Displaying publications 1 - 20 of 25 in total

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  1. Ngeow, W.C., Lim, D., Ng, C.S., Chai, W.L.
    Malaysian Dental Journal, 2015;38(2):5-15.
    MyJurnal
    Medical emergencies or unexpected events are situations that all dental practitioners are trained to face, yet none hope they become a reality. Although they occasionally happen, the prevalence is rather low. This special article will touch on three aspects: before, during and after an unexpected event happening in a general dental practice. Emphasis will be given on the ‘during and after’ phases, which includes the activation of basic life support when necessary, and the documentation that a dental practitioner needs to prepare in the event of adverse outcome despite of efforts made to prevent and manage it.
  2. Ngeow WC, Lim D
    Adv Ther, 2016 Jul;33(7):1105-39.
    PMID: 27287853 DOI: 10.1007/s12325-016-0357-y
    INTRODUCTION: The use of corticosteroids to reduce the post-operative sequelae of lower third molar surgery, namely pain, swelling and trismus, has been well studied by many researchers over the past 6 decades. This study reviewed the reported outcome of corticosteroids used in controlling the above sequalae after third molar surgery.

    MATERIALS AND METHODS: A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015).

    RESULTS: Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone.

    CONCLUSION: Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed.

    FUNDING: This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.

  3. Lim D, Ngeow WC
    J Oral Maxillofac Surg, 2018 06;76(6):1141-1142.
    PMID: 29596795 DOI: 10.1016/j.joms.2018.03.001
  4. Lim D, Ngeow WC
    J Oral Maxillofac Surg, 2017 Nov;75(11):2278-2286.
    PMID: 28666096 DOI: 10.1016/j.joms.2017.05.033
    PURPOSE: To compare the efficacy of preoperative submucosal injection of 4 mg of dexamethasone versus 40 mg of methylprednisolone in reducing postoperative sequelae after surgical removal of impacted mandibular third molars.

    PATIENTS AND METHODS: This prospective, randomized, double-blind study included 65 patients who required surgical removal of impacted mandibular third molars with Class II or position B impaction (Pell and Gregory classification). Patients were randomly assigned to 1 of 3 groups: dexamethasone, methylprednisolone, or placebo (control). Surgery was performed with patients under local anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on postoperative day 1, 2, 5, and 7 to measure postoperative facial swelling by use of 2 linear measurements: interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Wound healing also was assessed on postoperative day 7. Descriptive and multivariate statistics were computed, and significance was set at P 

  5. Lim D, Ma BC, Parumo R, Shanmuhasuntharam P
    Int J Oral Maxillofac Surg, 2018 Sep;47(9):1161-1165.
    PMID: 29731193 DOI: 10.1016/j.ijom.2018.04.015
    Submental intubation has been used as an alternative to conventional intubation in the field of oral and maxillofacial surgery since its introduction by Francisco Hernández Altemir in 1986. A review of submental intubation was performed using data from all case reports, case-series, and prospective and retrospective studies published between 1986 and 2016. The indications, variations in incision length, incision sites, types of endotracheal tube used, methods of exteriorization, and complications were recorded and analyzed. A total of 70 articles reporting 1021 patients were included. The main indication was maxillofacial trauma (86.9%, n=887), followed by orthognathic surgery (5.8%, n=59), skull base surgery (2.8%, n=29), and rhinoplasty and rhytidectomy (1.5%, n=15). The complication rate was relatively low: 91.0% of patients (n=929) were complication-free. The most common complication was infection, occurring in 3.5% (n=36) of the total number of patients, followed by scarring (1.2%, n=12) and formation of an orocutaneous or salivary fistula (1.1%, n=11). In summary, submental intubation is a good alternative airway with minimal complications.
  6. Goh YC, Tan CC, Lim D
    J Stomatol Oral Maxillofac Surg, 2020 Sep;121(4):397-403.
    PMID: 31904534 DOI: 10.1016/j.jormas.2019.12.019
    Coronoid hyperplasia is one of the rare causes of progressive limitation of mouth opening due to impingement of the enlarged coronoid process of the mandible on the zygomatic bone. A review was performed on all cases reports and case series on coronoid hyperplasia. Gender, age at treatment, age of onset, types of hyperplasia (unilateral/bilateral), associated history, treatment, surgical approach, preoperative mouth opening, intraoperative mouth opening, mouth opening at follow up and follow up period were recorded and analyzed. A total of 82 articles which reported 115 cases were included. Coronoid hyperplasia was commonly reported at mean age of 22.64 years old with male preponderance. Most of the cases were diagnosed and treated between the age of 11-20 years old. This condition commonly involved bilateral coronoid process of mandible. The mean width of preoperative mouth opening was 16.5mm and was improved to a mean mouth opening of 36.3mm intraoperatively. Mean mouth opening was 34.8mm at an average follow up of 19 months. While the etiopathogenesis of coronoid hyperplasia is still not conclusive, treatment with either coronoidectomy or coronoidotomy produced good improvement in mouth opening.
  7. Lim EL, Ngeow WC, Lim D
    Braz Oral Res, 2017 Nov 27;31:e97.
    PMID: 29185606 DOI: 10.1590/1807-3107bor-2017.vol31.0097
    The objective of this study was to measure the topographic thickness of the lateral wall of the maxillary sinus in selected Asian populations. Measurements were made on the lateral walls of maxillary sinuses recorded using CBCT in a convenient sample of patients attending an Asian teaching hospital. The points of measurement were the intersections between the axes along the apices of the canine, first premolar, and second premolar and along the mesiobuccal and distobuccal apices of the first and second molars and horizontal planes 10 mm, 20 mm, 30 mm and 40 mm beneath the orbital floor. The CBCT images of 109 patients were reviewed. The mean age of the patients was 33.0 (SD 14.8) years. Almost three quarters (71.8%) of the patients were male. The mean bone thickness decreased beginning at the 10-mm level and continuing to 40 mm below the orbital floor. Few canine regions showed encroachment of the maxillary sinus. The thickness of the buccal wall gradually increased from the canine region (where sinus encroachment of the canine region was present) to the first molar region, after which it decreased to the thickness observed at the canine region. The buccal wall of the maxillary sinus became thicker anteroposteriorly, except in the region of the second molar, and thinner superoinferiorly. These changes will affect the approach used to osteotomize the lateral sinus wall for oral surgery and for the sinus lift procedure.
  8. Lim PE, Wong TF, Lim DV
    Environ Int, 2001 May;26(5-6):425-31.
    PMID: 11392762
    This study was conducted to: (1) assess the role of wetland vegetation in the removal of oxygen demand and nitrogen under tropical conditions, (2) estimate the uptake of nitrogen and copper by wetland plants and (3) investigate the speciation of Cu in wetland media among four operationally defined host fractions, namely exchangeable, carbonate, reducible and organically bound. Four laboratory-scale wetland units, two free-water-surface (FWS) and two subsurface-flow (SF) with one of each planted with cattails (Typha augustifolia), were fed with primary-treated sewage and operated at nominal retention times of 0.6-7 days. The influent and effluent BOD/COD and nitrogen concentrations were monitored to assess the performance of the wetland units for various mass loading rates. At the end of the study, all cattail plants were harvested and analyzed for total Kjeldahl nitrogen (TKN). Four other wetland units, which were identical to the first four, were fed with domestic wastewater spiked with copper in increasing concentrations. Copper speciation patterns in the sand layer were determined at the end of the study. The results showed that wetland vegetation did not play an important role in oxygen demand removal but were capable of removing about 22% and 26% of the nitrogen input in the FWS and SF wetland units, respectively. Mass balance analysis indicated that less than 1% of copper introduced was taken up by the cattails. Copper speciation patterns in the sand media showed that the exchangeable fraction contributed 30-57% and 63-80% of the nonresidual copper in the planted and unplanted FWS wetlands, respectively. For SF units, the percentages were 52-62% and 59-67%, respectively. This indicates that large amount of copper in the media were potentially remobilizable.
  9. Bador KM, Wee LD, Halim SA, Fadi MF, Santhiran P, Rosli NF, et al.
    Diabetes Metab Syndr, 2016 Jan-Mar;10(1 Suppl 1):S42-5.
    PMID: 26482049 DOI: 10.1016/j.dsx.2015.09.009
    AIMS: The aim of this study was to determine if osteocalcin is related to adiposity and hyperglycaemia in metabolic syndrome irrespective of the presence of diabetes mellitus.
    MATERIALS AND METHODS: This was a cross sectional study of 90 patients (59 men and 31 women) with metabolic syndrome as defined by the International Diabetes Federation criteria. Based on medical history 50 out of 90 patients had a diabetes. Anthropometric data were collected and blood taken for measurement of osteocalcin, fasting lipids, fasting glucose and insulin resistance (using homeostatic model assessment index, HOMA-IR).
    RESULTS: Osteocalcin correlated negatively with fasting glucose (r=-0.366, p<0.001) and HOMA-IR (r=-0.305, p<0.05) but not with waist circumference (r=0.079), body mass index (r=0.028), total cholesterol (r=0.061) or triglycerides (r=0.009). Diabetics had higher HOMA-IR (p<0.01) and lower osteocalcin levels (p<0.01) than non-diabetics. Among diabetics, osteocalcin correlated with glucose only (r=-0.341, p=0.015). In non-diabetics, osteocalcin correlated with HOMA-IR (r=-0.359, p=0.023) via insulin (r=-0.402, p=0.010). Patients with impaired fasting glucose levels (5.6-6.9mmol/L) had the same HOMA-IR as diabetics (p=0.076) but not low osteocalcin (p=0.025).
    CONCLUSIONS: In this cross-sectional study of subjects with metabolic syndrome and central obesity, low osteocalcin was associated with diabetes but not adiposity.
    KEYWORDS: Adiposity; Central obesity; Diabetes; Metabolic syndrome; Osteocalcin
  10. Ho JY, Ngeow WC, Lim D, Wong CS
    Folia Morphol (Warsz), 2021 Jun 29.
    PMID: 34184752 DOI: 10.5603/FM.a2021.0060
    BACKGROUND: There is concern regarding immediate implantation in the molar region because of discrepancy between socket size and inserted implant diameter. The purpose of this study was to assess the local anatomy of the posterior mandibular region in relation to immediate implant placement using cone-beam computed tomography (CBCT).

    MATERIALS AND METHODS: Using CBCT imaging data, 204 mandibular first molars and 201 mandibular second molars were assessed for the interradicular and alveolar bone dimensions, tooth sizes and proximity to vital structures. The cross-sectional mandibular shape and root configuration of these molars were determined.

    RESULTS: Distances to the inferior alveolar canal (IAC) from the root apices of the first molar were significantly greater than the second molar. Up to 14.5% of second molars had less than 10mm of vertical bone height between the IAC and furcation bone crest. Interradicular bone width of <3mm was found in 57% of second molars. All first molars in this study had two to three roots while 16% of second molars presented with a single root. The prevalent mandible shape at the first and second molars was the parallel and undercut ridges, respectively.

    CONCLUSIONS: The mandibular second molars from samples of a Southeast Asian population presented with greater anatomical difficulties for immediate implant placement which include absent or inadequate interradicular bone thickness, higher incidence of unfavorable mandible shape and increased proximity to vital structures.

  11. Lim D, Tan CC, Tilakaratne WM, Goh YC
    Braz J Otorhinolaryngol, 2021 02 27;88(1):118-129.
    PMID: 33715971 DOI: 10.1016/j.bjorl.2021.01.007
    INTRODUCTION: Sclerosing odontogenic carcinoma was a new addition to the list of head and neck tumors by World Health Organization in 2017. This lesion has scarcely been reported and a lack of pathognomonic markers for diagnosis exists.

    OBJECTIVE: The aim of the study was to summarize findings from the available literature to provide up-to-date information on sclerosing odontogenic carcinoma and to analyse clinical, radiological, and histopathological features to obtain information for and against as an odontogenic malignancy.

    METHODS: We conducted a comprehensive review of literature by searching Pubmed, EBSCO and Web of Science databases, according to PRISMA guidelines. All the cases reported as sclerosing odontogenic carcinoma in English were included. Data retrieved from the articles were gender, age, clinical features, site, relevant medical history, radiographical findings, histopathological findings, immunohistochemical findings, treatments provided and prognosis.

    RESULTS: Mean age at diagnosis of sclerosing odontogenic carcinoma was 54.4 years with a very slight female predilection. Sclerosing odontogenic carcinoma was commonly reported in the mandible as an expansile swelling which can be asymptomatic or associated with pain or paraesthesia. They appeared radiolucent with cortical resorption in radiograph evaluation. Histologically, sclerosing odontogenic carcinoma was composed of epithelioid cells in dense, fibrous, or sclerotic stroma with equivocal perineural invasion. Mild cellular atypia and inconspicuous mitotic activity were observed. There is no specific immunohistochemical marker for sclerosing odontogenic carcinoma. AE1/AE3, CK 5/6, CK 14, CK19, p63 and E-cadherin were the widely expressed markers for sclerosing odontogenic carcinoma. Surgical resection was the main treatment provided with no recurrence in most cases. No cases of metastasis were reported.

    CONCLUSION: From the literature available, sclerosing odontogenic carcinoma is justifiable as a malignant tumor with no or unknown metastatic potential which can be adequately treated with surgical resection. However, there is insufficient evidence for histological grading or degree of malignancy of this tumor.

  12. Ong TK, Lim D, Singh M, Fial AV
    J Evid Based Dent Pract, 2022 Dec;22(4):101722.
    PMID: 36494117 DOI: 10.1016/j.jebdp.2022.101722
    OBJECTIVES: The purpose of this review was to appraise the quality of evidence of the existing publications on IR, and to perform a meta-analysis on the treatment outcomes of IR.

    METHODS: The specific PIO questions were as follows: Population: Patients with periapical periodontitis either before or after non-surgical endodontic therapy.

    INTERVENTION: IR performed with retrograde preparation and retrograde filling.

    OUTCOMES: the healing, treatment complications, and the factors influencing these outcomes after IR. Electronic and hand searches were performed in the Web of Science, PubMed, CINAHL, and Cochrane Library databases. Two authors independently screened the titles and abstracts for eligibility. The risk of bias was performed using the NIH Quality Assessment Tool, and each study was rated as "Good", "Fair" or "Poor". The analyses were performed on the treatment outcome (healing and complications), and the factors influencing the outcome of the procedure.

    RESULTS: Fourteen articles were included in the qualitative and quantitative syntheses. One was a prospective cohort study, and the other 13 were retrospective cohort studies. Overall, the evidence of this review was of poor-to-fair quality. The pooled healing rate was 80.2%, and there was a 21.7% of complication rate. Longer follow-up period, the presence of perio-endo disease, the use of non-bioceramic material as retrograde filling, longer extraoral time, and maxillary molar were found to be associated with lower healing rates. However, the differences between the subgroups were not statistically significant.

    CONCLUSIONS: The present review showed IR yielded a good overall healing rate with a low complication rate. Taking the quality of evidence into account, more high-quality studies are required to evaluate the validity of the factors that may influence the treatment outcome of IR.

  13. Zainuddin NI, Chin Kai L, Lim D, Wm T
    Cureus, 2023 Jul;15(7):e42213.
    PMID: 37602060 DOI: 10.7759/cureus.42213
    Desmoplastic fibroma (DF) is a rare, benign, yet locally aggressive bone tumor. It frequently affects the facial bones, and the mandible is the most commonly affected site. Treatment of choice is the removal of the tumor with resection of surrounding bone due to its aggressive behavior. We report a case of DF where the tumor showed resolution and almost complete bone deposition following enucleation. Although DF has a high recurrence rate, the patient remains disease-free 31 months post-surgery.
  14. Lim D, Parumo R, Chai MB, Shanmuganathan J
    J Oral Implantol, 2017 Jun;43(3):228-231.
    PMID: 27996585 DOI: 10.1563/aaid-joi-D-16-00172
    Displacement of dental implants into the maxillary sinus is a rare complication. This article presents a case of displaced dental implant into maxillary sinus. Retrieval of the dental implant from left maxillary sinus was performed via endoscopic sinus surgery. This case highlighted a delayed referral of a 53-year-old male by a general dental practitioner for management of a dislodged dental implant into the left maxillary antrum. The implant was dislodged during placement of a healing abutment 4 months after implant insertion to replace missing 25. Cone beam computerized tomography revealed the displaced implant was located at the ostium of the left nose. A sudden change in sinonasal pressure when the patient took a deep breath during the procedure may have created a negative pressure and suction effect causing the implant to be dislodged and embedded at the ostium. In view of its position, a referral to an otorhinolaryngologist was made for endoscopic removal of the displaced implant. This case also highlighted the need for inter disciplinary cooperation in the management of such a complication for the best interest of the patients.
  15. Kumarasingha R, Palombo EA, Bhave M, Yeo TC, Lim DS, Tu CL, et al.
    Int J Parasitol, 2014 Apr;44(5):291-8.
    PMID: 24583111 DOI: 10.1016/j.ijpara.2014.01.008
    Traditional healers in Sarawak, Malaysia, use plants such as Picria fel-terrae, Linariantha bicolor and Lansium domesticum to treat gastrointestinal infections. This study aimed to test whether their nematocidal activities could be confirmed in vitro using highly standardised Caenorhabditis elegans models. We applied eight different ethanol solubilised plant extracts and two commercial anthelmintic drugs to larval and adult stages of C. elegans in vitro. Seven C. elegans strains were evaluated, one wild type and six strains with GFP-tagged stress response pathways to help characterise and compare the pathways affected by plant extracts. Our in vitro screen confirmed that both of the commercial anthelmintic drugs and five of the eight traditionally used plant extracts had significant nematocidal activity against both larval and adult C. elegans. The most effective extracts were from P. fel-terrae. The plant extracts triggered different stress response pathways from the commercial anthelmintic drugs. This study showed that using traditional knowledge of plant medicinal properties in combination with a C. elegans in vitro screen provided a rapid and economical test with a high hit rate compared with the random screening of plants for nematocidal activities. The use of transgenic C. elegans strains may allow this approach to be refined further to investigate the mode of action of active extracts.
  16. Kc B, Lim D, Low CC, Chew C, Blebil AQ, Dujaili JA, et al.
    JMIR Med Inform, 2020 Jul 08;8(7):e17982.
    PMID: 32463787 DOI: 10.2196/17982
    BACKGROUND: Information and communication technology (ICT) is an essential element of modern "smart" cities. These smart cities have integrated housing, marketplace, public amenities, services, business, and transportation via ICT. ICT is also now widely used in urban health care delivery.

    OBJECTIVE: The aim of this study was to determine the positioning and roles of ICT in community pharmacies in the state of Selangor, Malaysia.

    METHODS: A cross-sectional study was conducted from November 2018 to January 2019 across 9 different subdistricts in the state of Selangor, including Subang Jaya, Cheras, Puchong, Port Klang, Kota Kemuning, Selayang, Chow Kit, Ampang, and Seri Kembangan. A total of 90 community pharmacists were approached from the 9 subdistricts and invited to participate in the study.

    RESULTS: Of the 90 community pharmacies approached, 60 agreed to participate in the study, representing a response rate of 67%. The majority (36/60, 60%) of the respondents were women, and more than half (32/60, 53%) of the community pharmacies were run by young adults (ie, 30 years old and younger). More than three-quarters of the community pharmacies (46/60, 77%) used electronic health records. Half of the community pharmacies used online social media platforms for advertising and promoting their pharmacies. The vast majority of the community pharmacies (55/60, 92%) were using modern electronic payment systems, and some were also using other new electronic payment methods. Moreover, most of the community pharmacies (41/60, 68%) were using software and programs for accounting and logistics purposes. In addition, 47/60 (78%) of the community pharmacies used a barcode reading system for medicines/health products, and 16/60 (27%) of the pharmacies had online stores, and consumers could buy medicines and health products from these pharmacies via their online portal. In addition, 20/60 (33%) of the community pharmacies used at least one of the common online business platforms available in Southeast Asia to sell products/medicines. The telephone was the most commonly used means of communication with patients, although some pharmacies also used email, WhatsApp, SMS text messaging, and other communication platforms.

    CONCLUSIONS: This study showed that the majority of community pharmacies in Selangor, Malaysia are using ICT for different purposes. However, there is still limited use of mobile apps to provide health services. Overall, community pharmacies have been adopting ICT apps for pharmacy services but the rate of adoption is relatively slower than that in other sectors of Malaysia.

  17. Stanley GHM, Pitt ER, Lim D, Keloid Survey Collaborative, Research librarian, Manuscript revisers (in alphabetical order), et al.
    J Plast Reconstr Aesthet Surg, 2023 Feb;77:359-370.
    PMID: 36621239 DOI: 10.1016/j.bjps.2022.11.017
    INTRODUCTION: Keloid scars are associated with physical and psychological sequelae. No studies have investigated the general public's understanding of keloids. Targeted, short educational interventions in susceptible individuals may aid understanding of the condition and compliance with treatment. We aimed to identify the population with the highest prevalence and lowest knowledge.

    METHODS: We surveyed four countries to determine the public's understanding of keloids. A quantitative, subjective and cross-sectional street survey was designed using the knowledge, attitudes and practice model principles. The target populations were cities in Ghana, Australia, Canada and England. Surveyors used a hybrid stratified/convenience sampling method. Primary outcomes were prevalence, exposure to keloids as an entity and overall keloid knowledge score compared across demographic groups. Study data have been made fully available for reproducibility and education (https://doi.org/10.17605/OSF.IO/3KZ5E).

    RESULTS: There were 402 respondents, with a median age of 32 (interquartile range 25-45.25) years, of which 193 were females. The survey was carried out between June 2015 and October 2017. The prevalence of self-identified keloids was 11% in Ghana, 6% in Australia, 2% in Canada and 7% in England. Prevalence, exposure and knowledge were higher in the Ghanaian population.

    CONCLUSIONS: There was association between knowledge, prevalence and the exposure to keloids as an entity. Findings may suggest targeting public health campaigns towards populations where knowledge is lowest, and exposure to and prevalence of keloids are the highest.

  18. Tan CC, Lim D, Mohd Hisham NQ, Elias NA, Azli AS, Goh YC
    Malays J Pathol, 2023 Aug;45(2):237-246.
    PMID: 37658533
    INTRODUCTION: Oral candidiasis is one of the most common fungal infections that has been widely reported around the world. In Malaysia, the available studies for this infection are scarce.

    MATERIALS AND METHODS: This is a 20-year retrospective study aimed to investigate the prevalence, demographic characteristics, clinical presentations, and the association of oral candidiasis with clinical parameters in oral candidiasis cases reported in the Faculty of Dentistry, Universiti Malaya from 1999 until 2019. A total of 12,964 histopathological records from the Oral Pathology Diagnostic and Research Laboratory (OPDRL) between 1999 to 2019 were retrieved. Oral candidiasis cases were selected according to the inclusion and exclusion criteria. Information of interest was obtained and analysed.

    RESULTS: From the total records retrieved, 378 oral candidiasis cases were recorded and 82.8% were diagnosed from smear test. This study showed that oral candidiasis was predominantly reported in female (64.2%) and Indian population (64.2%). The peak incidence was in the sixth decades of life (27.0%). The most commonly affected site was tongue and coated tongue was the most common clinical presentation. More than 50% of the cases had comorbidity and 10.6% were associated with dentures. Ethnicity and site of occurrence were significantly associated (p<0.05) with oral candidiasis.

    CONCLUSION: This is the first large-scale study of oral candidiasis cases in Malaysia. The findings of this study are useful for clinical assessment of patients suspected of oral candidiasis.

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