Periodontal Diseases in Adult and Elderly Nigerians: A National Survey.

BACKGROUND: Periodontitis has been shown to have links with general health and increase the risk of complications of some systemic diseases now showing a rising prevalence with age. The rising proportion of the elderly globally, and a high prevalence of periodontal disease among older adults may significantly impact the need for oral health care services in the near future. This national survey was carried out to highlight the trend of periodontal diseases among adult and elderly Nigerians and make evidence-based recommendations for good management outcomes. MATERIALS AND METHODS: A national cross-sectional survey of periodontal diseases (using the CPITN Index) among adult (35-44-year-old) and elderly (65-74-year-old) Nigerians selected by multistage sampling method. RESULTS: Periodontal disease is prevalent among adults (96.5%) and elderly (97.6%) Nigerians, with the zonal prevalence approximating the national prevalence. Gingivitis is the prevalent periodontal disease type in these age groups, with a national prevalence of 86.8%, 67.6% respectively, and more in the South than the North for both adults (90.7%, 83%) and elderly (75.7%, 59.7%), respectively (p<0.005). Destructive Periodontitis prevalence in adult and elderly Nigerians is 9.5%, 29.9%, respectively (p<0.05), with the North being more affected than South for both adults (13.4%, 5.6%) and elderly (37%, 22.7%), respectively (p<0.05). There is also a significant rise in the occurrence of destructive periodontitis with age, nationally and in all the zones (p<0.05). CONCLUSION: There is a high prevalence of periodontal diseases in adult and elderly Nigerians. The outcome of the management of periodontal diseases in adults and the elderly is inter-dependent on best practices in both oral and general health care service provision.

CONTEXTE: La parodontite a été liée à la santé générale et à l'augmentation du risque de complications de certaines maladies systémiques, montrant maintenant une prévalence croissante avec l'âge. La proportion croissante de personnes âgées dans le monde et une prévalence élevée des maladies parodontales chez les personnes âgées pourraient avoir un impact significatif sur le besoin de services de santé bucco-dentaire dans un avenir proche. Cette enquête nationale a été réalisée pour mettre en évidence la tendance des maladies parodontales chez les adultes et les personnes âgées nigérianes et formuler des recommandations fondées sur des preuves pour de bons résultats en matière de gestion. MATÉRIEL ET MÉTHODES: Une enquête nationale transversale sur les maladies parodontales (utilisant l'indice CPITN) parmi les adultes (35-44 ans) et les personnes âgées (65-74 ans) nigérianes sélectionnées par méthode d'échantillonnage à plusieurs niveaux. RÉSULTATS: Les maladies parodontales sont prévalentes chez les adultes (96,5 %) et les personnes âgées (97,6 %) nigérianes, la prévalence zonale approchant la prévalence nationale. La gingivite est le type de maladie parodontale prédominant dans ces groupes d'âge, avec une prévalence nationale de 86,8 %, 67,6 % respectivement, et plus dans le Sud que dans le Nord pour les adultes (90,7 %, 83 %) et les personnes âgées (75,7 %, 59,7 %), respectivement (p<0,005). La prévalence de la parodontite destructrice chez les adultes et les personnes âgées nigérianes est de 9,5 %, 29,9 %, respectivement (p<0,05), le Nord étant plus touché que le Sud pour les adultes (13,4 %, 5,6 %) et les personnes âgées (37 %, 22,7 %), respectivement (p<0,05). On observe également une augmentation significative de l'occurrence de la parodontite destructive avec l'âge, nationalement et dans toutes les zones (p<0,05). CONCLUSION: Il existe une prévalence élevée des maladies parodontales chez les adultes et les personnes âgées nigérianes. Les résultats de la gestion des maladies parodontales chez les adultes et les personnes âgées dépendent des meilleures pratiques dans la prestation de services de santé bucco-dentaire et générale. MOTS CLÉS: Prévalence, Gingivite, Parodontite, Nationale, Enquête.

Prevalence of Complete Edentulism in Adults and Older Nigerian Population.

INTRODUCTION: The prevalence of complete edentulism varies from country to country and from one region to another region, and making comparisons between national data challenging because of the impact of lifestyle, socio-economic and educational factors. There is no reported national data for Nigeria. AIMS AND OBJECTIVES: The study was to determine the prevalence of complete edentulism among adult (35-44 years) and older (65-74 years) Nigerians, being part of a national oral health survey of Nigerians conducted in 2014. METHODOLOGY: The study was a cross-sectional survey of oral diseases, specifically dental caries, periodontal diseases, dental trauma, and tooth loss, among adult and older Nigerian populations using a multi-stage stratified sampling technique for all 36 states and the FCT, and clinical examination in field situations using daylight settings, with findings collected using data entry forms (WHO 1997). Ethical approvals were obtained from the FMOH, SMOH and SMLGCA. Data was analysed using SPSS-11 and nominal variables compared using chi-square. A p-value of 0.05 was considered significant. RESULTS: A total of 5,038 adults and 4,658 older Nigerians were examined, of which 4(0.08%) and 84 (1.8%), respectively had complete edentulism. Among the adults, it was reported exclusively in Northern Nigeria; whereas among the older population, 66(2.8%) and 18(0.8%) participants in Northern and Southern Nigeria respectively, were reported to be edentulous (p<0.05). 45 cases (4.7%) of edentulism in older Nigerians were reported from the North West geopolitical zone alone. Edentulism is higher in the older population than the adult population in both Northern and Southern regions (p<0.05). Socio-demographic variation was significant in the North, with a higher prevalence in the rural localities among the older population (p<0.05). CONCLUSION: The study showed that there are variations in the prevalence of edentulism in Nigeria, reflecting lower prevalence in comparison with global trends. National prevalence values did not reflect variations along geographical and socio-political divide.

INTRODUCTION: La prévalence de l'édentation complète varie d'un pays à l'autre et d'une région à l'autre, ce qui rend les comparaisons entre les données nationales difficiles en raison de l'impact des facteurs liés au mode de vie, à la situation socio- économique et à l'éducation. Il n'existe pas de données nationales pour le Nigéria. BUTS ET OBJECTIFS: L'étude visait à déterminer la prévalence de l'édentation complète chez les Nigérians adultes (35-44 ans) et plus âgés (65-74 ans), dans le cadre d'une enquête nationale sur la santé bucco-dentaire des Nigérians menée en 2014. MÉTHODOLOGIES: L'étude était une enquête transversale sur les maladies bucco-dentaires, en particulier les caries dentaires, les maladies parodontales, les traumatismes dentaires et la perte de dents, parmi les populations nigérianes adultes et âgées, en utilisant une technique d'échantillonnage stratifiée à plusieurs niveaux pour les 36 États et le FCT, et un examen clinique dans des situations de terrain utilisant des environnements de lumière du jour, avec des résultats recueillis à l'aide de formulaires de saisie de données (OMS 1997). Les autorisations éthiques ont été obtenues auprès de la FMOH, de la SMOH et de la SMLGCA. Les données ont été analysées à l'aide du logiciel SPSS -11 et les variables nominales ont été comparées à l'aide du chi-carré. Une valeur p de 0,05 a été considérée comme significative. RÉSULTATS: Au total, 5 038 adultes et 4 658 Nigérians âgés ont été examinés, dont 4 (0,08 %) et 84 (1,8 %), respectivement, souffraient d'édentation complète. Chez les adultes, l'édentation a été signalée exclusivement dans le nord du Nigeria, tandis que chez les personnes âgées, 66 (2,8 %) et 18 (0,8 %) participants du nord et du sud du Nigeria respectivement ont été déclarés édentés (p<0,05). 45 cas (4,7%) d'édentulisme chez des Nigérians âgés ont été signalés dans la seule zone géopolitique du Nord-Ouest. L'édentulisme est plus élevé dans la population âgée que dans la population adulte, tant dans les régions du Nord que du Sud (p<0,05). Les variations sociodémographiques étaient significatives dans le Nord, avec une prévalence plus élevée dans les localités rurales parmi la population âgée (p<0,05). CONCLUSION: L'étude a montré qu'il existe des variations dans la prévalence de l'édentation au Nigéria, reflétant une prévalence plus faible par rapport aux tendances mondiales. Les valeurs de prévalence nationale ne reflètent pas les variations géographiques et sociopolitiques. Mots-clés: Édentulisme, Prévalence, Adultes, Personnes âgées, Nigérians.

Dental Trauma in Adult and Elderly Nigerians: A National Survey.

BACKGROUND: Various studies on Traumatic Dental Injuries (TDI) have been carried out in different small localities and mostly among children and adolescents in Nigeria, but there has not been any national study to determine its prevalence. This national survey was carried out to understand the complexities of dental trauma epidemiology among adult and elderly Nigerians. MATERIAL AND METHODS: A national cross-sectional survey of TDI among adult and elderly Nigerians, following WHO recommendations. RESULTS: A total of 5,067 adults (35-44 years) and 4,680 elderly (65-74 years) Nigerians were examined, and the prevalence of dental trauma among the adult and elderly was 15.9 % and 22.1%, respectively. Gender comparison showed males were more affected than females in the North (p<0.05), while TDIs occurred more among females in Southern Nigeria (p<0.05). In Nigeria, Type 2 injuries were most prevalent among the adults and elderly (53.9% and 55.7%, respectively). Among the elderly, while Type 1 injuries were more common in the North, Type 2 injuries were more prevalent in Southern Nigeria (p<0.05). Types 3-10 injuries were more prevalent in the South (p<0.05). TDI 1,2 occurred more in the anterior teeth among adults (p<0.05) and in posterior teeth among the elderly, especially in Southern Nigeria (p<0.05); while TDI 3-10 affected mostly the anterior teeth in both age groups (p<0.05. CONCLUSIONS: The observed pattern of dental trauma among the adults and elderly Nigerians could reflect the diverse dietary and socio-cultural practices. Advocacy for prevention of, relevant education on, research into and improvement of access to treatments for dental trauma is recommended.

CONTEXTE: Diverses études sur les traumatismes dentaires (TDI) ont été menées dans différentes petites localités et principalement chez des enfants et des adolescents au Nigéria, mais aucune étude nationale n'a été menée pour déterminer sa prévalence. Cette enquête nationale a été menée pour comprendre les complexités de l'épidémiologie des traumatismes dentaires chez les Nigérians adultes et âgés. MATÉRIEL ET MÉTHODES: Une enquête nationale transversale sur le TDI parmi les Nigérians adultes et âgés, conformément aux recommandations de l'OMS. RÉSULTATS: Un total de 5 067 adultes (35 à 44 ans) et 4 680 personnes âgées (65 à 74 ans) Nigérians ont été examinés, et la prévalence des traumatismes dentaires chez les adultes et les personnes âgées était de 15,9% et 22,1%, respectivement. La comparaison entre les sexes a montré que les hommes étaient plus touchés que les femmes dans le Nord (p <0,05), tandis que les IDT se produisaient davantage chez les femmes du sud du Nigeria (p <0,05). Au Nigéria, les blessures de type 2 étaient les plus fréquentes chez les adultes et les personnes âgées (53,9% et 55,7%, respectivement). Chez les personnes âgées, alors que les blessures de type 1 étaient plus fréquentes dans le nord, les blessures de type 2 étaient plus fréquentes dans le sud du Nigéria (p <0,05). Les blessures de type 3 à 10 étaient plus fréquentes dans le Sud (p <0,05). Le TDI 1,2 s'est produit davantage dans les dents antérieures chez les adultes (p <0,05) et dans les dents postérieures chez les personnes âgées, en particulier dans le sud du Nigéria (p <0,05); tandis que le TDI 3-10 affectait principalement les dents antérieures dans les deux groupes d'âge (p <0,05). CONCLUSIONS: Le modèle observé de traumatisme dentaire chez les adultes et les Nigérians âgés pourrait refléter les diverses pratiques alimentaires et socioculturelles. Il est recommandé de plaider en faveur de la prévention, de l'éducation pertinente, de la recherche et de l'amélioration de l'accès aux traitements des traumatismes dentaires. MOTS CLÉS: Blessures dentaires traumatiques, types, dentaires, traumatismes, adultes, personnes âgées, Nigéria.

Global oral health inequalities in incidence and outcomes for oral cancer: causes and solutions.

The mouth and oropharynx are among the ten most common sites affected by cancer worldwide, but global incidence varies widely. Five-year survival rates exceed 50% in only the best treatment centers. Causes are predominantly lifestyle-related: Tobacco, areca nut, alcohol, poor diet, viral infections, and pollution are all important etiological factors. Oral cancer is a disease of the poor and dispossessed, and reducing social inequalities requires national policies co-ordinated with wider health and social initiatives - the common risk factor approach: control of the environment; safe water; adequate food; public and professional education about early signs and symptoms; early diagnosis and intervention; evidence-based treatments appropriate to available resources; and thoughtful rehabilitation and palliative care. Reductions in inequalities, both within and between countries, are more likely to accrue from the application of existing knowledge in a whole-of-society approach. Basic research aimed at determining individual predisposition and acquired genetic determinants of carcinogenesis and tumor progression, thus allowing for targeted therapies, should be pursued opportunistically.

Primary head and neck cancers in North -Western Nigeria.

BACKGROUND: Reported epidemiological studies on oro-facial cancers in Nigeria over the last four decades showed nonstandardized inclusion criteria and an overlap of study periods, resulting in conflicting findings. OBJECTIVE: To document the pattern of reportable primary head and neck cancers in North-Western Nigeria and analyse Methods: A review of both clinical and histopathology records of head and neck cancers diagnosed by histopathology at the ABUTH, Zaria, was undertaken. Socio-demographic information and history of cancer management, which followed the pattern of the Minimum Cancer Dataset developed by the British Association of Head and Neck Oncologists, were retrieved from pathology and medical records of patients diagnosed of cancers of the head and neck at the hospital from January 1972 to December 2002. RESULTS: A total of 2611 cases were diagnosed, 730 (28%) occurred in children, 1775 (68%) in adults, with 64% occurring at or below 40 years of age. The eye, 564(21.6%) and the mouth, 251(9.6%) were the most commonly affected sites. Carcinomas (55%), lymphomas (23%) and retino-blastomas (10%) were the most common cancers. Cancers of viral origin constituted 18% of head and neck cancers and AIDS-defining cancers were 6%. A significant increase was noted in the occurrence of conjunctival squamous cell carinoma (SCC) and Non-Hodgkins Lymphoma NHL when comparing the periods pre- and post- advent of HIV/ AIDS in Nigeria in 1986. Comparing the two periods, there was a reduction in the ages of occurrence of conjunctival SCC; Non-Hodgkins Lymphoma (NHL), Kaposis sarcoma (KS) and nasopharyngeal carcinoma, a rise in the occurrence of nasopharyngeal carcinoma and a significant drop in the occurrence of Burkitt lymphoma. CONCLUSION: Reduced age at presentation and the rising prevalence of several virus-associated cancers suggests the role of immuno-suppression in the pathogenesis of these cancers. Further studies into nutritional and viral epidemiology in the population are desirable as the implication for prevention and public health policies are profound.

Geographical mapping of fluoride levels in drinking water sources in Nigeria.

BACKGROUND: Knowledge of fluoride levels in drinking water is of importance in dental public health, yet this information is lacking, at national level, in Nigeria. OBJECTIVE: To map out fluoride levels in drinking water sources in Nigeria. MATERIALS AND METHODS: Fluoride levels in drinking water sources from 109 randomly selected Local Government Areas (LGAs) in the 6 Nigerian geopolitical zones were determined. From the results, maps showing LGAs with fluoride concentrations exceeding 0.3 ppm, were drawn. ANOVA and t-test were used to determine the significance of the differences between the fluoride levels in the drinking water sources. RESULTS: Fluoride levels were low in most parts of the country, being 0.3 ppm or less in 62% of the LGAs. Fluoride concentrations were generally higher in North Central geopolitical zone, than the other zones in the country (p<0.05). In a few drinking water sources, fluoride concentrations exceeded 1.5 ppm, but was as high as 6.7 ppm in one well. Only 9% of the water sources were from waterworks. CONCLUSION: Most of the water sources in Nigeria contained low fluoride levels; but few had excessive concentrations and need to be partially defluoridated, or else alternative sources of drinking water provided for the community.

Primary head and neck cancers in Jos, Nigeria: a re-visit.

BACKGROUND: To document the pattern of primary head and neck cancers in Jos, Nigeria. STUDY DESIGN: A record-based study of head and neck cancers histologically diagnosed at the Jos University Teaching Hospital (JUTH), Jos, between January 1987 and December 2002. RESULTS: A total of 710 cases (over 44 cases per year) were diagnosed, with a rising trend. The most common sites for cancer were the eyes (15.4%), lymph nodes (12.4 %), thyroid gland (11.8%) and the oral cavity (7.6%). Carcinomas 432(60.8%), lymphomas 119(16.8%) and sarcomas 105(14.8%) were the commonly reported cancers. Carcinomas were most commonly reported in the thyroid gland (19.2%), oral cavity (10.2%) and the eyes (9.5%). AIDS-related cancers constituted 12.3% of all head and neck cancers and were commonly reported in the 3rd decade of life. This is higher than the 10.9% and 7.6% previously reported for Jos (p=0.89) and Maiduguri (p=0.034) respectively. Carcinomas were associated with alcohol use and tobacco smoking (p<0.001), while kaposi sarcoma was more associated with HIV-positive patients than squamous cell carcinoma (p=0.016). The duration of symptoms for cancers varied with sites and cancer type but ranged from 6.5-89.7 months (mean= 37.7 +/- 51.1 months). 59 (93.7%) of the staged cancers reported in the late stages (III & IV). 48 (43.2%) of the treated cancers had primary surgery, while most lymphomas were treated with primary chemotherapy. CONCLUSION: There is a rising trend in the occurrence of head and neck cancers in Jos, with a considerable proportion of the patients being below 30 years. The late presentation of patients, late stage at presentation, the rising profile of HIV/AIDS in the area and the non-availability of relevant specialists in the hospital could adversely affect the prognosis of these cancers.

Intra-oral carcinomas in Maiduguri, north-eastern Nigeria.

OBJECTIVE: To document the pattern of intra-oral carcinomas diagnosed in north-eastern Nigeria. DESIGN AND SETTING: A retrospective clinical and histopathological review seen in a tertiary care hospital (January 1987-December 2002). MATERIALS AND METHODS: Information on socio-demographic characteristics of patients and details of cancer management were retrieved from the files and histopathology records of cases diagnosed at the hospital. RESULTS: A total of 378 biopsies, 317 primary cancers including 279 carcinomas of the head and neck were diagnosed during the study period. Intra-oral carcinomas constitute 43 (15.4%) of all head and neck carcinomas reported, with no occurrence in children. The overall mean age of occurrence was 51.2 +/- 15.6 years (male = 56.2 +/- 13.7 years; females = 47.5 +/- 16.2 years) and an overall male-female ratio of 3:4. Carcinomas were commonly reported in the palate 19 (44.2%) and lip six (13.9%) and floor of mouth four (9.3%). Squamous cell carcinoma 28 (65.1%), adenoidcystic carcinoma seven (16.3%) and mucoepidermoid carcinoma five (11.6%) were the commonly reported carcinomas. Squamous cell carcinoma was the most common carcinoma in all sites, in the sixth decade of life, of equal gender distribution and commonly reported in users of kola nuts and tobacco. The occupation of patients diagnosed with oral carcinoma and squamous cell carcinoma was farming (50%, 61.5%). All the staged cancers patients (n = 7) reported in the late stages (III/IV) of the disease. The mean interval between symptoms and presentation for the different carcinomas ranged between 9 and 25 months, with the least interval reported for mucoepidermoid carcinoma. CONCLUSIONS: Squamous cell carcinoma was the most common oral carcinoma, commonly reported in the palate, among farmers and in the sixth decade of life. Its occurrence in under 40 year olds is three to six times greater than reported for the USA and Europe and may be associated with poor diet and the habitual use of kola nuts and tobacco. The survival rates of patients diagnosed with intra-oral carcinomas, although not available, would be expectedly low in view of the prognostic indicators recorded in this series. The routine oral cancer screening of each patient, and counselling of patients with high-risk habits, by dentists is recommended to improve the prognosis of the disease.

Salivary gland neoplasms in Maiduguri, north-eastern Nigeria.

OBJECTIVE: To document the pattern of salivary gland neoplasia in Maiduguri, Nigeria. DESIGN AND SETTING: A retrospective clinical and histopathological review (January 1987-December 2002) of cases diagnosed at a tertiary care hospital. MATERIALS AND METHODS: Information on demographics, diagnosis and cancer management in the hospital were retrieved from biopsy reports and case notes of patients. RESULTS: The palatal (71.9%) and parotid (78.3%) glands were the most common minor and major salivary glands involved, with a benign-malignant ratio of 1:1 and 1.4:1, respectively. Pleomorphic adenoma (44.3%) was the most common salivary gland neoplasm recorded. It was commonly reported in the third decade (mean 30.4 years) and among males (M:F, 1.4:1). Ectopic lesions (17.1%) were reported in the neck, nose and cervical nodes. Mucoepidermoid carcinoma (10.1%) was the most common salivary gland malignancy, occurring in the second and sixth decades; of equal gender distribution and predominantly in the palate (50%). The squamous cell carcinoma (10.9%) and adenoidcystic carcinoma (21.9%) were the most common malignancies in the major and minor glands respectively. There was a higher prevalence of malignancies of the parotid than previously reported for northern Nigeria (P = 0.036). CONCLUSION: Pleomorphic adenoma and mucoepidermoid carcinoma were the most commonly reported benign and malignant neoplasia in this series. The prevalence of mucoepidermoid carcinoma contrasts with reported findings in other African studies.

Prevalence of HIV--related oral lesions in Nigerian women.

BACKGROUND: Human immunodeficiency virus (HIV) infection affects an increasing number of women throughout the world. Oral lesions are among the earliest clinical manifestations of HIV infection and are associated with its progression. We describe the oral manifestations of HIV/AIDS in Nigerian women and its clinical correlates. METHODS: Nigerian women with HIV/AIDS were examined for the presence of oral lesions attributable to HIV/AIDS. These lesions were diagnosed clinically, according to the criteria established by the European Community Clearinghouse (ECC) on oral problems related to HIV infection. RESULTS: Two hundred and sixty-nine seropositive women were examined with a range of 17-60 years (mean of 32.4 years < 8.09). The age group of 21 30 years was the worst affected (n = 125, 46.5%). Of these patients, 109 (40.5%) were married, 67 (24.9%) were single while 47 (17.5%) had multiple sexual partners. One hundred and eighteen (43.9%) had at least an oral lesion associated with HIV/AIDS. The most common was oral candidiasis, which was present in 98 (36.4%) patients. Pseudomembraneous candidiasis (n = 66, 24.5%) and angular cheilitis (n = 23, 8.6%) were the commonest variants seen. The former was the only lesion significantly associated with the clinical stage of the infection (p = 0.002) while necrotizing gingivitis, linear gingival erythema and angular cheilitis were associated with the age of the patients (p < 0.05). CONCLUSION: Oral manifestations are common features of HIV infection among Nigerian women. Oral candidiasis (OC) was the most notable oral lesion associated with HIV/AIDS. It may be a useful clinical indicator of early immune dysfunction mediated by HIV.

Primary head and neck cancers in North Eastern Nigeria.

BACKGROUND: To document the pattern of primary head and neck cancers in North Eastern Nigeria. STUDY DESIGN: A record-based study of primary head and neck cancers histologically diagnosed at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, North Eastern Nigeria between 1987 and 2002. RESULTS: A total of 317 cases (20 cases per year) were diagnosed. The most common cancer sites were the oral cavity (15.1%) and nasopharynx (11.7%). Carcinomas (68.4 %) were the most common cancers reported, mostly affecting the oral cavity (20.3%). Carcinomas were associated with farmers, kola nut chewers and tobacco users in this region, while kaposi sarcoma was the only cancer associated with HIV-positive patients. The overall mean duration of symptoms for cancers was 29.1+/-62.2 months. The mean duration for carcinomas was longer than for sarcomas (p>0.05) and lymphomas (p= 0.05). 81 % of the staged cancers reported in the stage IV; while treated cancers required primary radiotherapy (51 %) or an adjuvant radical surgery and chemotherapy (9.4%). CONCLUSION: Intra-oral carcinomas were the most common histological types of cancers in the head and neck. The delay before and the cancer stage at presentation may be due to the lack of cancer management facilities and manpower in most of the hospitals in the region.