel disease. The various features of simple and complex aphthosis are given below: Simple Common Episodic Short-lived lesions Few lesions 3-6 episodes per year Heals quickly Minimal pain Little disability Limited to oral cavity
Complex Rare Episodic or continuous Persistent Few to many lesions. Continues ulceration Slow healing Marked pain Disability Lesions involving oral, genital or perianal regions.
Simple and complex aphthous ulcers can be morphologically classified as major aphthous ulcers, minor aphthous ulcers and herpetiform ulcers. MINOR APHTHOUS STOMATITIS Minor Aphthous Stomatitis ( MiAS) is common form of recurrent aphthous stomatitis and occurs in 80 percent of patients. It is charac¬terized by a prodromal stage in which the patient develops a pricking or burning sensation on mucosa. After this stage (within 24-48 hrs), there is development of shallow, round or oval ulcer. These are seldom more than 5 mm in diameter. The ulcers
may be 1 to 5 in number and are often covered by a gray or yellowish fibrinous surface and are surroun-ded by an area of erythema. The lesions of MiAS are seen entirely on non-keratinized areas, e.g. buccal mucosa, labial mucosa and floor of the mouth or tongue. The anterior part of the mouth is more favorable site while pharynx and tonsillar fauces are rarely affected. The ulcers are painful especially if the tongue is involved thereby making speaking or eating difficult. Pain may persist for a period of few to 7 to 10 days. After this, the ulcers subsequently heal without scar¬ring. The ulcers may recur. Recurrence rate is highly variable ranging from one ulceration every few years up to 2 episodes per month. MAJOR RECURRENT APHTHOUS STOMATITIS (MjRAS) MjRAS is a less common type of recurrent aphthous stomatitis that exhibits ulcers that are larger than seen in minor type and persist for greater period of time (even to a period of months in some cases). The number of ulcers vary from 1 to 10 somewhat inter¬mediary between MiRAS and herpetiform type. The ulcers are larger, deeper, ranging from 1 to 3 cm in diameter, often showing raised border. Ulcers mostly last for more than a month and are not painful during this period. As a result of long period or duration, the ulcer margin gives a heaped up appearance. Eventually, the ulcers heal and may leave a scar. The destruction of tissue (which may occur during the active phase of ulcerations) and scarring may lead to gross distortion of the involved tissue. MjRAS are seen throughout the oral cavity
including soft palate, tonsillar areas and even oro¬pharynx. Frequently, a single ulcer will persist for a long period while others fade. The lesions of MjRAS do not follow a cyclic pattern of MiRAS. Long periods of remission may be followed by intervals of intense ulcer activity without any obvious precipitating factor. The prolonged painful ulceration presents the usual speaking, eating, and swallowing difficulties. Some studies show an increased prevalence of major aphthous ulcers in patients with Behçet’s disease when compared to all patients with recurrent aphthous stomatitis.
DESIGN MGZ 6 | 21
HERPETIFORM ULCERATION (HU) The individuals who develop the lesions of Herpetiform ulceration is the least common variant of recurrent aphthous recurrent aphthous stomatitis may have a family history. stomatitis involving 5 to 10 percent of cases. The ulcers seen are small in Various studies suggest the linkage of size (1-3 mm), multiple (100 to 150) genetics with the recurrent aphthous stomatitis. An increased expression of HLA in number and appear in clus¬ters. These clusters may be relatively small, antigen subtypes like DR2, DR5, DRw9, loca¬lized or distributed throughout etc. has been reported. the oral cavity. Often these ulcers may Recurrent Aphthous Stomatitis and Hormones.The recurrent aphthous stomacoalesce and produce a widespread titis has been linked with onset of menarea of irregular ulceration. struation or the luteal phase of menstrual Although the ulcers appear on any cycle. non-keratinized mucosa, the sites chiefly involved are lateral margins of Food Hypersensitivity tongue and floor of mouth. Individual The exposure of certain foods like milk, ulcers are gray without an erythema- gluten, choco¬lates, cheese, etc. is linked tous border making them quite diffi- with occurrence of this disorder. cult to visualize. These ulcers, which Drugs are small resembling HSV infections, Uncommonly drugs, e.g. NSAIDs may are very painful and make eating and lead to oral ulcers. Hematinic Deficiencies speaking difficult. These clusters of About 20 percent of patients have been reulcers last for 7 to 14 days and the period of remission between attacks is ported to have hematinic deficiencies, e.g. variable. Healing with scar forma-tion zinc, iron, vitamin B12, etc. has been reported but it is probably as Stress a result of coalescing of ulcers to form Stress may play a role in causation of recurrent aphthous stomatitis but it is not large confluent areas. Table 6.1 shows types of recurrent aph- accepted by many researchers. thous stomatitis with respective clinical Local Trauma Some patients do develop ulcers in refeatures. sponse to trauma. Tobacco Etiopathogenesis Etiology of recurrent aphthous stoma- Tobacco smoking has not been associated titis is unknown but a number of local with the appearance of ulcers. and systemic predisposing factors oc- Microbial Factors It was suggested that oral streptococci incur. These include; duce the formation of antibodies that may Age and Sex According to studies the prevalence of cross react with keratinocytic antigenic recurrent aphthous stomatitis has been determinant. found to be ranging from 1 to 40 percent among children in developed na- The role of virus has also been suggested tions. Among adults it has been found but it has not been validated. to occur in 60 to 85 percent of cases. A Although vast majority of patients with recurrent aphthous stomatitis have no obvifemale predilection is noted. ous associated condition but similar oral Family History and Heredity 22 | DESIGN MGZ 6
ulceration is seen in Behçet’s syndrome, sweets syndrome, agranulocytosis, periodic fever syn¬drome, cyclic neutropenia, gastrointestinal disorders, nutritional deficiencies, immunodeficiency diseases, e.g. HIV. The pathogenesis has been considered to be immunologically mediated but not fully elucidated. There is a strong evidence from histopathological and immunological studies that T-cell mediated immune response is implicated in development of recurrent aphthous stomatitis. Studies report that T inducer subsets, including CDW29 helper and CD45R suppressor lymphocyte to be depressed, suggesting a primary immunologic abnormality. The role of the neutrophils, macrophages and mast cells have not been clearly linked with the disease. The T-cells infiltrate into epithelium in response to unidentified keratinocyte-associated antigen. The cytotoxic T-cells and other leukocytes differentiate and produce tumor necrosis factor. The TNF- in turn evoke inflammatory response by its effect on endothelial cell adhesion and neutrophil chemotaxis.
Several RAS cases have been reported to have occurred in HIV individuals and have been charac-terized by the appearance of ulcers of major, minor and herpetiform type. The site of involvement has been found to be, e.g. soft palate, tongue or tonsils. Management The objectives of the treatment of recurrent aphthous stomatitis are to relieve discomfort, reduce secondary infection and promote healing of existing ulceration and prevent development of new ulcers. The usage of topical analgesics or sprays, antiseptic mouthwashes or mouth washes containing anti¬biotics, topical steroids should fulfil the objectives mentioned. The severe cases may be treated with systemic therapy, e.g. thalidomide, etc.
Microscopic features: Often on microscopy a pre¬ulcerative stage shows mononuclear (lymphocyte) cell infiltrate in lamina propria. As the ulcerative phase approaches, there is increased infiltration of the tissues by mononuclear cells, more edema and degeneration of epithelium. Often this phase progresses to frank ulceration with a fibrinous membrane covering the ulcer. Neutrophils predo¬minate near ulcer area. During the healing phase there is regeneration of epithelium HIV-associated Recurrent Aphthous Stomatitis DESIGN MGZ 6 | 23
By Dr.Ayida AlWahaibi
Frankincense and Medicine
Frankincense has been one of the world's most treasured commodities since the beginning of written history. It is the oleo gum-resin obtained from trees of the genus Boswellia (family Burseraceae). The name for this resin comes from "incense of Franks" since it was reintroduced to Europe by Frankish Crusaders. The resin is also known as olibanum, which is derived from the Arabic al-lubān, a reference to the milky sap tapped from the was used to make the distinctive black eyeliner Boswellia tree. seen on so many figures in Egyptian art. The To obtain the Frankincense, a deep, aroma of frankincense is said to represent life longitudinal incision is made in the and the Judaic, Christian and Islamic faiths trunk of the tree and below it a nar- have often used frankincense mixed with oils row strip of bark 5 inches in length to anoint newborn infants and individuals conis peeled off. The white emulsion sidered to be moving into a new phase in their produced solidifies, when exposed spiritual lives. Olibanum is the best known of to the air and sun, into globular, the ancient plant resins: it has been used as an pear or club shaped tears. The resin incense, in embalming and in preparation of takes about three months to obtain medicines, cosmetics and perfumes since the the required degree of consisten- Egyptians, and nowadays it is still used theracy and hardening converting into peutically. Commercial Frankincense comes yellowish ‘tears’. Frankincense is from three distinct regions: East Africa (Eritrea, generously used in religious rites. Ethiopia, Somalia and Sudan), Southern part of In the Bible’s Old Testament, it was the Arabian Peninsula (Yemen and Oman) and part of the temple rites. The Egyp- North-Western India. tians ground the charred resin into a powder called kohl. Kohl
24 | DESIGN MGZ 6
The last few years showed a great interest for Frankincense in medical researches. Researches demonstrated that the actions of frankincense include anti-inflammatory, anti-tumoral, immune-stimulant, antidepressant and muscle relaxing. It is strongly anti-viral, antioxidant, antifungal, antibacterial, antiseptic and expectorant oil. There are a few researchers studying the effects of frankincense on various cancers with some degree of success. In vitro effects show inhibition or stimulation of cell proliferation depending on the concentration of frankincense oil in the growth media. A study conducted at the University of Oklahoma showed that frankincense kills bladder cancer cells without harming surrounding tissue. A Chinese study conducted in 2000, indicated that Boswellia has “anti-carcinogenic and anti-tumor activities.” These boswellic acids from frankincense inhibited “a variety of malignant cells” in people suffering from leukemia and brain tumors. Multiple recent studies conducted at Sultan Qaboos University have also demonstrated the wide medical properties of the Frankincense oil. In 2008, the use of the Frankincense, as an impregnating and embedding medium was tested on different types of specimens. The impregnation properties of the Frankincense oil was supported by the fact that it contains 60-70% resins according to literature. One recent
study (2014) demonstrated the ability of the oil to improve the kidney functions in patients suffering from different grades of kidney failure. In the field of dentistry, a study on the extract of Boswellia Serrata species displayed anti-inflammatory properties of Frankincense extract on chronic plaque induced gingivitis, which is a periodontal tissue inflammatory disease, (Khosravi-Samani et al, 2011).
DESIGN MGZ 6 | 25
By Muneer AlSalmi
General Anesthesia
The word ‘anesthesia’ is used to describe the absence of all sensations, while ‘analgesia’ means the absence of pain(1). During surgical procedures, the patients will be under general anesthesia in which more than one agent is administered intravenously or via inhalation route. There will be a loss of all sensations and the functions of some organs or systems will be compromised, such as the respiratory system. For this reason, external ventilation might be required in order to maintain the respiration. Pre-Operative evaluation and taking history is essential prior to a patient’s admission. This evaluation is important in order to highlight the risks and the complications that might occur, and to determine the amount and the suitable type of drugs
26 | DESIGN MGZ 6
to
be used according to the patient medical and physical conditions. The usage of premedication is indicated to improve the quality of the anesthesia and to reduce anxiety and fear. This is most commonly achieved by using benzodiazepines, such as diazepam or lorazepam. However, these drugs would lead to anterograde amnesia(1). Pre-Operative evaluation and taking history is essential prior to a patient’s admission. This evaluation is important in order to highlight the risks and the complications that might occur, and to determine the amount and the suitable type of drugs to be used according to the patient medical and physical conditions. The usage of premedication is indicated to improve the quality of the anesthesia and to reduce anxiety and fear. This is most commonly achieved by using benzodiazepines, such as diazepam or lorazepam. However, these drugs would lead to anterograde amnesia(1). Anesthetic agents’ administration can be achieved through two main routes: 1)Via inhalation, such as halothane, enflurane, isoflurane or sevoflurane, where it would be accompanied with nitrous oxide and oxygen not less than 30%. 2)Intravenously, such as thiopentone, etomidate, propofol and ketamine. The main advantage of such a route is that it has rapid onset and recovery when compared to inhalation agents(1) (2). According to 1937 GA guide(2), there are four main stages of GA effect: Stage I (Analgesia): It is the period between the administration of the inhalation agents and the loss of consciousness. Stage II (Excitement): Where the pa-
tient loses consciousness, heart rate and respiration become irregular; however, pharyngeal and laryngeal reflexes are maintained. Stage III (Surgical Anesthesia): Initially the patient develops regular respiration, reaching the stage of abolishment of the respiration reflexes and skeletal muscular relaxation; in this stage the surgeon can start the operation. Stage IV (Impending respiratory and circulatory failure): In this stage the anesthesia becomes very deep; there will be brainstem depression, which leads to respiratory failure if the concentration of the agent has not been decreased and oxygen has not been introduced(1) Once the patient enters the stage of surgical anesthesia, the level of the anesthetics should be maintained to provide the surgeon with an appropriate length of time and to avoid patient recovery during the surgery; this is achieved by either inhalation agents, intravenous anesthetic agents or intravenous opioids(1)(2). Postoperative care is essential during patient recovery, monitoring cardiovascular system, respiratory system, body fluid and other systems to ensure that the patient is safe. Postoperative pain is very common after the anesthetic agents start to dissolve, so pain should be managed by pain killers such as paracetamol or NSAID(2). Anesthesia is one of the most important aids that has improved the quality of surgery and has made it safer than ever before. Modern equipment and skilled operators make general anesthesia easy to apply and safe for both the patient and the surgeon.
DESIGN MGZ 6 | 27
Assessment By Amal AlWadi Of Salivary Flow Rates In the context of oral dryness there are two types of patients. On one hand some patients might complain of xerostomia symptoms but they may have normal salivary flow. On the other hand, other patients might not complain of symptoms of oral dryness but they may have low flow of salivary secretion in comparison to healthy individuals(2). The previous statement indicates that the patient complaint is not sufficient to diagnose the hypo function of salivary glands. This article discusses the different tests that are used to assess the hypo function of salivary glands. There are multiple tests which are used to assess the flow rate of salivary secretions. All these tests are categorized as one group called Sialometry Tests(2). The ‘candy weight loss test’ is one of the quick tests that are used to screen whether the patient has normal or hypo-salivation. This test is done by placing a candy between the tongue and the hard palate for 3 minutes. In normal flow of saliva, the candy decreases in its size and active secretions of saliva is reported, while for hypo-salivation neither candy weight loss nor active salivary secretion is seen. This test is beneficial before subjecting the patient to other overwhelming tests of salivary function(1). Another test which is considered one of the sialometry tests, is the whole saliva test. It is one of the commonly used tests. The whole saliva means collecting all the oral secretions including the major salivary glands secretions(1). It is collected in two conditions: the resting saliva and the stimulated saliva. Each condition has a different method to collect saliva and 28 | DESIGN MGZ 6
they definitely have a different flow rate. The flow rate of saliva could be affected by different factors like time of the day, the length of collecting saliva, body position, temperature and exposure to light. Therefore it is very essential to standardise the collection of saliva in fixed variables(2) . There is a proposal that is used to standardise the whole saliva collection. The standardised proposal mentions the following: collect saliva between 9-11 am where the patient should refrain eating for 90 minutes prior to the sample collection, stop any medication that could cause any hypo-salivation according to half-life of the drug, rinse with deionized water and collect saliva for 10 minutes(1) Resting whole saliva is done by four main methods. There is the draining, spitting, suction and swap/absorbent method. The draining method is done by having a test tube and funnel. Using the standardised proposal, the patient is asked to sit in with head tilted down and is instructed not to swallow the saliva. Every five minutes the patient should expectorate saliva passively into the test tube. The spitting method resembles the draining method; the difference is that the patient expectorates saliva twice every minute. Spitting method could introduce the amount of stimulation. The draining and spitting method gives almost the same data(2.) The third method is the suction method, which is a continuous suctioning of sa-
liva for 10 minutes, by using a salivary ejector. It has been said as well, that it can introduce some amount of stimulation. (1) Lastly, the swab method is the least reliable one and it is done to estimate the hypo salivation in severe dryness of the mouth. The swab technique is done by placing a cotton roll or gauze sponge in the mouth. The cotton roll is weighed before and after placement(2). The stimulated whole saliva is collected by two methods: the masticatory and gustatory method. The masticatory method stimulates salivary secretions by mastication. It is achieved by chewing paraffin wax (1-2 gm) for 5 minutes. The patient is asked to expectorate saliva every one minute. The other method is the gustatory method which stimulates saliva by taste perceptions. This technique is done by applying citric acid with the concentration of 2%, on the tongue laterally, every 30 seconds for 5 minutes. The citric acid is available in pharmacies(2). In conclusion, dry mouth is a problem that is needed to be investigated in early term for giving early diagnosis. Sialometry tests have reliable methods for assessment of salivary flow. However they are not reliable if not used in standardised conditions.
DESIGN MGZ 6 | 29
Behcet’s Disease By Sharifa AlJahdami
Is a multisystemic inflammatory disease that was discovered by the Turkish dermatologist Hulusi Behcet. Behcet’s disease affects oral and genital mucosa with recurrent ulceration. Furthermore, this disease affects joints, vascular systems, CNS, the eye and skin. Behcet’s disease has been proved to be an autoimmune disease, induced by T lymphocytes and plasma cells. Mainly, the disease is found in young people but it can be found rarely in children. Such disease is more common in males than in females. Mostly, it is common in Mediterranean countries, South East Asia, and particularly in Japan and Turkey. There is no obvious etiology for the disease(1). The most important oral manifestation is recurrent aphthous stomatitis. Recurrent aphthous stomatitis has been seen mostly in the initial stage of Behcet’s disease. It may appear in any form, minor, major or herpetiform. However, few cases of recurrent aphthous stomatitis may progress to Behcet’s disease. Furthermore, patients with Behcet’s disease suffer from painful recurrent genital ulceration that tends to heal leaving a scar. Beside oral and genital ulceration, other clinical features of the disease are pustules, erythema nodosum, arthralgia (large joints), aneurysms, thromboses of vena cava, proteinuria, haematuria, syndromes resembling multiple sclerosis, syndromes resembling pseudobulbar 30 | DESIGN MGZ 6
palsy, benign intracranial hypertension, brainstem lesions and depression(2). Behcet’s disease is rare and it can be quite difficult to diagnose. The presence of oral, genital and ocular features contribute to the clinical diagnoses of Behcet’s disease. In Behcet’s patients, plaque, sulcus bleeding, gingival indices and probing depth are higher than is healthy patients. Also the number of extracted teeth found in Behcet’s patients is higher than in healthy patients. Significantly, the periodontal indices in a patient suffering from Behcet’s disease are higher than in a healthy control patient(3). In addition, the people who have mouth ulcer have higher scores of periodontal indices than ulcer free patients. Oral ulceration is considered a main factor that leads to poor oral health in patients with the disease(4). Streptococcus spp is considered one of the infection related factors which usually reactivate the clinical manifestation of Behcet’s disease. In addition, streptococcus spp reactivates the oral ulcers and also consume to increase the incidence of dental caries. Since patients have painful oral ulcers, tooth brushing may become less effective(3).
Patients tend to decrease the number of good oral health. Using dental floss and brushing times, which affects the peri- increasing brushing times contributes to odontal status, leading to an increase in maintaining good oral health in patients with the disease(3)A patient who is a the attachment loss, pocket depth and calculus deposits(3). Some clinical stud- regular dental clinic attender has better ies found that there is a relation between oral health. Furthermore, regular tooth the severity of Behcet’s disease and oral brushing decreases the recall period hygiene. Patients who have severe Beh- and assess in management of the oral health(5). Dental cet’s disease have poor oral hygiene, and periodontal worse than patreatments have a tients with mild to role in flaring up moderate Behcet’s the oral ulcers(5). (6) disease . In addiconclusion, paBehcet’s Disease Is Like Having In tients with Behcet’s tion, patients with disease are more Behcet’s disease Multiple Sclerosis, Lupus , prone to have experience eating Crohn’s Disease & Arthritis periodontal and problems. MostALL IN ONE DISEASE dental problems. ly, patients with The most effective painful recurrent way to manage ulceration feel periodontal and discomfort in oral dental problems function. Indirectis to motivate the ly, this issue could patient to attend dental appointments affect the patient`s social life and may regularly. Oral hygiene habits and regucause depression(7). To maintain oral lar dental checkups are very important health in patients who have Behcet’s disease, it is necessary to motivate them to maintain oral health and to follow up to improve their oral hygiene(5). Topical the oral ulcers. steroids are used to treat recurrent oral ulcers in patients with Behcet’s disease. The illumination of oral ulcers promotes
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DESIGN MGZ 6 | 31
By Omar AlHanshi
Cementoma
Odontogenic tumors are rarely seen in the dental field and range from benign or malignant to dental hamartomas. The term odontogenic refers to tissues of dental origin, which either might be epithelial rooted or ectomesenchymal. They can also be lesions of mixed origin(4). A cementoma is an odontogenic tumor which arises from the cementum. It is usually seen when root formation is complete. Studies show that cementomas are most commonly seen In African women where the mandibular arch is more affected than the maxillary(2)(3). Risk Factors, Pathology, Histological Features According to Cawson, cementomas has been classified into four subdivisions: •Periapical cemental-dysplasia •Florid cemento-osseous dysplasia •Focal cemento-osseous dysplasia •Gigantiform Cementoma Periapical cemental-dysplasia Periapical cemental-dysplasia is a reactionary lesion which develops as a result of stimulation leading to granulation formation on the apices of the teeth. Typically, it is seen in vital lower anterior teeth. Blacks have a higher tendency to develop the condition as compared to other races. Initially, cementomas are similar to cemento-ossifying fibromas histologically. However, as the lesion progresses they are filled with solid, bone like calcifications(1)(2). Usually, cementomas are asymptomatic lesions that are discovered during routine dental 32 | DESIGN MGZ 6
radiographic investigations. Radiographically, at the very early stage the lesion is seen as a rounded radiolucent area, but with calcification the lesion changes to clear radio-opaque . Florid cemento-osseous dysplasia Florid cemento-osseous dysplasia is defined as the florid type of the periapical cemental-dysplasia; however, the florid cemento-osseous dysplasia shows sclerotic masses which tend to appear symmetrical in shape involving both maxillary and mandibular quadrants. Unless it gets infected, the sclerotic masses are symptomless and the patient will not complain of any pain or complications. In addition, as the lesion progresses it leads to expand the jaw leading to development of solitary bone cysts. Radiographically, unlike a periapical cemental-dysplasia, florid dysplasia shows no radiolucency and radio-opaque appearances will be seen clearly(1)(2). Focal cemento-osseous dysplasia The focal cemento-osseous dysplasia differs from the florid dysplasia in three main features, Firstly, focal cemento-osseous dysplasia has more
(1)
tendency to occur in Caucasians rather than in blacks. Secondly, the dysplasia is seen to be predominant in the mandibular posterior teeth instead of occurring in the anterior. Thirdly, the dysplasia forms single lesions rather than multiple ones(2). Radiographically, just like the florid cemento-osseous dysplasia the lesion appears radio-opaque on the radiograph(1). Gigantiform cementoma This is the least common type of cementoma and mostly affects black women. This condition is inherited and has the capability to grow aggressively leading to large lesions progressively affecting both jaws. Gigantiform cementoma dysplasia usually affects more than one quadrant and it can lead to complete deformity of the face(2). Treatment: There is no cure for cementoma. Although surgical removal is done to prevent the progression of the lesion, reoccurrence has been reported in some cases(2).
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Life After Graduation
By Raiya AlBrashdi
1-Introduce yourself to the readers. My name is Noor Jabbar Al Saadi, first batch graduate of Oman Dental College. 2-Tell us about your educational journey starting from school till now. I have received both my primary and secondary education in different schools in Muscat; overall the experiences at these schools were modest and humble. Soon after completion of high school, and receiving of the diploma degree with distinction, my search of a future career has just started. Initially to pursue a degree in architecture was appealing; however medicine was more appealing to my parents, until an acquaintance of my father proposed the idea of considering dentistry as an option. Since the option was too alluring, I accepted the deal and started doing dentistry. Subsequent to the rewarding accomplishment at Oman Dental College and obtaining of my Bachelors in dental surgery, I applied for a job in the Ministry of Health; unfortunately the process was nothing close to being smooth as promised! Nonetheless; I enrolled myself in different clinics and hospitals observing and practicing, attending workshops and conferences trying my best to stay in touch with my profession and keep on hold of my skills and developing more expertise in my field. After that, almost a year later, vacancies by the ministry were announced and I got employed. Then internship program nominees were announced including me to start rotation in different dental departments. It was a great turning point in my career, starting my rotation in oral and maxillofacial department which was one of the most 34 | DESIGN MGZ 6
dynamic, rewarding positive rotations followed by the rest of the specialties. During my training period, I applied for my MFD examinations and successfully passing them. And I also presented in first military dental conference, which was one of the best experiences in my life. Following my successful attempts I set to myself a new target, and that was applying for surgery through (Oman Medical Specialty Board), lucky enough to be granted a seat and fulfilling my dream by being accepted in this program. And here I am an OMFS resident! Learning, working and presenting abroad. 3-Why have you picked dentistry as your life time major and nothing else? I believe that medicine as whole is a very noble profession, where an individual may help alleviate pain and suffer of a patient, thus making a difference in his/her quality of life. Dentistry in specific serves the same purpose, but with arts and dynamics. 4-Has it occurred to you to go for any other major even for a day and why? After landing in ODC and getting more
all live on the same planet, going through Although we the same number of days and nights life isn’t
the same for all of us. It is how we live it, deal with life issues and achieve what we have in mind determines how amazing the life we live can be. On our second issue we chose an ambitious young lady. Who not only managed to graduate from dental school with honor but even went further by achieving even more by specializing in maxillofacial surgery....
involved with dentistry, it never occurred to me to switch to anything different, it seemed to me that I have found the kind of profession that suits my personality.
complex, new environment more responsibilities and more goals to be achieved. Thankfully its moving according to plan, can’t wish for more!
10-Advises you would give dental students inside and outside Oman? I advise them to always have a dream, set a goal and 5-Would you recommend 8-Are you currently spedentistry to others and why? cializing in anything? If yes work and pray for it. Never give up and don’t let anyone Dentistry is not a trip or a what is it? And why have question your abilities or place that needs be recomyou choose it? suppress your enthusiasm. Yes. I am currently an oral mended to others in my We are all students at the opinion. Dentistry requires maxillofacial surgery resend of the day and we will passion, dedication and ident. I have chosen this commitment. As long as the specialization because I have always remain. (Amount of knowledge is infinite) person/student has eagerdeveloped passion towards ness to pursue dentistry as a surgery and medicine since 11-Any last words you want career he/she will definitely college days. to say? Any people you want find a way to do dentistry. to thank? I want to thank you for this 9-Who is Noor? Her likes 6-What would you answer beautiful interview. I would people whom find dentistry and dislikes. Her hobbies. also like to thank my family What does she do in her to be a very unappealing for their everlasting support free time? major? Noor is a very energetic yet and motivation and finalGod have created us difa shy girl who likes to draw ly I would like to take this ferently with an element and paint, who also likes of uniqueness in each and opportunity to express my outdoor activities, walking every person. This creates deep appreciation to my diversity in passion and be- by the beach, reading and tutors especially Dr. Moliefs. This diversity therefore updating herself. hamed Al Ismaili and Dr. Mostly I like to go out with Ahmed Al Hashmi for their creates an integrated commy friends or go shopping continuous guidance and plete society. in my free time; otherwise encouragement into develI will be at home baking or oping myself and the Omani 7-How is life after college? working on a future redental profession in general. If you find it any different, then how different? search or projects. Life gets more serious and Dislikes are insignificant! DESIGN MGZ 6 | 35
References: References Enamel : 1.B.K.B.Berkovitz,G.R.Holland,B.J.Moxham (1992), Oral anatomy, histology and embryology ,Fourth Edition, united kingdom: British Library. 2.Antonion Nanci (1980), Ten Cate’s oral histology, development, structure and function, Seventh Edition, India: India Reprint ISBN. 3.E.A.M.Kidd, B.G.N.Smith, T.F.Watson (2003), Pickard’s manual of operative dentistry, Ninth Edition, Newyourk: Oxford University Press. References of Dental Caries : 1.Avijit,B. Watson,T (2010). Pickard’s Manual Of Operative dentistry. Nine edition. Oxford press. 2.National Center for Biotechnology Information(NCBI).( 2006 Nov). http://www.ncbi.nlm.nih.gov. accessed 26 January 2015 3.National Health and Nutrition Examination Survey (NHANES). (September2014).http://www.nidcr.nih.gov.accessed 23 January 2015. 4.SS Hiremath MDS (2007). Textbook of Preventive and Community dentistry. New Delhi: Elsevier. References Of Post and core : 1.Cohen’s Pathways of the Pulp Expert Consult, 10e Hardcover by Kenneth M. Hargreaves DDS PhD FICD FACD (Author), Louis H. Berman DDS FACD (Author). 2.Contemporary Restoration of Endodontically Treated Teeth: Evidence-Based Diagnosis and Treatment Planning Hardcover, 1e by Nadim Z. Baba (Author) References Gummy Smile : 1.Matthews, TG (1978), The anatomy of a smile. J Prosthet Dent . 2. Silberbeg, NS (2009), excessive gingival display. 40(10).809818. 3.Diamond O (1996), facial esthetic and orthodontics, J Esthet Dent. 4.Edward, SC (2007), Atlas of cosmetic and reconstructive periodontal surgery, third edition, people’s medical publishing house. 5.Stephen, MD (2005), minimally invasive techniques of oculofacial rejuvenation, thieme medical publi 36 | DESIGN MGZ 6
References of NUD: Journal of Clinical Periodontology September \1986 page 727-734 3-V.Clerehugh A.Tugnait Robert J.Genco Periodontology at a glance 2011 4-F.Rathe,P.Chondros , Necrotising periodontal diseases . 5-Wada DN.(2007).Acute Necrotizing Gingivitis-Periodontitis: A literature review. 6-Rowland Rw.MesteckyJ, Gunsolley JC.cogen RB. Serum IgG and IgM levels to bacterial antigens in necrotizing ulcerative gingivitis. J Periodontal 1993 References GA : 1-David Wray, David Stenhouse, David Lee, Andrew J E Clark (2003), Textbook of general and oral surgery, United Kingdom: British Library. 2-Pual G.Barash,Bruce F.Cullen,Robert K.Stoelting, Michael K.Cahalan, M. Christine Stock (2009). Clinical Anesthesia, China: Library of Congress Cataloging in publication data.
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