Tooth formation in Sudanese children

PhDThe aim of this study was to describe the average age of permanent mandibular tooth formation in two groups of Sudanese children using a cross-sectional design following STROBE guidelines. The Northern groups are of Arab origin whilst the Western groups are predominantly Fur of African origin (Darfur). North Sudanese sample (844 males, 802 females) consisted of equally distributed, randomly selected healthy university students and school children, whilst the West Sudanese (848 males, 401 females) consisted of a convenience sample attending religious schools in camps for the internally displaced. Panoramic radiographs (2-23 years), with known date of birth were taken. Height and weight were also measured. Developing permanent mandibular teeth were staged from radiographs (Moorrees et al., 1963). The mean age of attainments were calculated using logistic regression and comparisons carried out on 331 tooth stages to determine gender and ethnic differences. Results showed that mean age of attainment of teeth was not significantly different between the genders within each ethnic group (p>0.05) for 135 out of 155 stage comparisons. The mean age of attainment of teeth was not significantly different between same sex groups in 113 out of 174 stage comparisons (p>0.05). The canine was more advanced in females compared to males while the reverse was true for some crown and root stages of third molars. Growth indicators showed that all groups are undernourished (z-scores =< -2). Severe malnutrition had minimal effect on tooth formation of M1 and M2 (p>0.05) in Northern females. The prevalence of hypodontia (excluding third molars) was 0.7% in the Western group and 2.6% in the Northern group. The pattern of hypodontia differed between groups. In conclusion, the within group variation for most tooth stages is considerable while the differences between groups are small. The study represents the first radiographic investigation of permanent tooth formation in Africa

The timing of mandibular tooth formation in two African groups

Background: Ethnic differences in the timing of human tooth development are unclear. Aim: To describe similarities and differences in the timing of tooth formation in two groups of Sudanese children and young adults. Subjects and methods: The sample consisted of healthy individuals from Khartoum, Sudan, aged 2–23 years. The Northern group was of Arab origin (848 males, 802 females) and the Western group was of African origin (846 males, 402 females). Each mandibular left permanent tooth from first incisor to third molar was assessed from dental radiographs into one of 15 development stages. Mean ages at entry for 306 tooth stages were calculated using probit regression in males/females in each group and compared using a t-test. Results: Mean ages were not significantly different in most tooth stage comparisons between ethnic groups for both males (61/75) and females (56/76), despite a tendency of earlier mean ages in the Western group. Mean ages for most tooth stage comparisons between males and females (137/155) were not significantly different within ethnic groups suggesting low sexual dimorphism. Conclusion: The mean ages of most mandibular tooth formation stages were generally not significantly different between ethnic groups or between males and females in this study

The face in Down’s syndrome: indices of overall size and harmony in Sudanese vs Italian subjects

The study aimed to provide quantitative information about the facial soft-tissues of Italian and Northern Sudanese subjects with Down’s syndrome (DS) by using summary anthropometric measurements representative of facial size and harmony. The 3D coordinates of soft-tissue facial landmarks were obtained by a computerized digitizer in 54 Italian subjects with DS (20 females, 34 males, aged 13-52 years), in 64 Northern Sudanese subjects with DS (18 females, 46 males, aged 5-34 years), in 578 healthy Italian, and 653 healthy Northern Sudanese reference subjects, matched for sex and age. From the landmarks, 16 facial dimensions were calculated. Data from subjects with DS were compared to those collected in reference individuals by computing z-scores. Two summary anthropometric measurements for quantifying craniofacial variations were obtained: the mean z-score (an index of overall facial size), and its standard deviation, or the craniofacial variability index (an index of facial harmony) [1]. In subjects with DS, facial size was significantly smaller, and craniofacial variability was significantly larger than in normal individuals; 93% of Italian and 81% of Northern Sudanese subjects with DS had one or both values outside the normal interval. Overall, Italian subjects with DS differed more from the norm than Northern Sudanese ones. In the Northern Sudanese subjects, the mean z-scores and the CVI decreased significantly with age. The facial soft-tissue structures of subjects with DS differed from those of normal controls of the same age, sex and ethnic group: a reduced facial size was coupled with a global anomalous relationship between individual measurements. The alterations in soft-tissue facial dimensions were different in the two ethnic groups and partially influenced by age

Gender- and age-related changes in three dimensional facial profiles of healthy Northern Sudanese persons

The study aimed to provide quantitative information about gender-related normative data and growth changes between childhood and young adulthood in the soft tissue facial profiles of Northern Sudanese individuals. The three dimensional coordinates of 50 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 654 healthy Northern Sudanese subjects (327 males and 327 females) aged 4-30 years. The subjects were divided into 8 nonoverlapping age groups [1]. From selected landmarks, 15 facial angles were calculated and averaged for gender and age: upper, middle, and lower facial, and mandibular corpus convexities in the horizontal plane; relative position of the exocanthia and nasion; facial convexity in the sagittal plane; midfacial to mandibular plane, nasal convexity, nasolabial, mentolabial, interlabial, maxillary prominence, and left and right gonial angles. Comparisons were performed by factorial analysis of variance. On average men had larger facial and mandibular corpus convexities in the horizontal plane than women (ANOVA, p&lt;0.01); on the contrary, no gender differences were found for facial convexities in the sagittal plane. Gender significantly influenced also the relative position of exocanthia and nasion, the maxillary prominence angle and the gonial angles (p&lt;0.01). All analysed measurements were influenced by age (p&lt;0.001): nasal convexity and interlabial angle increased from childhood to young adulthood, while mentolabial and gonial angles, horizontal facial convexity and sagittal facial convexity including the nose decreased as a function of age. No consistent age-related patterns were found for the other evaluated angles. Data collected in the current study can be used as a database for the quantitative description of facial profiles in Northern Sudanese subjects during normal growth and development

Facial anthropometry in Northern Sudanese persons from childhood to young adulthood

A deep knowledge of the dimensions and relative positions of facial structures in the different age, gender and ethnic groups, is necessary for a complete anatomical description as well as for a correct reconstruction of the global facial appearance, both for surgical and forensic purposes. No current normative data exist for Northern Sudanese subjects. Sudan is the second largest country in Africa, and it has a multiethnic population, with four major ethnic groups: those of Arab descent in the North, Nilotic tribes in the South, West African tribes in the region of Darfur and Eastern Tribes [1]. In the current study information about normal sex- and age-related linear distances was provided. The three-dimensional coordinates of 14 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 653 healthy Northern Sudanese subjects (326 males and 327 females) aged 4 to 30 years. From the landmarks, 13 linear distances were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analyzed linear soft-tissue facial dimensions were significantly larger in men than in women (p &lt; 0.05), except mouth width (ch-ch), upper facial height (n-sn) and mandibular corpus length (pg-go). All measurements underwent significant modifications as a function of age (p &lt; 0.01), with significant age x sex interactions (p &lt; 0.01) for all linear dimensions except lower face height (sn-pg). Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data [2]. Data collected in the present investigation could serve as a database for the quantitative description of human facial morphology during normal growth and development

Facial soft-tissue volumes in adult Northern Sudanese individuals with Down syndrome

Objective: To investigate dimensions and ratios of soft-tissue facial volumes of adult Northern Sudanese subjects with Down syndrome by using computerized anthropometric measurements. Design, Setting, and Patients: The 3D coordinates of soft-tissue facial landmarks were obtained by a computerized digitizer in 26 Northern Sudanese adult subjects with Down syndrome (18 men, 8 women, aged 17-34 years), and in 99 healthy Northern Sudanese controls (48 women, 51 men) of the same age range. From the landmarks, several facial volumes and volume ratios were calculated. Data were compared to those collected in healthy individuals by computing z-scores. Results: In subjects with Down syndrome, facial volumes were significantly smaller than in control subjects (Student’s t, p &lt; 0.05). The patterns of deviation from the norm were similar in men and women. When compared to controls, subjects with Down syndrome had no differences in nose volume as a fraction of total facial volume and a larger total lip volume as a fraction of total facial volume; within the facial middle third, they had relatively larger upper lip volumes and relatively smaller nose volumes. Conclusions: The facial soft-tissue structures of subjects with Down syndrome differed from those of normal controls of the same age, sex and ethnic group: a reduced facial size was coupled with specific variations in the nasal and labial regions

Malnutrition Has No Effect on the Timing of Human Tooth Formation

The effect of nutrition on the timing of human tooth formation is poorly understood. Delays and advancements in dental maturation have all been reported as well as no effect. We investigated the effect of severe malnutrition on the timing of human tooth formation in a large representative sample of North Sudanese children. The sample (1102 males, 1013 females) consisted of stratified randomly selected healthy individuals in Khartoum, Sudan, aged 2-22 years using a cross-sectional design following the STROBE statement. Nutritional status was defined using WHO criteria of height and weight. Body mass index Z-scores and height for age Z-scores of ≤-2 (cut-off) were used to identify the malnourished group (N = 474) while the normal was defined by Z-scores of ≥0 (N = 799). Clinical and radiographic examination of individuals, with known ages of birth was performed including height and weight measurements. Mandibular left permanent teeth were assessed using eight crown and seven root established tooth formation stages. Mean age at entry and mean age within tooth stages were calculated for each available tooth stage in each group and compared using a t-test. Results show the mean age at entry and mean age within tooth stages were not significantly different between groups affected by severe malnutrition and normal children (p>0.05). This remarkable finding was evident across the span of dental development. We demonstrate that there is little measurable effect of sustained malnutrition on the average timing of tooth formation. This noteworthy finding supports the notion that teeth have substantial biological stability and are insulated from extreme nutritional conditions compared to other maturing body systems

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mean ages of children entering tooth stages in malnourished and normal groups.

<p>Similarity of 95% confidence intervals of mean age <i>entering</i> selected tooth stages of molar teeth in malnourished and normal groups for body mass index (BMI) Z score shown in A and height for age (HA) Z score in B. This can be observed at each tooth stage. Open circles represent BMIZ and HAZ≤−2, dots represent BMIZ and HAZ ≥0. M1, first molar, M2, second molar, M3, third molar, C½, crown half formed, Cc, crown complete, Ri, initial root formation, Rcl, root cleft formation, R½, root half formed, Rc, root length complete, A½, apex half formed.</p

Descriptives of age of entry and age <i>within</i> tooth stages (years) between groups defined by Height for Age Z score.

<p>The mean ages for tooth stages for groups defined by height for age Z score (HAZ) are similar and the difference between them is not significantly different to zero. This was observed at all molar stages for both statistical approaches.</p><p>95% CI 95% confidence interval, difference between normal and malnourished mean ages, SE diff standard error of mean difference, p value for 95% CI of difference in mean ages.</p