Prevalence of dental caries and gingivitis among children with type 1 diabetes mellitus attending an outpatient clinic at Kenyatta National Hospital in Kenya

Background: Diabetes mellitus (DM) has previously been associated with affluence, but currently its prevalence has been rising at an alarming rate in all populations worldwide. The reduced salivary secretions associated with type 1 diabetes mellitus (T1DM) can predispose the children to dental caries and gingivitis.Objective of the study: To determine the prevalence of dental caries and gingivitis among a cohort of 3-18 year-old children diagnosed with T1DM attending Kenyatta National Hospital (KNH) paediatric outpatient clinic.Design: A descriptive cross-sectional study using a purposive sampling method.Setting: KNH paediatric outpatient clinic.Subjects: A total of 82 patients with T1DM and who attended the diabetic outpatient clinic at KNH during the months of January to May 2015 were studied. The diagnostic tests, duration since diagnosis of the disease and level of control of T1DM were obtained from the participants’ hospital records. An oral examination was undertaken under field conditions. Dental caries was determined using the WHO criteria 2005 and gingivitis scored using the gingival index by Loe and Silness 1963. The collected data were analyzed using SPSS version 20 computer software. Fisher’s exact test, Pearson’s Chi Square and regression models were used to test significant relationships (p<0.05) between the variables.Results: The mean age of the participants was 11.6 ±4.1 SD, with the duration of having T1DM ranging from one month to six years. Seventy-two percent of the children had poorly controlled T1DM. While the prevalence of dental caries among the children was 78% and for gingivitis was 100%, there were no statistically significant relationships between T1DM and dental caries (p>0.05) and gingivitis (p>0.05)Conclusion: The prevalence of dental caries and gingivitis was high, perhaps as a result of the high level of uncontrolled T1DM (72%) and the lack of oral health education among the patients in the study

A pilot study on the global practice of informed consent in paediatric dentistry

Background: Conducting oral treatment early in the disease course, is encouraged for better health outcomes. Obtaining informed consent is an essential part of medical practice, protecting the legal rights of patients and guiding the ethical practice of medicine. In practice, consent means different things in different contexts. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) is becoming popular and cost effective methods to manage carious lesions, however, cause black discolouration of lesions treated. Obtaining informed consent and assent is crucial for any dental treatment—and has specific relevance with SDF/ SF treatments. Methods: The aim of this paper is to describe informed consent regulations for dental care in a selection of countries, focusing on children and patients with special health care needs. An online survey was shared with a convenience sample of dental professionals from 13 countries. The information was explored and the processes of consent were compared. Results: Findings suggest that there are variations in terms of informed consent for medical practice. In Tanzania, South Africa, India, Kenya, Malaysia and Brazil age is the determining factor for competence and the ability to give self-consent. In other countries, other factors are considered alongside age. For example, in Singapore, the United Kingdom, and the United States the principle of Gillick Competence is applied. Many countries' laws and regulations do not specify when a dentist may overrule general consent to act in the “best interest” of the patient. Conclusion: It is recommended that it is clarified globally when a dentist may act in the “best interest” of the patient, and that guidance is produced to indicate what constitutes a dental emergency. The insights gathered provide insights on international practice of obtaining informed consent and to identify areas for change, to more efficient and ethical treatment for children and patients with special needs. A larger follow up study is recommended to include more or all countries

Factor analysis in relation to survival rate of proximal ART restorations in primary molars

Atraumatic Restorative Treatment (ART) is een tandheelkundige behandeling die veelvuldig wordt toegepast in minder ontwikkelde landen en gebieden. Hiermee kan met alleen handinstrumenten cariës verwijderd worden en kunnen geprepareerde caviteiten gevuld worden met een adhesief vulmateriaal, zoals glasionomeercement. Arthur Kemoli analyseerde de overlevingskans van tweevlaks-ART-restauraties na twee jaar. Hij keek daarbij naar de invloed van de caviteitsgrootte, de ervaring van behandelaar en assistent, de methode van droogleggen, en het merk glasionomeercement. In totaal werden 804 kinderen van zes tot en met acht jaar van 30 scholen in het Machakos-district in Kenia behandeld. Bij ieder kind werd één restauratie vervaardigd. Op basis van een set van beoordelingscriteria beoordeelde Kemoli de vullingen kort na de vervaardiging en na twee jaar. De overleving liep daarbij terug van 94,4 naar 30,8 procent. Ongeacht het gebruikte vulmateriaal, hadden de ervaring van behandelaar en van de assistent, de grootte van de caviteit en de wijze van isolatie invloed op het resultaat. Meer ervaring van zowel behandelaar als assistent, een caviteit met medium omvang, en droogleggen met rubberdam geven een grotere overlevingskans

ORTHODONTIC TREATMENT NEEDS AMONG 12-15 YEAR-OLDS IN MOSHI, TANZANIA

ABSTRACTObjective: To assess malocclusion and orthodontic treatment needs among 12-15-year-olds in Moshimunicipality, Tanzania.Design: A cross-sectional study.Setting: Moshi municipality, Tanzania.Subjects: Two hundred and eighty nine randomly selected primary school children in Moshimunicipality in the year 2003.Results: Maxillary median diastema occurred in 20.1% of the children. Crowding and spacing inthe incisor segments occurred in 41.2% and 28.4% respectively with significantly more crowdingin males than in females (p = 0.009). Anterior irregularities occurred in 46% of the sample in themaxilla and 51.6% in the mandible. These irregularities were significantly more common in thefemales than in males in the maxilla and mandible (p=0.014, p=0.037 respectively). Reverse overjetwas extremely rare (0.3%). Anterior openbite and antero-posterior molar relation discrepanciesoccurred in 6.2% and 32.5% of the sample, respectively. Crowding, irregularities in the incisorsegments and antero-posterior molar relation discrepancies were dominant malocclusion traitsin this population. The sample mean DAI score was 24.6 points (CI 95% 23.86–25.36). There wasno statistically significant gender difference of DAI scores (p = 0.473). About 65% of the subjectshad either no need or had slight need for treatment whereas 35.3% were found with orthodontictreatment needs ranging from elective (21.5%), highly desirable (6.9%) to mandatory (6.9%).There was no significant gender difference in the categories of treatment need (p = 0.942). Unmetorthodontic treatment needs were present in this population with a very small proportion ofsubjects exhibiting handicapping malocclusion.Conclusion: The information from this study forms part of the basis not only for further research,but also for planning orthodontic care in this community where unmet orthodontic treatmentneeds are present

The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using ART technique

OBJECTIVE: To determine the examiner's accuracy in selecting proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART) approach. BASIC RESEARCH DESIGN: Intervention study. CLINICAL SETTING AND PARTICIPANTS: A total of 804 six to eight year-olds from 30 rural schools in Kenya participated in the study. INTERVENTION: Three examiners selected a total of 1,280 suitable proximal carious lesions in primary molars after examining 6,002 children from 30 schools randomly selected out of 142 schools in two divisions. Seven operators randomly paired on a daily basis with eight assistants restored the lesions. An explanation was provided for any cavity that was not restored. Pre-and post-operative radiographs of the cavities were also taken for evaluation. MAIN OUTCOME MEASURES: The examiner's choice of suitable proximal cavities restorable using the ART approach was related to the decision made to either restore or not during the operative stage. The radiographic findings of the selected cavities were also compared to the decision made by the operator. The results obtained were used to determine the examiner's accuracy in selecting suitable proximal cavities for restoration using the ART approach. RESULTS: The majority of the children recruited in the study were excluded due to absenteeism, pulpal-exposure or anxiety during the operative stage. Only 804 children received one restoration in their primary molars. The examiner's accuracy in selecting suitable ART-restorable cavities clinically was 94.9% and based on radiographic analysis was 91.7%. CONCLUSIONS: A trained and diligent examiner has a very good chance of selecting proximal carious lesions restorable with the use of ART approach, without the threat of dental pulpal-involvement during the excavation of caries

PREVALENCE AND PATTERN OF EARLY CHILDHOOD CARIES AMONG 3-5 YEAR OLDS IN KIAMBAA, KENYA

Objective: To determine the prevalence and pattern of early childhood caries among three to five year olds.Design: This was a descriptive, cross-sectional study.Subjects: A total of 336 children aged 3-5 years.Setting: Pre-schools in Kiambaa division, Kiambu District, Kenya.Results: Slightly over a half, 201 (59.5%) had dental caries. The mean decayed, missing and filled teeth (dmft) was 2.46 ± 2:3.2 with the greatest component (95%) being decayed teeth. The mandibular deciduous molars and the maxillary incisors were the most frequently carious teeth.Conclusions: The prevalence of early childhood tumours in Kiambaa was 59.5%. The mandibular deciduous molars and maxillary incisors had the highest caries frequency