IIUM Journal of Orofacial and Health Sciences

The digital workflow in dentistry: adoption and challenges

Seng Boon Chu — 2025-07-31

The incorporation of digital technologies has brought about a revolution in the profession of dentistry, resulting in greater diagnostic accuracy, enhanced patient outcomes and streamlined operations. Intraoral scanners, cone beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM) systems, and 3D printing have profoundly influenced the field of prosthodontics, implantology and orthodontics. These developments provide enhanced precision in planning, manufacture and customization of dental prostheses and surgical guides. Nonetheless, the implementation of digital workflows entails problems such as elevated expenses, steep learning curves and the need for ongoing equipment maintenance. This study examines the advantages and obstacles of digital dentistry, emphasizes technological improvements, and considers future directions, including the potential for AI integration. A balanced approach, addressing the technological and clinical challenges, is crucial for maximizing the benefits of digital tools in modern dental practice.

Prosthetic rehabilitation of a severely resorbed ridge using a maxillary complete denture opposing a mandibular implant-supported overdenture: a case report

Norfaezah Ahmad — 2025-07-31

A 64-year-old patient was referred to the prosthodontics clinic with a history of two failed mandibular dentures and significant functional impairment. The patient had been completely edentulous since the age of 40 due to advanced chronic periodontal disease. She experienced progressive loss of retention and stability of the mandibular prostheses, resulting in discomfort, pain, and difficulty with speech and mastication. The intraoral examination revealed severe alveolar bone resorption of both arches, shallow palatal vault, and reduced maxillary and mandibular arch height and width. The existing dentures, partially lined with soft lining material, exhibited poor retention and stability. The maxillary denture lacked posterior seal, and the mandibular denture, despite adequate extension, was considered intolerable. A treatment plan consisting of a combination of maxillary conventional complete denture and mandibular implant-supported overdenture was executed. This approach was found to be a clinically effective, cost-efficient, and predictable solution in addressing the patient’s concern for improved oral function.

Root canal treatment of a maxillary left first molar with 2 palatal canals - a case report

Hema Devi Sivan — 2025-07-31

Comprehensive knowledge of normal dental anatomy and awareness of potential anatomical variations are crucial to successful endodontic treatment. Anatomical variations such as additional canals in the palatal root of the maxillary molar are poorly reported, attributed to their low prevalence in general populations. This case report highlights the utilization of cone beam computed tomography (CBCT) as a diagnostic tool for locating additional canal in the palatal root of maxillary left first molar. The application of CBCT imaging technology in endodontics enables precise diagnosis through enhanced visualization of anatomical variations, thereby enhancing treatment planning and management of cases presenting with complex canal morphology. The present case documents the successful management of a maxillary left first molar exhibiting abnormal morphology of four canals: two located in the palatal root, one in the mesiobuccal root, and one in the distobuccal root. The canals were biomechanically prepared with crown-down technique and obturated using cold lateral compaction technique with gutta-percha points and AH-Plus root canal sealer. Post-treatment evaluation at six months demonstrated clinical success, with the tooth remaining asymptomatic and maintaining its normal function.

A rare genetic disorder encountered in dentistry: a case of lipoid proteinosis

Betul Yazmaci — 2025-07-31

Lipoid proteinosis disease is a rare autosomal recessive genodermatosis first described by Urbach and Wiethe in 1929. This disease occurs as a result of homozygous or compound heterozygous mutations in the ECM1 gene located in the 1q21 chromosome region. Approximately 400 cases have been encountered in the literature to date. Although it is seen worldwide, a higher prevalence of has been observed in Europe and South Africa. Although this disease can be seen anywhere in the body, the upper respiratory tract and mouth are affected in the majority of patients. The first clinical sign in Lipoid Proteinosis patients is a weak and muffled cry caused by laryngeal infiltration that develops shortly after birth or during infancy. Skin and mucosal changes develop during the first few years of life and later. Intraoral symptoms include macroglossia due to infiltration of waxy yellowish-white plaques and nodules, fissured macrocheilia, and nodular thickened mucosa. The prognosis of Lipoid Proteinosis disease is good and there is no specific treatment. Dentists are in the earliest position to diagnose Lipoid Proteinosis and help provide appropriate treatment to improve the quality of life impaired by the disease.

Prevalence of geriatric psychiatric cases in Malaysia and their association with clinical mental health workforce availability

Ely Salwana — 2025-07-31

The aging population presents a global challenge, with increasing attention on the mental health needs of elderly individuals. In Malaysia, the rising number of geriatric psychiatric cases emphasizes the urgent need for effective mental health care solutions. This study investigates the relationship between clinical staffing levels in psychiatric care and the management of geriatric psychiatric conditions. While previous research has established a link between staffing levels and care quality, this study provides specific insights into how workforce availability influences the management of elderly psychiatric patients in Malaysia. Given the growing prevalence of psychiatric disorders such as depression, anxiety, and dementia among older adults, this research addresses a critical gap in understanding the effects of staffing on mental health outcomes. Using descriptive and regression analyses, the study assesses data on psychiatric cases and clinical staffing across Malaysian states. The analysis reveals that higher clinical staffing levels significantly improve the management of geriatric psychiatric conditions. This evidence highlights the critical role that adequate staffing plays in enhancing psychiatric care for the elderly. The study underscores the importance of strategic investments in mental health services, offering insights for policymakers and healthcare planners as they strive to meet the increasing demand for mental health care in Malaysia. By optimizing staffing and resource allocation, the research contributes to better mental health outcomes for Malaysia’s aging population, improving their quality of life.

Potential of Cananga odorata and Citrus limon essential oils in modulating NOTCH1 signalling for non-melanoma skin cancer treatment

Muslihah Muzamil — 2025-07-31

Natural products have drawn increasing attention as potential therapeutic agents, particularly for their anticancer properties. Essential oils (EOs) from Cananga odorata (CO) and Citrus limon (CL) are well-known for their antibacterial and antioxidant activities, yet their ability to suppress skin cancer cell growth remains uncertain. Whereas NOTCH1 signalling pathway plays an oncogenic role in cancer development due to uncontrolled cell proliferation. This study evaluates the antiproliferative effects of CO and CL EOs on skin cancer cells by examining their impact on NOTCH1 gene expression and protein secretion. Human foreskin fibroblast (HFF-1) and skin carcinoma (A431) cell lines were treated with DMSO-dissolved cisplatin and varying concentrations (125, 250, and 500 ?g/ml) of CO or CL EO for 24 hours. Cellular morphology was observed under 20–40x magnification, while qRT-PCR and western blot analyses were conducted to measure NOTCH1 gene expression and protein secretion. In A431 cells, CO EO at 125 ?g/ml significantly downregulated NOTCH1 gene expression compared to untreated cells, with levels lower than those induced by cisplatin. In contrast, CL EO at the same concentration upregulated NOTCH1 gene expression. At higher EO concentrations, both CO and CL EOs exhibited effects similar to cisplatin, with increased NOTCH1 protein secretion, likely resulting from apoptosis or necrosis-associated membrane leakage. These findings underscore the potential of natural products, particularly CO EO as an anticancer agent via modulation of NOTCH1 signalling. Further studies are essential to unravel the precise mechanisms by which these EOs affect A431 cells, advancing their potential use in skin cancer therapy.

A retrospective study on the evaluation, management, and outcomes of oral mucosal lesions in patients at the Oral Medicine Clinic

Muhanad Ali Kashmola — 2025-07-31

Oral mucosal lesions (OMLs) are prevalent across different populations worldwide, with varying frequencies in different regions. This study aims to evaluate the frequency of OMLs and analyse their distribution concerning age, gender, race, and systemic conditions. A retrospective cross-sectional study was conducted on patients who attended the Oral Medicine students’ polyclinic, International Islamic University Malaysia, over a period of seven years. Data from a total of 85 patients were collected and analysed using descriptive statistical methods. The analysis included patient demographics such as age, gender, race, systemic diseases, as well as the types and sites of oral mucosal lesions (OMLs). OMLs were categorized into four main groups: ulcers, white lesions, infections, and others. Among the data collected from eighty-five patients, the prevalence of oral mucosal lesions was found to be higher in females than in males. The most common lesions were ulcers (65.9%), followed by infections (19.4%), white lesions (13.6%), and others (12.6%). Ulcers were predominantly found in individuals aged 15–30 years, whereas white lesions, infections, and other types were more frequent in the 31–60 age group. No significant association was found between systemic conditions and lesion types. Ulcers commonly appeared in multiple locations (37.5%), white lesions were most frequently found on the buccal mucosa (35.7%), infections were primarily observed on the hard palate (40.0%), and other lesions occurred most often on the labial mucosa (30.7%). Ulcers were the most prevalent type of oral mucosal lesions; however, no significant correlation was found between OMLs and systemic conditions.

Antimicrobial properties of local Kelulut honey against selected oral pathogens

Andek Nurul Hafizah Andek Jelantek — 2025-07-31

There are limited reports on the antimicrobial properties of Kelulut honey against oral pathogens. Hence, this study aimed to determine the antimicrobial properties of local Kelulut honeys obtained from the Malaysian Agriculture Research and Development Institute (MARDI) and Tangkak, Johor, Malaysia. The samples were mixed with sterile deionised water to obtain series of honey concentrations and evaluated against Streptococcus mutans, Staphylococcus aureus, Candida albicans and Candida tropicalis using agar well diffusion method. Bacteria S. mutans and S. aureus were grown anaerobically on Mueller-Hinton agar and incubated at 37°C for 24 hours, while fungi, C. albicans and C. tropicalis were grown on Sabouraud Dextrose agar at 25°C for 48 hours. Cultures were prepared in triplicates and adjusted to 0.5 McFarland standard (1 x 10⁸ CFU/ml). Wells (6 mm diameter) were made on the agar, and 60 µl of honey at concentrations of 2.5, 2.0, 1.5, 1.0 and 0.75 g/ml were added onto each well. Sterile deionised water was used as negative control, and 0.2% chlorhexidine as positive control. Upon incubation, the zones of inhibition were measured using a digital calliper. Both Kelulut honeys exhibited zones of inhibition against S. mutans at 2.5, 2.0 and 1.5 g/ml whereas for S. aureus, the inhibition was noticed only at 2.5 and 2.0 g/ml. No inhibition zones were observed against C. albicans and C. tropicalis at any concentration. This study showed that both Kelulut honeys exhibited antibacterial properties against S. mutans and S. aureus but did not exhibit antifungal activity against C. albicans and C. tropicalis.

Development and validation of a questionnaire to assess the psychological impact and fearfulness of COVID-19 among Human Immunodeficiency Virus (HIV) patients

Mohemmad Redzuan Mohemmad Rizal — 2025-07-31

The outbreak of COVID-19 has led to a serious and uncertain condition, including an abrupt national economy and increased psychological distress especially among vulnerable population such as people living with HIV (PLHIV). Fear of infection, prolonged lockdown and isolation, and stigma merged with mental health burden for this group. This study aims to develop and validate a questionnaire assessing the psychological impact and fearfulness related to COVID-19 among HIV patients. The questionnaire was developed through a comprehensive literature review, followed by expert validation and statistical reliability testing. Content and face validity were conducted by medical, psychological, and public health professionals. Internal consistency and test-retest reliability were analysed using Cronbach’s alpha and Spearman correlation. The final questionnaire included two domains: psychological impact (10 items) and fearfulness (14 items), each with a Scale-Content Validity Index (S-CVI) of 1.0. Face validity scores exceeded 90% in clarity, readability, and layout. Cronbach’s alpha for psychological impact and fearfulness was 0.81 and 0.92, respectively. A test-retest correlation coefficient of 0.728 indicated strong stability. In conclusion, this validated questionnaire is a reliable tool for measuring psychological and emotional responses to COVID-19 among HIV patients, offering insight into their mental health needs during public health crises.

Association of periodontal status and metabolic control in periodontitis patients with diabetes mellitus in Hospital Pakar Universiti Sains Malaysia

Ainatul Husna Assmar — 2025-07-31

Evidence establishes diabetes mellitus (DM) as a significant risk factor for periodontitis. Periodontitis with DM patients exhibit more pronounced periodontal loss, elevated clinical attachment levels (CAL), and deeper periodontal pockets. This study aims to determine the association between periodontal status and metabolic control indicators in periodontitis with type 2 DM patients. A retrospective record review study was conducted from 2015 to 2024 at Periodontal Clinic, Hospital Pakar Universiti Sains Malaysia. All data of periodontitis with Type 2 DM patients were recorded and analyzed using SPSS 29.0. Demographic data was analysed descriptively and Fisher’s exact test was used to evaluate the association between periodontal status and metabolic control indicators. Fourty two periodontitis patients were included with the mean (SD) age of 59.26 (9.97) years and male predominance (61.9%). Most patients were Malay (97.6%), and 28.6% had blood pressure of more than 140/90 mmHg. Periodontal status revealed 61.9% of patients were in stage 3 and 14.3% in stage 4 with grade B periodontitis was the most common (59.5%). Metabolic control indicators showed 64.3% of patients has HbA1c of ?7.0%, 83.3% has fasting blood glucose of >6.0 mmol/L, and 54.8% with LDL of >2.6 mmol/L. Fisher’s exact test analysis shows no significant association between periodontal severity and metabolic control indicators, including HbA1c (p=0.513), fasting blood glucose (p=0.539), and fasting lipid profiles (p? 0.05). The findings highlight a high prevalence of severe periodontitis among patients with poor glycemic control. However, no significant association of periodontal status and metabolic control indicators.

Integration of Islamic principles in healthcare delivery: a narrative review

Sarah Shakina Suhaimey — 2025-07-31

The integration of Islamic principles in healthcare services offers several benefits. This approach fosters a more inclusive healthcare environment by recognizing and respecting the cultural and religious values of both Muslim and non-Muslim patients. However, the extent to which Islamic principles have been integrated into healthcare services remains unclear. This review aims to collate and analyse existing evidence on the implementation of Islamic principles within the healthcare delivery system. Relevant literature was identified through databases including IIUM Research Repositories (IREP), ScienceDirect, ResearchGate, SCOPUS, ProQuest, Emerald, PubMed, and BMJ. Search terms included combinations of the following keywords: Clinical, Shariah-compliant, Muslim, Religion, Medical, Muslim-friendly, Cultural competence, and Spiritual care, using Boolean operators “AND” and “OR.” The search was limited to articles published in English, Malay, and Indonesian. Each article was reviewed, and relevant information extracted from them was incorporated into this review. The review found that integrating Islamic principles into healthcare services is complex and influenced by various factors, including understanding religious beliefs, adherence to Islamic teachings, and the interaction of cultural norms within healthcare. Three key components related to Islamic healthcare services were identified: (a) global healthcare service management, (b) patient satisfaction with service delivery, and (c) the behaviour of healthcare professionals. In conclusion, there remain gaps and disparities in integrating Islamic principles into healthcare services. Further research is recommended to explore the integration of Islamic principles in healthcare services globally.

The current status of intentional replantation: a narrative review

Musliana Mustaffa — 2025-07-31

Intentional replantation which has been practiced since the 1940s has evolved from its initial position as a final course of treatment to a viable alternative for managing failed root canal treatment. This review provides an overview of the current status of intentional replantation, clinical considerations prior to intentional replantation procedure, treatment outcomes and to explore future direction in this field. A literature search was conducted via Google Scholar using the search terms ‘tooth reimplantation’ and ‘intentional replantation’, and PubMed using the search terms ‘tooth reimplantation AND endodontics’, and ‘intentional replantation’ AND endodontics’ for English language publications from January 2000 to December 2024. Additional relevant articles were identified through manual review of reference list from selected publications. Findings from this review indicate that favourable treatment outcomes can be achieved depending on several critical factors such as the access and understanding of current intentional replantation protocols, meticulous preoperative assessments, careful case selection criteria, adherence to established extra-oral manipulation time limitations during the procedure, and implementation of atraumatic tooth extraction techniques to prevent root damage.

To calm, to hold or to refer? When managing children becomes managing parents

Ahmad Faisal Ismail — 2025-07-31