Journal of Rehman College of Dentistry

Age Estimation: A Comparison of Dental And Skeletal Radiological Assessed Age with Chronological Age in Individuals Presented to Forensic Medicine Department Peshawar: A Cross Sectional Study

2025-12-04T07:06:39+00:00

Background:
Age estimation is a critical aspect of forensic and legal investigations, especially in populations where documentation is unreliable or absent. Among the most reliable biological indicators for assessing age are dental and skeletal radiological methods. However, their accuracy can vary across populations due to differences in ethnicity, nutrition, and socio-economic status.

Objective:
To compare dental and skeletal radiologically assessed age with actual chronological age in adolescents and young adults from Peshawar, Pakistan, and to determine which method offers greater accuracy, reliability, and agreement with known age.

Methods:
This cross-sectional study included 150 participants (80 males, 70 females) aged 8 to 20 years. Dental age was determined using Demirjian’s method from orthopantomograms, and skeletal age was assessed using hand-wrist radiographs interpreted via the Greulich and Pyle Atlas. Statistical analyses included mean absolute error (MAE), paired sample t-tests, Pearson correlation coefficients, to assess method accuracy, correlation, and reproducibility.

Results:
The mean chronological age was 14.2 ± 3.1 years. Dental age (mean: 14.6 ± 2.9 years) showed a tendency to overestimate chronological age (MAE: 0.75 years), whereas skeletal age (mean: 14.0 ± 2.8 years) demonstrated a closer agreement (MAE: 0.45 years). Skeletal age had a stronger correlation with chronological age (r = 0.91, p < 0.001) compared to dental age (r = 0.85, p < 0.001). The skeletal method also maintained better consistency across age groups, particularly in the 16–20 years bracket. Gender-based differences were minimal and statistically insignificant. Both methods showed excellent inter-rater reliability (ICC > 0.89).

Conclusion:
Skeletal radiological age assessment using the Greulich and Pyle Atlas demonstrates superior accuracy and correlation with chronological age compared to dental age estimation via Demirjian’s method in the adolescent population of Peshawar.

Keywords: Age estimation, Dental age, Skeletal age,, KPK.

Prevalence of Stress-Related Oral Lesions and their Association with Academic Stress among Dental Students: A Multi-Stage Study

2025-10-09T12:38:45+00:00

Background: Dental education is known to be demanding, often exerting psychological pressure on students, which can manifest physically, including in the oral cavity. Stress-related oral lesions such as aphthous ulcers, bruxism-related trauma, burning mouth, and herpetic eruptions are commonly reported in high-stress populations. However, data on their prevalence and association with academic stress among dental students in Pakistan remain scarce

Objective: To determine the prevalence of stress-related oral lesions and explore their association with academic stress among dental students in Pakistan.

Methods: This cross-sectional analytical study was conducted using a multi-stage sampling method involving one dental college from Punjab and one from Khyber Pakhtunkhwa (KP). Stratified random sampling was employed to recruit students from each academic year. Data were collected using a structured questionnaire that included demographic details and the Perceived Stress Scale (PSS-10). Clinical oral examinations were conducted to identify stress-related oral lesions. Statistical analysis included descriptive statistics, Chi-square test, and logistic regression to evaluate associations.

Results: A total of 356 students participated (Punjab: 178, KP: 178). The overall prevalence of stress-related oral lesions was 38.2%. The most common lesions were aphthous ulcers (18.5%), bruxism-related trauma (12.6%), and burning mouth sensation (7.1%). High levels of academic stress were significantly associated with the presence of oral lesions (p < 0.01). Logistic regression identified academic stress (OR = 2.41, 95% CI: 1.45–4.02), female gender (OR = 1.73, 95% CI: 1.02–2.91), and inadequate sleep (OR = 2.19, 95% CI: 1.28–3.74) as significant predictors.

Conclusion: Stress-related oral lesions are prevalent among dental students, with academic stress playing a significant role. Regular mental health support and stress management interventions are recommended to improve students' oral and general well-being.Stress-related oral lesions

Comparative Analysis of the Erosive Effects of Carbonated and Energy Drinks on Dental Enamel

2026-01-21T13:37:49+00:00

Background: The global consumption of soft and energy drinks has increased markedly, especially among younger individuals. These beverages adversely affect general health and also contribute significantly to dental enamel erosion due to their high acidity.

Objective: This study aimed to evaluate and compare the surface-level erosive effects of Coca-Cola^®, Pepsi^®, Sting^®, and Red Bull^® on dental enamel using Scanning Electron Microscopy.

Materials and Methods: An in-vitro experimental study was conducted on forty extracted human third molars at Sardar Begum Dental College, Gandhara University, Peshawar. The samples were divided into four groups (n=10), each immersed in one of four beverages: Coca-Cola^®, Pepsi^®, Sting^®, and Red Bull^®. The pH of each drink was measured using a pH meter. Scanning electron microscopy (SEM) images were obtained before and after immersion to observe surface enamel changes. Data were analyzed using SPSS (Version 23) with Tests of Normality and Fisher’s Exact Test to evaluate erosive effects.

Results: All the teeth showed normal appearing enamel before immersion in their respective drinks. After 10 minutes immersion, SEM images revealed varying degrees of enamel etching with a statistically significant change in the appearance of enamel (p = 0.004). Coca Cola® and Pepsi groups caused more pronounced and deeper etching patterns compared to Energy drinks.

Conclusion: Short-term exposure to acidic beverages produces significant microscopic alterations in enamel surface morphology, with Coca Cola^® and Pepsi^® causing the most pronounced etching patterns. These findings emphasize the role of acidic beverages in enamel erosion and the importance of preventive strategies for dental health.

A Tomography Cone Beam Computed (CBCT) Analysis of Mental Foramen Location, Prevalence of Anterior Loop and Extension of Anterior Loop in the Local Population of Lahore: A Cross-Sectional Study

2025-12-18T06:08:53+00:00

Background: The precise location of the mental foramen (MF) and the variability of the anterior loop (AL) of the inferior alveolar nerve is of greatest relevance in the placement of implants, endodontic surgery, and osteotomy of the mandible. Anatomical variations may predispose to neurovascular damage if they are not appreciated. Cone-beam computed tomography (CBCT) offers accurate visualization, but population-based information on local population is limited.

Objectives: To determine distribution of MF zones, prevalence and frequency of the AL, demographic relationships, and bilateral symmetry in a local Pakistani population through CBCT.

Methodology: This cross-sectional descriptive study analyzed 217 CBCT scans (age range: 16–60 years). MF positions were characterized as four zones (A–D). Presence of AL was recorded as absent, unilateral, or bilateral. Loop extension was measured at deepest loop curvature. Descriptive statistics yielded prevalence and morphometric information. Independent and paired t-tests, one-way ANOVA, chi-square tests, logistic regression, and McNemar–Bowker χ² tests were utilized, and p ≤ 0.05 was considered significant.

Results: On the right, MF was most frequently found in Zone B (42.4%) and Zone C (42.4%), while on the left, Zone B (45.2%) and Zone C (38.7%) prevailed. AL was absent in 76% of scans, unilateral in 22.1%, and bilateral in 1.8%. Mean loop extension was 3.05 ± 0.68 mm (right) and 3.12 ± 0.57 mm (left) with no side, gender, or age difference (p > 0.4). Logistic regression had limited predictability value, but MF Zone C was inversely correlated with presence of loop (OR = 0.29; p = 0.022). Highly significant side-to-side asymmetry of MF location was detected by cross-tabulation (χ² = 22.26; p = 0.001).

Conclusion: The MF in local population sample was most commonly located between or in relation to premolars and exhibited high left–right asymmetry. The AL was relatively uncommon, but when encountered measured ~3 mm, highlighting the significance of individualized CBCT evaluation prior to surgical intervention in the interforaminal region.

Keywords (MeSH): Mental Foramen; Mandible; Cone-Beam Computed Tomography; Inferior Alveolar Nerve; Dental Implants;

A Descriptive Cross Sectional Study on Occurrence of Caries in Natural Tooth Surfaces Adjacent to Fixed Dental Prosthesis

2025-11-24T04:22:28+00:00

Background: Caries contiguous to FDPs is a major biological complication that can compromise the longevity of restorations. Limited evidence is available from the Lahore population, where variations in clinical technique, laboratory quality, and patient hygiene may influence outcomes.

Objective: To assess the frequency of caries in natural tooth surfaces adjacent to fixed dental prostheses.

Methods and Materials: This cross-sectional descriptive study was conducted at the Department of Prosthodontics, Fatima Memorial Hospital, Lahore. A total of 246 patients aged 18–65 years with porcelain-fused-to-metal crowns or bridges in place for at least six months were included. Clinical and radiographic examinations were performed to assess caries and contact status (acceptable, open, tight). Data were analyzed in R software (version 4.3.3) using descriptive statistics and chi-square/Fisher’s exact tests, with p < 0.05 considered significant.

Results: The mean age was 37.7 years (SD = 13.5), with 56.5% males. Bridges (56.5%) were slightly more frequent than crowns (43.5%). Caries were observed on the mesial side in 32.1% and on the distal side in 28.9% of adjacent teeth. No significant association was found with age, gender, or prosthesis type. However, caries were significantly higher in open contacts compared with acceptable or tight contacts (p < 0.001).

Conclusion: Caries adjacent to FDPs were common, with one-third of patients affected. Open contacts were the strongest risk factor, underscoring the importance of precise clinical and laboratory procedures to ensure proper contact formation and minimize biological complications.

Keywords: Fixed dental prosthesis, Adjacent caries, Contact points, Porcelain-fused-to-metal crowns, Prosthodontic complications

Evaluating the Impact of a Tobacco Cessation Training Program for Medical and Dental Students: A Pre-Post Intervention Study

2026-01-21T13:36:42+00:00

Background: Tobacco dependence is a leading cause of preventable mortality. This study evaluated the impact of a Tobacco Cessation Training (TCT) program integrated into the medical/dental curriculum on students' knowledge, confidence, and subsequent patient outcomes.

Methdology: A pre-post intervention study was conducted from January to March 2025. A total of 400 clinical-year medical and dental students received the TCT program. Pre- and post-training knowledge scores and counseling confidence (5-point Likert scale) were measured. Following training, students counseled 200 adult tobacco users (smoking ≥5 cigarettes/day or using other forms, motivated to quit). Secondary patient-related outcomes (quit attempts, 7-day point-prevalence abstinence, ≥50% reduction in use) were assessed via patient self-report at one-month follow-up.

Results: Post-training, students’ knowledge scores increased significantly (mean difference +26.6 points, 95% CI: 24.1–29.1, *p*<0.001). Counseling confidence improved from 2.1±0.8 to 4.3±0.6 (*p*<0.001). Among patients counseled, 68% (136/200) initiated a quit attempt, 42% (84/200) achieved 7-day abstinence, and 58% (116/200) reduced tobacco consumption by ≥50%.

Conclusion: The integrated TCT program significantly improved students' cessation competencies and led to positive short-term behavioral changes in patients. This supports the formal inclusion of structured tobacco cessation training in health professions education.

Keywords: Tobacco cessation, Medical education, Dental education, Curriculum intervention, Patient counseling, Pre-post study

A Cross-sectional Comparative Study on perception of Oral Hygiene of the Patients Visiting the Dental OPD of a Dental College of Khyber Pakhtunkhwa

2025-06-26T18:55:47+00:00

Objective: This study aimed to determine the perception of Oral Hygiene habits and Oral Hygiene Index-Simplified. (OHI-S) in patients coming to the outpatient department of Sardar Begum of Dental College, Peshawar for routine dental check-ups and treatment.

Material and methods: This cross-sectional/comparative study was conducted for One Year, after the acceptance of the research proposal (Jan 2022-Jan 2023) at the outpatient department of the Sardar Begum Dental College Peshawar KPK. The demographic details (residence, age, gender, occupation) etc. were recorded on a specially designed performa. The age limit was from 20-40 years. The patient was interviewed properly for oral hygiene habits and level of education in oral health and hygiene. The oral examination was performed with a dental explorer on the surfaces of posterior and anterior teeth to calculate the oral hygiene index-simplified (OHI-S). The anticipated population proportion, using the study of Lea ¹¹ is 0.86 with a confidence interval of 95% and a margin of error of 0.05 the sample size calculated was 185 subjects. The SPSS version 16.0 (IBM, SPSS) was used to derive the frequency and percentages for all numeric variables. The chi-square test was used to determine the significant relationship for different age groups between both genders

Results: The male-to-female ratio was found to be 1.3:2, with more female patients visiting for oral health problems. Most of the patients belong to urban areas The most common age group presenting for oral health issues belongs to 21-25 years (n=50, 27.0%). The Mean/SD for the age group was 19.86±10. The most common dentifrice used by both genders was toothpaste (148, 80.0%) of fluoridated type (133, 89.86%). The frequency of tongue (123, 66.50%) and interdental cleaning (100, 54.10%) was not followed by most patients. The last dental check was done more than a year ago by the majority of patients (116, 62.70%). Among 185 patients, the oral hygiene index was mostly found to be fair oral hygiene (78, 42.2%). The inter-examiner and intra-examiner Kappa statistics were greater than 0.87 (substantial agreement) for OHI-S recorded in all subjects, which is satisfactory for this oral health evaluation for both genders.

Conclusion: Females were found to be more conscious of oral health issues and visited the dental setups for regular oral checkups more than males. The mean age group was 19.86±10. The frequency of tongue and interdental cleaning was ignored by both genders. The dental checkups were routinely followed after a year. OHI-S was recorded to be a fair type among both genders.

Effects of Mismatch Between Dentin Bonding Agents and Composite Resin on Shear Bond Strength of Composite Restoration: An In Vitro Study

2026-01-02T06:45:51+00:00

Background: Adequate adhesion between the restorative material and its substrate, along with the integrity of the adhesive interface, is essential for the clinical success of restorations.

Objective: The purpose of the study was to evaluate the effect of using mismatched brands of bonding agents and restorative composite on shear bond strength of composite restoration, with emphasis on their interfacial compatibility.

Methodology: Thirty sound human premolars extracted for orthodontic purpose were collected and equally divided into control and experimental groups. Samples in the control group were restored with composite resin and bonding agents of the same brands whereas samples in experimental group were restored with composite resin and bonding agents of different brands. Composite resins and bonding agents from three brands, SDI, Itena and Dentsply were used in the study. Specimens of both the groups were subjected to shear bond strength test using universal testing machine. Statistical analysis was performed using one-way ANOVA and post hoc Tukey test.

Results: Results showed significant difference in shear bond strength of control and experimental groups. High bond strength was manifested by samples restored with similar brands of composite resin and bonding agents and low bond strength was shown by samples restored with different brands.

Conclusion: Application of different brands of bonding agents and restorative composite adversely effects the bond strength of the restoration. Clinicians should incorporate using the right brand of prescribed bonding agents with matched composite resin in clinical practice to achieve optimal bonding performance and clinical outcomes.

Frequency Of Iatrogenic Damage to the Adjacent Teeth During Abutment Preparation by Residents and House Officers of a Dental College of Peshawar Khyber Pakhtunkhwa

2026-03-26T05:01:09+00:00

Background

Iatrogenic damage in the process of crown preparation is related to the skill of the operator, and the awareness of the damage patterns can enhance the training and minimize the errors.

Objective
The objective of study was to evaluate the frequency, degree and type of unintentional damage occured to adjacent teeth during abutment preparation performed by House Officers and Residents

Methodology
The study was cross-sectional nature (July 2024-July 2025) and it assessed 161 dental casts in Rehman college of dentistry through visual examination and magnification. The information about the degree and type of damage was put on a structured proforma and processed using SPSS 23. Calculations were made of means, standard deviations, frequencies and percentages and the chi-square test was used to determine the relationship between operator experience and damage (p < 0.05).

Results
House Officers were more affected in terms of average damage (M = 1.86) compared to Residents (M = 0.81), and Residents were slightly more averagely damaged in terms of type (M = 2.06). Most common were abrasion (42.9%) and nicks (36) with 21.1% bearing no damage. Damage related to magnification was common (37.9%). The level of operator had a significant correlation with damage (p < 0.001).

Conclusion
House Officers were more damaging to procedures than the Residents. The majority of damages were minor such as abrasions and nicks. The experience of operators also had a great impact on the patterns of damage, and it is necessary to have better supervision and formal clinical education.

Keywords. Abutment Preparation, Iatrogenic Damage

Effect of Air Abrasion, Diamond Bur Roughening and Hydrofluoric Acid Etching on Shear Bond Strength of Repaired Resin Composites: An In Vitro Study

2026-03-11T05:57:06+00:00

Background: Composite restorations often fail over time, and repair is a minimally invasive alternative to replacement that preserves tooth structure.

Objectives: To evaluate and compare the effect of various surface treatments on the shear bond strength of repaired dental composite restorations.

Methodology: This experimental in-vitro study was conducted from Jan 24 to Mar 25 after the approval of Review Board of Azra Naheed Dental College, on 60 cylindrical micro-hybrid composite specimens fabricated in Teflon molds, light-cured in 2.5-mm increments, stored in distilled water at 37°C for 24h, and thermocycled for 500 cycles. The samples were divided into to 4 groups (n=15): Group A (silane only), B (air abrasion with 50µm Al₂O₃+silane+adhesive), C (diamond bur roughening+silane+adhesive) and D (9% HF etching+silane+adhesive). A repair layer of the same composite was applied to form bilayer samples. SBS was measured using universal testing machine.

Results: All 60 specimens were tested. The overall SBS was 18±8.07 MPa. Mean SBS (MPa) in the air abrasion group (B) was 30.47±2.03, followed by diamond bur group (C) 18.17±2.10, HF 13.96±1.19 (D) and the control group (A) 9.42±1.20. Surface treatment significantly affected SBS (p<0.001). Tukey HSD showed that all pairwise associations were significant (p<0.001).

Conclusion: Air abrasion produced the highest repair SBS and the most favorable failure pattern, outperforming diamond bur roughening, HF etching and silane treatment. Air abrasion is the preferred surface treatment for composite repair, however, diamond bur is an acceptable alternative, while HF etching is least favorable as the primary conditioning method.

Keywords: Air Abrasion, Dental; Composite Resins; Dental Restoration, Hydrofluoric Acid; Shear Strength; Surface Properties

Impact of Global Geopolitical Conflict on Professional Education

2026-03-10T06:14:16+00:00