Determination of Streptococcus Mutans and Lactobacillus Counts and their Association with Resting pH of Saliva and Dental Caries in Preschool Children in Lagos.

BACKGROUND: Caries is controlled by several factors including exposure to diets rich in carbohydrates, tooth susceptibility, and the presence of some oral flora bacteria such as Streptococcus mutans (S. mutans) and Lactobacilli sp. Tooth demineralisation occurs when the pH in the oral cavity is lower than the critical pH of 5.5 which occurs because of the production of acid by the acidogenic bacteria in the oral flora when they break down sugars (substrate) for energy. OBJECTIVE: The objective of this study was to determine the salivary Streptococcus mutans and Lactobacillus counts and their association with resting pH of saliva and dental caries in pre-school children in Lagos. MATERIALSAND METHODS: Fifty preschoolers with and without caries were recruited from the dental clinic and staff primary school in Lagos University Teaching Hospital, Idi-araba respectively. Saliva was collected in Thioglycollate media. The resting pH of the saliva was measured immediately in the clinic with a pH meter (Jenway pH meter, PHS 25). In the laboratory, the samples were streaked on Mitis salivarius bacitracin agar (MSB) and Rogosa agar for S. mutans and Lactobacillus respectively and incubated anaerobically for 48 hours at 37°C. Biochemical tests and morphological characteristics of colonies were used to identify S. mutans and Lactobacillus. RESULTS: The children were aged between 45 to 71 months with a mean age of 56.66 7.17 months. The mean age of the caries-free group was 55.48 7.57 months and that of caries active group was 57.84 6.76 months. The caries-active subjects recorded significantly higher bacterial counts of S. mutans and Lactobacillus compared to the cariesfree subjects. Streptococcus mutans and Lactobacillus showed a negative and highly significant correlation with resting pH (r = - 0.38 and r = - 0.32 value respectively). CONCLUSION: The resting pH of saliva in both groups was within normal values. Streptococcus mutans and Lactobacillus counts were significantly inversely correlated to the resting pH value of saliva. Streptococcus mutans and Lactobacillus counts were significantly higher in the caries active group. CONTEXTE: La carie est contrôlée par plusieurs facteurs dont l'exposition à des régimes riches en glucides, la sensibilité des dents et la présence de certaines bactéries de la flore buccale telles que Streptococcus mutans (S. mutans) et Lactobacilli sp.. La déminéralisation des dents se produit lorsque le pH dans la cavité buccale est inférieur au pH critique de 5,5 qui se produit à la suite de la production d'acide par les bactéries acidurogènes dans la flore buccale lorsqu'elles décomposent les sucres (substrat) pour l'énergie. BUT ET OBJECTIF: L'objectif de cette étude était de déterminer le nombre de Streptococcus mutans et de Lactobacillus et leur association avec le pH au repos de la salive et des caries dentaires chez les enfants d'âge préscolaire à Lagos. MATÉRIEL ET MÉTHODES: Cinquante enfants d'âge préscolaire avec et sans caries ont été recrutés respectivement à la clinique dentaire et à l'école primaire du personnel de l'hôpital universitaire de Lagos, Idiaraba. La salive a été recueillie dans un milieu au thioglycolate. Le pH au repos de la salive a été mesuré immédiatement en clinique avec un pHmètre (Jenway pH meter, PHS 25).Au laboratoire, les échantillons ont été striés sur gélose bacitracine Mitis salivarius (MSB) et gélose Rogosa pour S. mutans et Lactobacillus respectivement et incubés en anaérobiose pendant 48 heures à 37°C. Des tests biochimiques et des caractéristiques morphologiques des colonies ont été utilisés pour identifier S. mutans et Lactobacillus. RÉSULTATS: Les enfants étaient âgés de 45 à 71 mois avec un âge moyen de 56,66 ± 7,17 mois. L'âge moyen du groupe sans carie était de 55,48 ± 7,57 mois et celui du groupe avec carie active était de 57,84 ± 6,76 mois. Les sujets actifs carieux ont enregistré un nombre de bactéries significativement plus élevé de S. mutans et Lactobacillus par rapport aux sujets sans caries. Streptococcus mutans et Lactobacillus ont montré une corrélation négative et hautement significative avec la valeur du pH au repos (r = - 0.38 et r = - 0.32 respectivement) . CONCLUSION: Le pH au repos de la salive dans les deux groupes était dans les valeurs normales. Les numérations de Streptococcus mutans et de Lactobacillus étaient significativement inversement corrélées à la valeur du pH de la salive au repos. Les numérations de Streptococcus mutans et de Lactobacillus étaient significativement plus élevées dans le groupe actif carieux. Mots-clés: Numération bactérienne, Streptococcus mutans, Lactobacillus, pH delasalive,Enfants d'âgepréscolaire.

Comparative Analysis of Streptococcus Mutans and Streptococcus Sobrinus from Dental Plaque Samples of Nigerian Pre-school Children with and Without Caries.

BACKGROUND: Early childhood caries (ECC), despite being a preventable disease, remains prevalent in sub-Saharan Africa. This study compared the occurrence of Streptococcus mutans and Streptococcus sobrinus in dental plaque from caries free and caries active Nigerian preschool children. METHODS: Structured questionnaire were administered to eighty (80) mothers to inquire about the sociodemographic characteristics of their children. Diagnosis of dental caries was made according to the diagnostic criteria of the World Health Organization (WHO). Supragingival plaque sample collected from caries free children and children with dental caries (cavitated and non-cavitated lesions) using wooden toothpicks were cultured anaerobically. Samples were cultured in anaerobiosis and isolates obtained were identified based on molecular characterization performed by polymerase chain reaction (PCR) analysis. Statistical package for the social sciences (SPSS 25.0) was used for analysis. RESULTS: Streptococcus mutans was detected in 26(65.0%) children with early childhood caries, and S. sobrinus in 10(25.0%) children with early childhood caries. The presence of S. mutans and S. sobrinus occurring together was associated with a higher deft score. Occurrence of S. mutans did not show significant difference between children with ECC and caries free children (p=0.099), however, the proportion of children with ECC positive for S. sobrinus was significantly higher than that of caries free children (p= 0.003). CONCLUSIONS: S. mutans and S. sobrinus had a similar frequency of occurrence in children with ECC and caries free children. The occurrence of S. mutans alongside S. sobrinus in ECC is related to its severity.

CONTEXTE: La carie de la petite enfance (CPE), bien qu'étant une maladie évitable, reste prévalente en Afrique sub-saharienne. Cette étude a comparé la présence de Streptococcus mutans et Streptococcus sobrinus dans la plaque dentaire d'enfants nigérians d'âge préscolaire avec et sans caries. MÉTHODES: Des questionnaires structurés ont été administrés à quatrevingts (80) mères pour connaître les caractéristiques sociodémographiques de leurs enfants. Le diagnostic de la carie dentaire a été établi selon les critères de diagnostic de l'Organisation mondiale de la santé (OMS). Des échantillons de plaque supragingivale prélevés sur des enfants exempts de caries et des enfants atteints de caries dentaires (lésions cavitaires et non cavitaires) à l'aide de cure-dents en bois ont été mis en culture en anaérobiose. Les échantillons ont été mis en culture en anaérobiose. Les isolats obtenus ont été identifiés sur la base d'une caractérisation moléculaire effectuée par une analyse de réaction en chaîne par polymérase (PCR). Le progiciel statistique pour les sciences sociales (SPSS 25.0) a été utilisé pour l'analyse. RÉSULTATS: Streptococcus mutans a été détecté chez 26(65,0%) enfants atteints de caries de la petite enfance, et S. sobrinus chez 10(25,0%) enfants atteints de caries de la petite enfance. La présence simultanée de S. mutans et de S. sobrinus était associée à un score de déformation plus élevé. La présence de S. mutans n'a pas montré de différence significative entre les enfants atteints de CEC et les enfants indemnes de caries (p=0,099), cependant, la proportion d'enfants atteints de CEC positifs pour S. sobrinus était significativement plus élevée que celle des enfants indemnes de caries (p= 0,003). CONCLUSIONS: S. mutans et S. sobrinus ont une fréquence d'apparition similaire chez les enfants atteints de CEC et les enfants indemnes de caries. La présence de S. mutans et de S. sobrinus dans l'ECC est liée à sa gravité. MOTS CLÉS: Streptococcus mutans, Streptococcus sobrinus, caries de lapetite enfance, plaque supragingivale.

Comparison of the treatment outcomes of the conventional stainless steel crown restorations and the hall technique in the treatment of carious primary molars.

BACKGROUND: Dental caries is a multifactorial disease that causes reversible decalcification and cavitation of susceptible teeth exposed to sugary substrates over a period of time in the oral cavity. It gives clinical and social burdens to the child patients and their parents/carers. Stainless steel crown (SSC) restoration is one of the restorative treatment options in the management of carious primary molars. AIMS: The Hall technique is a biologic method of managing primary teeth by sealing in the caries with preformed metal crowns (SSCs). The objectives of this study were to assess and compare the primary and secondary treatment outcomes of stainless steel crown restorations using the conventional method and the Hall technique in primary molars immediately after placement and over a 12-month period using both clinical and radiological parameters. METHODS: The study was a randomized control clinical trial using a split mouth approach. A total of 25 stainless steel crown restorations using the conventional method and 25 stainless steel crown restorations using the Hall technique were placed in 25 subjects aged 3-8 years with a pair or pairs of unrestored enamel or dentinal carious primary molars matched for tooth type, dental arch, and extent of caries. All subjects were monitored and reviewed every 3 months for 12 months. RESULTS: Twenty three subjects returned for follow-up. There was no statistically significant difference (P-value > 0.05) between the conventional SSC restoration and the Hall technique for both the primary outcomes/major failures (irreversible pulpitis, dental abscess, peri-radicular radiolucency, and crown loss with tooth unrestorable) and secondary outcomes/minor failures (crown loss and tooth restorable, crown perforation, secondary/marginal caries, and reversible pulpitis). But, there was a statistical significant difference in the average time taken for the placement of the restorations between the two groups (P-value 0.001). CONCLUSION: Both the conventional SSC restorations and the Hall technique can be provided for all the subjects in this study. The Hall Technique compared favorably well with the conventional SSC restoration in clinical and radiological outcomes. The Hall Technique appears to offer an effective treatment option for managing dental caries in primary molar teeth especially in a resource challenged environment where electricity and treatment under general aaesthesia can sometimes be a problem.

Comparison of the Treatment Assessments of the Conventional Stainless-Steel Crown Restorations and the Hall Technique.

BACKGROUND: Stainless steel crown (SSC) restoration is one of the restorative treatment options in the management of carious primary molars. The Hall technique is a biologic method of managing carious primary teeth by sealing in the caries with SSCs without the routine local anaesthesia and tooth preparations. The objectives of this study was to compare the treatment assessments of the conventional stainless steel crown restoration with Hall technique using subjects' discomfort during treatments and parents' treatment perception, treatment acceptability and satisfaction with the treatment. METHODS: The study was a comparative analytical study involving the placement of 25 SSC restorations using the conventional method and 25 SSC restorations using the Hall technique in 25 subjects aged 3-8 years with a pair or pairs of unrestored enamel or dentinal carious primary molars matched for tooth type, dental arch and extent of caries. Discomfort during the placements of the SSCs was assessed by the subjects while treatment perception, acceptability and satisfaction were assessed by the parents with the use of questionnaires. RESULTS: There was statistically significant difference (p-value 0.00001) between the conventional method and the Hall technique for the discomfort outcomes. There was no statistically significant difference for treatment perception (p=0.73), acceptability (0.72) and satisfaction (0.60). CONCLUSION: The Hall Technique compared favourably well with the conventional method in treatment perception, acceptability and satisfaction but it gave higher level of discomfort in some of the subjects. The Hall Technique appears to be a good method for managing dental caries in primary molar teeth especially in a resource challenged environment where electricity and access to care are contending issues.

Translation and Validation of the Nigerian Pidgin English Version of the Early Childhood Oral Health Impact Scale (NAIJA ECOHIS).

OBJECTIVES: The Early Childhood Oral Health Impact Scale (ECOHIS) has been used in different countries and in different versions to assess the impact of oral health conditions on preschoolers. This study aimed to develop the Nigeria Pidgin English version of ECOHIS and investigate its psychometric properties. METHODS: The Nigerian Pidgin English version (NAIJA ECOHIS) was developed from the English version using the forward-backward translation technique. One hundred and four children aged 2-5 years attending a clinic were recruited for the study and the new version was administered to their parents/caregivers. Validity of the instrument was assessed based on the relationship between the NAIJA-ECOHIS scores and the global health rating scores using Spearman's rank correlation. The internal consistency reliability was tested using Cronbach's alpha coefficient while the test-retest reliability was assessed using intraclass correlation coefficient by using scores of fifty participants who reported no change in their symptoms after one week. RESULTS: The NAIJA-ECOHIS version was created with some modifications to the original version. The association between the NAIJA ECOHIS scores and the two global questions as well as the correlation between the child and family sections were statistically significant (p <0.001). Cronbach's alpha coefficient for the child section, family section and Total NAIJA ECOHIS scores were 0.83, 0.79 and 0.86 respectively demonstrating good internal consistency. CONCLUSION: The NAIJA ECOHIS version was valid and reliable for assessing oral health related quality of life of preschool children whose parents/caregivers speak the Nigerian Pidgin English.

The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution.

OBJECTIVE: The aim was to determine the prevalence of early childhood caries (ECC) and its association with infant feeding and oral health-related behavior among preschool children aged 6-71 months in Lagos. MATERIALS AND METHODS: This was a descriptive cross-sectional study in which 302 children aged 6-71 months were selected from four pediatric outpatient clinics in Lagos, Nigeria. A structured questionnaire was used to obtain information regarding oral hygiene practices, dietary habits, breast and bottle feeding, birth weight of child and socioeconomic status of the family, from mothers of the children. The status of dental caries was recorded according to the World Health Organization criteria. RESULTS: The prevalence of ECC among 302 children aged 6-71 months was 21.2% while the mean deft was 0.735. Multivariate logistic regression analysis showed the correlation of ECC with the associated risk factors. ECC was significantly higher in children who were bottle-fed at night. Method of tooth cleaning other than using fluoridated toothpaste significantly increased the prevalence of ECC. Breastfeeding for duration of 3-6 months showed significantly lesser caries prevalence. Caries significantly increased with age. CONCLUSION: Early childhood caries is a multifactorial disease in which prolonged duration of breastfeeding, nocturnal bottle feeding, and use of cleaning methods other than fluoridated toothpaste are risk factors for ECC. Oral health promotion programs should be targeted at mothers, pediatricians, nurses, caretakers at day care centers and primary care health workers.

Effect of mineral trioxide aggregate and formocresol pulpotomy on vital primary teeth: a clinical and radiographic study.

BACKGROUND: Pulpotomy is the common therapy for cariously exposed pulps in symptom-free primary molar teeth. Formocresol (FC) is considered the gold standard dressing agent for pulpotomy, but concerns have been raised over the years about its safety. Other alternative pulpotomy agents have been investigated and suggested. OBJECTIVE: The objective was to evaluate and compare the clinical and radiographic response of FC and white mineral trioxide aggregate (MTA) as pulpotomy materials on primary molars. MATERIALS AND METHODS: Fifty primary molars, with deep carious lesion that exposed a vital but asymptomatic pulp, in 37 children aged 4-7 years were treated with conventional pulpotomy procedure. The teeth were divided randomly into two groups. Group I (FC) and group II (MTA). The treated teeth were evaluated clinically and radiographically and were followed-up for 12 months. RESULTS: At the end of the 12 months follow-up, the clinical success rates for FC and MTA were 81% and 100%, respectively. There was a statistically significant difference ( P = 0.04) between the clinical success rates of FC and MTA. While the radiographic success rates for FC and MTA were 81% and 96%, respectively, there was no statistically significant difference between the radiographic success of MTA and FC. CONCLUSION: White MTA showed a higher clinical and radiographic success rate when compared to FC as a pulpotomy agent in vital primary molars, and it has a potential to become a replacement for FC in primary molars.

ASSOCIATION OF EARLY CHILDHOOD CARIES WITH BREASTFEEDING AND BOTTLE FEEDING IN SOUTHWESTERN NIGERIAN CHILDREN OF PRESCHOOL AGE.

BACKGROUND: Early childhood caries constitute one of the most prevalent chronic diseases among children which have been found to be related to infant feeding practices. OBJECTIVE: to determine the association of early childhood caries with breastfeeding and bottle-feeding practices among children of preschool age. PATIENTS & METHODS: Information about oral health, infant feeding and other child and family characteristics were obtained through structured interviewer administered questionnaire from mothers of preschool children. Intra-oral examination of the children was done and dental caries status was recorded according to the World Health Organization (WHO) criteria. The data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0. Statistical analyses of association of early childhood caries with various categorical variables were performed using chi-square. A logistic regression analysis was also performed with factors that were significant. P-value ≤ 0.05 was considered statistically significant. RESULTS: Of the 302 children in this study, 44% were solely breastfed, 2% were solely bottle-fed while 54% were both breastfed and bottle-fed. Statistical analysis showed that ECC significantly increased with night time bottle feeding (OR=4.5, p=0.001, CI=1.8-11.1), whereas it was significantly lower in children who were breastfed for 3 to 6 months (OR= 0.1, p<0.001, CI=0.03-0.18) as compared to those who were breastfed greater than 12 months duration. CONCLUSION: . This study has shown that breastfeeding for the first 3 - 6 months of life is associated with low incidence of dental caries while babies solely bottle-fed and night time bottle feeding are associated with high incidence of childhood dental caries.

Prevention of dental caries: knowledge, practice and opinion of paediatricians in Lagos.

BACKGROUND: Dental caries is the most prevalent oral disease in children and this is preventable. Paediatricians are the first professionals whom children visit and are in good position to begin the process of prevention of dental caries if they recognize and encourage good preventive habits. OBJECTIVE: To determine the knowledge, practice and opinion of pediatricians in prevention of dental caries. MATERIALS AND METHODS: A cross sectional survey was undertaken among pediatricians in Lagos. Questionnaires were administered to pediatricians practicing in Teaching hospitals, general and private hospitals in Lagos. The questionnaire assessed their personal details, knowledge about caries, practice guidelines and opinion towards its prevention. RESULTS: Less than one-third (27.7%) of the pediatricians knew that bacteria causing caries can be transmitted from mother to child. Only about one-third (30.8 %) of the paediatricians examine children's teeth for dental caries. Majority (87.7%) were of the opinion that paediatricians have a role in promoting oral health. A total of 59% of the paediatricians had moderate knowledge, while (71%) of them had poor practice and their opinion for prevention of dental caries was positive in more than two-thirds of them (71%). CONCLUSION: We concluded that most paediatricians in Lagos had moderate knowledge, poor practice and lacked proper awareness about prevention of dental caries. Recommendation: we recommend that preventive dentistry topics in oral health promotion and prevention of dental caries be part of their postgraduate curriculum, continued dental health education programme for paediatricians, referral of related cases to paediatric dentists and oral health related topics be published in paediatric medical journals.

Causes and pattern of tooth loss in children and adolescents in a Nigerian tertiary hospital.

BACKGROUND: Tooth loss diminishes the quality of life and is also related to poorer general health. Premature tooth loss in children can have devastating effects such as compromised aesthetics and function, mesial and distal drifts of adjacent teeth leading to crowding and impaction of the permanent successors and other forms of malocclusion. OBJECTIVE: To assess the causes and pattern of tooth loss in children and adolescents at the Paedodontic Clinic of the Lagos University Teaching Hospital, Lagos. METHODS: This retrospective study was carried out at the Paedodontic Unit of the Lagos University Teaching Hospital, Lagos using clinical records over a period of time from January 2008 to April 2010. Information obtained included age, gender, missing and extracted teeth, and reasons for extraction/tooth loss. Exfoliated primary teeth and congenitally missing teeth were excluded. Data was analysed using Epi info 2007 statistical software. Chi-square test was used to compare proportions of tooth loss among age groups. The level of significance was set at P < 0.05. RESULTS: A total of 493 patients aged 1-16 years had lost one or more teeth due to various reasons. There were 244 (49.5%) males and 249 (50.5%) females. Majority of the subjects lost their teeth due to caries and its sequelae (64.3%) compared to trauma (10.8%) and orthodontic reasons (23.5%). Seven (1.4%) lost their teeth due to failure of previous treatment such as pulp therapy. CONCLUSION: Extraction largely due to caries and its sequelae was responsible for most of the tooth loss among the study population. There is the need for intensified oral health education and awareness programmes in the populace with emphasis on prevention of dental caries and early presentation for dental treatment in order to avert premature tooth loss in children and adolescents.

Variations of crown dimensions of permanent dentitions in a selected population of Nigerian children.

BACKGROUND: Race, gender, genetic/ environmental factors contribute to tooth variations which could be in size or shape. However, little has been reported on dimensional variations in permanent dentitions among Nigerians. OBJECTIVE: To investigate the pattern of variability of mesiodistal and buccolingual tooth dimensions of permanent dentition in Nigerians. METHODS: Mesiodistal (MD) and buccolingual (BL) tooth dimensions were obtained from teeth on dental stone models of selected 400 healthy adolescents aged 12-15 years using an electronic digital caliper. The descriptive statistics and the variability (determined from the Coefficient of Variation; SD/mean x100) were obtained using SPSS version 13. RESULTS: The mean tooth dimensions were larger in the males than in the females in all tooth types except in mean MD tooth dimension of maxillary second premolars which was larger in the females though not significant (p = 0.70). The coefficient of variation (CV) in the mean MD and BL dimensions ranged from 5.02 in the mandibula rfirst molars to 7.68 in the maxillary lateral incisors and from 5.38 to 11.07 in the maxillary first molars and the mandibular central incisors respectively. The least variable teeth in MD dimensions were the maxillary first molars in males (CV = 4.94) and mandibular first molars in females (CV = 4.88), while the highest variability was seen in the maxillary second premolars in females (CV = 10.46). In BL dimension the maxillary first molars were the least variable in both genders (CV = 5.22 in males, CV = 5.24 females) while the maxillary lateral incisors of males had the highest variability(CV = 11.90). CONCLUSION: The pattern of variation showed that the later-forming teeth in each tooth class showed more variability than the mesial members. The mesiodistal tooth dimensions were less variable than the buccolingual tooth dimensions.

A comparison of clinical and radiographic caries diagnosis on posterior teeth of children seen at a Nigerian teaching hospital.

Early detection and initiation of therapy for dental caries is the most effective means of ensuring resolution of the condition and its sequelae. The aim of this study was to compare the effectiveness of clinical and radiographic (using bitewing radiograph) methods of caries diagnosis in children. The subjects were 172 children within the age range of 5-12 years attending the Paedodontic Clinic of the University College Hospital for the first time. They were clinically examined for the presence of dental caries using the WHO criteria. Left and right bitewing radiographs were taken following the clinical examination to detect dental caries. Clinical examination found additional 4 occlusal caries (incipient caries) that were not diagnosed radiographically and radiographic examination revealed additional 20 approximal surface caries that were not evident clinically in deciduous teeth. In permanent teeth, 3 additional occlusal caries were diagnosed clinically while only one additional approximal caries was diagnosed radiographically. These observations revealed the additional diagnostic value of bitewing radiograph in the diagnosis of approximal caries in children and the importance of clinical examinations in diagnosis of early occlusal caries (incipient caries) which are difficult to see on dental radiographs. In view of these findings, the use of bitewing radiographs combined with careful clinical examination will be of great advantage in early detection of caries in children.

Pattern of endodontic treatment in children in a Nigerian tertiary hospital.

OBJECTIVES: The aim of this study was to determine the frequency and reasons for endodontic treatment in patients aged 16 years and below seen at the Paedodontic clinic of the Department of Child Dental Health of the Lagos University Teaching Hospital. METHODS: Dental records of patients aged 16 years and below treated for various dental problems at the Paedodontic clinic of the Lagos University Teaching Hospital between January 2006 and December 2007 were reviewed to select cases that received endodontic treatment. The survey was conducted to determine the frequency of endodontic treatment for each tooth in the maxilla and mandible, the reasons for endodontic treatment and type of endodontic treatment performed in each tooth. Data on age, sex, endodontically treated teeth, reasons for endodontic treatment and date of treatment was retrieved from the patients' dental records. RESULTS: A total of 2376 patients were seen during the period of survey, out of which 260 (11%) patients received endodontic treatment of three hundred teeth comprising 194 mandibular teeth and 106 maxillary teeth. The primary lower second molar (26%) was the most frequently endodontically treated tooth followed by the permanent lower first molar (22%). All the primary and permanent molars were endodontically treated due to caries while 62.5% and 60% of permanent and primary central incisors respectively were endodontically treated due to caries. The other infrequent reasons for endodontic treatment were trauma (5.3%) and failed root canal treatment (1.3%). CONCLUSION: The primary lower second molar was the most frequently (26%) treated endodontically and the major reason (93.3%) for endodontic treatment was caries. Only 5.3% of the endodontically treated teeth were due to trauma.

Early childhood caries: experience in Nigerian children at Lagos.

UNLABELLED: Objective of the paper was to assess the prevalence of Early Childhood Caries among Nigerian children aged 6 months to 5 years, describe the pattern and relate it to the socioeconomic status of their parents/guardians. METHODS: It was a descriptive study carried out in three randomly selected local government areas in Lagos State. Questionnaires designed to provide information on the socio-economic status of the parents were completed by one of the authors. All the children were examined using sterile instruments for the presence of early childhood caries. RESULTS: The prevalence of early childhood caries amongst the children was 10.5%, among them 4.8% had severe early childhood caries. Early childhood caries was observed in children as early as 13 months. The primary incisors were most affected. Only 17 (4.4%) had visited the dentist. CONCLUSION: There was a tendency towards higher caries level in children of higher socio-economic status. Preschool children had great demand for restorative care.

Need for preventive and interceptive orthodontic treatment in 3-5 year-old Nigerian children in two major cities.

There is a growing emphasis world-wide for early orthodontic treatment but in Nigeria there is very little information regarding the occlusal development in pre-school children reported. The need for preventive and interceptive intervention for malocclusion was studied in a sample of 563 Nigerian children (289 boys and 274 girls) aged 3-5 years. Orthodontic intervention was estimated to be needed in 12.8% of the children due to cross bite of the anterior or lateral segments. Education was needed in 12.5% of the children in cases of digit sucking, lip sucking and tongue thrusting. Extraction was indicated in 0.4% of children in cases of retained primary incisors causing displacement of the erupting successors. The need for further follow-up of occlusal development was noted in 1.4% of the children due to double primary teeth (0.4%), numerical variation of primary teeth (0.4%), crown dilaceration of a tooth (0.2%) and true class III skeletal malocclusion (0.4%).

Prevalence of oral habits in 563 Nigerian preschool children age 3-5 years.

One of the contributory factors in the establishment of occlusion is the child's oral habits. A limited amount of information is available on oral habits of pre-school children especially on Nigerian pre-school children. With an increasing interest in the early recognition of mal-occlusion and a corresponding emphasis on preventive procedures, more information on pre-school children may prove to be useful. This study revealed the prevalence of oral habits among 563 Nigerian pre-school children aged 3-5 years at 13.14%: 6.74% for males, 6.4%for females. The acquired data were tested with chi-square(chi2). The results indicate significant gender difference for tongue thrusting/sucking only (P=0.01) using the fisher's exact test. The relationship between digital sucking habit and mal-occlusion was very significant (P<0.01).

Occlusal relationships and spacing or crowding of teeth in the dentitions of 3-4-year-old Nigerian children.

A study of 525 3-4-year-old children in nursery schools and day-care centres was carried out to assess occlusal relationships and the presence of spacing or crowding of teeth. No significant differences in occlusal relationships were found between boys and girls (P > 0.05). Bilateral straight terminal planes of molars and class 1 canine relationship were the most prevalent features (74.5% and 73.3% respectively). Most of the children had 'normal' vertical and transverse occlusal relationships. The most common sites of spacing were mesial to maxillary canines and distal to mandibular canines. 32% of the children were found to have generalized anterior segment spacing, 4% showed exclusively anthropoid spaces, and 18% had either contact between all the teeth or crowding in the anterior region.

In-vitro antibacterial effects of extracts of Nigerian tooth-cleaning sticks on periodontopathic bacteria.

Aqueous extracts from 8 plants used for tooth-cleaning in Nigeria were tested for their ability to inhibit the growth of five periodontopathic bacteria, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Eikenella corrodens and Campylobacter rectus. Extracts of all the plants except that of Massularia acuminata exhibited varying growth inhibitory potentials on the microorganisms. Extract of Terminalia glaucescens showed the widest spectrum of activity, inhibiting the growth of all the tested bacteria except P. gingivalis. These findings corroborate other studies that the plants possess antiplaque properties and suggest that they may be useful tools in preventive dentistry in poor developing countries. However, the bioavailability of the active ingredients of the plants and their long term effects in vivo need to be investigated.

The tooth-cleaning stick: its merits and demerits.

The use of various plants for oral hygiene purposes is still commonly practised among various cultures. Pencil-sized sticks are fashioned from certain plant-parts and are chewed on one end until they become frayed into a brush. The brush-end is used to clean the teeth in a similar manner to the tooth-brush and paste. The plants when used in this manner are commonly referred to as the "chewing stick". The paper introduces a more appropriate term, the "tooth-cleaning stick". The new concept impresses on the mind the objective and the ultimate goal of using the stick, that is, for cleaning--and not merely for chewing as it is often practised. The merits and demerits of this oral hygiene procedure are presented. Suggestions on how to minimize the reported shortcomings associated with the procedure are offered.

HIV infection in children: a challenge to dental practice.

Human immunodeficiency virus infection in children is on the increase globally. Because of diagnostic difficulties of HIV infection in children, among other reasons, all children are suspects. As a result of new developments in the treatment of this condition, more people with HIV infection/AIDS will survive and require dental treatment on a long-term basis. Dental practitioners who treat children and adolescents are faced with increasing challenge of providing optimum oral health care for all youths regardless of their being infected with HIV or not. The paper presents the diversified roles dentists in African countries have to play owing to prevailing peculiar circumstances in their communities. They should not only be oral diagnosticians and oral health care providers, but also health educators and promoters, researchers, counsellors, and social workers. All oral health personnel particularly the dentist, must be well-learned to meet these demands. By discharging these duties effectively, the spread of HIV infection will be curbed, and both the oral health and the entire well-being of the child population will be enhanced.