Distribution of medical conditions among dental patients

Aims: The aim of the study was to determine the distribution of medical conditions among dental patients in our local environment. Settings and Design: This is a descriptive cross‑sectional study conducted at the Oral Diagnosis (OD) Clinic of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile‑Ife, Osun State. Materials and Methods: Participants were selected using a simple random method from the pool of dental patients who presented at the OD Clinic of OAUTHC during the study period. Information was obtained from each participant using a structured questionnaire organized into sections. Section 1 collected information on participants’ biodata such as age, sex, and weight. Section 2 recorded data on the history of the presence of relevant oral and systemic symptoms, while section 3 collected information on findings from intraoral and extraoral examination. Statistical Analysis Used: The results were analyzed using STATA 13 statistical software. Results: Of the 1503 patients who visited dental hospital during the study period, 176 (11.7%) had medical problems. The mean age of patients with medical problems was 48.5 ± 21.0 years. The mean age was higher in men compared to women (P = 0.013). More than one‑fifth (21.6%) of the patients were first diagnosed in the dental clinic. Hypertension was the most frequently seen medical condition, closely followed by peptic ulcer and diabetes mellitus. Patients whose medical problems were first diagnosed following dental consultation were significantly older than those with known medical conditions. Conclusions: Prevalence of medical conditions in dental patients is high. Hypertension is the most frequently associated systemic conditions among dental patients. Medical conditions were common among older age group (>50 years), males, and those with gum problems

A national survey of oral maxillofacial surgeons’ and trainees’ awareness and practice regarding psychological problems associated with facial trauma

Background: The psychological problems associated with facial trauma may sometimes pose additional health concerns for the injured patient. Understanding the gaps in the Oral and Maxillofacial surgeons’ (OMFS) awareness of patient in need of specialist mental health intervention is important in ensuring holistic care for the trauma patient. Objectives: To determine the knowledge, practices and self-assessed level of competence of Nigerian Oral maxillofacial surgeons/trainees regarding psychological problems associated with facial trauma and to determine their perceived need for training in assessment of psychological consequences following facial trauma. Methods: A cross-sectional study was conducted in which a web-based structured questionnaire was sent to Oral and maxillofacial surgeons and trainees. Results: Majority of respondents (85.2%) had encountered psychological problems in patients who have sustained facial trauma. Half (50.6%) of OMFS / trainees had high level of knowledge regarding psychological problems associated with facial trauma; depression, anxiety, post-traumatic stress disorder, body image disorder and acute stress syndrome were the five most common trauma related psychological problems mentioned. More respondents reported low level of competence in conducting mental state examination when compared to other skill sets. In-unit counselling was reported as the method of intervention by majority (69.1 %), followed by referral to the mental health specialists (17.3%). More than one third (40.7%) of OMFS were extremely interested in undergoing additional training in the psychological assessment of patients who have sustained facial trauma. Conclusion: Nigerian Oral and maxillofacial surgeons frequently encounter psychological problems in patients with traumatic facial injuries. Notwithstanding their perceived self-assessed low level of competence in psychological assessment of trauma patients, objective assessment revealed a relatively high level of knowledge of psychological problems that can affect the facial trauma patient with many indicating a high perceived need for additional training in the psychological assessment of facial trauma patient. There is a need for incorporating psychological assessment into the management to ensure holistic care of trauma patients. Keywords: Maxillofacial trauma; psychological problems; Nigeria

Bilateral Mucous Retention Cyst of the Submandibular Salivary Gland: A Rare Unusual Presentation and Review of the Literature.: Bilateral Mucous Retention Cyst

Background: Mucous Retention Cyst (MRC) are non-neoplastic, developmental salivary gland lesion. Although more common in the minor salivary gland, few cases have been reported in the major salivary gland. Objective: To draw the attention of clinicians to a rare occurrence of MRC in the submandibular gland bilaterally.   Case Report: The index case presents as a slowly progressive painless lesion of 10 years duration associated with aesthetics concerns. The lesion appeared as a double jaw with extension into the neck. Though lobulated and fluctuant, aspirate yielded yellow coloured, non-viscous and non-foul smelling fluid. Ultrasonography revealed a multilobulated mass with mobile heterogeneous fluid-like content in the submental and submandibular regions bilaterally. The massive size of the lesion limited the ultrasonic visualization of the submandibular salivary glands. The patient could not afford advanced imaging. During surgery, the lesion had involved the submandibular gland bilaterally with attachment to the hyoid bone and in close relation to the recurrent laryngeal nerve. Although the nerve was preserved, the patient experienced temporary hoarseness, which resolved with medication. Histopathologic examination of the excised lesion revealed the lesion as Mucous Retention Cyst. Conclusion: The massive size of the lesion, delayed presentation and financial constraints in obtaining advanced imaging could have contributed to the diagnostic dilemma. This rare case will help the clinicians include MRC as a differential diagnosis of lesions involving submandibular salivary gland bilaterally. It also draws the attention of the maxillofacial surgeons to the unexpected injury to the recurrent laryngeal nerve and its management in a low-income setting environment.   &nbsp

Spreading Oro-fascial Infections: Is the Trend in Burden Changing?

Spreading orofacial infections are often encountered and managed by oral and maxillofacial surgeons. Several factors have been attributed to this spread. It has been reported to be the leading cause of death in maxillofacial patients seen in most hospitals, especially in a resource constraint country like Nigeria. The current study aims to assess factors that contribute to the disease burden of patients with orofacial infection. The case files of 101 patients who were diagnosed clinically of spreading orofacial infections with radiographic confirmation of involved tooth/teeth managed at the LASUTH and OAUTHC Ile Ife over twelve months. The following information was obtained in a prospective study using a proforma; patients’ demographics, underlying morbidity, teeth involved, site location, fascial spaces involved, treatment, and outcome. Patients with incomplete data were excluded. All patients had adequate rehydration followed by incision and drainage or decompression as the case required before administration of empirical antibiotics via the intravenous route. Data were analyzed using IBM SPSS version 21.0. One hundred and one cases were retrieved for the study. There was an almost equal gender distribution of males 51 (50.05%) and females 50 (49.50%). The female to male ratio of 1.02:1.00. The age range was 12-82 years, the mean age for females and males was (17.6 ± 0.448). The majority of the cases were in the 21-40 age group. A significant percentage (95.0%) of the patients were managed as in-patients. The majority of the death 8 out of 12 were recorded among the age group 51-82 years. Mandibular teeth were more affected compared to the maxillary teeth. Though not statistically significant (p=0.054). The lower right first and second molar (17.82%) each were mostly implicated in the mandible while the maxillary upper right second molar tooth (one-third of the total number of maxillary teeth affected) was the most implicated tooth in the maxilla. Twenty-five of the patients had underlying medical conditions with diabetes mellitus being the commonest (66.7%) among the patients under review. Majority of the patients presented with multiple facial spaces involvement with Ludwig’s angina being the commonest presentation. The submandibular space was the most involved space both in single and multiple spaces involvement. The mortality recorded were in patients with Ludwig’s angina, temporal and parapharyngeal space involvement. Seven (58.33%) out of the recorded death had involvement of more than four fascial spaces. The commonest treatment offered was incision and drainage with the extraction of the offending tooth/teeth. There was a positive correlation between the length of hospital stay and the duration of drain in-situ. Fascial space infections in a resource- and personnel-scarce setting still confers a great burden on management. The need for quick surgical intervention, aggressive and adequate antibiotics administrations, high protein nutritional support, and co-managing of patients with other medical teams in controlling associated morbidities are very essential to a good outcome