The past year has been filled with unexpected twists and turns, and we found ourselves needing to adapt and change in ways we never imagined.
Now as we are in a new normalcy, the Fiji Dental Association will in the next 2 years act on its core aims , to promote, improve the dental professionandproduceexcellencein dentalpractice.
Improving oral health in Fiji will requireamultifacetedapproachthat addresses the various challenges to dental care and oral hygiene. By working together, the Fiji Dental Association and with other health organizations , the FDA can help ensurethatallFijianshaveaccessto goodoralhealthcare.
For the next 2 years some of the several strategies that the association will use to improve national oral health are: Offer affordable dental care: dentists can makedentalcaremoreaccessibleto underservedcommunitiesbyoffering discounted or low-cost services through the Government Free Dental Scheme.
Participate in Oral Health Global Events at National level. The World Oral Health Day celebration on the 20th of March continues the campaignthemeof"e;BeProud ofYourMouth.
It is time for dental practitioners to volunteer their time and resources to participate in dental outreach programs that provide care to underservedcommunities.
Promote preventative care during the National Toothbrushing Day and Oral Health Month : FDA through its member dental practitioners will educate their patients and public on the importance of preventative care, suchasregularbrushing,flossing,and dental check-ups, to help prevent dentalproblemsbeforetheystart.
Promote advancement of dental practice through Continuing Dental Education:
The Annual Dental Conference ,an event for yearly updating of dental knowledge and skill together with webinars from accredited international world renowned speakers will be delivered directly and continually through various platforms that connect to FDA members.
Increase our membership base through the efficient membership drive throughout the year and cultivate inclusive spirit of practitioners while demonstrating good camaraderie. The modernization effort of the association such as the Website design , IT and media committee is an example of how members talents and interests can help us to enrich theassociationatthe same time allow practitioners use theirskillsforagoodcause.
Collaborate with other healthcare providersandeducators:
Encourageworkwithotherhealthcare providers, such as primary care physicians and public health agencies, to address the oral health needsoftheirpatients.
We will be Supportive for Oral Health policy and legislative efforts, advocate for policies and legislation that promote oral health, such as increased funding for dental care andaccesstodentalinsurance.
Overall the Fiji Dental Association will allow individual members to be become enriched , empowered as they share share knowledge, ideas and experience whilst working togetherinunity.
With this , I look forward to seeing everyone at future events and wish everyone a Happy Prosperous New Year.
Thankyou.
DrParikshathCNaidu PresidentofFijiDentalAssociation
To maintain and improve the standards of conduct and expertise of the dental profession in Fiji
To promote the welfare and to preserve and maintain the integrity and the status of the dental profession.
To represent the views, interest and wishes of the dental profession.
To represent, protect and assist members of the dental profession in Fiji as regards to conditions of practice and otherwise
Protect and assist the members of the dental profession in Fiji as regards to conditions of employment with the Government
To settle controversial points of practice and to provide means for the amicable settlement of professional differences
To protect and assist the public and the dental profession in all matters touching ancillary or incidental to dental practice
To assist needy members and former members of the Association or their immediate relatives and the immediate relatives of deceased members
To cultivate a generous professional spirit amongst the dental practitioners by encouraging meetings of the members
Generally to promote excellence in dental practice in any manner which the Association thinks fit in the interest of the profession and the country.
To be the negotiating body for its members as regards terms and conditions of employment in the public sector.
The association started its journey 5 decades ago with a handful of dentists who saw the need to formally register an association to be the voice of the dental profession in Fiji and to provide service to the profession ensuring that the community had access to quality dental healthcare which was kept updated through relevant professional development and peer support. Since its inception the association has undergone considerable growth, and has become a critical partner in the pursuit of Universal Health Coverage for our people. Currently our members provide a significantly high proportion of dental care in Fiji and it’s likely that your dentist is a member of our association.
The association looks forward to furthering the aims and objectives by working with our members and stakeholders to ensure quality dental care is available to all.
Reference:(About, June 4) Fiji Dental Association Retrieved September 22, 2022, written byDrLeenu Maimanuku: https://fijidaorg/about/
Dearvaluedreaders, Astheeditorofthisdentalmagazine,Iamdelightedtopresentthelatestissuefilledwith informativeandengagingarticles.
Our team has worked tirelessly to bring you the most up-to-date information on the latestadvancementsinthefieldofdentistry,aswellaspracticaladvice
IhopethatyouallhadawonderfulandblessedChristmasandaNewYearwithquality timewithfriendsfriendsandfamily.Iamverygratefultoourmembersandfriendsinour societyandforanoutstandingpreviousyear(2022).
In this issue, we are very proud to feature promotional material from our beloved sponsors.Thesematerialsarefeaturedinaccordancewiththetimescalethathadbeen senttous.Pleasekeepsendingusmore,asithelpsusprovidevaluetoourreaders.
We are also honored to feature Dr. Rowena Kang in this issue. We are very proud to featureherforhergreatdevotiontocommunitydentalcarethroughGod.Itisabouttime weknowmoreaboutherandgiverecognitionforheroutstandingcommunitywork.
In this issue, apart from providing information about the field of dentistry, I delve more into oral health topics to give readers in-depth knowledge of various topics. This is only possible through the contributions of our wonderful authors and partners So, thank you verymuchforyourcontributions!
We hope you enjoy browsing this second issue! If there are any suggestions for improvement,pleaseletusknow.Yourfeedbackisgreatlyappreciated.
Dr Chamath Karunaratne Chief Editor
Dr Tara Savou Co- Editor
served countless outreach programs in Fiji, Dr.Rowenaisbelievedtohaveservedincountlessnumber
Having
Hello, my name is Rowena Kang, and I am 51 yearsofage.Iamamotherof4childreninwhich 3 are born in Fiji, and every time I introduce myself, I say, “I was born in Philippines, married my wonderful husband, Daeseong Kang from South Korea, and am a Korean citizen by passport,howevermyheartbelongstoFiji.”
Afterthatoutreach,theLordwasquietasto what was next. I joined several short-term missiontrips,notjustinthefieldofDentistry, but some other mission opportunities leading youth groups, camps, musical and church activities. Not long after those trips, theLordshowedupinanamazingwayand openedupmoreopportunitiesformissions.
In 1999, I joined the M/V Island Mercy Ship with YWAM (Youth With A Mission) for 2 years as a dentist and sailed all over the PhilippineIslands,servinglocalFilipinosthru dental, medical and optical services It was agreatexperienceformeandImetalotof people from different nations all working togetherandgettingtoknowothercultures, allwhilelearninghowtolivewith80people onasmallship Ofcoursethereweresome challenges along the way, but those are part of growing and learning, which I believe helped me to grow in my life. While volunteering on board the ship, I met my husband from Korea, Daeseong, which I would say that it was a match made in heavenbyourLord Iamverygratefultothe Lord that He gave me a man who is likeminded as I am with a heart to serve and do mission works together. We got married andwereblessedwithachildwhileworking onboardtheship.
Our journey as missionaries didn't stop on the boat, the Lord led us to come to Fiji in 2002 and we joined Marine Reach Fiji, a charitable Christian organization. We are based in Lautoka and we were helping to pioneer with our leaders from New Zealand along with other staff from Canada and Australia This is the organization where we are involved at present. Marine Reach Fiji is registeredinFijiundertheCharitableTrust
This trust provides free Dental, Primary Health Care and Optical care for Fijian citizens. Several times each year, we bring teams of foreign professionals and helpers. All our long-term and short-term volunteers receive no salary as it is a voluntary service.
My husband is leading our ministry and I'm helping him in any way I can, but mainly as an outreach coordinator and a community dentist.
We have reached many villages and islands around Fiji providing them free services Since 2002 and until the present, we were able to conduct outreaches and have treated 66,493 children, men and women alike.
We don't normally operate everyday but trytohaveoutreaches4or5timesayear Wechooseamonth,villageorislandtogo and advertise it in our website in order to have short term volunteers, and they pay fortheirownwayofcomingandoutreach fees,andwehaveneverhadashortageof volunteers.Thisisarealblessing.
We usually camp in a community hall and set up our clinic, accommodations and kitchen. We bring with us our food and kitchen utensils as we don't want to be a burdentothevillage.
Living in a village is an opportunity to get connected with villagers and know their dailylife Wealwayshavepositivefeedback after outreach, not just from the villagers, but also from our volunteers and it's the warmwelcomefromFijiansthatenergizeus to keep going. Even though there are alwayschallengesalongtheway,wenever regretdoinganoutreach.
Our supplies and equipment are all donations from people in other countries that we connect with. It's just amazing to see so many generous people who give theirmoney,timeandskillsinordertohelp reach out to the people of Fiji, especially those located in remote places. Once we choose a location to go, we do our research work and meet the chief messengerinthatvillage.
Lots of paperwork is involved in preparing for outreach to get temporary registration for our professionals, customs papers and otherlogistics
In the next year, we have lined up several outreaches and we are excited to see where we go and whom we serve. We will continue to do what God has called us to do. We don't know how long we will be doing this beautiful service, but we trust in theLordforHistimingforHeknowswhento startandwhentofinish.
I would like to invite you to come on an outreachwithus,
Iguaranteeitwillchangeyourlife!Youcan contact us at wwwmarinereachfijicom or MarineReachFiji,YWAMonFacebook.
Postgraduate Diploma in Dental Public Health programme is a specialisation which train graduate students “To think globally and act locally” by acquiring epidemiological skills necessary to examine populations, diagnose oral health problems and related risk factors to derive at appropriate health system programs in promoting better oral health in the Pacific region
DNT 820:
The course provides students with the knowledge, skill and attitude necessary for a manager in public health dentistry with regards to prevention of oral diseases Students will have a deeper understanding of oral disease burden while appraising scientific literatures for evidence based practice in oral health care Based on these, students acquire the ability to critically appraise individual and community-based preventive interventions and related legislative framework Further, it will assist them to prescribe, implement and amend preventive strategies accordingly by designing a comprehensive preventative plan
DNT 821:
The course provides students with sufficient background and appreciation of the role and scope of dental health service management within health care This should provide them with the opportunity to develop skills and acquire essential knowledge in this field for the effective practice of population oral health
DNT 822:
The course appraises principles, goals, importance in decision making and application of evidence based practice to oral health care With this background, students are able to carry out a SWOT analysis and establish measurable oral health goals In addition, the students will also be expected to formulate oral health strategies by recognising common risk factors in the procurement of dental services
to create and advocate positive team dynamics and collaborate constructively with community and stakeholders 10 Leadership qualities in mentorship, an agent of change and advocate good governance in developing strategies and achieving goals in a community setting
teamwork at various
Students will also be expected to design an oral health promotion project that will be applicable to relevant target population Furthermore, students will also develop an evaluation plan of an existing health promotion programmes
Author:DrChamathKarunaratne
Fiji Dental Association (FDA) launched their 49th Annual Dental Conference 2022 and Annual General Meeting on 24th September, 2022.
Association is continuing the vision to empower dental professionals in Fiji to create awareness and educational content among their members
The conference's theme was ‘Creative Approach to Dental Health' where speakers from Australia, UK, USA, Hong Kong, and Sri Lanka presented their fantastic presentations. The conference also included a live question/answer session with the speakers. The event was moderated by Dr.Parish Naidu, President of Fiji Dental Association
Member who had registered early had access to a free patient management service software and early bird price deductions.
Total of 126 members participated in the conference while 97 participants attended during day time.
Conference began with the opening lecture by Commonwealth Dental Association President Professor Samarawikrama who is currently UK based. He discussed about improving techniques and basics of Endodontics.
Thereafter, from Hongkong, highly experienced Dr.Ryan Tse delivered a lecture on "Shade match on Fixed Prosthetics"
DrTse taught the audience on color theory and different shade matching techniques
Dr.Kartika Kajal delivered a great presentation on Research in Covid in Dental practices. She outlined the protocolsofinfectioncontrolofaclinic duringinaCovidoutbreak
Professor Jayantha presented on the latest short course introduced by Fiji NationalUniversity.
You might be surprised variety of topics in dentistry but no one expected a lecture on Neonatal dentistry DrRobert AConvissar for the very first time introduced us to neonatal dentistry and latest innovation "Peel technique". He further described about how to solve tongue tie cases in a hospitalsettingusinglasertechnology.
Dr.Vinal Harikishan delivered a great presentation backed by evidence on Success, survival and complications of Tooth supported All ceramic fixed dental prosthesis. He further outlined that metal ceramics are a strong and durable option for restoring teeth in areas of the mouth that experience high levels of stress. They can also be customized to match the color of the surrounding teeth Careful diagnosis, treatment planning, and proper technique is vital to obtain the best possibleresultswithmetalceramics.
Maintaining your patient's periodontal health effectively is one of our main objectives. Professor Allesandro Quaranta delivered a great presentation on current evidence and limitations about reconstructive periodontal therapy with techniques to improve intra-bony defects around single root teeth
Mrs Misau Whippy, the registrar for the Fiji Dental and Medical Secretariat, gave a informative and useful presentation to the audience about the current structure of the organization and the steps involved in opening a new dental clinic in Fiji.
As the registrar, Mrs Whippy likely has a wealth of experience and statistical data By sharing this information with the audience, she may have provided valuable insights and guidance to those who are interested in setting up a dental practice in the country. It is important for professionals to stay up to date with the latest developments in their field and to be aware of any regulations or requirements that may affect their practice
Completing the required Continuing Professional Development (CPD) activities helps professionals to ensure that they are able to provide the best possible service to their patients.
Members were certified with 10 points as part of heir Continuing Professional Development training
This means that dental professionals who attended the conference received all their required points within a span of a day
Thereafter, Annual General Meeting was held and a new executive committee had been elected.
Cocktails really adds to the overall ambiance of the evening This was a great opportunity for dental professionals to network and enjoy a relaxing evening catching up with their colleagues.
Gala event dinner was a stylish dinner environment, with absolutely stunning performances by FNU BDS final year dental students Chief guest for the event was Dr Devina Nand Dr Devina Nand is the Head of Wellness and the Director of Epidemiology.
HighlightsfromFijiDentalAssociationAnnualConference, 2022
INR (International Normalized Ratio) is the value calculated from the Prothrombin Time (PT).
Prothrombin Time test measures the time it takesfortheplasmatoclotinabloodsample. Prothrombinisaproteinproducedintheliver.
It is one of the several clotting factors The normal range for INR is below 10 for healthy individuals
Patients on anti-coagulation medications or blood thinners can be expected to have INR between2.0to3.0.
An elevated INR means blood is taking longer than required to clot and this means there is an increased risk in bleeding complications. Therefore, INR test should be performed on patients who are on anti-coagulants such as Warfarin before certain procedures such as InvasiveDentalTreatments
However, certain medical conditions increase the risk of thrombosis where a blood clot can cause a blockage in the blood vessel either at the site of formation or by dislodging and travellingtoanothercriticalsite.
Anti-coagulant drugs are prescribed to lower theriskofsuchcomplications However,asthe risk of thromboembolic events is reduced, the risk of bleeding whether spontaneously or followinganinvasiveprocedureisincreased
It is crucial that these risks are balanced for patients on anti-coagulation drugs before undergoinganyinvasivedentaltreatment.
Anti-coagulants and anti-platelet drugs are agents which reduce the formation of clots or coagulation in blood Blood clotting occurs as anaturalresponsetodamagetobloodvessels whetherduetoinjuryoraninvasiveprocedure. Plateletsgetactivatedwithinthebloodandset off a cascade of reactions where inactive coagulation factors are converted to their active forms. Anti-coagulant drugs inhibit the production or activity of factors required for thecoagulationcascade.Bloodcoagulationin response to damaged blood vessel is an essentialprocess.
For patients on anticoagulants, before any Invasive Dental Treatments or treatments that are likely to cause bleeding, it is important to ensure that INR has been checked no more than24hoursbeforetheprocedure.
IfthepatienthasastableINR,checkingtheINR no more than 72 hours before the procedure can be acceptable. If INR is >4, invasive dental treatment will need to be delayed until INR is reduced to avoid prolonged bleeding or bleedingcomplication.
Sample for an INR test is to be collected in the specimentubecontaining3.2%sodiumcitrate.
INR is performed at VanMed Labs for $27. Coagulationprofileistestedat$43.
References: Brose,M.(2003June01).Prothrombintime(PT) MedlinePlus Medical Encyclopedia [updated 2021Jan19;cited2023Jan06]Availableonline at https://www.nlm.nih.gov/medlineplus/ency/art icle/003652htm
Lab Tests Online [Internet]. Washington D.C.; American Association for Clinical Chemistry; c2001–2020 Prothrombin Time (PT) and International Normalized Ratio (PT/INR); [updated 2021 Nov 09; cited 2023 Jan 06]. Availablefrom: https://labtestsonline.org/tests/prothrombintime-and-international-normalized-ratio-ptinr Manfredi M, Dave B, Percudani D, et al World workshop on oral medicine VII. Direct anticoagulant agents management for invasive oral procedures: A systematic review and meta-analysis. Oral Diseases. 2019;25 Suppl1:157-173
Scottish Dental Clinical Effectiveness Programme (SDCEP). Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs. (2nd Edition). 2022; [cited 2023 Jan 06]. Available from: https://www.sdcep.org.uk/media/ypnl2cpz/sd cep-management-of-dental-patients-takinganticoagulants-or-antiplatelet-drugs-2ndeditionpdf
On 18 th November 2022, WHO launched the Oral Health Status Report : Towards universal healthcoveragefororalhealthby2030
Thereportprovidesanoverviewofthestateof oralhealtharoundtheworldandidentifieskey challenges and opportunities for improving oralhealth.
It states that oral diseases affect almost 3.5 billion people worldwide, with three out of four people affected living in middle-income countries. It states that the burden of oral diseases has been increasing globally, with case numbers growing by more than 1 billion (50%)between1990and2019
The main oral diseases include untreated caries of deciduous and permanent teeth, severe periodontal disease, edentulous (total tooth loss), and cancer of the lip and oral cavity.
Despite most oral diseases being preventable through self-care or simple, evidence-based, and cost-effective population-wide measures, includingactiononthewidersocial,economic, andpoliticaldeterminantsofhealth,itisnoted that there are significant disparities in oral health outcomes between and within countries, with disadvantaged and marginalized populations often experiencing worseoralhealthoutcomes
Emphasizing the need to address these disparities in order to improve oral health outcomes for all people in order to achieve global health equity. This includes ensuring thatallpopulationshaveaccesstoaffordable, high-quality oral health care, regardless of theirincomeorlocation,aswellasaddressing the underlying social, economic, and political factors that contribute to oral health disparities.
Challenges have been identified related to persisting or increasing inequalities in oral health, linked to risk factors such as high sugar consumption and tobacco or alcohol use,aswellaswidersocial,commercial,and politicaldeterminantsoforalhealth.
The importance of the common risk factor approach has been highlighted, recognizing that oral diseases and other noncommunicable diseases share modifiable risk factors and can therefore be addressed throughintegratedactiononimprovingdiets, reducing tobacco use, and reducing harmful alcoholconsumption
The report recommends a comprehensive approach to oral health that includes promotionof healthy lifestyles and prevention of oral diseases, access to quality oral health care services,and integration of oral health into primary health caresystems
WHO also calls for increased investments in oralhealthresearchandthedevelopmentof new technologies and interventions to improveoral healthoutcomes.
Finally, the report emphasizes the importance of universal health coverage for oralhealthasakey step towards achieving global health equity and reducing the burden of oral diseases worldwide
Foramoredetailedreadofthereport,please visittheFijiDentalassociationwebsiteat https://fijidaorg/
Over the years of practicing dentistry in Fiji I havenotednumerouspatientscomingintothe dental practice wanting anterior teeth gold onlays, or to address issues with a failed gold onlayonanteriorteeth
Patientswantanteriorgoldon-layfor:
Cosmetic reasons
Totreatanteriortoothdecay
Tocloseupdiastema. Asagiftorremembranceforimportantlife events
As dentists we should educate our patients into making an informed choice rather than just picking up our handpieces to prepare anterior teeth for gold on-lays as per patients’ demand
Problems with having gold onlays on anterior teethinclude:
Onlayoverhangscausingsecondarycaries. Onlays falling off leaving an ugly looking void
Periodontal problems from overhangs of theonlays.
Worse case situations pulp death and a dentalabscess
A factor which greatly contributes to all of theaboveproblemsispooroperatorskills.
Dentistsshouldinformpatientsoftheoptions available instead of just putting on gold onlays.Thealternativesinclude:
Composite restorations for fixing decays onanteriorteeth
Compositefordiastemaclosures. ·Ceramics (Veneers) for diastema closures(dependingonpatientsbudget) ·tick-ontoothjewelry
When patients want gold on anterior teeth they should be encouraged to put dentally certified adhesive gold tooth jewelry. (Warn patients of cheap gimmick stick-on teeth jewelry done at beauty salons, which are getting prevalent in Fiji now). Adhesive gold tooth jewelry done by dental professionals are readily available with dental supply companiesandcomeinvariousshapes.The most common brand available in Fiji is the “IZI”toothjewelry Thesearetoothfriendlyas:
Does not need cutting of sound tooth surfaces.
Onevisittreatmentonly. Itispainless.
If tooth jewelry falls off it does not leave anuglycraterbehind.
So, the next time a patient walks into your dental practice seeking anterior tooth gold onlay,sharealltheinformationwiththemfor the patient to make an informed choice, rather than just picking up the handpiece and………….
InosiSalababa,SailasaLuvunakoro,JayanthaWeerasinghe,OralSurgeryUnit, ColonialWarMemorialHospital,Suva
Introduction:
Ameloblastomaisarelativelyraretumorofthe facialskeletonwithhigherreportscomingfrom Japan, Nigeria and USA1 The average age for reported cases is around 36 years with young cases being reported from developing countries including Papua New Guinea and African countries with an average age of 30 years. 1 It is benign in nature but can be very aggressive and disfiguring to the face if left untreated
The etiology of this tumor is still not clear but several studies have proposed that dysregulation of several genes involved in toothdevelopmentmayplayanimportantrole initsdevelopment 2
Ameloblastomas are classified under odontogenic tumors due to their odontogenic epithelial origin and for this reason it is exclusively found in the jaws. 3 It is the most common odontogenic tumor as its relative frequency combines all other odontogenic tumors, excluding odontomas. 3 According to the 2005 WHO Classification2, there are different clinico-radiographic variants listed from the most common to the least common; multicystic, unicystic, peripheral and malignant subtypes The most common histolopathological variants are follicular and plexiform. Other less common variants are acanthomatous, desmoplastic and basal types.3
Ameloblastoma has a preference for the mandible, mostly the molar-ramus region. Theyusuallypresentinthejawasunilocularor multilocularradiolucency 1,4-6
The management for ameloblastoma is controversial The method of management ranges from conservative to radical modes of treatment. 7Procedures that have been described in the management of ameloblastoma include enucleation, curettage, marsupialization and radical jaw resectionwithreconstructionofdefects.7-13
We present the case of a 21 year old Fijian female with ameloblastoma. She had a recent history of dental extraction to her tooth 47 After the dental extraction she noticed an intraoral soft tissue growth at the site of the extraction and the extraction site was not healing. She also noticed right mandibular swelling and numbness to the right lower lip and chin area. On her first visit to the Oral Surgery Department of the Colonial War Memorial (CWM) Hospital in August 2013, the clinical presentation was swelling of the right angle of the mandible with intra-oral soft tissue mass of about 3x4cm on the right retromolar region (Figure 1) accompanied with right cervical lymphadenopathy
Radiological evaluation with orthopantomograph (Figure 2) showed an irregular multi-locular radiolucencywithborderswithoutwhitelineinvolvingtherightsidecondylarneck,coronoid,ramus andbodyofmandiblewithanassociateddisplacedimpactedlowerrightwisdommolar,displaced inferioralveolarnerveandrootresorptionoftooth46
Anincisionalbiopsywascarriedoutundergeneralanesthesia.Thespecimenwasfixedinformalin and sent to the laboratory for histopathology using hematoxylin-eosin staining Microscopic features(Figure4)showedcysticallydilatedacanthomatousameloblastoma,whichislinedbytall columnar epithelial cells. Their nucleus shows reverse polarization while loose stromal network resemblesstellatereticulum.Thiswasconsistentwithacanthomatousameloblastoma.
A 3-D imaging (Figure 3) shows that the lesion is expansile medio-laterally expanding the right mandilblebothlinguallyandbuccally.
FIGURE 3: 3-D IMAGING SHOWING MEDIO-LATERAL EXPANSION OF RIGHT MANDIBLE.
Figure 4: H&E stain shows cystically dilated acanthomatous ameloblastoma, which is lined by tall columnar epithelial cells. Their nucleus shows reverse polarization while their loose stromal networkresemblesstellatereticulum.
Onthebasisoftheabovediagnosis,thetreatmentplanforthispatientwastoundergofunctional neck dissection and hemi-mandibulectomy with reconstructive surgery which was planned for October,2013.TherewasavisitingOralandMaxillofacialSurgeryteamfromAustraliaatthetimeof the planned surgery and therefore a two team approach took place The neck dissection and hemi-mandibulectomy was carried out by the visiting ENT surgical team and the defect was then reconstructedbyourlocalteamfromtheOralSurgeryteamoftheCWMHospitalusingmandibular recon plate with condyle and intra-oral soft tissue defect using Pectoralis Major Myofascial Flap (Figure5&Figure6) Thepatientwasthenreviewed3monthslaterandthepediclewasresected
FIGURE 5: FIGURE 6:
Fixation of mandibular reconstruction plate with condylar attachment after resection and developing PMMF Flap.
PMMF Flap mobilsed to cover the intraoral soft tissue defect
Post-operative review was carried out with no complications The latest review took place in November 2014 about a year after the surgery.An OPG was taken also and revealed positive outcomes with no signs of recurrence. The patient has recovered and functioning well in terms of speech and mastication She had started working in a retail shop and carrying out life as normal again
Discussion:
For the treatment of ameloblastoma, the main goalistoadequatelyremovethetumorandthen restore the defect with acceptable aesthetics andfunction.
Theoptionscouldrangefromasconservativeas enucleationandcurettagetoamoreaggressive segmental mandibulectomy or radical hemimandibulectomy. For our case, considering she was young and the tumor being multicystic, largeandaggressive,enucleationandcurettage is not indicated as there is a high chance of reccurrence.14,15 Enucleation and curettage is usually indicated for small unicystic lesions and lesions which had not perforated the cortex, whichisnotforthiscase.
13,16Segmentalmandibulectomycouldnothave been used in this case due to the extensiveness of the tumor and condylar involvement leaving little margin at the condylar area for recon plate placement
Right hemi-mandibulectomy including the condyle was therefore the treatment of choice forthiscase
Neckdissectionwasperformedonthiscasedue to several reasons Firstly, the tumor was quite aggressive, secondly, the tumor was not just contained within bone but there was also soft tissue involvement.14 Thirdly, was to allow the chosen pedicle flap which was the Pectoralis MajorMyofascialFlaptobemobilized.
The gold standard for reconstruction of extensive mandibular bone and soft tissue defects such as this is osteo- myocutaneous vascularized fibula flap, followed by recon plate with iliac crest flap, scapular osteocutaneous flapandthenreconplatewithpedicledregional flaps 17
Depending on patient factors, the expertise and experience of the surgeon and the hospital facility, treatment choices would be tailored accordingtothepracticabilityofthesetting.
In our resource-challenged facility lacking the correct instruments and specialists with the appropriate skills, osteo-myocutaneous vascularizedfibulaflapcouldnotbeperformed.
Thesecondbestchoiceisusingreconplatewith iliaccrest Wedidnotoptforthisduetotheriskof infection of the graft leading to necrosis and failure.18 In our case the recon plate was used withPMMFforthedefect.Consideringthelimited resources we work in, this was the best for hard tissueandsofttissuereconstruction
For reconstruction of large soft tissue defects such as in this case, regional pedicled flaps e.g. the forehead or temporalis muscle or pectoralis major muscle could be used or free microvascular flaps e.g. radial forearm flap, lateral forearm flap or fibular osteocutaneous flap.17,19 In this case, the Pectoralis Major Myofascial Flap (PMMF) was chosen as it had sufficient bulk to cover the defect compared to the other flaps. However, PMMF was chosen over Pectoralis Major Myocutaneous Flap (PMMC) as PMMCwouldhavebeentoobulkywithadditional skin and fat layer with a higher chance of postoperativeinfection.20-22.
This case highlights the aggressiveness of ameloblastoma and the importance of early detection to avoid radical debilitating surgical management especially in a country like Fiji with limited resources Public awareness is essential for early diagnosis and management. The resource challenged facility in this developing countrywithmoreandmorecasessimilartothis justshowshowimportantitistodevelopsupport locallyandabroadtobestmanagesuchcases
1.Reichart PA, Philipsen HP, Sonner S. Ameloblastoma:biologicalprofileof3677cases European journal of cancer. Part B, Oral oncology.1995;31B(2):86-99.
2 WHO IARCPublications-PDFsonline-Cancer Pathology and Genetics - Pathology and Genetics of Head and Neck Tumours. WHO Classification of Tumors: Pathology and Genetics of Head and Neck Tumors. 2014;IARC 2005. http://www.iarc.fr/en/publications/pdfsonline/pat-gen/bb9/index.php.
3 NevilleBW Oral&MaxillofacialPathology WB Saunders;2002.
4.DarshaniGunawardhanaKSN,JayasooriyaPR, Rambukewela IK, Tilakaratne WM A clinicopathological comparison between mandibular and maxillary ameloblastomas in Sri Lanka. 2010;39(3):236-241
5. Krishnapillai R, Angadi PV. A clinical, radiographic, and histologic review of 73 cases of ameloblastoma in an Indian population 2010;41(5):e90-100.
6. Kim SG, Jang HS. Ameloblastoma: a clinical, radiographic, and histopathologic analysis of 71 cases. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2001;91(6):649-653
7. Adeyamo;WL,Bamgbose;BO,Ladeinde; AL, Ogunlewe MO. Surgical management of ameloblastomas:conservative or radical approach? A critical review of the literature JournalofOralSurgery.2008(1):6.
8. Gomes CC, Duarte AP, Diniz MG, Gomez RS Review article: Current concepts of ameloblastoma pathogenesis. J Oral Pathol Med.2010;39(8):585-591.
9 Hong J, Yun PY, Chung IH, et al Long-term follow up on recurrence of 305 ameloblastoma cases. Int J Oral Maxillofac Surg. 2007;36(4):283288.
10. Feinberg SE, Steinberg B. Surgical management of ameloblastoma Current status of the literature Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 1996;81(4):383-388.
11. Muller H, Slootweg PJ. The ameloblastoma, the controversial approach to therapy J Maxillofac Surg 1985;13(2):79-84
12. Sehdev MK, Huvos AG, Strong EW, Gerold FP, Willis GW. Proceedings: Ameloblastoma of maxilla and mandible. Cancer. 1974;33(2):324333
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Browse the December issue of the International Dental Journal and discover a variety of oral health-related articles.
TheIDJistheofficialscientificjournalofFDI.Published every two months, IDJ features peer-reviewed articles relevant to oral health issues worldwide These focus on international public health, practice-related research, interprofessional education and practice, andonscienceandtechnologyindentistry.
Date:December7,2022
Source:UniversityofPlymouth
Summary:Researchershaveexaminedtherecordsof87patientsadmittedtohospitalwithbrain abscesses,andfoundthatthe52patientsforwhomnocausehadbeenfoundwereaboutthree timesaslikelytohaveoralbacteriapresentintheirsamples
Date:July5,2022
Source:UniversityofPennsylvania
Summary:Aroboticmicroswarmmayonedayautomatetheroutineofrinsing,brushing,and flossingteeth.Amultidisciplinaryteamdevelopedthetechnology,whichemploysamagnetic fieldtodirecttheironoxidenanoparticle-basedmicrorobotsintoantimicrobialbristle-and floss-shapedarrays.
Date:August30,2019
Source:UniversityofPlymouth
Summary: NewresearchpublishedintheJournalofDentalResearchhasshedlightonthesciencebehind the formation of the periodontal ligament, which helps keep the tooth stable in the jawbone. This improved understanding will help scientists work towards regenerating the tissues that support teeth. This is a peer-reviewed, observational study conducted in rodent teeth and humancells
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