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Background: An effective communication between the doctor and patient is the foremost factor in establishing good interpersonal relationships. This comprises of both verbal and non-verbal communicators. Particularly in the geriatric population, communication can be hindered due to physiological and psychological deterioration. This study was designed to assess the communication skills of dentistry postgraduate residents (PGRs), with their geriatric patients and provide a baseline for the shortcomings and improvements. Methods: Four postgraduate residents of both genders were selected to take clinical interviews of geriatric patients. Audio-video recordings were made by an expert and reviewed by all researchers. The interviews were transcribed individually and thematic analysis was done. Open and axial coding was done for data organization under themes and subthemes. Results: Data transcription led to initial generation of 61 codes. These codes were categorized under nine codes through axial coding and grouping of similar codes. Persistent overlapping of content was found in data transcription, which may indicate data saturation. Conclusion: Workshop-trained postgraduate students of dentistry demonstrated relatively instrumental communication skills at their clinical encounter with geriatric patients. However, the professional demeanor demands further finesse in soft skills, which can be achieved through its regular practice.

Aim: To assess the psychological impact of COVID-19 on mental status of undergraduate medical students, after reopening of educational institutions. Methods: This descriptive, online cross-sectional study was conducted on medical students of Combined Military Hospital Lahore Medical College & Institute of Dentistry, Lahore Pakistan for 6 months from 1st June to 30th November, 2021. Generalized Anxiety Disorder Scale (GAD-7) was used as the study tool. Data was analyzed by using statistical software SPSS - 23. Frequencies and percentages were used for descriptive variables. A univariate analysis was utilized to identify the noticeable associations between traits of sample and the anxiety level in current scenario of COVID-19 pandemic. Finally multivariate logistic regression analyses, odds ratio (OR), and Spearman's correlation coefficient, r, was used to evaluate the association between COVID-19-related stressors and anxiety level. Results: Of the 324 respondents, majority were females residing in urban areas with their parents. Severe anxiety was experienced by 23.8% of students. Female respondents were found to have more anxiety as compared to males (OR = 1.81; 95% CI = 1.173 – 2.815). Moreover, respondents having a relative or an acquaintance infected with COVID-19 reported to have more anxiety (OR = 3.007, 95% CI = 2.377 - 3.804). Conclusion: A significant number of students are experiencing anxiety in the post COVID-19 phase, especially those that had an acquaintance infected with COVID-19. There is a need to look after student's mental health and to implement appropriate psychological strategies and interventions to deal with this level of psychological distress in the students at this phase of pandemic for optimum training of future health professionals. Keywords: Anxiety, COVID-19, healthcare professionals, mental health, medical students, pandemic

Background: Forensic odontology (FO) has an important role to play in the field of forensic science to gather evidence for human identification. Dental records form an integral component of forensic evidence in this regard. Dental practitioners need to be aware of the legal significance of dental record keeping. They should be able to provide accurate information on which forensic evidence can be based. Aim: To assess the awareness regarding FO and dental record-keeping practices amongst dental partitioners in Pakistan. Methods: A cross-sectional study was conducted among dental practitioners to assess the awareness regarding FO and dental record-keeping in clinical practice. Results: A total of 380 responses were received. Results showed that only 2% of the respondents studied the subject of forensic dentistry at the undergraduate or postgraduate level. 88 % of the individuals were interested in receiving formal training in forensic dentistry and 96% recommended the subject of forensic dentistry to be introduced as a separate postgraduate training program in Pakistan. More than half of the respondents reported a lack of record-keeping in their clinical practice. Conclusions: Limited awareness was observed regarding FO among dental practitioners in Pakistan primarily due to lack of exposure to the subject. In terms of dental record keeping, a limited number of practitioners in our study reported adhering to it. Hence, there is a need to develop measures to promote awareness and knowledge about FO and dental record management in Pakistan. Keywords: Forensic odontology, awareness, education, dental records, dental identification.

Objective: To assess the knowledge, attitude and practices of medical and dental practitioners regarding COVID-19. Methodology: A cross sectional study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore from July 2021 to July 2022 on medical and dental practitioners. Medical and dental practitioners irrespective of their age, gender and specialty of practice were included in the study. Participants who refused to give consent to be included in the study were excluded. Informed consent was taken from the participants before data collection. Data was collected using a pre-validated questionnaire Results: There was a statistically significant difference in the scores of attitude (p=≤0.001) and practices (p=≤0.001) while the non-significant difference in the scores of knowledge (p=0.200) across medical and dental practitioners regarding COVID-19 pandemic. Conclusion: The level of knowledge, attitude and practices of dental practitioners was higher in comparison to the medical practitioners. Keywords: COVID 19 pandemic, Dental practitioners, medical practitioners, knowledge, attitude, practice

Background: The rehabilitation of edentulous patients requires acrylic resin complete dentures to fulfil their functional and esthetic needs. Fractures of dentures are one of the commonest complaints around the world. Aim: To evaluate the frequency of acrylic complete denture fractures among edentulous patients and find out their association with certain variables. Methodology: A cross sectional observational study was carried out in Prosthodontic department of Lahore Medical and Dental College, Lahore from 26th March 2020 to 26th September 2021. A total of 58 completely edentulous patients reported with fractured acrylic dentures were selected. Patients were evaluated both intra and extra orally to find out the cause and site of fracture. Various parameters namely, denture age, fracture sites, gender were statistically evaluated to find out their relationship with denture fracture. Results: Results showed that male patients; 56.9% were presenting more with fractured dentures than female; 43.10%. In males the midline denture fractures were most commonly seen 45.5%, whereas in females’ fracture at premolar area was commonly observed 28.0% however no statistical dependance between fractured dentures sites and gender was found. Denture fractures were most prevalent in mandibular arch 50% as compared to maxillary 39.7%. Mid line fracture was the commonest site observed in both maxillary 30.4% and mandibular arches 31.0%. Insignificant association between fracture sites and dental arches was seen. Maximum denture fractures were recorded in first 2 years of denture fabrication 55.2%. The most frequent cause of denture fracture was accidental falling 34.5%. Conclusion: The frequency of complete denture fracture is more in mandible as compared to maxilla and the main reason is patients’ negligence. The study also showed midline fracture of dentures to be the most frequent site of denture fracture. Keywords: Acrylic dentures, Complete dentures, Edentulism, Edentulous, Prosthesis, Tooth loss

Nasal septal defects may present with no clinical symptoms to dryness, nasal obstruction, pain, mucosal injury, crusting, epistaxis, rhinorrhea, nasal twang in speech, hyposmia, and breathing difficulties. Prosthetic rehabilitation of these defects may lead to improvement in these conditions. This case report describes the construction of a custom-made two-piece, magnet-retained nasal prosthesis fabricated in heat-cured acrylic resin. Intra-nasal and extra-nasal alginate impressions were splinted with soft plaster. Sequential model pouring was done for convenient access to the complicated intra-nasal anatomy. Two individual nasal stent waxups, containing two magnets with opposing poles facing each other, were well adapted to their respective medial nasal walls and anterior retentive rounded tips. Waxups were processed in heat-cured acrylic resin and delivered after finishing and polishing. Patient's symptoms were relieved, while maintaining the nasal patency. Such inexpensive method with a tissue-friendly material may prove beneficial for rehabilitation of larger nasal septal defects. Key Words: Nasal septal defects, Rehabilitation, Acrylic resin, Prosthesis.

Objective: The aim of this study was to assess the perceived barriers that dental professionals in Pakistan have to use teledentistry, as well as to measure awareness of teledentistry among dental students and dentists.Study Design: A descriptive cross-sectional study.Place and Duration of Study: The study was conducted at the Department of Operative Dentistry, CMH-Lahore Medical College and Institute of Dentistry from September 2021 to December 2021.Material and Methods: During the course of about four months, a descriptive cross-sectional study of dental professionals and students was carried out throughout Pakistan. Dental professionals and dental students within the age range of 18-60 years were included in the study. Any dental practitioner not using a smartphone was excluded from the study.Results: A total of 428 dental students and professionals, with 222 (51.9%) undergraduate students, 127 (29.7%) house officers, 58 (13.6%) postgraduate trainees, and 21 (4.9%) specialists participated in the study. The overall mean knowledge and attitude scores were reported as 29.68 ± 4.24 and 32.55 ± 4.82, respectively. Although the study participants had satisfactory/good knowledge and a positive attitude towards teledentistry, they also believed that there are many challenges to face regarding the equipment and awareness.Conclusion: Conclusively, our study displays a good knowledge, attitude, and awareness regarding teledentistry along with its advantages and disadvantages among the dental community of Pakistan where the legislature is bringing public health services to the doorsteps of the general public by use of information and communication technology.

OBJECTIVE: This study was conducted to observe the relationship of mesio-angular impacted third molars to the development of distal caries in adjacent second molars. METHODOLOGY: This cross-sectional study was conducted at Nishtar Institute of Dentistry, Multan. Nine hundred and eighty nine periapical, bitewing and Panoramic radiographs were recorded and examined for distally carious second molars and impacted mandibular third molars. SPSS version 23.0 was used for data entry and analysis. RESULTS: Almost 40.8% of the target population reported with distal caries due to third molar impactions. A total of 53.30% of these impactions were of the mesio-angular variety. No distal caries was detected in transverse type of impactions. CONCLUSION: The current study concluded that the prevalence of distal caries in mandibular second molars and the positioning of adjacent impacted mandibular third molars in the dental arch were interlinked. Consequently, extraction of mandibular third molars should be considered to prevent caries and premature loss of second molar teeth. KEYWORDS: Distal caries, Impacted third molar, Infections, Risk Factor HOW TO CITE: Ashar T, Shakoor A, Ghazal S, Parveen N, Saleem MN, Raja HZ. Prevalence of distal carious lesions in mandibular second molars due to mesio-angular impacted third molars. J Pak Dent Assoc 2021;30(1):50-55.

OBJECTIVES: To determine the trends in endodontic protocols amongst practicing dentists in teaching institutions and private clinics in Lahore. METHODOLOGY: A cross sectional survey was conducted amongst dentists working in the teaching institutions and in the private clinics of Lahore. A pre-piloted questionnaire survey adopted from Kohli et al with slight modifications was used. In this descriptive study 270 practicing dentists were selected using consecutive sampling with a 5% level of significance and margin of error. RESULTS: The 270 respondents had a mean age of 28.16 ± 6.18 participated in this study among which 111 (41.1%) were males and 159(58.9%) were females with the mean age of 30.28 ± 7.416 and 26.68 ± 4.62 respectively (12.2%) were consultants, 175(64.8%) were general dentists whereas 62(23%) were postgraduate residents. In our study population, 76(28.1%) dentists were using magnification among which 67(88.2%) were using loupes and 9(11.8%) were using microscope. The prevalence of the rubber dam usage for isolation among our respondents was 110(40.7%) only, 201(74.4%) dentists reported for routine removal of smear layer. Manual canal preparation technique was the most commonly used method practiced by 149(55.2%) dentists. 136(50.4%) dentists were using beveled needles for irrigation, whereas only 71(26.3%) were using side venting irrigation needles. Majority of the dentists (45.2%) were not using any method to increase the efficacy of the irrigants. CONCLUSION: There are deficiencies in the endodontic protocols followed by majority of the dentists in Lahore and these short comings should be addressed by governing bodies. KEYWORDS: Root canal therapy, Endodontic, Practice Patterns, Dentists HOW TO CITE: Lodhi Sk, Ehsan S, Rafique A, Saleem MN. Trends in endodontic protocols amongst dentists in Lahore. J Pak Dent Assoc 2020;29(4):239-245. DOI: https://doi.org/10.25301/JPDA.294.239 Received: 30 July 2020, Accepted: 08 September 2020

The treatment of keloid and hypertrophic scar is challenging with no universally accepted mode for permanent ablation. Conventional therapies yield unpredictable results, significant complications and require elaborate hardware. Objective The objective was to establish the safety and efficacy of intralesional 5-fluorouracil (5-FU) for the treatment of keloids and hypertrophic scars. Study design Randomized controlled trial (RCT). Place and duration It was conducted at the Jinnah Burn and Reconstructive Surgery Center/Allama Iqbal Medical College, Lahore, Pakistan from May 2012 to March 2013. Subjects and methods We included 120 patients divided in two groups. The group A patients received intralesional triamcinolone acetonide (TAC) and the group B patients received both 5-FU and TAC. 8 injections at a week interval were given and patients were evaluated at the start of treatment and then at 4th and at 8th week during the treatment and then 4 weeks after the end of treatment. Patents were assessed for mean reduction in scar height, efficacy and complications. Results Total of 108 patients completed the study. The mean reduction in the scar height in group B (5-FU + TAC) 1.144 + .4717 was markedly better than that of group A (TAC alone) 1.894 + 1.0751 (t = 4.781, p = .000). The efficacy (defined previously as >50% reduction in initial scar height) was superior in group B 44 (77.2%) than that of group A 25 (49.0% (X2 = 9.260, p = .002). Recurrence was seen in 39.2% (20) of patients of the group A while in only 17.5% (10) of the cases of group B (P = 0.012). Mean follow up was of 22 months. Conclusion 5-FU + TAC is safe, easy to administer and effective treatment for problematic scars and has the lower rate of recurrence on larger follow up.

Background The ear is the common site for keloid formation especially in women after ear piercing. Surgery is the main stay of treatment in these lesions but there are large numbers of treatment failures in surgery alone. Objective The objective of this study was to compare the efficacy of post-excision intralesional 5-fluorouracil/triamcinolone acetonide (5-FU/TAC) and post-excision radiotherapy in the treatment of ear keloids. Study design A randomized controlled trial. Setting The study was conducted from May 2014 to January 2015 at Jinnah Burn and Reconstructive Surgery Centre, Allama Iqbal Medical College, Lahore. Subject & methodology After approval from the hospital ethical committee, 60 patients presented in the outpatient department fulfilling the inclusion criteria were selected and randomly assigned in two groups with the help of the random number table. Patients in group A had excision followed by intralesional 5-FU/TAC injections while patients of group B had excision followed by radiotherapy. Patients were assessed at 6 months after completion of treatment for efficacy (no recurrence within 6 months of treatment). Results In our study total of 60 patients completed the study, with 30 patients in each group. 7 patients (23.34%) in Group-A and 9 patients (30%) in Group-B were males while 23 patients (76.67%) in Group-A and 21 patients (70%) in Group-B were females i.e. male to female ratio is 1:2.75. Mean age was 31.8 + 6.48 years. The comparison of frequency of efficacy in both groups showed that 73.33% (n = 22) in Group-A and 43.33% (n = 13) in Group-B had efficacy, p value was calculated as 0.01, showing a significant statistical difference. Conclusion Excision and intralesional 5-FU/TAC is an effective treatment for keloids on the ears.

Domestic violence is a complex social issue worldwide that includes a wide range of physical, sexual, psychological, economic, or emotional trauma to a child or adult. A large proportion of domestic violence cases remain unreported or undocumented. Dentists can play an important role in identifying and reporting these cases, but no such local study is available assessing the dental practitioners’ attitudes and knowledge of evaluating physical abuse in Pakistan. The objective of this study was to assess the knowledge and practices of dental practitioners of Pakistan about domestic violence. This cross-sectional study was carried out over 2 months, among 330 dentists across Pakistan, selected by convenience sampling technique. Data was collected via a pre-validated online questionnaire, filled anonymously after taking informed consent. The survey questionnaire collected data about dentists’ demographics, awareness, and experiences about domestic violence cases via close-ended questions. Only 10.6% of participating dentists received formal training in the management of domestic violence cases. Approximately 55% of participants knew that physical abuse should be reported in all circumstances; however, half of them could not accurately identify the legal authorities where suspected cases should be reported. Only 20% of the participating dentists had ever suspected a case of physical abuse and 30% of those actually reported it to legal authorities. Participants characterized fear of anger from relatives as the most significant barrier toward reporting suspected cases. The analysis revealed that Pakistan’s dentists lack adequate knowledge regarding domestic violence in terms of identification, relevant physical signs/symptoms, and social indicators. Dentists of Pakistan had insufficient knowledge about the identification, management, and reporting of domestic violence cases. However, formal training and dentists’ qualification were positively associated with overall awareness and practices regarding domestic violence case management.

OBJECTIVE To compare the graft survival between fat harvested from abdomen and medial thigh for facial contour deformity. STUDY DESIGN Randomised control trial (RCT) . PLACE AND DURATION OF STUDY Jinnah Burn and Reconstructive Surgery Center, Lahore, from October 2015 to April 2017. METHODOLOGY Patients fulfilling the inclusion criteria were randomly divided into two groups. Fat was harvested from medial thigh in Group A and from abdomen in Group B. Outcome was measured in terms of fat survival by comparing mean fat at baseline, first and 12ᵗʰ week. Final fat survival thickness >6.00 mm at 12ᵗʰ week was considered as excellent. ANOVA was used for comparison of mean fat thickness (mm) between the groups, and Chi-square test for outcome and complications among groups with p-value

Construction of a maxillectomy obturator for any surgical defect requires optimum retention, stability and obturation of defect. In the following case a closed hollow bulb obturator was constructed while utilizing surveying and neutral zone impression technique. After insertion, soft liner was applied to record functional impression of the surgical defect. The obturator was resurfaced with heat cure acrylic to improve the outcome. Patient was able to masticate adequately and speak comprehensively. Patient's resonance, speech, retention and stability were markedly improved. Follow-up was done weekly in first month, fortnightly for the next 2 months then after every 3 months. In succeeding years it will be once every year.

To estimate the amount of shift in position of the neutral zone and the centre of alveolar ridge crest in different edentulous periods.Observational study.The study was carried out on edentulous patients reporting in Prosthodontics Department of Lahore Medical and Dental College, Lahore, from August 2006 to December 2008.Patients with edentulous period for at least 6 months exhibiting normal range of maximal mouth opening (40-50 mm) and normal temporomandibular joint movements were included and allocated into two groups, according to period of edentulism. Patient with any intra oral soft tissue or bony pathology and reduced intermaxillary space were excluded. The neutral zone was clinically recorded for all patients with impression compound. The shift between neutral zone and ridge crest in different edentulous periods was analyzed radio graphically and compared statistically.In longer edentulous period (2 years), neutral zone was lingually shifted by an average of 1.06 mm in anterior, premolar and molar regions.Neutral zone may be lingually shifted in relation to alveolar ridge crest in patients with prolonged edentulous period. This may help in arranging the teeth according to the clinical situation.