National Dental Center Singapore

Singapore, Singapore

National Dental Center Singapore

Singapore, Singapore

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Tan W.C.,National Dental Center Singapore | Ong M.,National Dental Center Singapore | Han J.,Peking University | Mattheos N.,Griffith University | And 7 more authors.
Clinical Oral Implants Research | Year: 2014

Objectives: To determine the effect of various systemic antibiotic prophylaxis regimes on patient-reported outcomes and postsurgical complications in patients undergoing conventional implant installation. Material and methods: Three hundred and twenty-nine healthy adults in need of conventional implant installation were randomly assigned to one of four groups: (i) preoperatively 2 g of amoxycillin 1 h before surgery (positive control, PC), (ii) postoperatively 2 g of amoxycillin immediately following surgery (test 1, T1), (iii) preoperatively 2 g of amoxycillin 1 h before and 500 mg thrice daily on days 2 and 3 after surgery (test 2, T2), (iv) preoperatively 2 g of placebo 1 h before surgery (negative control, NC). Subjects were examined clinically by blinded examiners over 8 weeks after implant installation. In addition, Visual Analogue Scales (VAS) for pain, swelling, bruising and bleeding were obtained over 14 days. ANOVA was performed for the VAS. Chi-square tests were applied for postsurgical complications. Results: All VAS scores were low for all groups and decreased over time (P < 0.001). There were no significant differences for the VAS scores between the various groups at any time point (P > 0.05). There was only a significant difference in flap closure at week 4, where NC had 5% of the subjects not achieving complete wound closure compared to 0% for the three other groups (P = 0.01), with no other significant differences for any postsurgical complications (P > 0.05). Conclusion: For standard single implant placement, prophylactic systemic antibiotics either before or after, or before and after the surgical procedure do not improve patient-reported outcomes or prevalence of postsurgical complications. © 2013 John Wiley & Sons A/S.


PubMed | National University of Singapore, Academia Sinica, Taiwan and National Dental Center Singapore
Type: | Journal: Gerodontology | Year: 2016

To assess the dental health status of older Singaporeans by age, gender and ethnicity.Poor dental health in elders has been linked to a number of adverse health conditions and is often associated with an increased risk of mortality in older people.Data came from a nationally representative cross-sectional 2009 survey of community-dwelling Singaporeans aged 60 and over. The distribution of the number of natural teeth, chewing ability and the presence of dentures were assessed by age, gender and ethnicity (Chinese/Malay/Indian) using sampling weights.With increasing age, there was a decrease in the average number of natural teeth, a decrease in the proportion of people with 20 or more natural teeth and with the strongest chewing ability, and an increase in the proportion that was edentulous or had dentures. Women, vs. men, had a lower average number of natural teeth (10.3 vs. 12.8), and they were more likely to be edentulous (37 vs. 24%) and to have dentures (73 vs. 63%). Across ethnic groups, Indians had the highest average number of natural teeth (17.0). However, among those who had dentures, Indians were the least likely to have the strongest chewing ability.The findings demonstrated differences in dental health status by age, gender and ethnicity. They highlight the need for improvements in the dental health status of all older Singaporeans, especially older women. The data presented herein may serve as a baseline for policymakers to evaluate the impact of recent schemes launched by the Ministry of Health (Singapore) to subsidise dental treatment.


PubMed | National Healthcare Group Polyclinics, National University of Singapore, National University Hospital Singapore and National Dental Center Singapore
Type: Journal Article | Journal: Journal of clinical nursing | Year: 2016

To investigate the perspectives of nursing home caregivers towards oral care and the determinants of their attitudes and perceived behavioural control.There are few studies analysing nursing home caregivers perspectives on the provision of oral care and factors correlated with these perspectives.Cross-sectional study.Interviewer-administered survey questionnaires were completed by caregivers from five nursing homes in Singapore (n=94). The rating-scale questionnaire items explored caregivers attitudes, subjective norms and perceived behavioural control, as guided by the theory of planned behaviour. Demographic characteristics, oral care training received, years of work experience, oral hygiene behaviour and dental visit frequency of the caregivers, as well as organisational characteristics such as a requirement for oral care and the number of patients under their care, were obtained.Caregivers had very positive attitudes towards the provision of oral care. Half of the caregivers lacked confidence in providing oral care without harming the patients and this was not different by oral care training received. Multivariable linear regression analysis found that receiving oral care training and having a requirement by the nursing home to provide oral care were related to higher attitude scores but not perceived behaviour control. Having more residents under their care and on-the-job caregiver training were associated with lower perceived behavioural control.This study found that nursing home caregivers had positive attitudes towards providing oral care, but more modest perspectives about their ability to perform that behaviour.These findings have useful implications for the oral care training of nursing home caregivers. While attitudes towards the importance of oral care may be positive among nursing home caregivers, our study suggests that future interventions should include practical skills training for oral care management and consider organisational strategies for encouraging oral care provision.


Wee T.H.,National Dental Center Singapore | Poon C.Y.,National Dental Center Singapore
Proceedings of Singapore Healthcare | Year: 2014

Introduction: Bimaxillary osteotomies are commonly done to correct dentofacial deformities. Osteotomy at the LeFort I level and bilateral sagittal split osteotomy (BSSO) are commonly used in combination to treat patients with Class III skeletal dentofacial deformities. However, few studies are available which assess the treatment outcome measured in terms of quality of life (QoL) of Class III skeletal patients after bimaxillary osteotomies. This study aims to evaluate the long-term benefits of bimaxillary osteotomies, measured in terms of QoL outcomes of Class III skeletal patients at two (2) years post-surgery. Methods: This study was conducted at the National Dental Centre Singapore and selected patients were given 2 questionnaires each based on Oral Health Impact Profile (OHIP-14) and Orthognathic Quality of Life Questionnaire (OQLQ). The patients were told to report each question using a Likert-type scale and their perception for each question before and after surgery. Results: A total of 41 patients were recruited in this study, of which 23 were males and 18 were females. Their age ranged from 17 to 32 years old at the time of surgery and the median age was 20 years 2 months. All the patients in this study were Chinese. All the patients underwent LeFort I maxillary procedure in addition to BSSO setback surgery. The Wilcoxon Signed Rank test was used for evaluation of the statistics. There were significant changes to both OHIP-14 and OQLQ scores (p<0.001) two-years post-operatively. All the OHIP-14 domains, functional limitation (p<0.001), physical pain (p<0.001), psychological discomfort (p<0.001), physical disability (p=0.001), social disability (p<0.001) and handicap (p<0.001), were significantly decreased when compared to pre-surgical scores. The OQLQ domain scores, social aspects of deformity (p<0.001), facial aesthetics (p<0.001), oral function (p<0.001), and awareness of facial deformity (p=0.013), were also significantly lower two-years post-operatively. Conclusion: Treatment outcomes measured in terms of QoL were significantly improved in Class III skeletal patients after bimaxillary osteotomies. The function, psychosocial and facial aesthetics improved significantly after surgery and these aspects continued well into two-years post-surgery. The inclusion of QoL as a routine treatment outcome measure in orthognathic surgery would be beneficial in clinical profiling of patients, decision making and evaluating the efficacy of the procedure. It could potentially be used to evaluate surgical complications, arising from orthognathic surgery, and its impact on QoL in patients. More studies would be required to establish its correlation in the future.


Schaller B.,University of Bern | Soong P.L.,University of Bern | Soong P.L.,National Dental Center Singapore | Zix J.,University of Bern | And 2 more authors.
British Journal of Oral and Maxillofacial Surgery | Year: 2013

The aim of this study was to evaluate the difference between a 5-day and a 1-day postoperative course of antibiotic on the incidence of infection after mandibular fractures involving the alveolus. Sixty-two patients with fractures of the mandible involving the dentoalveolar region were randomly assigned to 2 groups, both of which were given amoxicillin/clavulanic acid 1.2 g intravenously every 8 h from admission until 24 h postoperatively. The 5-day group were then given amoxicillin/clavulanic acid 625 mg orally every 8 h for another 4 days. The 1-day group was given an oral placebo at the same intervals. Follow-up appointments were 1, 2, 4, 6, 12 weeks and 6 months postoperatively. Development of an infection was the primary end point. Fifty-nine of the 62 patients completed this study. Six of the 30 patients in the 5-day group (20%) and 6 out of the 29 in the 1-day group (21%) developed local wound infections. Three of the 6 in the 1-day group developed purulent discharge and swelling. One patient in the 5-day group developed a rash on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. In fractures of the mandible involving the alveolus, a 1-day postoperative course of antibiotic is as effective in preventing infective complications as a 5-day regimen. © 2013 The British Association of Oral and Maxillofacial Surgeons.


Seah T.E.,National Dental Center Singapore
Proceedings of Singapore Healthcare | Year: 2014

Patients with repaired cleft lip and palate often require orthognathic surgery and rhinoplasty to achieve better aesthetics and function. Conventionally, rhinoplasty is performed as a staged procedure after orthognathic surgery. An online search by the author through PubMed and Google Scholar revealed one article describing simultaneous Lefort I osteotomy and rhinoplasty for a bilateral cleft lip and palate patient. This paper reports on a case of simultaneous Lefort I osteotomy, mandibular bilateral saggital split, genioplasty and rhinoplasty for a repaired unilateral cleft lip and palate patient. It also touches on certain operative considerations for the surgeon performing this operation.


Chee H.K.,National Dental Center Singapore
Proceedings of Singapore Healthcare | Year: 2012

Wegener's Granulomatosis is a rare and potentially life-threatening vasculitic disease of unknown origin. The diagnosis of Wegener's Granulomatosis is made on the basis of clinical presentation, positivity for serum c-ANCA and histologic examination of the lesions. This report details a case of limited Wegener's Granulomatosis with hyperplastic gingivitis lesions presenting as an initial manifestation of Wegener's Granulomatosis. The resemblance of the affected gums to over-ripe strawberries is pathognomonic of this condition and is thus highlighted. Because of the rarity of Wegener's Granulomatosis presenting initially in the oral cavity, clinicians should be alerted to the characteristic appearance of "strawberry gingivitis".


PubMed | National Dental Center Singapore
Type: | Journal: Clinical oral implants research | Year: 2016

To compare the periodontal and peri-implant conditions of periodontally susceptible and periodontally healthy subjects under maintenance care for a period of at least 3years.Sixty periodontally susceptible patients (PSP) and 56 periodontally non-susceptible subjects (PHS) were treated with dental implants in the National Dental Centre Singapore (NDCS) and were maintained in a regular supportive periodontal care program for a mean of 6years. Full mouth bleeding on probing (BoP), full mouth probing pocket depths (PPD), implant loss, and absence of crestal bone loss were recorded at the time of prosthesis delivery and following a mean follow-up of 6years 2months.Although there were significant differences in the BoP and the percentage of subjects with tooth probing pocket depth 5mm between PSP and PHS at the time of implant prosthesis installation (TOwing to a rigid regular SPT program, implants placed in PSP perform equally well when compared to implants installed in PHS over a mean period of 6-year follow-up.


PubMed | University of Bern, Synthes Biomaterials, RMS Foundation, National University Hospital Singapore and National Dental Center Singapore
Type: Journal Article | Journal: Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery | Year: 2016

Biodegradable magnesium plate/screw osteosynthesis systems were implanted on the frontal bone of adult miniature pigs. The chosen implant geometries were based on existing titanium systems used for the treatment of facial fractures. The aim of this study was to evaluate the invivo degradation and tissue response of the magnesium alloy WE43 with and without a plasma electrolytic surface coating. Of 14 animals, 6 received magnesium implants with surface modification (coated), 6 without surface modification (uncoated), and 2 titanium implants. Radiological examination of the skull was performed at 1, 4, and 8 weeks post-implantation. After euthanasia at 12 and 24 weeks, X-ray, computed tomography, and microfocus computed tomography analyses and histological and histomorphological examinations of the bone/implant blocks were performed. The results showed a good tolerance of the plate/screw system without wound healing disturbance. In the radiological examination, gas pocket formation was found mainly around the uncoated plates 4 weeks after surgery. The micro-CT and histological analyses showed significantly lower corrosion rates and increased bone density and bone implant contact area around the coated screws compared to the uncoated screws at both endpoints. This study shows promising results for the further development of coated magnesium implants for the osteosynthesis of the facial skeleton.


PubMed | University of Bern, Synthes Biomaterials, RMS Foundation, National University Hospital Singapore and National Dental Center Singapore
Type: | Journal: Materials science & engineering. C, Materials for biological applications | Year: 2016

Self-tapping of magnesium screws in hard bone may be a challenge due to the limited torsional strength of magnesium alloys in comparison with titanium. To avoid screw failure upon implantation, the new concept of a rivet-screw was applied to a WE43 magnesium alloy. Hollow cylinders with threads on the outside were expanded inside drill holes of minipig mandibles. During the expansion with a hexagonal mandrel, the threads engaged the surrounding bone and the inside of the screw transformed into a hexagonal screw drive to allow further screwing in or out of the implant. The in vivo degradation of the magnesium implants and the performance of the used coating were studied in a human standard-sized animal model. Four magnesium alloy rivet-screws were implanted in each mandible of 12 minipigs. Six animals received the plasmaelectrolytically coated magnesium alloy implants; another six received the uncoated magnesium alloy rivet-screws. Two further animals received one titanium rivet-screw each as control. In vivo radiologic examination was performed at one, four, and eight weeks. Euthanasia was performed for one group of seven animals (three animals with coated, three with uncoated magnesium alloy implants and one with titanium implant) at 12weeks and for the remaining seven animals at 24weeks. After euthanasia, micro-computed tomography and histological examination with histomorphometry were performed. Significantly less void formation as well as higher bone volume density (BV/TV) and bone-implant contact area (BIC) were measured around the coated implants compared to the uncoated ones. The surface coating was effective in delaying degradation despite plastic deformation. The results showed potential for further development of magnesium hollow coated screws for bone fixation.

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