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.

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

Mandibular Fractures Associated with Domestic Violence in Calabar, Nigeria

Background: The purpose of this study was to analyze the pattern of mandibular fractures associated with domestic violence.Methods: This prospective study was carried out at the University of Calabar Teaching Hospital (UCTH) in the Accident and Emergency Centre and Dental and Maxillofacial Clinic between the calendar years of 2005 and 2008 (four years). Only consecutive Dental and Maxillofacial injury cases that sustained mandibu-lar fracture by domestic violence were included in the data collection.Results: The ages of patients ranged from 15-42 years with a mean of 30±3.2 years. Majority of the patients were in the second, third and fourth decades of life. There were 52(71.2%) males and 21(28.8%) females with a male- to- female ratio of 2.5:1. There was sig-nificant association between social class and type of fracture sustained (÷2 = 14.0, p= 0.0073). Patients in the lower social class were more likely to sustain mul-tiple fractures. The mechanisms of injury were by punching with the fist 41(56.2%), use of weapons 27(37.0%) and kicking with legs 5(6.8%). Majority of the fractures occurred at the angle, 52(31.3%) and condyles, 45(27.1%). All the patients were treated by closed reduction technique. The complications re-corded were delayed union, 5(38.4%), infection, 3(23.1%), paraesthesia / anaesthesia of the lower lip, 3(23.1%) and malunion, 2(15.4%).Conclusion: Mandibular fractures due to domestic violence do occur and constitute part of the cases to be encountered by the practising oral and maxillofacial surgeon who should be cognizant to its surgical and social implication

Mandibular Sites Prone to Fracture: Analysis of 174 Cases in a Nigerian Tertiary Hospital

Background: Mandibular fracture is an important surgical condition in our environment and elsewhere in the world. Objective: The purpose of this study is to clinically determine the most common sites of the mandible prone to fracture. Patients and method: This two-year prospective study was carried out at the Dental and Maxillofacial clinic, University of Calabar Teaching Hospital, Nigeria, in 2007 and 2008. Results: One hundred and seventy four patients’ ages between six to 70 years (mean 28.7± 5.3 years) were studied. One hundred and forty two (81.6%) of them were males and 32 (18.4%) females, with a male/female ratio of 4.4:1.Road traffic accident significantly (χ2=17.1607, P=0.0087) accounted for 139 (79.9%) of the fractures. There were 244 fracture sites in the 174 patients, with the body of the mandible being significantly (χ2=21, P=0.0008) affected than other sites in fracture (n= 115, 47.1%). However, 96 (39.3%) and 132 (54.1%) of the fractures occurred on the right and left sides of the mandible respectively. Most patients had single (44.3%) and double (31.6%) fractures and this finding was significant (χ2=60.9314, P=0.0000). The patients encountered were fully (62.6%) and partially dentate (37.4%). The fractures were successfully treated by conservative method, closed reduction and open reduction techniques. Conclusion: This study shows that the tooth-bearing portion, body, left and right sides of the mandible are most commonly prone to fracture when multiple aetiologies are considered. Keywords: Mandible, site, fracture, CalabarGhana Medical Journal, September 2011, Volume 45, Number

Impact of an add-on strategy of the C-C chemokine receptor 5 (CCR5) antagonist maraviroc on hepatic inflammation in HIV-infected individuals with non-alcoholic steatohepatitis: a paired-liver biopsy proof-of-concept study

Introduction. Non-alcoholic steatohepatitis (NASH) is of concern in an aging and antiretroviral therapy (ART)-pretreated HIV-infected population. No therapeutic agent has yet been licensed for the treatment of NASH in order to reduce hepatic inflammation, steatosis, or liver fibrosis. The CCR5 receptor antagonist maraviroc is an approved HIV drug, but hepatic CCR5 inhibition has also been suggested to reduce hepatic inflammation and fibrogenesis in animal models. This study aimed to investigate the impact of a maraviroc add-on strategy on hepatic inflammation in ART-treated HIVmono-infected individuals with NASH. Methods. The MASH study (Maraviroc-Add on for Steatohepatitis in HIV infected patients) was a single-arm, open-label trial conducted across 5 sites in Germany and the United Kingdom. HIV-infected individuals with biopsy proven NASH were invited to add maraviroc BID to their existing, suppressive ART regimen for 48 weeks, and undergo a second liver biopsy thereafter. Patients had immunologic, cytokine, metabolic, and histologic assessment at baseline and end of treatment (EOT). Results. Overall, 24 subjects were screened, and 13 completed the study and were analyzed. All participants were male, median age 50.5 years [45.5-55.5], baseline BMI 30.66 kg/m2 [27.92-33.63]; 83.3% (10/12) had insulin resistance. At baseline, 11/13 patients (85%) had fibrosis >1 (Metavir). At EOT no significant changes in the hepatic immune cell infiltrate (CD4/CD8/CD68) were observed, however, the NAS score decreased non significantly from 4.077 ± 0.76 at baseline to 3.64 ± 0.51 at EOT (p = 0.125). At week 48, 7/11 patients (63%) showed significant fibrosis> stage 1, EOT BMI was similar compared to baseline. Add-on MVC had no significant impact on inflammatory markers or lipid metabolism