Journal of Rehman College of Dentistry

Declining BDS Admissions in Pakistan: Are Limited Career Opportunities Threatening the Future Dental Workforce?

Usama Siddiqui, Ghulam Rasool — Tue, 14 Jul 2026 00:00:00 +0000

Investigating the Link between Mandibular Arch Form and Intermental Foramina Measurements with Advanced CBCT Imaging

Tue, 14 Jul 2026 00:00:00 +0000

Background: The mandibular arch form and intermental foramina (IMF) dimensions are critical anatomical parameters influencing prosthetic stability, orthodontic outcomes, implant safety, and surgical planning.

Objective: To investigate the association between mandibular arch form and intermental foramina measurements using CBCT imaging.

Methods: This cross-sectional analytical study was conducted at Department of prosthetic, Fatima memorial hospital, Lahore from July 2024 to Jan 2025. A total of 200 patients who underwent CBCT scans were included in the study. Mandibular arch form was categorized as ovoid, square, or tapered. The interforaminal distance was measured bilaterally and analyzed according to arch type and gender.

Results: The mean age of participants was 34.7 ± 10.2 years, with 54% males and 46% females. Ovoid arch form was the most common (46%), followed by square (30.5%) and tapered (23.5%). The overall mean IMF distance was 26.9 ± 2.7 mm. Square arches showed the greatest mean distance (28.4 ± 2.7 mm), ovoid arches were intermediate (26.8 ± 2.5 mm), and tapered arches were narrowest (25.1 ± 2.3 mm). ANOVA demonstrated statistically significant differences among arch types (p <0.001). Gender analysis revealed that males had significantly greater IMF distances (27.4 ± 2.8 mm) compared to females (26.2 ± 2.5 mm, p = 0.04).

Conclusion: Mandibular arch form significantly influences intermental foramina distance, with square arches associated with the widest spacing and tapered arches with the narrowest. Males demonstrated larger IMF distances compared to females. CBCT imaging provides precise evaluation of these anatomical relationships, enhancing surgical safety and individualized treatment planning in prosthodontics, orthodontics, and implantology.

Comparative Evaluation of Oral Health Knowledge, Attitudes, and Behaviors among Preclinical and Clinical Dental Students: A Survey at Baqai Dental College

Aisha Kiran, Ayesha Imtiaz, Samreen Shafqat, Mahwish Bano — Tue, 14 Jul 2026 00:00:00 +0000

Background: Dental students play a critical role in public oral health education. Their knowledge and attitudes reflect their understanding of disease prevention and responsibility for improving patients' oral health.

Objective: To evaluate the differences in oral health knowledge, attitudes, and behaviors between preclinical and clinical dental students in Karachi, Pakistan.

Methods: This cross-sectional study was conducted among dental students at Baqai Dental College after obtaining ethical approval. Data were collected using a structured, validated questionnaire measuring oral health knowledge, attitudes, and behaviors. Statistical analysis was performed using SPSS version 23.

Results: A total of 220 Bachelor of Dental Surgery (BDS) students participated. The second-year cohort had the highest representation (31.8%), while the fourth year had the lowest (8.6%). Gender distribution varied, with an equal male-to-female ratio in the first year, more females in the second year, and a male majority in the fourth year. Attitude scores were significantly higher among clinical students than preclinical students (p = 0.038). No significant differences were observed in knowledge or behavior scores between the two groups. Gender analysis revealed no significant difference in knowledge scores (p = 0.087), but behavior scores were significantly higher among female students (p = 0.02).

Conclusion: These findings emphasize the importance of integrating both academic and behavioral components in dental education, particularly as students advance to clinical practice. The results may inform curriculum development to enhance students' inclination to provide optimal patient care.

Variations in Contemporary Fixed Prosthodontics Practice in Pakistan: A Cross-Sectional Study

Tue, 14 Jul 2026 00:00:00 +0000

Background:
Fixed prosthodontics involve various techniques and materials for fabrication of prostheses. Understanding the current clinical practices and adherence to established protocols among dentists is essential for improving treatment outcomes. This study aimed to assess the knowledge and practice patterns of Pakistani dental practitioners about fixed prosthodontics.

Methods:
A cross-sectional survey was conducted across Pakistan from June 2020 to July 2020. Using a convenience sampling technique, an online questionnaire was distributed via social media platforms and email, targeting an estimated 500 dentists. A final sample of 261 dentists was finalized using WHO sample size formula with confidence level of 95% and 5% margin of error. The questionnaire comprised two sections: demographic and personal data, and preferred materials, techniques, and clinical practices for fixed prosthodontic procedures. Data was analyzed using SPSS Version 27.0.1, with descriptive statistics and chi-square tests applied to evaluate associations between variables.

Results:
Out of 500 targeted dentists, 261 responded (response rate: 52.20%). Study models were routinely obtained by 41.0% of practitioners, and 66.70% consistently used interocclusal records for multiple tooth preparations. Alginate (85.10%) and glass ionomer cement (69.70%) were the most frequently used impression and luting materials, respectively. Only 35.20% of respondents consistently disinfected impressions, and 55.90% provided both written and verbal instructions to dental technicians. High-speed handpieces (80.10%) and diamond burs (41.40%) were the instruments of choice, while depth-orientation grooves (54.80%) were the preferred technique of tooth preparation. The regular use of retraction cords and provision of interim restorations were reported by only 13.40% of participants.

Conclusion:
Dentists across Pakistan demonstrate a generally acceptable level of knowledge in fixed prosthodontics; however, significant deviations from recommended clinical protocols remain. Notably, the inconsistent use of impression disinfection, retraction cords, and interim restorations highlights areas for targeted continuing education and reinforcement of evidence-based guidelines to optimize patient care.

Keywords: Fixed prosthodontics, dental practice, clinical knowledge, Pakistan, practice patterns

Atraumatic Restorative Technique and its application in Early Childhood Caries

Natasha Nadeem, Anum Nadeem, Hajra Safeer, Faisal Saeed, Sajjad Ahmad — Tue, 14 Jul 2026 00:00:00 +0000

Background: Early Childhood Caries (ECC) is a prevalent dental condition that affects infants and preschoolers, charac-terized by rapid decay of their deciduous teeth. It is common in children with poor bottle-feeding habits and is often ob-served in the maxillary anterior teeth and molars. If left untreated, the disease progresses from initial white-spot lesions to complete tooth crown destruction.

Objectives: This study aims to compare the success rate of Atraumatic Restorative Technique (ART) and conventional techniques in managing Early Childhood Caries.

Materials and Methods: A randomized control trial (RCT) was conducted at Rehman College of Dentistry with 121 chil-dren under 6 years diagnosed with ECC. They were randomly allotted to ART and Conventional groups. Data was collect-ed on pain, restoration failure, and patient experience, with follow-up after 1–3 months.

Results:105 participants completed the study. ART was associated with a higher satisfaction rate (91%) compared to con-ventional methods (67%). Postoperative pain was reported by 6 patients in the ART group and 27 in the conventional group. A total of 32 restorations failed, with 5 ART restorations and 27 conventional restorations dislodging. Statistical analysis showed a significant difference in patient experience between the two techniques (p = 0.003).

Conclusion: ART is a more effective and patient-friendly approach for managing Early Childhood Caries, offering higher patient satisfaction. ART is recommended as a preferable treatment option for young children with ECC.

Empathy and its Association with Stress and other factors in Medical Students

Mohi Ud Din, Mehreen Babar, Ayesha Nizami, Shazia, Sidra Faryal, Ali Raza Khan — Tue, 14 Jul 2026 00:00:00 +0000

Objectives: Empathy is the cornerstone of quality healthcare; however, stress has the potential to diminish it, with a possibility of differences between genders. The objectives of study were to evaluate the levels of empathy among medical students, the research also aimed to explore the possible associations existing with stress and gender and other factors.

Methods: About 300 medical students participated in this study. The study lasted for seven months. Sampling done was of non-probability quota type. Those who completed the questionnaire first were included. The online questionnaire was distributed to each class of MBBS through social media platforms. Data then imported to excel sheet and subsequently to SPSS 25 on which statistical analysis was conducted. Frequency and percentages were determined for categorical variables. For comparing categorical data, chi-square was employed. To see the association between empathy and stress, correlation is employed. A significance threshold of p < 0.05 was used.

Results: Most (61%) had below average empathy; 67% reported moderate stress. A weak positive correlation (r=0.25, p<0.05) was found between empathy and stress, also gender showed significant association (p = < 0.05) both with empathy and stress.

Conclusion: Participants had a relatively low level of empathy. A key factor influencing empathy and perceived stress level was gender. Establishing an ethical education program for medical students could aid in preserving their empathy. The curriculum for medical schools ought to place greater emphasis on encouraging empathy.

Keywords: Empathy, medical, stress, students

Frequency of Porcelain Fracture in Patients with Bruxism Reporting to the Department of Prosthodontics Bacha Khan College of Dentistry

Sajid Ali, Momena Mumtaz, Naila, Munir Khan, Mahnoor Fazal, Samid Ullah — Tue, 14 Jul 2026 00:00:00 +0000

Background: Bruxism increases the risk of mechanical complications in porcelain-based restorations, potentially affecting their longevity.

Objective: To determine the prevalence and associated factors of porcelain fracture among bruxism patients presenting to the Department of Prosthodontics, Bacha Khan College of Dentistry, Mardan.

Methodology: This six-month cross-sectional study included 154 patients aged 18–60 years diagnosed with bruxism who had porcelain-based restorations placed at least three months prior. Bruxism was diagnosed based on self-reported morning jaw pain (VAS > 3), morning headaches (VAS > 3), and pain/discomfort during chewing, in accordance with symptom-based criteria used in clinical cross-sectional research in resource-limited settings. Clinical examination assessed the presence, location, and severity of porcelain fractures. Data were analyzed using SPSS version 27. Chi-square and logistic regression tests evaluated associations between incidence of fracture and type of bruxism, restoration type, restoration age, and gender (p ≤ 0.05).

Results: The prevalence of porcelain fracture was 63.6% (98/154). Fractures occurred exclusively in metal-ceramic crowns, where the within-group fracture rate was 96.1% (98/102) (p < 0.001). Nocturnal bruxism and restorations older than five years were significantly associated with fractures (p < 0.001; p < 0.01). Gender showed no significant association (OR = 0.67; 95% CI: 0.346–1.296; p = 0.234). Most fractures involved posterior teeth (79.6%), with over half requiring replacement.

Conclusion: Porcelain fractures were observed exclusively in metal-ceramic crowns among bruxism patients in this single-center cross-sectional study. Nocturnal bruxism and restoration age exceeding five years were significantly associated with fracture occurrence. These findings should be interpreted in light of study limitations and confirmed by future longitudinal research.

Oral Health Literacy and Its Impact on DMFT Index Among Medical Students: A Cross-Sectional Study

Tue, 14 Jul 2026 00:00:00 +0000

Background:

Oral health literacy (OHL) is essential in empowering individuals to make knowledgeable decisions about their oral health. Poor oral health literacy (limited OHL) is linked with poor oral health behaviors and negative health outcomes. Determinants of the oral health status are socioeconomic status, education, and, most importantly, OHL.

Objective:

This research sought to investigate the influence of oral health literacy on the Decayed, Missing, and Filled Teeth (DMFT) index among university students and assess how much OHL affects the outcome of dental health.

Methods:

A quantitative cross-sectional study was carried out among 97 King Edward Medical University students above 18 years of age. Data were gathered through a self-report questionnaire and clinical oral assessment, during which the DMFT index was evaluated.

Results:

Findings illustrated a substantial correlation between OHL and DMFT values. Poor OHL students showed a greater mean DMFT value than those with good OHL, indicating worse oral health.

Conclusion:

Oral health literacy has a quantifiable impact on oral health, as indicated by the DMFT index. Fortifying OHL through education, ensuring proper oral hygiene techniques, and prevention is critical for minimizing the dental disease burden and enhancing overall oral health outcomes.

Cephalometric Norms of Orthognathic Surgery (COGS) For Patients Visiting a Public Sector Institute of Southern Punjab

Rabia Anwar, Zubair Hassan Awaisi, Sarwat Memon, Farah Saleem, Zubair Ahmed — Tue, 14 Jul 2026 00:00:00 +0000

Background: Precise cephalometric analysis is crucial for successful orthognathic surgery, yet most existing standards come from Western and regional populations. This is the first study in southern Punjab to use the COGS method to develop local cephalometric norms for adults and to assess for sexual dimorphism.

Objectives: This study aims to establish COGS-derived cephalometric norms for the southern Punjab population.

Material and Methods: We analyzed 100 standardized lateral cephalograms of adult patients (48 male, 52 female; aged 18-30 years) visiting Nishtar Institute of Dentistry, Multan. Hard tissue COGS protocol was manually traced, and measure-ments were taken. Gender differences were assessed through independent samples t-test.

Results: Clear and significant sexual dimorphism was observed. Males showed statistically greater values in key skeletal parameters, including upper anterior facial height (N-ANS), mandibular ramus length (Ar-Go), mandibular body length (Go-Pog), and chin depth (B-Pog) (p < 0.05). While maxillary length (ANS-PNS) and posterior facial height (PNS-N) were also larger in males but these differences were not statistically significant. These findings reveal distinct craniofacial char-acteristics and emphasize variations from established Western and regional norms.

Conclusion: This study is the first to establish COGS-based cephalometric standards for the southern Punjab population. It also confirms clear gender-based differences in facial structure, which are crucial for accurate diagnosis and surgical treat-ment planning.

Exploring Optimal Number of Clinical Encounters for Competency development in a fresh Dental graduate: Insights from a Pilot Study at Islamic International Dental College and Hospital

Sana Iqbal, Seema Shafiq, Momina Zahra, Ulfat Bashir — Tue, 14 Jul 2026 00:00:00 +0000

Abstract

Background/Objectives: The purpose of this nationwide pilot study was to compare the requirements of clinical encounters in different dental specialties and in institutions operating in the private and the public sector in Pakistan. Although there are the required clinical quotas by Pakistan Medical and Dental Council (PMDC), the difference in the genuine clinical exposure among dental institutions may affect graduate readiness.

Methods: Ethical approval for the study was obtained from the Institutional Review Committee (IIDC/IRC02024/001/009), and written informed consent was obtained from all participants. A faculty validated questionnaire was administered to senior institutional representatives at PMDC-recognized dental colleges across all four provinces of Pakistan. Responses were received from 22 out of 50 institutions, yielding a response rate of 44%, comprising 5 public sector and 17 private sector colleges. Descriptive statistical analysis was conducted using SPSS version 24. Clinical quota requirements were summarized using frequencies, measures of central tendency, and range with mode prioritized to minimize the influence of outliners; no inferential statistical tests were employed.

Results: The results revealed considerable variability in clinical quotas across specialties. In oral and maxillofacial surgery, the mode for simple extractions was 75(range: 10-150), while complicated extractions had a mode of 15(range: 0-45). The mode for local anesthesia administration was also 75(range:10-105). In operative dentistry, wide variation was observed in restoration quotas, with modes of 15 for both amalgam and composite restorations, requirements for root canal treatments remained consistently low, with a mode of 3. Prosthodontic denture requirements showed modes of 3, while the mode for fixed orthodontic appliance fabrication was 1. In periodontology, the scaling requirements are clustered with modes of 25 for manual and 10 for ultrasonic procedures. Mean history taking requirements were lowest in Orthodontics and periodontology. Overall, public sector institutions tended to higher mean quotas for commonly performed procedures.

Conclusions: Undergraduate dental clinical encounter requirements in Pakistan vary widely and appear driven by local capacity rather than standardized targets. Nationally benchmarked encounter ranges aligned with competency-based assessment may improve equity and graduate preparedness in resource-limited settings.

Keywords: Undergraduate dental education, Clinical competency, Clinical encounter, Procedural quotas, Competency-based education

Prevalence of Tooth Wear with Canine Guided and Group Function Occlusion in Rehman College of Dentistry

Tue, 14 Jul 2026 00:00:00 +0000

Objective: To determine the prevalence and extcnt of tooth wear in canine guided and group function occlusion.

Methodology: This Cross sectional study was performed at the Department of Prosthodontic, Rehman College of Dentistry, Peshawar involving 383 patients aged 18 to 30 years visiting the OPD for restorative treatment. The occlusal scheme for each patient was determined, canine guidance was defined by disocclusion of posterior teeth on the working side, while group function involved multiple simultaneous contacts. Tooth wear was assessed using the Bardsley classification system in the occlusion groups. Data were analysed with SPSS 24.

Results: Mean age of the cohort was 23.86 ± 3.74 years, with 210 (54.8%) male and 173 (45.2%) female patients. Canine guided occlusion was observed in 237 participants (61.9%), group function occlusion in 146 (38.1%) patients. Severe tooth wear (Grade 2) was significantly more common in the group function group (28, 19.2%) than in the canine guidance group (18, 7.6%) (P = 0.001).

Conclusion: Prevalence and severity of tooth wear was significantly higher in the group function occlusion compared to canine guided occlusion.

Keywords: Tooth wear, occlusal scheme, canine guidance, group function, risk factors, Bardsley classification, young adults.

Therapeutic Potential of Platelet Rich Plasma in the Treatment of Temporomandibular Joints Dysfunction

Adil Yousaf, Tahirullah Khan, Gulalai Khan, Gulfam Ali, Muhammad Nauman Khan — Tue, 14 Jul 2026 00:00:00 +0000

Background: Temporomandibular joint disorders (TMDs) are a prevalent condition causing pain, functional limitations, and reduced quality of life. Conventional non-surgical treatments offer symptom relief but often fail to address underlying joint degeneration. Platelet-rich plasma (PRP) has emerged as a regenerative therapy with potential benefits over traditional approaches.

Objective: To compare the clinical efficacy of PRP injections with conventional conservative treatments (NSAIDs and physical therapy) in reducing pain and improving jaw function among patients with TMDs.

Methods: This was a prospective non-randomized comparative interventional study, conducted at the Department of Oral and Maxillofacial Surgery, Lady Reading Hospital, Peshawar from March 2025 to November 2025, involving two groups: one receiving intra-articular PRP injections and the other undergoing standard conservative management. Pain was assessed using the Visual Analogue Scale (VAS), and functional outcomes included maximal mouth opening and lateral jaw excursion. Additional outcomes included joint sound reduction, patient satisfaction, and number of PRP injections. Data were analyzed using appropriate statistical tests with significance set at p<0.05.

Results: The PRP group showed significantly greater reduction in pain (mean VAS score: 2.3 vs 4.6, p<0.001), increased maximal mouth opening (42.5 mm vs 36.4 mm, p=0.004), and improved lateral excursion (8.5 mm vs 6.2 mm, p=0.012) compared to the conventional therapy group. Patient satisfaction, joint sound reduction, and perceived functional improvement were higher in the PRP group. Most patients (60%) required two PRP injections, while 15% improved after a single dose.

Conclusion: PRP therapy demonstrated better outcomes in pain reduction, functional improvement, and patient satisfaction compared to conventional conservative treatments in TMDs. These findings support PRP as a promising alternative for the non-surgical management of TMDs.

Keywords: Temporomandibular joint disorders, PRP, conservative treatment, pain, jaw function, randomized controlled trial.

Oncological Safety of Contralateral Submental Flap: Case Report and Literature Review

Taj uddin, Imran Mohib, zubair durrani — Tue, 14 Jul 2026 00:00:00 +0000

Introduction: With the development of pedicle lengthening procedures for submental flap pedicle, it has become possible to this flap based upon the contralateral submental vessels for intraoral reconstruction. The oncological safety of such flap, however, remains to be ascertained.

Case Report: Here we report a case where a contralateral submental island flap was harvested to reconstruct a defect over the left alveolus following excision of a squamous cell carcinoma. The patient developed multiple oncologically positive lymph nodes in the flap bed and also in the contralateral neck at level III.

Discussion: We discuss here the safety of harvesting this flap in oncological cases particularly when there is clinically or radiologically evidence of ipsilateral regional lymph nodes involvement.

Conclusion: While there is not enough data on contralateral flaps, such flaps should be used with extreme caution where there is a possibility of ipsilateral regional disease.