Prevention of alveolar osteitis after third molar surgery: Comparative study of the effect of warm saline and chlorhexidine mouth rinses

Background: Chlorhexidine mouth rinses have a proven efficacy for the prevention of alveolar osteitis after third molar surgery. This study compares the efficacy of warm saline rinse, a component of postextraction instructions, with that of chlorhexidine in our institution over a period of 2 years.Patients and Methods: Apparently healthy patients who were referred to the Oral Surgery Clinic of our institution, with an indication for surgical extraction of lower third molar were prospectively, consecutively, and uniformly randomized into warm saline and chlorhexidine groups. The experimental group (n = 50/100) were instructed to gargle twice daily with warm saline, whereas the chlorhexidine group (n = 50/100) were instructed to gargle with 0.12% chlorhexidine. Information on demographic, types and level of impaction, indications for extraction, and development of alveolar osteitis were obtained and analyzed. Comparative statistics were done using Pearson’s Chi-square, Fisher’s exact, or Mann–Whitney U-tests as appropriate. P <0.05 was considered statistically significant.Results: The demographic, types and level of impaction as well as indications for extractions were comparable between the study groups (P > 0.05). The overall prevalence of alveolar osteitis was 5%. There was no statistically significant difference between application of warm saline and 0.12% chlorhexidine rinse with respect to the development of alveolar osteitis (P = 0.648).Conclusion: Warm saline mouth rinse is equally as effective as chlorhexidine mouth rinse, as prophylaxis against prevention of alveolar osteitis after third molar surgery.Keywords: Alveolar osteitis, chlorhexidine, prevention, warm salin

Intestinal Parasitoses and CD4 Levels among HIV/AIDS Patients Attending a Health Facility in Akpabuyo, Nigeria

Many HIV/AIDS patients still present with low CD4 count and other complications even when placed on highly active antiretroviral therapy (HAART). Prevalence of intestinal parasitoses and their influence on CD4 levels of HIV/AIDS patients attending a Hospital in Nigeria was studied to determine their role in low CD4 levels during treatment. Two hundred and fifty HIV sero-positive and 100 sero-negative subjects were recruited for the study. HIV screening was done using Determine and confirmed with Unigold with Start Park as tie breaker. Questionnaires were used to obtain subject’s bio-data, Partec Cyflow counter (GEM Laboratories, Germany) was used for estimation and differentiation of CD4 cells while parasites were detected using direct stool microscopy, formal ether and modified Ziehl Neelson techniques. Prevalence of parasites was 25 (7.1%) with test subjects being more infected (7.6%) than  controls (6.0%) (P < 0.001). The parasites detected were Entamoeba histolytica/dispar (7.8%), Ascaris lumbricoides (4.2%), Gairdia intestinalis (1.2%), Cryptosporidium parvum (0.6%), and Hookworm (0.4%). Parasite positive subjects had significantly lower mean CD4 count (373.3±275.6 c/μl) than their parasite negative counterpart (626.7±337.6 c/μl), P = 0.028, and likewise in the control group.  HIV/parasite infected subjects on ART had significantly lower mean CD4 count (391.8±270 c/μl) than HIV/parasite negative subjects on ART (659.8±331.1), P = 0.01. Intestinal parasitoses may aggravate CD4 reduction in HIV/AIDS patients even when on  HAART, hence undermine the potency of ART and hinder their successful management. Screening tests before baseline treatment for HIV/AIDS patients should include parasitological diagnosis

Ankylosis of the mandible: a study of 32 cases.

Objectives: The aim of this study was to clinically evaluate ankylosis of the mandible amongst 32 Nigerians who presented at the Dental & Maxillofacial Surgery clinic, University of Calabar Teaching Hospital Calabar, southsouth Nigeria. Methods: We carried out a prospective study on the 32 patients with mandibular ankylosis. The focus was on the ages at onset of limitation in mouth opening, time of presentation for treatment, gender, aetiological factors, clinical features, radiographical findings, type of ankylosis, anaesthetic technique, surgical treatment, complications, results and follow-up review. The data obtained were subjected to statistical analysis using EPI Info 2000 version software Results: There were 18 (56.3%) males and 14(43.7%) females giving a male-to-female ratio of 1.3:1. Patients’ ages ranged from 3.5 years to 54 years with mean age of 34 + SD 6.4 years. All the patients complied with the follow-up appointments as scheduled within the first one year after commencement of treatment. Six (20.0%) absconded thereafter, while 7 (29.2%) had varying reductions of interincisal distance achieved at surgery. No relapse of ankylosis was recorded. Conclusion: Trauma and infection are the main aetiological factors in temporo-mandibular joint ankylosis. The technique of surgery and conservative treatment employed in each case depended on the site, extent, and type of ankylosis. There was no relapse in all the cases treated. It is expected that this effort would further increase the understanding in the management- of this disabling condition among oral & maxillofacial surgeons.Keywords: Ankylosis, mandible, temporomandibular joint, Nigeria