Malocclusion and orthodontic treatment need of patients attending the Lagos University Teaching Hospital, Lagos, Nigeria.

OBJECTIVE: To determine the orthodontic treatment needs of patients attending a Nigerian Teaching Hospital using the Dental Aesthetic Index. METHOD: One hundred and fifty study models of patients who attended the Orthodontic clinic of the Lagos University Teaching Hospital were assessed using the DAI. The data was collected using an evaluation form. Descriptive statistics, Chi-square values and t-tests were used to analyze the data. RESULTS: The mean DAI score was 31.5 ± 9.7. Overall, 32% of the subjects had no need or slight need for orthodontic treatment. In 23.3% the need for treatment was elective. Severe malocclusion with treatment highly desirable was found in 16.7% and 28% had handicapping malocclusion with treatment considered mandatory. There were no significant gender differences with regard to the DAI treatment categories (p > 0.05). There were no statistically significant differences in mean DAI scores between age groups, gender and social class (p > 0.05). CONCLUSIONS: This study showed that close to one-third of the subjects had dental appearance that did not require treatment. A significant proportion (28%) of the subjects had very severe (handicapping) malocclusion and could qualify for publicly subsidized orthodontic treatment.

Prevalence of malocclusion and occlusal traits among adolescents and young adults in Rivers State, Nigeria.

BACKGROUND AND AIMS: A systematic and well-organized dental care program for any target population in a community requires some basic information, such as the prevalence of the condition to be assessed. Thus, the aims of this study were to determine the prevalence of malocclusion among predominantly Rivers State adolescents and to compare the results with other authors. METHODS: The sample which was randomly selected from seven secondary schools comprised 620 schoolchildren, 297 (48%) males and 323 (52%) females aged 13-20 years old with a mean age of 16.74 +/- 2.0 (SD) years. The children were examined for occlusal traits which included the occlusal antero-posterior relationship (Angles classification), overjet, overbite, openbite, crossbite, spacing and crowding. The Index of Complexity, Outcome and Need (ICON) protocol was employed in their classrooms using wooden spatulae and orthodontic millimeter rulers under natural illumination. None of the subjects had undergone any form of orthodontic treatment. RESULTS: Results showed that about 11.8% had normal occlusions, 80.3% had Class I malocclusions, 6.3% had Class II malocclusions (Div 1, 3.9%; Div 11, 2.4%) and 1.6% had Class III malocclusions. About 70% had normal overjets, normal overbite was seen in about 56%, whilst in the maxillary arch 14.4% had crowding and 60% spacing. Open bite was present in 7.1% while crossbite was found in 17.1%. Significant gender differences were found for overbite, overjet and Angles classification (P < 0.05). CONCLUSION: Angles Class I malocclusion is the predominant occlusal pattern among these students. This finding compares favorably with other studies done in other parts of Nigeria.

Causes and pattern of tooth extractions in children treated at the University of Port Harcourt Teaching Hospital.

BACKGROUND: Tooth mortality is mainly a reflection of untreated dental caries and periodontal disease and is considered a crude but useful measure for the dental status of a community. Oral health status of the people of Niger Delta particularly that of children, is currently vague. AIM: To investigate the reasons and pattern of tooth extractions among children who presented at the Paediatric dental clinic of University of Port Harcourt Teaching Hospital (UPTH). METHODS: A retrospective study of children aged 16 years and below who attended the paediatric dental clinic of UPTH for treatment from March 2008 to August 2010 was done. The following information was retrieved from hospital records of the patients: age, sex, indications for extraction and the extracted teeth. RESULTS: A total of 462 children aged between 2-16 years were seen out of which 115 (24.9%) patients had extraction. On the whole, 145 teeth were extracted. Dental caries and its sequelae (irreversible pulpitis, dentoalveolar abscess etc) accounted for the highest indication for extraction 71 (61.7%) while periodontal disease accounted for the least (2.6%). The other indications for extractions were trauma, orthodontic reasons and eruption anomalies. Primary teeth 103 (71.0%) were mostly affected with the anterior teeth (33.8%) being the most frequently involved. The molars (73.8%) were the most frequently involved teeth in the permanent dentition. CONCLUSION: Dental caries and its sequelae is the commonest reason for tooth extraction. Efforts must be made to improve the dental health awareness and status of Nigerian children in this region.

Maternal knowledge and awareness of factors affecting oral health in the paediatric population.

AIM: To assess expectant mothers on their knowledge and awareness of factors affecting paediatric oral health. METHOD: Seven hundred and six women in different stages of pregnancy were recruited from the antenatal clinic of the University of Port Harcourt Teaching Hospital over a period of four weeks. A self-administered structured questionnaire on socio-demographic information, oral health knowledge and oral health behaviour was filled by the participants. Data was analyzed using SPSS version 17. RESULTS: The mean age of the subjects was 29.6 (SD + 4.4) years. Seventy percent of them had tertiary education and 63.9% were unemployed. A significant proportion (83.4%) of the women had medium to high score (> 50%) in the knowledge of causal and preventive factors in dental caries and gingivitis. Over seventy nine percent (79.2%) of them acknowledged that primary teeth are important, but 43.6% did not know whether primary teeth should be restored or not. Only 39.3% of the women knew that leaving a feeding bottle/breast in the mouth of a sleeping child could be harmful to the teeth. Knowledge of the role of bacteria in gingivitis (81.3%) and dental caries (86.6%) was high. Over 45% of participants agreed that mothers could transmit cariogenic bacteria to their children. Only 0.7% of the women had taken their children to the dental clinic for routine checkup. CONCLUSION: Most of the participants had medium to high knowledge of the factors that affect paediatric oral health, yet the participants did not demonstrate adequate and proper concomitant oral health practice.

Restorative orthodontic treatment approach in the correction of anterior proclination in special cases (Port Harcourt-Onyeaso appliance): two case reports.

BACKGROUND: Removable orthodontic appliance may be indicated in the management of anterior proclination and increased overjet especially in the younger age group. Generally, proclined maxillary incisors are prone to trauma in young active children. This makes prompt preventive and interceptive intervention very necessary. This condition is complicated in the event of associated trauma to such tooth/teeth that could require orthodontic tooth movement. CASES: The first report involves a 12-year-old boy who presented three years ago with loss of his two central incisors due to traumatic avulsion. The second report is a 10- year-old boy who presented a year ago with a dento alveolar abscess in relation to a long standing Ellis class III and class II fractures on the maxillary right and left central incisors, respectively. In both cases two different innovative management procedures were undertaken which combined restorative and orthodontic procedures concurrently, which helped the children psychologically in school. The first has been discharged to continue with the appliance as both a retainer and a denture while the second has completed an acceptable dental restoration and is still receiving orthodontic care with satisfactory progress. CONCLUSION: These innovative procedures yielded good results. Both patients and parents were very co-operative and appreciative of the outcomes.

Anteroposterior, vertical and space malocclusions in adolescents with special needs in Lagos, Nigeria.

OBJECTIVE: To determine the prevalence of malocclusion in adolescents with special needs and to compare the results with those of other authors. METHODS: The study sample consisted of 230 adolescents with special needs aged 12-17 years randomly selected from 5 special school/centres in Lagos. Occlusal anteroposterior relationships were assessed based on Angle classification. RESULTS: Normal occlusion was seen in 11.7%, Angle's class I malocclusion in 77.4%, class II malocclusion in 8.3% and class III malocclusion in 2.6%. Over 63% had normal overbites, and 6.5% and 12.5% had increased and reduced values, respectively. Overjet relationship was normal in 50%, increased in 25.7% and reduced in 6.5%. Crowding was observed in 29% of the subjects and midline diastema in 27%. Males had a significantly higher prevalence of midline diastema than females (p < 0.05). The intellectually impaired had significantly higher frequency of class II division 1 malocclusion and anterior openbite when compared with the other disabled groups. CONCLUSION: Class I malocclusion is the most prevalent occlusal pattern among adolescents with special needs. Statistically significant differences in occlusal pattern were observed between the disabled groups.

Attitudes and perception of Nigerian dentists about shortened dental arch therapy (SDAT).

OBJECTIVE: The shortened dental arch therapy (SDAT) is a strategy to reduce complex restorative treatment in the molar area. By offering the partially dentate patients, a treatment option that ensures oral functionality, improved oral hygiene, comfort and possibly reduced costs, the SDA treatment approach appears to provide an advantage without compromising patient care. Despite these encouraging reports, it has been stated that there are few papers in the literature addressing clinical attitudes to SDAT. The current study is, therefore, designed to determine the attitude and perception of dentist in Nigeria about the concept. MATERIALS AND METHODS: A cross-sectional study was conducted using a self-administered structured questionnaire. The questionnaire employed by Sarita et al. was modified and employed as the instrument for data collection. The respondents were requested to provide information about their socio-demographic variables and their attitudes and perception of SDAT. The questionnaires were randomly distributed among general dental practitioners and residents (postgraduate doctors) in dental training institutions in Nigeria. RESULT: The clinical experience of most of the respondents was < or = 10 years. Most of the respondents were working in government institutions. Few of the respondents (36.1%) indicated that the concept was good for developing country like Nigeria and only few of the respondents (38.0%) agreed with the problem-oriented approach. Most respondents indicated that patients with shortened dental arches are not nutritionally less healthy and that, the oral functions and TMJ health of these patients is acceptable. CONCLUSION: It appears the attitude and perception of dentists in Nigeria as it relates to shortened dental arch concept is not impressive at the moment.

Dental caries experience among the elderly population in South East local government area in Ibadan, Nigeria.

OBJECTIVE: To determine the caries experience of the elderly people in South East Local Government Area (S.E.L.G.A) in Ibadan. SUBJECTS AND METHODS: A randomly selected sample of 690 elderly people from 23 wards in S.E.L.G.A were examined by two trained and calibrated examiners according to WHO criteria. RESULTS: Majority of them (85.5%) had no caries experience. Their mean DMFT was 0.46. More teeth in the mandible (160) than the maxilla were affected by caries or treated for caries. Their MNI was 25.5% and RI was 21%. CONCLUSION: The elderly in S.E.L.G.A have low caries experience and very high-unmet dental health needs.

Occlusion in the primary dentition. Part 2: a comparison of some occlusal traits among pre-school children of the 3 major ethnic groups in Nigeria.

This paper attempted to compare some of the other occlusal variations in the primary dentition of the children from the 3 major ethnic groups in Nigeria. Cross-sectional epidemiological study involving two major cities in Nigeria. 269, 3-5 year-old children from the 3 major ethnic groups in Nigeria consisting of 125 (46.5%) males and 144 (53.6%) females selected from pre-primary schools/centres. Only children with confirmed ages were included in the study and the criteria of Foster and Hamilton were used in assessing the occlusal features. Although some ethnic differences were observed in relation to the assessed occlusal features, overjet, overbite, cross bite, scissors bite and midline relationship, none was found to be statistically significant (P > 0.05). The occlusal features among the children from the ethnic groups do not differ significantly. Prospective longitudinal study could be worthwhile in further understanding their occlusal developments.

Occlusion in the primary dentition. Part 1: A preliminary report on comparison of antero-posterior relationships and spacing among children of the major Nigerian ethnic groups.

This paper compares the antero-posterior occlusal pattern and arch spacing in the primary dentition of Nigerian children from the 3 major ethnic groups in the country Ibo, Yoruba and Hausa tribes. This is a cross-sectional epidemiological study involving eight randomly selected pre-primary schools and day-care centers in Ibadan and Lagos cities of Nigeria. Two hundred and sixty-nine 3-5-year-old children consisting of 125 (46.5%) males and 144 (53.6%) females were examined. A two-stage sampling method was adopted. The occlusions of the children were assessed according to the criteria by Foster and Hamilton, under natural illumination in their schools premises. Chi-square statistic was used to analyse the data. No statistically significant differences were observed in the molar and canine relationships among the ethnic groups (p > 0.05). Highly statistically significant differences were noted in relation to spacing of the arches (p = 0.001) in both the anterior and posterior segments. Also, statistically significant differences were found in relation to post canine spaces (p < 0.05) but not with pre-canine spaces. Spacing was found most in the Ibo ethnic group children. Although no statistically significant ethnic differences were found in the molar relationships of the study sample, very statistically significant differences were revealed in the spacing of the arches in both incisor and molar regions.

Effect of academic stress on periodontal health in Nigerians.

The aim of the study was to assess the effect of academic stress on periodontal health. The experimental group consisted of 22 final year dental students preparing for a major final BDS examination. The control group was made of 29 first year dental clinical students who were not preparing for any examination. Informed consents were obtained from all the students who participated in the study. The study was double blind as the examiners and the students were not aware of the aim of the study at the examination stage. The baseline measurements of Oral Hygiene Index (OHI) and Gingival Index (GI) were done 6 weeks prior to the commencement of the final BDS examination for both the experimental and the control groups. Statistical significant differences were observed in the two indices at final reading, between experimental and control groups while the baseline scores for the indices revealed no statistical significant differences. The results indicate that non-demonstrable factors like psychosocial stress represent a risk indicator for periodontal disease and these should be addressed in periodontal patients before and during treatment.

Expectations of orthodontic treatment and satisfaction with dental appearance among Nigerian parents [corrected].

The aim of this study was to investigate correlations between satisfaction with dental appearance and expectation of orthodontic treatment. The effects of sex and age on these variables were also explored. A sample of 466 parents comprising 238 (51.1%) males and 228 females (48.9%) were randomly surveyed in Ibadan Nigeria. Their ages ranged from 18 to 73 with mean age of 36.89 +/- 12.27 (SD). They were asked whether they were satisfied or otherwise with their dental appearance and to indicate their expectation of orthodontic treatment. A multiple regression analysis was used to estimate the effect of the dental satisfaction on expectation of orthodontic treatment as well as the influence of age and sex on orthodontic expectations. Significant correlation was not found between satisfaction between dental appearance and parents' expectations. These correlations were invariant over gender, but not over age. It was concluded that satisfaction with dental appearance is not a significant predictor of parents' expectations of orthodontic treatment among the study sample but age was.

Incidence of retained deciduous teeth in a Nigerian population: an indication of poor dental awareness/attitude.

This pilot study aimed at assessing the incidence of retained deciduous teeth in a Nigerian orthodontic population, which could be helpful in teaching, as well as motivation of the community. A total of 361 patients were seen between January 2001 and May 2003 at the orthodontic clinic of University College Hospital, Ibadan, Nigeria, and 60 (16.6%) of them comprising 31 (51.7%) males and 29 (48.3%) females with age range of 7-23 years (mean age, 12.3 + 4.8 SD) presented with retained deciduous teeth. The social classification of the patients was according to the Registrar General's Social Class with no significant differences between the social classes (p > 0.05). Generally, more males had this occlusal anomaly than females. Angle's class I occlusion was found most in the subjects with the anomaly. Bilateral presentation of the anomaly was more than unilateral cases. The incidence was considered high and suggests a need for intensified dental education for the community for earlier preventive/interceptive measures.

Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria.

The main purpose of this study was to analyze the current psychosocial implications of malocclusion in Ibadan, Nigeria. The study sample comprised 614 secondary school children (327 males and 287 females) aged 12-18 years (mean age, 14.9 +/- 2.9 SD) who filled in a questionnaire containing general questions about body image and specific inquires concerning self-perception and social implications of dental appearance. The children's occlusions were also assessed using the Dental Aesthetic Index (DAI) and the malocclusion traits related to body image, self-perception, and social implications of dental appearance. Subjects with malocclusion rated only the teeth significantly least satisfactory among other twelve items of body image. The lowest rating was observed in subjects with crowding of the maxillary and mandibular incisor segments. Highly significant differences (P < 0.001) were found between subjects with normal or minor malocclusion and those with marked malocclusion in indicating awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavourable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred significantly more often in the presence of malocclusion (P < 0.001). Unfavourable perceptions of the teeth were expressed significantly more often by subjects with anterior maxillary irregularities of up to 1 mm and more, spacing of both maxillary and mandibular incisor segments, midline diastema, crowding (especially of the mandibular incisor segment), anterior open bite and molar relation deviations. It was concluded that certain malocclusions, especially occlusal and space anomalies, may adversely affect body image and self-concept of Nigerian adolescents.

Tooth wear in the elderly population in South East Local Government area in Ibadan, Nigeria.

It is the aim of this study to determine the pattern and degree of tooth wear in the elderly population in the South East Local Government Area in Ibadan. The study was carried out on 690 elderly individuals who were 65 years old and above, living in various wards in South East Local Government Area, in Ibadan. A multistage sampling technique was used to select elderly individuals for the study. Two interviewers, 2-record clerks and 2 examiners were trained for the study and the examiners were calibrated. The index of Eccles J.D was used to determine the severity of tooth wear. The results highlight the high prevalence of tooth wear, mainly attrition in the elderly in this local government area. Six hundred and forty (92.8%) of the elderly had tooth wear. Of these 58.59% were males and 41.41% females. Attrition was observed in 618 (89.6%) elderly individuals. The mandible exhibited a higher prevalence of tooth wear than the maxilla and was statistically significant. Severe tooth wear was observed in only 5.74% of the teeth whilst moderate and mild tooth wear were observed in 26.91% and 30.88% respectively. Unlike the Western European countries, attrition being the most common type of tooth wear in these elderly individuals suggests that the aetiological factors responsible for tooth wear are different. Common habits such as crushing of bones and chewing of sticks for routine oral hygiene care could be contributing factors to tooth wear in this environment.

Perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injury.

OBJECTIVE: The perception of Nigerian athletes of the use of mouth guards to prevent the stresses of sports injuries was examined using psychological, sociological, and physical stress variables. METHODS: The descriptive survey research design was used in this study. Participants (n = 333) were selected using the purposive random sampling technique and data were collected using the 4 point Likert type instrument. The coefficient alpha was used to determine the reliability of the instrument with r = 0.79 for psychological, r = 0.66 for physical, and r = 0.74 for sociological stress. RESULTS: The result reveals that female athletes perceived the use of mouth guards as being more important to prevent the stresses of sports injuries than male athletes, while athletes who had used mouth guards for longer periods also perceived them as being more important to prevent the stresses of sports injuries compared to those who had used them less. The result also revealed a significant difference (p<0.05) among the various sport groups as independent variables on the psychological and physical stress variables. Scheffe post hoc analysis was used to identify the group where significant difference was found. CONCLUSIONS: The study concluded that since the impact of injury is perceived to affect the cognitive function of athletes, athletes should be educated on the use of mouth guards in order to reduce the incidence of oral and dental injuries to the barest minimum.

Demand and referral pattern for orthodontic care at University College Hospital, Ibadan, Nigeria.

OBJECTIVE: To assess the demand and pattern of referral for orthodontic services at University College Hospital, Ibadan, Nigeria. DESIGN: A 21-month prospective clinic-based study of consecutive orthodontic patients. SETTING AND SAMPLE POPULATION: The orthodontic clinic of University College Hospital, Ibadan, Nigeria. One hundred and seventy-eight (178) consecutive patients, consisting of 79 (44.4%) males and 99 (55.6%) females with mean age of 16.21+/-7.81 years were studied. RESULTS: 80% of subjects were 20 years of age or younger, while less than 2% were over 40 years of age. More females sought orthodontic care than males. Over 43% of the patients needed removable orthodontic appliances while close to 17% required treatment with fixed appliances. Extractions of retained primary teeth and other grossly malpositioned teeth accounted for 9.6% while 24.7% needed observation of occlusal developments before any treatment decisions could be made. Dentists were noted to be the main referrers of these patients, accounting for over 49% of the referrals, followed by 25.4% who were self referred, and 18.3% who attended under parental influence. CONCLUSION: More girls than boys demanded orthodontic care and dentists were the major referrers of orthodontic patients.

An assessment of relationship between self-esteem, orthodontic concern, and Dental Aesthetic Index (DAI) scores among secondary school students in Ibadan, Nigeria.

OBJECTIVE: To ascertain the correlation between self-esteem, orthodontic concern and orthodontic status using DAI scores in a group of Nigerian potential orthodontic patients. DESIGN: A cross-sectional analytical study. SETTING: Secondary schools reflecting a good socio-economic spread of adolescents in the town. PARTICIPANTS: Randomly selected 520 junior and senior students 276 (53.1%) males and 244 (46.9%) females with mean age of 15.02 +/- 3.26 (SD) years participated in the study. METHODS: Each student was asked to fill in the questionnaire on orthodontic concern and Global Negative Self-Evaluation scale (GSE) with subsequent assessment of the occlusion according to the DAI by one orthodontist. After obtaining consent, thirty students were re-examined to test intra-examiner reliability which was good (r = 0.98, P < 0.001). RESULTS: The correlations between self-esteem, orthodontic concern and DAI scores were tested using Spearman rank order correlation coefficient. Significant positive correlations were observed between self-esteem and orthodontic concern according to DAI treatment category needs (r = 0.274, p<0.01; r = 0.396, p<0.01; r = 0.347, p<0.05) except for the severe malocclusion group which was positive but not statistically significant (r = 0.136, p> 0.05). Significant correlation was equally noted between DAI scores and orthodontic concern (r = 0.191, p<0.01). CONCLUSION: Significant positive correlation existed between self-esteem in a group of Nigerian adolescents and their orthodontic concern as well as between their DAI scores and orthodontic concern. DAI should be a relevant and useful occlusal index for the Nigerian orthodontic population.

Oro-facial injury and mouthguard usage by athletes in Nigeria.

OBJECTIVE: To determine the extent of awareness concerning mouthguard use for sports as well as the amount and type of oro-facial trauma associated with sporting activities among Nigerian athletes. DESIGN: A questionnaire survey. MATERIALS AND METHODS: A questionnaire was completed by 273 athletes (91% completion rate) who participated in the National Sports festival in May 2002 in Benin City, Nigeria. The sample was representative of all the 36 states in Nigeria including the Federal capital territory, Abuja. Descriptive statistics were employed and the data were further analysed using the chi-square test. RESULTS: Awareness concerning mouthguards was claimed by 226 (82.8%) of the athletes but significantly fewer athletes who claimed awareness of the devices were using them. Only 93 (41.2%) of this mouthguard-aware group knew of the three types of mouthguard available. Of all the respondents, 131 (48.0%) believed that wearing mouthguards would reduce the prevalence and/or severity of oro-facial injuries during sports. In all, 158 (57.9%) of them had one form of oro-facial injury or the other with contact sports accounting for most of them (78.5%) while 21.5% resulted from non-contact events. The prevalence of oro-facial injuries was significantly lower while wearing mouth protectors. CONCLUSIONS: Although the majority of the athletes claimed awareness of mouthguards, less than one-third used them. Over half of the athletes were not sure that mouthguards could reduce the prevalence and/or severity of oro-facial injuries. There is need to educate the athletes more concerning mouthguards.

Oral habits among 7-10 year-old school children in Ibadan, Nigeria.

OBJECTIVE: To assess the prevalence of oral habits among 7-10 year-old children in Ibadan, Nigeria. DESIGN: An epidemiological survey of randomly selected school children. Criteria for social class was based on registrar general's social class. SETTING: Primary schools from different parts of Ibadan city, Nigeria. SUBJECTS: 493 school children aged 7-10 years consisting of 237(48.1%) boys and 256(51.9%) girls. MAIN OUTCOME MEASURES: Only children still actively involved in oral habits were coded positive. RESULTS: In all, 49(9.9%) of the children were involved in one type of oral habit or the other with digit sucking being most prevalent 40(8.1%). Lip sucking was observed in 6(1.2%) while 1(0.2%) had an unusual sucking habit--sucking of left forearm with resultant severe anterior open bite (10 mm). The relationship between the oral habits anterior open-bite and increased overjets were very significant statistically (p<0.01). No significant associations were noted between the habits and social class as well as Angle's classification of molar relations. None of the children examined had gone for routine dental check-ups before except for the 62(12.6%) who had previous dental consultations due to toothaches. CONCLUSION: Oral habits especially digit sucking needing management was revealed by this study and none of them had been to a dentist for help. This suggests that there is need to intensify oral health education in our environment, targeted at both parents and school children to enable them benefit from interceptive orthodontic care which has numerous advantages.