Extraction of mesioangularly impacted third molar: Dental drill versus crane pick elevator on treatment outcome.

BACKGROUND: The use of dental drill during extraction of impacted mandibular third molars lead to production of aerosol, fear in some patients and this necessitates the need for an alternative instrument.OBJECTIVE: To compare the treatment outcome in two cohorts of patients after surgical extraction of symptomatic mesio-angularly impacted mandibular third molars.PATIENTS AND METHODS: Apparently healthy subjects who presented to the oral and maxillofacial surgery clinic of our institution, with an indication for surgical extraction of symptomatic mesio-angularly impacted mandibular third molar were assessed. Those classified as Pell and Gregory class 2 ramus relationship, class A and B depth, with favourable root morphology were uniformly randomized into dental drill and Crane pick elevator groups. Information on demographics, reasons for extraction, trismus, swelling, pain and complaints during follow-up were obtained and statistically analyzed.RESULTS: Overall 86 subjects, evenly distributed between the two groups were studied. Post-operative mean for trismus, swelling and pain were lower on the 3rd day in those treated with Crane pick elevator than dental drill. However, by the 7th day, the results were the same as the trismus, swelling and pain resolved clinically, without complication.CONCLUSION: Crane pick dental elevator could serve as a useful substitute to dental drill in the extraction of mild mesioangularly impacted mandibular third molars.KEYWORDS: Crane pick elevator, dental drill, mesio-angular impaction, osteotomy

Mandibular fractures caused by sports: a descriptive clinical study of 72 patients managed in a tertiary health facility

Background: There is need to understand the nature of sports-related traumatic injuries to the oro-facial region in an environment due to increasing popularity of sports.Objective: To report the prevalence, characteristics, treatment approach and outcome of mandibular fractures sustained through sports.Patients and Methods: This is a descriptive clinical study that evaluated mandibular fractures sustained during sports over 10 years. The data analyzed were age, sex, occupation, mechanism of injury, site, concomitant injuries, and monthly/yearly distribution of patients, treatment and complications.Results: The prevalence of sports related mandibular fractures over the 10 year period was 72 (7.4%) patients who had 79 (5.7%) different fractures. This prevalence was optimum in the month of July and in the year, 2012. The male to female ratio was 11:1. Their ages ranged from 16-31 years but majority (76.4%) were between 20 to 27 years (P=0.001). The frequency of patients was less in the first five years (43.1%) when compared with the subsequent five years (56.9%) of the ten-year study period (P=0.03). Football related injuries in patients (87.5%, P=0.000) were the most common cause. Concomitant injuries occurred in 23 (32.0%) subjects, and these were mostly cerebral concussion (n=13, 18.1%). The methods of treatment utilized to manage the patients were conservative (n=10, 13.9%) and closed reduction (n=62, 86.1%). Limitation of mouth opening was complication in 3 (4.2%) patients treated by inter-maxillary fixation and these were corrected during follow-up.Conclusion: Although the treatment outcome was good, this study has shown an increasing trend in the occurrence of mandibular fractures

Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above

Background: The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice.Objective: To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar.Methods: This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar.Results: Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001).Conclusion: This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical ex- traction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments.Keywords: Mandible, impaction, second molar, third molar, prognosis.

Complications of the use of trans-osseous wire osteosynthesis in the management of compound, unfavorable and non-comminuted mandibular angle fractures

Objective: To analyze cases of compound, unfavorable and non-comminuted mandibular angle fractures treated by trans-osseous wiring, presenting postoperative complications, in a low resource center.Materials and methods: This was a 13-year retrospective study of 1,324 fractures in 1,317 subjects. The predictor variables were age, gender, aetiology, time lag between injury and treatment, and concomitant mandibular and midfacial fractures. The outcome variable was the development of complication(s) after treatment. Descriptive and bivariate statistics were computed with EPI INFO 7 version software, and the P value was set at 0.05.Results: The sample size was composed of 63/1317 (4.8%) of patients with complications. There were 48 males and 15 females with male: female ratio of 3.2:1. The age of the patients ranged from 21 to 62 years (mean 37.4± 5.6 years). The test of significance showed statistically significant association between complications of mandibular angle fractures and increasing age (P<0.002), male gender (P<0.001), road traffic accident (P<0.001), longer time lag between injury and treatment of fractures (P<0.000), and concomitant mandibular fractures (P<0.000). Deranged occlusion (n=19, 28.8%) and limited mouth opening <35mm (n=16, 24.2%) were the common complications. The complications were successfully treated during follow-up.Conclusion: The use of trans-osseous wire osteosynthesis gave good results, and can still be useful in centres that are less well equipped and where access to rigid internal fixation with mini plates is either limited or unavailable. Funding: Self-fundedKeywords: Mandible, angle, fracture, trans-osseous wiring, complication

Parturients’ Awareness and Perception of Benefits of Breast Feeding in the Prevention of Infant and Childhood Oral and Dental Diseases

Background: Breastfed babies have a better chance of improved oral and dental health than their counterparts that were artificially-fed. Objective: To assess the knowledge and attitude of postnatal mothers on the benefits of breastfeeding in prevention of oral and dental diseases. Materials and Methods: A cross – sectional descriptive survey of 206 mothers attending the postnatal clinic of theUniversity of Calabar Teaching Hospital, Calabar on the knowledge and attitude of breastfeeding in prevention of oral diseases in infants.Results: Initiation of breastfeeding was early within 3 days of childbirth in 90.3% of mothers. The lack of awareness or knowledge of specific childhood dental/ oral disorders prevented by breastfeeding by majority (89.3%) of the respondents was statistically significant. Actual willingness to breastfeed baby for longer periods after instruction on specific oral health benefits of breastfeeding was elicited in 180 (87.4%) mothers.Conclusion: There is a need to improve the knowledge of specific benefits of breastfeeding in prevention of dental diseases. This calls for education of the health professionals beside the dental practitioners who handle the mothers for themselves to be aware.Funding: The study was funded by the authors.Keywords: Breastfeeding, prevention, oral, dental, disease

Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above

Background: The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice. Objective: To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar. Methods: This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar. Results: Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001). Conclusion: This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical extraction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments. DOI: https://dx.doi.org/10.4314/ahs.v19i1.55 Cite as: Anyanechi CE, Saheeb BD, UC O. Is prophylactic removal of impacted mandibular third molar justified in all patients? A prospective clinical study of patients 50 years and above. Afri Health Sci. 2019;19(1). 1789-1794. https:// dx.doi. org/10.4314/ ahs. v19i1.5

Prevention of collapse of the contralateral half of the mandible after hemimandibulectomy: Our experience in a low-resource center

Background: The management of pathologic lesions of the mandible includes plans for the reconstruction of the resultant defect to give the patients optimal surgical reconstructive and prosthetic results. Objective: To evaluate the degree of deviation of the contralateral half of the mandible toward the surgical defect after hemimandibulectomy and intermaxillary fixation (IMF). Patients and Methods: This is a 9-year prospective single-blinded clinical study conducted at the Dental and Maxillofacial Surgery Clinic of our institution. Information obtained from the patients included age, gender, type of mandibular lesion, method of wound closure, duration of IMF, temporo-mandibular joint (TMJ) symptom(s), and the deviation toward the surgical defect of the remnant contralateral half of the mandible, measured in centimeter at maximum mouth opening. Results: Ninety-six patients, unevenly distributed according to their duration of tolerance of IMF, were studied. The age of the patients ranged from 29 to 57 years with an overall mean age of 42.6 ± 5.1 years. There were 72 males and 24 females with a male-to-female ratio of 3:1 (P = 0.001). The lesions that were extirpated were all benign, and ameloblastoma was the most common tumor (P = 0.001). The shorter the duration of IMF, the greater the deviation of the mandibular mid-line toward the surgical defect (P = 0.001). Conclusion: This study shows that there is a deviation of mid-line of the residual mandible toward the surgical defect after hemimandibulectomy, even after its immobilization with IMF for 4–12 weeks. IMF is still useful in the prevention of mandibular collapse after hemimandibulectomy

Fungal footprints in oral cancer: unveiling the oral mycobiome

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer, with a high mortality rate. There is growing evidence supporting a link between oral cancer and the microbiome. The microbiome can impact various aspects of cancer, such as pathogenesis, diagnosis, treatment, and prognosis. While there is existing information on bacteria and its connection to oral cancer, the fungi residing in the oral cavity represent a significant component of the microbiome that remains in its early stages of exploration and understanding. Fungi comprise a minuscule part of the human microbiome called the mycobiome. Mycobiome is ubiquitous in the human body but a weakened immune system offers a leeway space for fungi to showcase its virulence. The role of mycobiome as a colonizer, facilitator, or driver of carcinogenesis is still ambiguous. Reactivating the mycobiome that undergoes collateral damage associated with cancer treatment can be watershed event in cancer research. The coordinated, virulent, non-virulent behavior of the fungi once they reach a critical density must be hacked, considering its diagnostic, prognostic and therapeutic implications in cancer. This review highlights the diversity of the mycobiome and its potential role in oral cancer