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

Effects of socio-economic and behavioural factors on early childhood caries among children attending a dental clinic in Nairobi, Kenya

Background: Early childhood caries (ECC) is a growing oral health problem in the developing nations and has been associated with a number of socio-economic and behavioural factors.Objective: To determine the effects of some socio-economic and behavioural factors related to ECC in 3-6-year-old children attending an out-patient paediatric dental clinic in Nairobi, Kenya.Design: A descriptive cross-sectional studySetting: The Lady Northey dental clinic during the period of October to November 2014.Subjects: Two hundred and seventy two (272) children whose parents/guardians were initially interviewed to determine the socio-economic status of each of the children.Results: The prevalence of dental caries among the children was 95.5%, most of whom had poor oral hygiene. The high decayed, missing and filled teeth (dmft) was associated with the low socio-economic status of the parents/guardians, poor oral hygiene, increased consumption of cariogenic sugars and low oral health seeking behaviour.Conclusion: The high prevalence of ECC of 95.5% found among the children who participated in the study has a prominent association to their socio-economic and behavioural factors

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

PREVALENCE OF MOLAR INCISOR HYPOMINERALISATION IN SIX TO EIGHT YEAR-OLDS IN TWO RURAL DIVISIONS IN KENYA

Objective: To determine the prevalence of molar incisor hypomineralization (MIH) and any associated causes of MIH in children from two rural divisions in Kenya.Design: Prospective cross-sectional study.Setting: Seventeen primary schools in Matungulu and Kangundo divisions of Machakos district in Kenya.Subjects: All six to eight year-olds in the seventeen primary schools.Results: A total of 3,591 children (55.6% males and 44.4% females) were examined for MIH. All the children were from a low socio-economic community with little access to proper medical/dental health care. The prevalence of MIH was 13.73%, with a female to male ratio of 3:1.Conclusion: The prevalence of MIH of 13.73% was high in the study population and was probably associated with the poor health conditions that the children went through during the most venerable period of between birth and age three years

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

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