Hereditary gingival fibromatosis: report of family case series

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic, dense fibrous connective tissue with acanthotic gingival epithelium. A family presented at the School of Dental Sciences, University of Nairobi with a complaint that some of the children developed swollen gums very early in life and that this got worse with eruption of the permanent teeth. The first born, a 23- year- old male, had had the swellings for over ten years. Other siblings aged 5,9 and 12 years were also affected. The swellings had affected the appearance, speech and the psychosocial wellbeing of the children. The parents were unaffected with apparently negative family histories. Following oral examination and appropriate investigations, conventional gingivectomy was performed of the maxillary and the mandibular gingivae for the siblings: the 23 -12- and the nine- year olds. The fourth affected child, a five- year- old, was still in primary dentition and had just started showing mild signs of gingival hyperplasia. The histopathological examination of the specimens from the present cases confirmed features consistent with those of HGF. This article highlights a familial presentation of HGF

Capacity of non-tertiary Kenyan health facilities selected for decentralised dental training

Objective: To determine the capacity of six non-tertiary Kenyan hospitals enrolled as sites for decentralised dental education.Design: A descriptive cross-sectional study.Setting: The Dental departments of six non-tertiary Kenyan health facilities.Main outcome measures: Capacity of the hospitals to be used as sites for decentralised dental education.Results: Five out of the six facilities had capacity for final year undergraduate students to gain learning experiences in more than 60% of the clinical disciplines studied. All the selected facilities had challenges of lack of specialists, broken down dental equipment and inadequate materials.Conclusion: Although the six hospitals faced various challenges in maintenance of equipment, availability of dental materials and specialist staff, five out of the six facilities had the capacity for dental student learning in more than 60% of the clinical disciplines studied

Factors impacting on the nutritional status of population aged 45 years and above in Nairobi: a cross sectional study

Objective: To provide data on nutritional status and risk factors affecting the population aged 45 years and above for health policy development and program planning.Design: A cross sectional studySetting: Dagoretti sub-County of Nairobi County.Subjects: Two hundred and eighty nine (289) purposefully selected households (29.8%males and 70.2%females) aged 45 years and above.Main outcome measures: Quantitative household data were collected using a semistructured questionnaire. In-depth interviews and focus group discussions were used to collect qualitative data. Information on selected demographic and socio-economic household characteristics, health and food security was documented. Nutritional status was assessed using body mass index (BMI) and mid-upper arm circumference (MUAC).Results: The study established that majority of this population faced many nutrition risks including lack of access to finances 161(58.5%), ill health 70(25.5%), rejection by community and relatives 26(9.5%) and taking care of grandchildren 10(3.6%) abandoned or orphaned by HIV/AIDS. Malnutrition using MUAC was 18.8% while by BMI was 11.4%. Of the population assessed, 46.4% had normal nutritional status while 40.9% were overweight, and 12.7% underweight, with more females (48.0%) than males (25.9%) being overweight.Conclusion: Under nutrition and obesity are problems facing this population group aged 45 years and above in Nairobi. There is need for policy makers and programme managers to develop interventions aimed at minimising the effects of risks faced by this population in order to improve their well being

Oral hygiene practices and risk of oral leukoplakia

Objective: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. Design: Case control study. Setting: Githongo sublocation in Meru District. Subjects: Eighty five cases and 141 controls identified in a house-to-house screening.Results: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the “don't brush” group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1 .4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). Conclusion: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes. East African Medical Journal Vol. 83(4) 2006: 73-7

Nutritional and oral health status of an elderly population in Nairobi

Objective: To determine the nutrition and oral health status of elderly persons in Nairobi, Kenya. Design: A cross-sectional study. Setting: Households in Dagoretti Division of Nairobi. Subjects: Two hundred and eighty nine persons (29.8% males and 70.2% females) aged 45 years and above were assessed. Results: The level of malnutrition using the mid upper arm circumference was 18.8% while by body mass index was 11.4%. Of the population assessed, 46.4% had normal nutritional status while 40.9% were overweight, with more females (48.0%) than males (25.9%) being overweight. The study established that many of the elderly persons suffered from dental problems, especially periodontitis with 89.9% having dental plaque, calculus 85.6%, gingival recession 82.5% and bleeding gums 77.4%. The decayed index missing and filled teeth, was 7.173 with 19.7% caries free, 51.9% reported tooth mobility and edentulousness was common. Conclusions: Under-nutrition, obesity and dental problems are issues of concern among the elderly. There is need to develop policies that will look into the nutrition and dental health of the elderly in order to improve their welfare.East African Medical Journal Vol. 85 (8) 2008: pp. 378-38

Guideline for Care of Patients with the Diagnoses of Craniosynostosis: Working Group on Craniosynostosis

This guideline for care of children with craniosynostosis was developed by a national working group with representatives of 11 matrix societies of specialties and the national patients' society. All medical aspects of care for nonsyndromic and syndromic craniosynostosis are included, as well as the social and psychologic impact for the patient and their parents. Managerial aspects are incorporated as well, such as organizing a timely referral to the craniofacial center, requirements for a dedicated craniofacial center, and centralization of this specialized care. The conclusions and recommendations within this document are founded on the available literature, with a grading of the level of evidence, thereby highlighting the areas of care that are in need of high-quality research. The development of this guideline was made possible by an educational grant of the Dutch Order of Medical Specialists. The development of this guideline was supported by an educational grant of the Dutch Order of Medical Specialists

HEREDITARY GINGIVAL FIBROMATOSIS: REPORT OF FAMILY CASE SERIES

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic,dense fibrous connective tissue with acanthotic gingival epithelium. A family presentedat the School of Dental Sciences, University of Nairobi with a complaint that someof the children developed swollen gums very early in life and that this got worsewith eruption of the permanent teeth. The first born, a 23- year- old male, had had theswellings for over ten years. Other siblings aged 5,9 and 12 years were also affected.The swellings had affected the appearance, speech and the psychosocial wellbeing ofthe children. The parents were unaffected with apparently negative family histories.Following oral examination and appropriate investigations, conventional gingivectomywas performed of the maxillary and the mandibular gingivae for the siblings: the 23-12- and the nine- year olds. The fourth affected child, a five- year- old, was still inprimary dentition and had just started showing mild signs of gingival hyperplasia.The histopathological examination of the specimens from the present cases confirmedfeatures consistent with those of HGF. This article highlights a familial presentationof HGF

Pattern of bone loss in dry Mandibles of individuals who died before 1957

Objective: To map out the pattern of periodontal disease in individuals who died before 1957 and were not exposed to formal dental services.Design: Descriptive cross-sectional study.Setting: National Museums of Kenya. Subjects: The skeletons of people who died before independence are preserved at the National Museums of Kenya in Nairobi. Sixty four out of the 170 dry mandibles stored at the Museum were assessed for periodontal bone loss using a calibrated ruler.Results: All the 64 mandibles assessed were of individuals who died before 1957. Two thousand two hundred and seventy four sites were examined. Most of the subjects were adults aged 30-45 years and the age range was 18-80 years. Majority of the mandibles examined were of the ethnic group from Central Kenya. Of the teeth examined, premolars and molars were the teeth most frequently preserved intact in the sockets. The total mean bone loss for all teeth was 2.51 (SD 1.15) with a range of 0.85-5.80. When the different sites were examined, values for bone loss were 2.59 for mesial surfaces; 2.55 buccal surfaces; 2.38 for distal surfaces. Three categories were identified as follows:- 70% of the individuals had minimal or no bone loss, 26.5% had 3-4mm or moderate bone loss and 3.5% had >5mm bone loss or advanced bone loss. Further analysis showed that when bone loss of >3mm was examined, only 28.12% of the individuals were in this group, 10.93% had >4mm bone loss and 3.12% had 5mm or more bone loss. The first molars were the teeth most commonly affected by bone loss of 3mm or more followed by second molars then the premolars. Conclusions: In this group of individuals mainly from Central Kenya, the bone loss pattern showed that only a small number had experienced periodontal destruction as recorded by bone loss levels. Three groups were identified; those who had no or minimal destruction, those who had experienced moderate destruction and those where obvious bone destruction was evident. Thus susceptibility to periodontal disease is evident in a small proportion of individuals even in populations not exposed to modern diet and formal dental services. Periodontal destruction seems to affect a fraction of the population even when older populations are examined, thus it would save on resources both human and physical if these susceptible individuals could be identified early and treatment provided.East African Medical Journal Vol 82(10) 2005: 510-51