Minimum intervention dentistry in resource challenged practice environments

This paper highlighted the clinical strategies for implementing minimum intervention dentistry (MID) in dental practice and in dental education in resource challenged practice environments (developing economies). The objectives of each of the 4 phases of minimum intervention treatment plan (MI Identify, MI Prevent, MI Restore and MI Recall) were highlighted and three levels of caries risk (Low risk, High risk and Super high risk) were adopted with the appropriate targeted preventive non restorative treatments. Three evaluation rating scales were introduced (early recall evaluation rating scale, caries control evaluation rating scale and oral health outcome evaluation rating scale) for monitoring the success or failure of counselling, the targeted preventive (non-surgical) treatments and the oral health outcome. Practitioners and academics in resource challenged practice environments should embrace MID with open minds, its goal is maximum preservation of healthy oral tissues with oral health promotion and targeted preventive non- surgical treatments as its cornerstones. Furthermore, MID is mercury free and will safeguard our environment from mercury pollution for the benefit of future generations. Keywords: Minimum intervention dentistry, mercury free dentistry, dental practice, dental education, resource challenged practice environments

Oral health characteristics and treatment of individuals with special needs a tertiary institution: A 3 year retrospective study.

Objectives: To assess the oral health characteristics and the treatments carried out on individuals with special needs attending the Dental Clinic of Lagos University Teaching Hospital.Methods: A three-year retrospective study of all individuals with special needs that ttended the dental clinic of a tertiary health center. All relevant data including biodata, type of special need, oral health conditions and treatments carried out were extracted from the case notes and analyzed.Results: Out of 115 records extracted, there were 15 different types of special needs. More than half of the participants were males (54.8%) and their mean age was 12.4 years (SD±7.2). The most frequently recorded study participants with special needs were those with Down syndrome (20.9%). The most common oral conditions were gingivitis (65.2%) and dental caries (37.4%). Dental caries was significantly prevalent among participants with cleft lip/palate and the visually impaired (p=0.02). Of all treatments offered, preventive therapies were most commonly performed.Conclusion:The most common oral health problems among the study population were gingivitis and dental caries. There is need for improved oral health promotion strategies and provision of services for these underserved populations. Keywords: Oral health, treatment, special needs

Oral squamous cell carcinoma in patients less than 40 years in a Nigerian population

Objectives: Oral cancer ranks amongst the sixth to eight most common cancers worldwide and exhibits a great variation in incidence among countries. Oral squamous cell carcinoma (OSCC) is rare in individuals less than 40 years of age, with occurrences averaging 4 to 6% in people less than 40 years. The aim of this study was to review the clinical and pathological characteristics of OSCC cases in patients less than 40 years of age in five tertiary health facilities in Nigeria.Methods:All OSCC in the period from 1970 to 2015 from case file records and biopsy reports were retrieved from the records of the five teaching hospitals, to obtain age, gender, location and histologic grades.Results: Ninety-seven (17.4%) cases of OSCC were diagnosed in patients less than 40 years of age. These included 58 males and 38 females giving a male: female ratio of 1.5:1. The mandibular mucosa with 27 (28.7%) cases was the most common site followed by the maxillary mucosa with 24 (25.5%) and palate with 14 (14.4%) cases. Only 5 (5.3 %) cases of OSCC occurred in the tongue. The well differentiated OSCC was the most common histological grade accounting for 48 (50.0 %) cases while the moderately differentiated and poorly differentiated OSCC accounted for 31 (32.3 %) and 17 (17.7 %) cases respectively.Conclusion: OSCC was relatively more common in patients less than 40 years of age in this study than those of previous studies from other regions and OSCC in patients less than 40 years of age was relatively rare in the tongue when compared with similar cohorts from other continents. Key words: oral squamous cell carcinoma; age less than 40; tongue; mandibular mucosa, Nigeria

Attitude and perception of orthodontic patients to orthodontic treatment time and accelerated orthodontics.

Objectives: The purpose of this study was to evaluate the a􀄴itude and perception of orthodontic patients to the duration of orthodontic treatment and the procedures for accelerating orthodontic tooth movement.Methods: This was a cross-sectional analytical study. The study population was made up of patients undergoing fixed appliance orthodontic treatment at the Orthodontic Unit of the Lagos University Teaching Hospital. A convenience sampling technique was used and data collection was via selfadministered questionnaires and an information sheet. The questionnaires assessed patients' knowledge of accelerated orthodontic procedures as well as their perception of orthodontic treatment time and willingness to undergo some accelerated orthodontic treatment procedures. The procedures evaluated included corticotomy, piezocision, micro-osteoperforation, laser therapy, local administration of injections and use of vibrations.Results: One hundred orthodontic patients (n=100, adolescents, 46%; adults, 54%) were surveyed comprising 36 males and 64 females. Most of the participants (88%) had never heard of accelerated orthodontics. A majority of respondents (75%) believed that orthodontic treatment time was too long, and were willing to undergo additional procedures to reduce treatment time (81%). Subjects' willingness to undergo the procedures were inversely proportional to the degree of its invasiveness for all groups, with at least a third of the patients willing to accept a 10% increase in treatment fees for a reduction in treatment time across all techniques surveyed.Conclusion: The orthodontic patients surveyed considered treatment time protracted and were interested in undergoing adjunctive orthodontic procedures to accelerate tooth movement, with a consequent increase in treatment cost. They, however, had a limited knowledge of the different methods of accelerating orthodontic treatment. Key words: Accelerated orthodontics, orthodontic treatment time

Concurrent presentation of dental lamina cysts of the new born and natal tooth in a child: a case report and literature review

Dental lamina cysts and natal/neonatal teeth are rare findings in a neonate with the dental lamina cysts presenting as white or pink small nodules, often multiple, approximately 1 to 3mm in diameter. They are usually located on the alveolar mucosa of both maxilla and mandible and also on the midpalatine raphe; the whitish colored lamina cysts found on the alveolar mucosa can be confused clinically with neonatal teeth. Neonatal teeth are teeth found in infants within the first 30 days of life, and they present a social stigma to the parent. They have been reported to be a component of the full complement of teeth in 90-95% of cases. Apart from the social stigmata, they can also induce trauma to surrounding soft tissues and / or to the mother’s breast (Riga-Fede phenomenon). While the dental lamina cysts usually resolve spontaneously within few weeks to months, there are indications that might preclude extraction of a natal/neonatal tooth.Keywords: Dental lamina cyst, Epstein’s pearls, Mucosal cyst, natal/neonatal tooth

Audit of head and neck fine needle aspiration cytology from a tertiary institution in south - west Nigeria

Objective: FNAC is a well-established initial investigative tool for head and neck masses due to its being cost effective, quick to perform, low associated morbidity, high patient acceptability and high diagnostic accuracy. This study aimed to audit the utilization and deployment of FNAC in the management of head and neck masses in our hospitalMethods: This is a retrospective study of all patients presenting for fine needle aspiration cytology of lesions in the head and neck region at our hospital for fifteen years (from 2008 to 2017). All data were extracted from the FNA clinic records. The data was analyzed using the SPSS version 21 and results presented as figures and percentages.Results: During the study period, 3194 patients were seen, 2789 had complete information for analysis. There were 875 males (31.4%) and 1914 females (68.6%). The ages ranged between 1 year and 103 years. Overall mean age was 39.7 + 17.9 years. The commonest site was the anterior neck, accounting for 1323 (47.4%) of the lesions. Cervical lymph nodal swellings accounted for 548 (19.6%)]. Benign lesions constituted 35%. A total of 160 (5.7%) specimens were reported as inconclusive. Malignant lesions had the highest prevalence in the 1-10year age group. There was no complication reported with any of the procedures.Conclusion: FNAC is an established tool for investigating head and neck lesions in our hospital. The practice however needs to be further developed in line with the recommendations of National Institute for Clinical Excellence for improved outcomes.Keywords: Fine needle aspiration cytology, head neck masses

Congenital granular cell epulis: report of a case and review of the literature

Congenital granular cell tumour of the new born is a rare benign lesion of soft tissues which normally affects the maxillary alveolar ridge in neonates. Though benign, it can cause respiratory embarrassment and prevent feeding causing physical distress to the infant and psychological distress to the parents or guardian. Very few cases are reported in the literature. We aimed to highlight the clinical presentation, management and a brief review of the literature of the lesion.A case of a 3-day old baby who presented to the Oral and Maxillofacial Surgery Clinic University of Benin Teaching Hospital (UBTH) was used to illustrate the clinical presentation and management of congenital epulis.Congenital epulis of the new-born is a rare occurrence, though it can grow to a frightening size, it still remains a benign lesion with li le or no recurrence following surgical excision. The role of counselling to the parents cannot be over-emphasized.Keywords: Congenital, epulis, granular, newborn

Demographics of Kenyan dentists under the predevolved system of government; a dental workforce study

Objective: The main aim of this study was to analyse the dental workforce in Kenya prior to the decentralization of health workforce management to county governments in 2013.Methods: This was a cross-sectional study of Kenyan dentists who were practising as at 2013. Demographic data was obtained from the Kenya Medical Practitioners and Dentists' Board and the Ministry of Health annual retention registers. These data were integrated and analysed in Microsoft Excel 2016. All tests for significance were set at 95% confidence level (p ≤0.05).Results: Most of the dentists studied were male (55.6%) and more than half (54.5%) were below the age of 40 years (M=39.8, SD=11.9). A majority (79.3%) were general practitioners and approximately half (50.8%) were involved in private practice. Whereas, 76% had received local undergraduate training, many specialists (51.2%) held foreign degrees.Conclusion: There is urgent need for Kenya to develop strategies that will increase and retain the number of dentists and specialists. It remains to be seen whether the creation of a decentralised system of government will address existing shortages as well as the age, gender and speciality imbalances affecting the dental workforce.Keywords: Kenya, dentists, dental specialists, demographics, pre-devolution

Oral health knowledge and practices of clinical medical and dental students in a North- Eastern Nigerian University

Objective: Medical and dental students as future health care professionals should be aware of adequate oral health care. Therefore, this study aimed to determine the knowledge and practices of oral health of clinical medical and dental students in a North-Eastern Nigerian University.Methods: Cross sectional study involving 150 students, comprising 107 medical and 43 dental students. They were interviewed on knowledge of oral health care, oral health practices and psychosocial impact of oral health using an interviewer-administered questionnaire. The students were further examined for dental caries and their oral hygiene status. The Student t-test was used to compare means while Chisquare test was used to test associations between categorical variables at p<0.05.Results: The mean ±SD age of the students was 24.5 , males constituted 61.3%. One hundred and twentysix (84.0%) students had good knowledge of oral health care. Forty-two (97.7%) of the dental students had good knowledge while 84 (78.5%) of the medical students had good knowledge (p=0.003). Twenty (46.5%) and 60(56.1%) of dental and medical students respectively had poor oral health practice (p=0.32). Mean ±SD psychosocial impact score was 1.26 ±2.06 and 1.53 ±2.34 for dental and medical students respectively (p=0.68). The prevalence of dental caries and poor oral hygiene was 15(34.9%) and 23(53.5%) for dental students. The corresponding value for medical students were 30(28.0%) and 51(47.6%).Conclusions: There was good knowledge of oral health care among these students. Dental students had better knowledge of oral health care than medical students. They also had better oral health care practices and lower psychosocial impact of oral health than medical students though not statistically significant. Overall, younger age group of students reported higher psychosocial impact of oral health care on daily activities than older ones.Keywords: Oral health, knowledge, behaviour, medical, dental, students, Nigeria

Prevalence and predictors of dental caries and trauma among institutionalised and non-institutionalised street children in Ibadan

Objective: Urbanization is increasing the number of street children in most regions of the world especially in many African cities which may be due to poverty and unemployment status of many parents. This study was aimed at determining the predictors and prevalence of dental caries and trauma among institutionalized (those in juvenile correctional home) and non-institutionalized street children in Ibadan.Methods: This cross-sectional study was carried out among institutionalized (juvenile correctional home) and non-institutionalized street children. Cluster sampling technique was used in the selection of children for this study. Children were selected from the juvenile correctional home and four major motor parks in Ibadan metropolis.Results: One hundred and thirty eight children participated in this study. Male constituted 65.9% while female was 34.1%. Thirty five (25.4%) are from the juvenile correctional home (institutionalized street children) while 103 (74.6%) are from the streets. The prevalence of dental caries among the children generally was 29.0%, while that of dental trauma was 18.8%.Conclusion: The significant predictors of dental caries were gender, tooth hypoplasia and the presence of visible plaque on the anterior teeth while those of dental trauma were lip competence, substance use, age and gender.Keywords: Street children, Juvenile home, Caries, Trauma