Oral health characteristics of children and teenagers with special health care needs in Ile-Ife, Nigeria

Objectives: The aim of this study is to determine the prevalence of periodontal disease, dental caries and malocclusion traits in children and teenagers who have hearing impairments, visual impairments, physical impairments and intellectual disability attending special schools in Ile-Ife. Methods: This cross-sectional comparative study comprised of children and teenagers with and without special health care needs aged 6 to 19 years who were recruited from the special schools and some regular schools in Ile-Ife. The prevalence of periodontal disease (gingivitis and periodontitis), dental caries and malocclusion traits were assessed using the Community Periodontal Index of Treatment Need, the Decayed, Missing and Filled Teeth Index and Angle's classification of malocclusion respectively. The severity of dental caries using the pulp exposure, ulceration, fistula and abscess index was also assessed. Chi-square test, Student t-test and ANOVA were conducted dp≤ 0.05 was considered statistically significant. The findings in children and teenagers with special health care needs (CTSHCN) were compared to that of children and teenagers without special health care needs in the same environment.Results: The study sample consisted of 206 children and teenagers with special health care needs aged 6 to 19 years. 104(50.5%) were males and 102(49.5%) females. One hundred and eighty-three (88.8%) had gingivitis, 15 (7.3%) had periodontitis and this was most prevalent in those with visual impairment. Significant associations were seen between the presence of gingivitis and periodontitis (p<0.001) and types of special health care needs. The prevalence of dental caries was 22.8%; the mean DMFT/dmft was (0.20±0.60/0.28±1.06) and the mean PUFA/pufa score was (0.07±0.59/0.17±0.81). Angles class I malocclusion (85.4%) and spacing (47.1%) were the most prevalent malocclusion traits. The type of special health care needs was not associated with the presence of dental caries (p=0.49) and malocclusion traits (p=0.44). When compared to the findings in 208 children and teenagers without special health care needs, 108(51.9%) males and 100 (48.1%) females, the CTSHCN had significantly higher prevalence of periodontal disease (p=0.001) and malocclusion traits (p=0.01). There was no significant difference in the prevalence of dental caries (p=0.86) in children and teenagers with and without special health care needs. Conclusion: CTSHCN in Ile-Ife have higher prevalence of gingivitis,  periodontitis and malocclusion traits when compared to children and teenagers without special health care needs. Despite the low mean DMFT/dmft in CTSHCN in Ile-Ife, majority of the decayed teeth was left untreated and 49.0% had progressed to involve the pulp. Key words: Special health care needs, malocclusion, dental caries, periodontal disease

Caries experience in the primary dentition of nursery school children in ile-ife, Nigeria.

Objective: To measure the prevalence and pattern of distribution of dental caries in suburban Nigerian children attending nursery school in Ile – Ife, Nigeria. Methods: A cross sectional survey of 423 children (225 boys, 198 girls) aged 3 – 6 years using dmft index. WHO recommendations for oral health survey were used for caries diagnosis (non cavitated lesions were excluded). All examinations were carried out by two calibrated examiners. Result: The prevalence of caries was 10.9% and a mean decayed, missing and filled teeth index (dmft) was 0.3 with the d - component comprising 92%.The mean dmft of children with high social status was higher than children with low social status. No statistically significant differences were found between boys and girls. The pattern of distribution revealed that out of 46 children diagnosed for caries 29 (63%) had caries confined to posterior teeth, 3 (6.5%) had caries only in anterior teeth and in 14(30.4%) both anterior and posterior teeth were affected. Caries free children accounted for 89.1% Discussion: The experience of caries in suburban Nigerian nursery school children found in this study was lower than that reported in most African countries and developed countries. Conclusion: Caries is not a widespread problem in some young suburban Nigerian nursery school children in the population examined. The importance of dental education and oral health programme both curative and preventive measures for this population are important to maintain the WHO / FDI millennium goal in Nigerian children population.Key words: Caries, dmft, suburban, nursery, children

Pulpal sequelae after trauma to anterior teeth among adult Nigerian dental patients

<p>Abstract</p> <p>Background</p> <p>Epidemiological studies show that about 11.6% to 33.0% of all boys and about 3.6% to 19.3% of all girls suffer dental trauma of varying severity before the age of 12 years. Moderate injuries to the periodontium such as concussion and subluxation are usually associated with relatively minor symptoms and hence may go unnoticed by the patient or the dentist, if consulted. Patients with these kinds of injuries present years after a traumatic accident most of the time with a single discoloured tooth. This study sets out to document the incidence of various posttraumatic sequelae of discoloured anterior teeth among adult Nigerian dental patients.</p> <p>Methods</p> <p>One hundred and sixty eight (168) traumatized discoloured anterior teeth in 165 patients were studied. Teeth with root canal treatment were excluded from the study. Partial obliteration was recorded when the pulp chamber or root canal was not discernible or reduced in size on radiographs, total obliteration was recorded when pulp chamber and root canal were not discernible. A retrospective diagnosis of concussion was made from patient's history of trauma to the tooth without abnormal loosening, while subluxation was made from patient's history of trauma to the tooth with abnormal loosening.</p> <p>Results</p> <p>Of the 168 traumatized discoloured anterior teeth, 47.6% and 31.6% had partial and total obliteration of the pulp canal spaces respectively, 20.8% had pulpal necrosis. Concussion and subluxation injuries resulted more in obliteration of the pulp canal space, while fracture of the teeth resulted in more pulpal necrosis (p < 0.001). Injuries sustained during the 1^stand 2^nddecade of life resulted more in obliteration of the pulp canal space, while injuries sustained in the 3^rddecade resulted in more pulpal necrosis.</p> <p>Conclusion</p> <p>Calcific metamorphosis developed more in teeth with concussion and subluxation injuries. Pulpal necrosis occurred more often in traumatized teeth including fractures.</p

The Dental Neglect Scale in adolescents

<p>Abstract</p> <p>Background</p> <p>Dental neglect has been found to be related to poor oral health, a tendency not to have had routine check-ups, and a longer period of time since the last dental appointment in samples of children and adults. The Dental Neglect Scale (DNS) has been found to be a valid measure of dental neglect in samples of children and adults, and may be valid for adolescents as well. We administered the DNS to a sample of adolescents and report on the relationships between the DNS and oral health status, whether or not the adolescent has been to the dentist recently for routine check-ups, and whether or not the adolescent currently goes to a dentist. We also report the internal and test-retest reliabilities of the DNS in this sample, as well as the results of an exploratory factor analysis.</p> <p>Methods</p> <p>One hundred seventeen adolescents from seven youth groups in the Seattle-Tacoma metropolitan area (Washington State, U.S.) completed the DNS and indicated whether they currently go to a dentist, while parents indicated whether the adolescent had a check-up in the previous three years. Adolescents also received a dental screening. Sixty six adolescents completed the questionnaire twice. T-tests were used to compare DNS scores of adolescents who have visible caries or not, adolescents who have had a check-up in the past three years or not, and adolescents who currently go to a dentist or not. Internal reliability was measured by Cronbach's alpha, and test-rest reliability was measured by intra-class correlation. Factor analysis (Varimax rotation) was used to examine the factor structure.</p> <p>Results</p> <p>In each comparison, significantly higher DNS scores were observed in adolescents with visible caries, who have not had a check-up in the past three years, or who do not go to a dentist (all p values < 0.05). The test-retest reliability of the DNS was high (ICC = 0.81), and its internal reliability was acceptable (Cronbach's alpha = 0.60). Factor analysis yielded two factors, characterized by home care and visiting a dentist.</p> <p>Conclusion</p> <p>The DNS appears to operate similarly in this sample of adolescents as it has in other samples of children and adults.</p

Global Theme Issue: Poverty and Human Development The effect of poverty on access to oral health care in Nigeria

Nigeria is a country with a population of over 140 million people (1). Over 60% of Nigerians live in rural areas. Poverty is especially severe in rural areas where social services and infrastructure are limited or non existent. Africa is the continent where the poorest people in the world live. Nigeria is the most populous black African country where about 70% of the population live under one dollar per day (2). Nigeria has been classified as a poor nation. In Nigeria, majority of those living in rural areas are poor and depend on agriculture for food and income. Small scale farmers who cultivate tiny plots of land and depend on rainfall rather than irrigation system produce about 90% of the country\'s food. Women play a major role in the production, processing and marketing of food crops. The poorest group go on subsistence living but are often short of food, particularly during the pre-harvest period. Many poor Nigerians suffer from malnutrition and other diseases related to poor nutrition such as acute necrotizing ulcerative gingivitis (ANUG) and cancrum oris (3-6). The HIV/AIDS pandemic has also taken a heavy toll on the rural population and could be considered an emerging public health problem. The extremes of poverty in Nigeria are outrageous. The outrage is not just that avoidable deprivation, suffering and death are intolerable; it is also that these situations coexist with affluence. Corruption is endemic in Nigeria and this has impoverished the nation. Intergenerational poverty exists in the country. Fight against poverty is necessary to reduce intergenerational transfer of poverty in Nigeria because most Nigerian children are born into poverty. The oral health status of underprivileged Nigerians is generally poor. Many Nigerians suffer from oral diseases such as caries, fracture teeth, gingivitis, periodontitis, acute necrotizing ulcerative gingivitis, cancrum oris, malocclusion, tumours and other dental problems (7-15). Non availability of National data on the prevalence of common oral diseases among Nigerians is a major problem and poses a great challenge to the Nigerian Dental Association whose members are major stakeholders regarding oral health care delivery system in the country. Lack of national data has affected planning meaningful oral health care for Nigerians. This paper identified the barriers to access oral health care and stress the various strategies by which the Nigerian Dental Association and all stakeholders could assist the Federal Government of Nigeria to overcome these barriers and formulate policies that will prevent oral disease and move the nation forward to achieve the millennium development goal. Nigerian Dental Journal Vol. 16 (1) 2008: pp. 40-4

Global Theme Issue: Poverty and Human Development The effect of poverty on access to oral health care in Nigeria

Nigeria is a country with a population of over 140 million people (1). Over 60% of Nigerians live in rural areas. Poverty is especially severe in rural areas where social services and infrastructure are limited or non existent. Africa is the continent where the poorest people in the world live. Nigeria is the most populous black African country where about 70% of the population live under one dollar per day (2). Nigeria has been classified as a poor nation. In Nigeria, majority of those living in rural areas are poor and depend on agriculture for food and income. Small scale farmers who cultivate tiny plots of land and depend on rainfall rather than irrigation system produce about 90% of the country\\u27s food. Women play a major role in the production, processing and marketing of food crops. The poorest group go on subsistence living but are often short of food, particularly during the pre-harvest period. Many poor Nigerians suffer from malnutrition and other diseases related to poor nutrition such as acute necrotizing ulcerative gingivitis (ANUG) and cancrum oris (3-6). The HIV/AIDS pandemic has also taken a heavy toll on the rural population and could be considered an emerging public health problem. The extremes of poverty in Nigeria are outrageous. The outrage is not just that avoidable deprivation, suffering and death are intolerable; it is also that these situations coexist with affluence. Corruption is endemic in Nigeria and this has impoverished the nation. Intergenerational poverty exists in the country. Fight against poverty is necessary to reduce intergenerational transfer of poverty in Nigeria because most Nigerian children are born into poverty. The oral health status of underprivileged Nigerians is generally poor. Many Nigerians suffer from oral diseases such as caries, fracture teeth, gingivitis, periodontitis, acute necrotizing ulcerative gingivitis, cancrum oris, malocclusion, tumours and other dental problems (7-15). Non availability of National data on the prevalence of common oral diseases among Nigerians is a major problem and poses a great challenge to the Nigerian Dental Association whose members are major stakeholders regarding oral health care delivery system in the country. Lack of national data has affected planning meaningful oral health care for Nigerians. This paper identified the barriers to access oral health care and stress the various strategies by which the Nigerian Dental Association and all stakeholders could assist the Federal Government of Nigeria to overcome these barriers and formulate policies that will prevent oral disease and move the nation forward to achieve the millennium development goal

A case of broomstick in the root canal extending beyond the apex causing epistaxis

There have been several reports describing the placement, by patients of foreign objects in to the exposed pulp chambers and canals. Foreign objects inserted in the canal have varied from radiolucent objects like wooden tooth picks or tooth brush bristles to radiopaque materials like paper pins, needles and pencil leads. In this present case a 13 year old boy reported at the outpatient clinic of the Department of Preventive Dentistry, Obafemi Awolowo University, Ile-Ife with a 6 year history of trauma to the upper anterior teeth. There was bleeding from the nose, painful labial swelling, and discharging sinus around the maxillary right permanent central incisor for 4 days. A periapical radiograph did not show presence of a foreign object in root canal of the fractured discoloured right maxillary central incisor. The patient denied inserting any object in the canal. The tooth was extracted and a broomstick extending by 12mm beyond the apex of the tooth and bleeding from the nose was observed. A case of a unique foreign object in the pulp chamber projecting beyond the apical foramen and resulting in epistaxis is reported. The importance of early treatment of fractured teeth in children is stressed to prevent complications. Keywords: Broomstick, root canal, epistaxisNigerian Dental Journal Vol. 15 (1) 2007: pp. 39-4

A case of broomstick in the root canal extending beyond the apex causing epistaxis

There have been several reports describing the placement, by patients of foreign objects in to the exposed pulp chambers and canals. Foreign objects inserted in the canal have varied from radiolucent objects like wooden tooth picks or tooth brush bristles to radiopaque materials like paper pins, needles and pencil leads. In this present case a 13 year old boy reported at the outpatient clinic of the Department of Preventive Dentistry, Obafemi Awolowo University, Ile-Ife with a 6 year history of trauma to the upper anterior teeth. There was bleeding from the nose, painful labial swelling, and discharging sinus around the maxillary right permanent central incisor for 4 days. A periapical radiograph did not show presence of a foreign object in root canal of the fractured discoloured right maxillary central incisor. The patient denied inserting any object in the canal. The tooth was extracted and a broomstick extending by 12mm beyond the apex of the tooth and bleeding from the nose was observed. A case of a unique foreign object in the pulp chamber projecting beyond the apical foramen and resulting in epistaxis is reported. The importance of early treatment of fractured teeth in children is stressed to prevent complications

Perceived and Normative Needs of Facial Cleft Patients Seen in Nigeria

Objective: To evaluate the pattern of presentation and assessing treatment needs of children with facial clefts. Material and Methods: This was a cross sectional study of 49 patients seen at the cleft clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife for a 39-month period of study. Data collected were patient’s bio-data including age, date of birth, sex, social class, age of parents, dental findings, associated malformations, treatment given and referral using an interviewer-administered questionnaire. Data was analyzed using the Statistical Package for Social Sciences. Frequency distributions were carried out for all variables and the Pearson Chi-Square Test was applied to assess the significance of differences between groups at a p value of 0.05. Results: Cleft lip and palate had the highest preponderance 23 (47.0%) followed by cleft lip 14 (28.6%) and cleft palate 12 (24.5%). There were more females 28 (57.14%) than males 21 (42.9%) at male to female ratio of 3: 4, though; it was not statistically significant (p-0.73). Most of the patients (73.5%) belong to the low social class. The high social class had 13 (26.5%) cases. Conclusion: The most important treatment needs of cleft patients in this study were: review/follow-up of treatment protocol, oral hygiene instructions, cleft palate repair, cleft lip repair, and referral to the Orthodontist for treatment of varying degrees of malocclusion in descending order. This trend in the treatment needs arose because most of the patients were still ignorant of the implications of managing facial cleft defects through the multi-disciplinary treatment approach