Oral Disorders and Serum Oestrogen Levels in Postmenopausal Women in Lagos, Nigeria.

BACKGROUND: Changes in hormonal levels during puberty, pregnancy, menstruation, and menopause have varying effects on the oral cavity. Several mucosal disorders manifest in the oral cavity of postmenopausal women partly due to a decrease in oestrogen and progesterone level which are significant. The aim of this study was to determine the oral disorders associated with serum blood oestrogen levels in Nigerian postmenopausal women. MATERIALS AND METHODS: A cross-sectional analytical study at the Oral Diagnosis and Oral Medicine clinics in a large tertiary hospital in Lagos, Nigeria between June 2019 and December 2019 involving 35 postmenopausal and 35 premenopausal women within the ages of 40 to 60 years. The prevalence of oral disorders such as hyposalivation, burning mouth sensation, and periodontitis in pre and postmenopausal women was determined, likewise the association between oral disorders and blood oestrogen levels. RESULTS: The mean age of the postmenopausal women was 53.2 ± 5.6 years and premenopausal women was 46.4 ± 4.0 years. Chronic periodontitis was the most prevalent oral disorder in 19(54.3%) postmenopausal women followed by hyposalivation 5(14.3%) compared with 13(37.1%) and 2(5.7%) respectively in premenopausal women. All postmenopausal women who had chronic periodontitis 19(100%) had relatively high oestradiol levels compared with 5(38.5%) premenopausal women. CONCLUSION: There was no statistically significant association between oral disorders and blood oestrogen levels.

CONTEXTE: Les changements des niveaux hormonaux pendant lapuberté, la grossesse, la menstruation et la ménopause ont des effets variables sur la cavité buccale. Plusieurs troubles des muqueuses se manifestent dans la cavité buccale des femmes ménopausées, en partie à cause d'une baisse significative des taux d'œstrogènes et de progestérone. L'objectif de cette étude était de déterminer les troubles bucco-dentaires associés aux niveaux d'œstrogènes dans le sang sérique chez les femmes ménopausées nigérianes. MATÉRIEL ET MÉTHODES: Une étude analytique transversale dans les cliniques de diagnostic oral et de médecine bucco-dentaire d'un grand hôpital tertiaire à Lagos, au Nigeria, entre juin 2019 et décembre 2019, impliquant 35 femmes ménopausées et 35 femmes préménopausées âgées de 40 à 60 ans. La prévalence des troubles bucco-dentaires tels que l'hyposalivation, la sensation de bouche brûlante et la parodontite chez les femmes pré et post-ménopausées a été déterminée, de même que l'association entre les troubles buccodentaires et les niveaux d'œstrogènes dans le sang. RÉSULTATS: L'âge moyen des femmes ménopausées était de 53,2 ± 5,6 ans et celui des femmes préménopausées de 46,4 ± 4,0 ans. La parodontite chronique était le trouble bucco-dentaire le plus répandu chez 19 (54,3 %) femmes ménopausées, suivie par l'hyposalivation 5 (14,3 %), contre 13 (37,1 %) et 2 (5,7 %) respectivement chez les femmes préménopausées. Toutes les femmes ménopausées qui souffraient de parodontite chronique 19(100%) avaient des taux d'œstradiol relativement élevés par rapport à 5(38,5%) femmes préménopausées. CONCLUSION: Il n'y a pas d'association statistiquement significative entre les troubles bucco-dentaires et les taux d'œstrogènes dans le sang.

Total Salivary Antioxidant and Serum Antioxidant Levels in Recurrent Aphthous Stomatitis: A Case-Control Study.

BACKGROUND: Recurrent Aphthous Stomatitis (RAS) is an inflammatory lesion of the oral mucous lining, accounting for 5 to 25% of the chronic oral lesions. Studies have suggested that RAS patients have increased oxidative stress (OS) and impaired antioxidant capacity, and non-invasive screening using saliva assessment of oxidative stress and antioxidant capacity may be beneficial in RAS. OBJECTIVES: This study determined total salivary antioxidant concentration and compared it to the total serum antioxidant levels in patients with RAS and controls. METHODS: This was a case-control study of subjects with RAS and without RAS. Unstimulated mid-morning saliva was collected using the spitting method, and venous blood was collected into a plastic vacutainer. Saliva and blood samples were assayed for total oxidative stress (TOS), total antioxidant capacity (TAC), ferric reducing antioxidant power (FRAP) and glutathione. RESULTS: A total of 46 subjects, 23 with RAS and 23 healthy controls, participated in the study. Twenty-five (54.35%) were males, and 21(45.65) were females aged 17 to 73 years. We identified an increase in salivary and serum TOS (10.06 ± 7.49, 8.26 ± 2.18/ 15.00 ± 8.92, 9.36 ± 3.55µmol/L) and OSI while the TAC (16.85 ± 1.97, 17.07 ± 2.36/17.07 ± 2.36, 2.97 ± 0.29mM/L) and significantly GSH (0.02 ± 0.02, 0.10 ± 0.02/0.10 ± 0.02/0.19 ± 0.11 µmol/ml) were decreased in serum and saliva of the RAS group compared to controls respectively. In addition, there were positive correlations between salivary and serum levels of FRAP r=0.588, p= 0.003 and glutathione r=0.703, p<0.001 in RAS subjects and controls. CONCLUSION: Oxidative stress is associated with RAS, and saliva can be used as a biological marker for glutathione and FRAP.

CONTEXTE: La stomatite aphteuse récurrente (SAR) est une lésion inflammatoire de la muqueuse buccale qui représente 5 à 25 % des lésions buccales chroniques. Des études ont suggéré que les patients atteints de stomatite aphteuse récurrente présentent un stress oxydatif (SO) accru et une capacité antioxydante altérée, et qu'un dépistage non invasif utilisant l'évaluation salivaire du stress oxydatif et de la capacité antioxydante pourrait être bénéfique dans la stomatite aphteuse récurrente. OBJECTIFS: Cette étude a déterminé la concentration totale d'antioxydants dans la salive et l'a comparée aux niveaux totaux d'antioxydants dans le sérum chez des patients atteints de SRA et chez des témoins. MÉTHODES: Il s'agit d'une étude cas-témoins portant sur des sujets atteints ou non du syndrome respiratoire aigu sévère. De la salive non stimulée a été recueillie en milieu de matinée par la méthode du crachat, et du sang veineux a été prélevé dans un vacutainer en plastique. Les échantillons de salive et de sang ont été analysés pour déterminer le stress oxydatif total (TOS), la capacité antioxydante totale (TAC), le pouvoir antioxydant réducteur ferrique (FRAP) et le glutathion. RÉSULTATS: Au total, 46 sujets, 23 atteints de SRA et 23 témoins sains, ont participé à l'étude. Vingt-cinq (54,35 %) étaient des hommes et 21 (45,65) des femmes âgés de 17 à 73 ans. Nous avons identifié une augmentation des TOS salivaires et sériques (10.06 ± 7.49, 8.26 ± 2.18/ 15.00 ± 8.92, 9.36 ± 3.55µmol/L) et de l'OSI tandis que le TAC (16.85 ± 1.97, 17.07 ± 2.36/17.07 ± 2.36, 2. 97 ± 0.29mM/L) et significativement le GSH (0.02 ± 0.02, 0.10 ± 0.02/0.10 ± 0.02/0.19 ± 0.11 µmol/ml) ont été diminués dans le sérum et la salive du groupe RAS par rapport aux contrôles respectivement. En outre, il y avait des corrélations positives entre les niveaux salivaires et sériques de FRAP r=0,588, p= 0,003 et de glutathion r=0,703, p<0,001 chez les sujets RAS et les témoins. CONCLUSION: Le stress oxydatif est associé au SAPR et la salive peut être utilisée comme marqueur biologique pour le glutathion et la FRAP. Mots clés: Stomatite aphteuse récurrente, Antioxydants, Salive, Stress oxydatif.

Comparative Immunohistochemical Analysis of p53 and Alpha-SMA in Ameloblastoma, AOT and OKC.

OBJECTIVES: Ameloblastoma is a benign but highly infiltrative tumour, a behaviour that is lacking in adenomatoid odontogenic tumour but partly shared by the odontogenic keratocyst which possesses a unique intrinsic growth potential with marked ability for destroying bone and a high tendency recurrence. High frequency of stromal myofibroblasts (assessed with alpha smooth muscle actin (α-SMA) correlates with aggressive behaviour while p53-cell cycle regulation system is critical in odontogenic tumours with immunoreactivity signifying prognostic status. This study aims to determine and compare the immunoreactivity of these selected tumours to p53 and α-SMA in order to establish if a relationship exists between the frequency and pattern of distribution of myofibroblasts and the behaviour of these lesions. MATERIALS AND METHODS: 69 blocks of ameloblastoma, and 23 each of adenomatoid odontogenic tumor (AOT), and odontogenic keratocyst (OKC/KCOT) were retrieved. Immunohistochemistry technique was applied for evaluation of these two markers staining with primary antibodies to p53 and -SMA and the frequency and pattern of distribution of myofibroblasts and immunoreactivity to p53 analysed and compared using ANOVA. p was set at <0.05. RESULTS AND CONCLUSION: Immunoreactivity to p53 and α-SMA was highest in ameloblastoma (solid compared to unicystic) with highest mean positive cells to α-SMA (29.7±20.1) and p53 (28.3±24.5) in plexiform ameloblastoma. This suggests that ameloblastoma was the most aggressive of tumours studied. Different pharmacological agents that can regulate stromal MF are useful aids to decrease the need for radical surgery in extensive and aggressive odontogenic tumours.

ABSTRAIT OBJECTIFS: L'améloblastome est bénin mais untumeur mes infiltratif, un comportement qui fait défaut dans la tumeur odontogénique adénomatoïde mais en partie partagé par le kératocyste odontogène qui possède un potentiel de croissance intrinsèque unique avec une capacité marquée de destructionet une récidive à forte tendance. Haute fréquence de stromalmyofibroblastes (évalués avec de l'actine musculaire alpha lisse (α-SMA) est en corrélation avec un comportement agressif lors de la régulation du cycle des cellules p53 est essentiel dans les tumeurs odontogènes immunoréactives signifiant le statut pronostique. Cette étude vise à déterminer et comparer activité l'immunoré de ces tumeurs sélectionnées à p53 et α-SMA afin d'établir s'il existe une relation entre le fréquence et schéma de distribution des myofibroblastes et de la comportement de ces lésions. MATÉRIAUX ET MÉTHODES: 69 blocs d'améloblastome, et 23 chacun de tumeur odontogénique adénomatoïde (AOT) et odontogènedes kératocystes (OKC/KCOT) ont été récupérés. Immunohistochimiela technique a été appliquée pour l'évaluation de ces deux marqueurs de coloration avec des anticorps primaires dirigés contre p53 et α-SMA et la fréquence et schéma de distribution des myofibroblastes et de l'immunoréactivité àp53 analysé et comparé à l'aide de l'ANOVA. p a été fixé à <0,05. RÉSULTATS ET CONCLUSION: Immuno réactivité à p53 et α-SMA était la plus élevée dans l'améloblastome (solide par rapport α-SMA (29,7±20,1) et p53(28,3±24,5) dans l'améloblastome plexiforme. Cela suggère que L'améloblastome était la tumeur la plus agressive étudiée. Les agents pharmacologiques différentes peuvent réguler la MF stromale sont des aides utiles pour diminuer le besoin de chirurgie radicale en cas de chirurgie étendue et agressive tumeurs odontogènes. Mots-clés: Améloblastome, AOT, OKC/KCOT, p53, α-SMA, myofibroblastes, tumeurs odontogènes, immunoréactivité.

Orthopantometric Assessment of Mandibular Parameters in a Sub-Population of Yorubas: A Study of 2 Tertiary Hospitals in South-Western Nigeria.

BACKGROUND: Considerable racial, gender and age differences exist in mandibular parameters, hence anthropometric analyses have evolved to be an important scientific tool in forensic medicine and medico-legal issues. AIMS: The purpose of this study was to determine the mandibular parameters (bilateral gonial angle/ ramus height and the bigonial width) in a sub-population of adult Yorubas with normal occlusion in south western part of Nigeria. METHODS: This was a retrospective study of digital panoramic radiographs (Planmeca ProMax®) of 116 subjects that had routine panoramic radiographic investigation done between January 2015 and June 2020 at two teaching hospitals. Angular and linear measurements of the mandible were made and values obtained analyzed for gender differences. RESULTS: The gonial angle for males (118.08o ) was lower than that for females (118.87o ) but this difference was not statistically significant ( p= 0.3742) while the ramus height and bigonial width for males (61.22mm and186.63mm respectively) were higher than that for females (57.06mm and 179.23 mm) which were statistically significant (p < 0.001 and p < 0.001 respectively). CONCLUSION: Males have statistically significant longer ramus height and bigonial width when compared with females. These finding may be useful in gender determination, however, further studies are recommended. KEY MESSAGES: Males have statistically significant longer ramus height and bigonial width when compared with females in the population studied, hence ramus height and bigonial width in combination with other parameters are useful parameters in studies on gender dimorphism.

CONTEXTE RÉSUMÉ: Des différences considérables de race, de sexe et d'âge existent dans les paramètres mandibulaires, d'où l'évolution des analyses anthropométriques pour devenir un outil scientifique important dans la médecine légale et les questions médico-légales. OBJECTIFS: Le but de cette étude était de déterminer les paramètres mandibulaires (angle gonial bilatéral/hauteur de branche et largeur bigoniale) dans une sous-population de Yorubas adultes avec une occlusion normale dans la partie sud-ouest du Nigeria. MÉTHODES: Il s'agissait d'une étude rétrospective de radiographies panoramiques numériques (Planmeca ProMax®) de 116 sujets ayant subi une exploration radiographique panoramique de routine entre janvier 2015 et juin 2020 dans deux hôpitaux universitaires. Des mesures angulaires et linéaires de la mandibule ont été effectuées et les valeurs obtenues ont été analysées pour les différences entre les sexes. RÉSULTATS: L'angle gonial des mâles (118,08o ) était inférieur à celui des femelles (118,87o ) mais cette différence n'était pas statistiquement significative (p = 0,3742) tandis que la hauteur de la branche et la largeur bigoniale pour les mâles (61,22 mm et 186,63 mm respectivement) étaient plus élevés que ceux des femmes (57,06 mm et 179,23 mm) qui étaient statistiquement significatifs (p < 0,001 et p < 0,001 respectivement). CONCLUSION: Les mâles ont une hauteur de ramus et une largeur bigoniales plus longues statistiquement significatives par rapport aux femelles. Ces résultats peuvent être utiles dans la détermination du sexe, cependant, d'autres études sont recommandées. WAJM 2021 ; 38(6) : 561­565. MESSAGES CLÉS: Les mâles ont une hauteur de ramus et une largeur de bigonie statistiquement plus longues que les femelles dans la population étudiée, donc la hauteur de ramus et la largeur de bigonial en combinaison avec d'autres paramètres sont des paramètres utiles dans les études sur le dimorphisme de genre. MOTS CLÉS: Angle gonial, paramètres mandibulaires, hauteur de branche, largeur bigoniale, Yoruba.

Comparative analgesic efficacy and tolerability of celecoxib and tramadol on postoperative pain after mandibular third molar extraction: A double blind randomized controlled trial.

BACKGROUND: The choice of an efficacious and well-tolerated analgesic for the control of postoperative pain after third molar surgical extraction remains a challenge. AIM: The aim of this study was to compare analgesic efficacy and tolerability of celecoxib and tramadol following mandibular third molar extraction. MATERIALS AND METHODS: This was a prospective randomized, double blind controlled trial. Ninety patients were randomly assigned equally to either celecoxib or tramadol. Appropriate doses of the assigned drugs were administered orally immediately after the surgical extraction and patients recorded the pain intensity felt before the extraction, immediately after extraction, at 4 h, 8 h, 16 h, 24 h, and 48 h after the extraction using the visual analogue scale (VAS). Adverse effects of the medications were also recorded. RESULTS: Four of the patients dropped out of the study. Fifty five percent of patients in tramadol group experienced adverse effects but none in celecoxib group. The median VAS score of the celecoxib group was lower than tramadol group throughout the postoperative period and there was statistically significant difference in the median VAS score between the two groups 4 hours after drug administration (P = 0.001). CONCLUSION: In our study, celecoxib was more efficacious and better tolerated than tramadol for the management of pain after surgical extraction of mandibular third molar.

Oral mycoses and other opportunistic infections in HIV: therapy and emerging problems - a workshop report.

Oral mycoses and other opportunistic infections are recognized features of HIV infection even after four decades of the epidemic. The therapeutic options, challenges of therapy, and evolving patterns of opportunistic infections were evaluated by the workshop. It was observed that high Candida counts and infection are still more prevalent in HIV-positive individuals even in the era of antiretroviral therapy. Furthermore, one or more non-Candida albicans are present in some HIV-positive individuals. While Candida species are more virulent in HIV infection, similar virulence may be present in other states of immunosuppression. Consequently, the interplay between host factors and virulence ultimately determines the clinical outcomes. Adverse clinical outcomes such as candidemia and other deep fungal infections are on the increase in HIV infection. Disseminated histoplasmosis and penicilliosis have been reported, especially with low CD4 counts. Even with advances in antifungal therapy, mortality and morbidity from deep fungal infections have not changed significantly. In addition, long-term exposure to common antifungal drugs such as fluconazole has led to the development of antifungal resistance in 6% to 36%. Development of new antifungal therapeutic agents and the use of alternative therapies may offer breakthrough. In addition, effective strategies to enhance the host immune status are being explored.

Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

Oral Candida albicans strain diversity and maintenance in HIV positive women in South Africa.

OBJECTIVE: This study investigated C. albicans strain diversity and maintenance in the oral cavity of HIV positive women over a 6 month period. STUDY DESIGN: C. albicans strains were isolated from 17 HIV positive women at Charlotte Maxeke Academic Hospital, Johannesburg at 3 intervals over a 6 month period. Strains were genotyped using ABC and Multilocus Sequence Typing (MLST) techniques. In the MLST technique, for each strain, a Diploid Sequence Type (DST) number was obtained. Using cluster analysis, an Unweighted Pair Group Method with Arithmetic Mean (UPGMA) dendrogram and a matrix of strain similarities were generated. Strains were also compared to the previous South African isolates documented in the MLST database. RESULTS: Ninety four percent of women carried the same ABC genotype for 6 months. MLST technique, showed that ten women (58.8%) carried the same DST at 2 visits, while seven (41.2%) carried different DST at all visits. Further analysis showed that 64.7% of women were recolonised with different strains and 35.3% carried the same strains of C. albicans with heterozygosity. A total of 40 diploid sequence types were identified of which 27 DSTs were unique to this study group that were added to the MLST database. Most of the strains were closely related to previously isolated strains from South Africa. CONCLUSION: Recolonization of the oral cavity with different strains and microevolution of the original strains of C. albicans can occur, which can be a potential problem for HIV patients, in whom highly virulent and drug resistant strains can emerge.

Risk factors for rampant caries in children from southwestern Nigeria.

OBJECTIVE: The cross sectional study tried to identify some risk factors for rampant caries in a hospital based population of Nigerian children. METHOD: 205 consecutive eligible children seen in the paediatric units of two hospitals in Nigeria were recruited into the study. All enrolled children were healthy with no chronic medical condition. Consent for study participation was received from their accompanying parent. The accompanying parent of each child was questioned on the duration of breast and bottle feeding, and form of breast feeding and the frequency of daily intake of sugary diet. The associations between sex, age of the child, frequency of daily consumption of sugar, birth rank, duration of breast feeding, form of breast feeding and duration of bottle feeding and rampant caries were established. RESULTS: No association was found between the occurrence of rampant caries and sex, birth rank, duration of breast feeding, form of breast feeding and duration of bottle feeding. However, and association existed between the rampant caries, the age (p < 0.001) of the child and frequency of daily consumption of sugar (p = 0.026). The odds for rampant caries was 0.63 for every year decrease in age (95% CI 0.53 to 0.76) p < 0.001. Also, the odds for rampant caries was 1.46 for every increase in frequency of daily consumption of sugar (95% CI 1.10 to 1.95) p = 0.009. However, threshold for rampant caries was established at a frequency of daily consumption of sugar greater than three times a day. At this threshold, the risk for rampant caries increased by 0.26 when the frequency of daily consumption of sugar is greater than 3 times a day (95% CI 0.023 to 0.50) p = 0.032. CONCLUSION: Children who report consuming sugary diet more than three times a day should be managed as a high risk patient for rampant caries.

Preparation of platelet-rich plasma from small volume of whole blood - a simplified approach.

AIM AND OBJECTIVES: Platelet-rich plasma (PRP) is frequently used to enhance wound healing in numerous surgical applications. There are many methods of preparation of PRP. The present report describes a laboratory technique which is rapid, simple and inexpensive for preparing PRP from small volume of whole blood. MATERIALS AND METHODS: Whole blood was drawn from 30 patients undergoing oral and maxillofacial surgery. PRP was prepared by the modified open system. Platelet counts for whole blood and PRP were determined using a cell counter. RESULTS: The data from 30 patients aged 20 to 33 years, with a mean of 24.4 (± 3.3) and male : female ratio of 1:1.1, were analysed. The platelet count in PRP was 3,157,667 ± 984,380 while that in whole blood was 268,667 (± 64,678) platelets /cubic ml, reflecting an 11-fold increase in platelet concentration. No effect of gender or ageing on platelet count was observed. CONCLUSION: This study demonstrates a simple, rapid and inexpensive technique that is useful in obtaining platelets concentrated approximately 11-fold.

Coinfections associated with human immunodeficiency virus infection: workshop 1A.

The importance of opportunistic pathogens in HIV disease has been demonstrated from the onset of the epidemic. This workshop aimed to review the evidence for the role of oral microorganisms in HIV-related periodontal disease and HIV transmission and the effect of HIV therapy on periodontal disease. Despite being a common copathogen, tuberculosis seems to have limited oral presentation. The oral manifestations seem to have little impact on the individual and, once diagnosed, are responsive to chemotherapy. The participants debated the available evidence on the role of microorganisms and whether further research was warranted and justified. Although the effects of lipodystrophy on facial aesthetics may be profound and may markedly affect quality of life, there is no evidence to suggest a direct effect on the oral cavity. Though of interest to oral health care workers, lipodystrophy and associated metabolic syndromes were thought to be further investigated by other, more appropriate groups.

Bacteriologic features and antimicrobial resistance of organisms associated with extracted teeth: findings from a Nigerian university teaching hospital.

BACKGROUND: Empirically prescribed antibiotics are widely employed in the management of odontogenic infections. OBJECTIVE: To characterise the infections associated with extracted teeth and assess effectiveness of the antibiotics prescribed empirically following tooth extraction. METHODS: The study was cross-sectional and consisted of 41 consecutively recruited subjects who required extraction for infections associated with the tooth. Appropriate clinical specimens were collected aseptically from each patient and transported in Stuart's transport medium for processing in the laboratory. Isolation, identification, and susceptibility pattern of anaerobic and facultative organisms were done employing standard bacteriologic techniques. Antimicrobial susceptibility testing was performed by the disc diffusion technique. RESULTS: There were positive cultures for 37 patients. Twenty-eight aerobic (45.9%) bacteria and 32 anaerobic (54.1%) bacteria were isolated, an approximation of two microorganisms per patient. Staphylococcus was the most predominant aerobe (25.0%) whereas Bacteroides fragilis was the most predominant anaerobe (34.2%). All the bacteria isolated showed in vitro resistance to cephalexin, cloxacillin and metronidazole. Eighteen (64.3%) different aerobic bacteria and 13 (40.6%) different anaerobic bacteria were sensitive to ciprofloxacillin and these included staphylococcus and Bacteroides fragilis. Sensitivity pattern for amoxycillin was very poor with 3.6% and 6.3% for aerobes and anaerobes respectively. CONCLUSION: Odontogenic infections from our centre are polymicrobial in nature with anaerobes predominating. High resistance to most of the antibiotics routinely prescribed in our centre is common. Ciprofloxacillin demonstrated the highest sensitivity pattern.

Malaria and oral health.

Half of the world population resides in malaria-prone areas, and the disease is responsible for more than a million deaths annually. This is apart from the economic impact of the disease through resources expended towards treatment and prevention and the loss of manpower. In addition to the overt clinical signs and symptoms, the association of malaria with other diseases such as tuberculosis and HIV infection has been described. However few studies have attempted to investigate its relationship to oral diseases. This review provides an overview of the relevance of malaria to the mouth and adjacent structures. The need for further research is also emphasized.

Prevalence of oral disease among adults with primary HIV infection.

OBJECTIVE: To explore the type and prevalence of oral mucosal lesions among adults with primary HIV infection (PHI) compared with HIV-negative adults at high risk for HIV disease, and in relation to HIV viral load. METHODS: We conducted standardized oral examinations to identify specific oral mucosal lesions among adults with PHI, both pre-seroconversion and post- seroconversion-recently infected, compared with HIV-negative adults. We compared the group with oral lesions to those without oral lesions with respect to HIV-RNA load and CD4 + T-cell count. RESULTS: Among 115 adults (predominantly men), pseudomembranous candidiasis was the most common oral lesion among those with PHI, and was found in 4% of the 23 participants in pre-seroconversion and in 9% of 69 participants with post-seroconversion recent infection, compared with none found among 23 HIV negatives. Among those with PHI, the median viral load was higher and the median CD4 + T-cell count lower among the 15 participants with an oral lesion of any type than among the 77 participants without oral lesions (P = 0.02 and 0.04, respectively). CONCLUSION: This finding suggests that individuals with PHI who have oral lesions may be more likely to transmit HIV because of their higher viral load.

Bilateral transverse facial cleft as an isolated deformity: case report.

Transverse facial clefts are rare deformities, these mostly occur as part of syndromes such as facial dysostosis and branchial arch syndrome. This is a report of a case of isolated, asyndromic bilateral facial cleft seen at a semi-urban specialist hospital. Congenital facial defects remain sources of mental and social stress to the families. Infanticide, perhaps a thing of the past in the developed world may still be practiced in cases of congenital deformities in the developing countries, hence the need for early involvement of social workers and clinical psychologist in management.

An investigation into the relationship between mandibular third molars and angle fractures in Nigerians.

We examined the relationship between the presence or absence of mandibular third molars and angle fractures in Nigerians between January 1976 and July 1997. Information was obtained from patients' case records and radiographs.A total of 490 patients were seen during the study period, 408 of whom (83%) had their third molars present, and 76 of whom had angle fractures. Road traffic accidents (n =304, 62%) were the main cause of the fractures. Of these, 44 (14%) had angle fractures compared with 14/75 (19%) patients in whom the mechanism of injury was a fight or assault.Sixty-five of the 408 patients whose third molars were present (16%) had angle fractures, as did 11/82 (13%) who did not have third molars (p =0.57). Of the 77 patients whose lower third molars were not erupted, 24 (31%) had angle fractures compared with 52/331 (16%) in whom the lower third molars were erupted (p =0.002). These findings suggest that angle fractures are uncommon in this population because of their particular mechanism of injury. In addition, the presence of a lower third molar does not necessarily predispose to fractures of the angle of the mandible. However, angle fractures are more likely to occur in people with unerupted lower third molars than in those in whom they have erupted.

Maxillary haemangiopericytoma: a case report.

BACKGROUND: Haemangiopericytoma is a very rare slow-growing vascular tumour with a variable malignant potential, constituting less than 1% of all neoplasms. It may arise from any blood vessel and in any organ of the body. Primary haemangiopericytoma of bone is even rarer, constituting about 0.1% of bone tumours. The tumour is extremely rare in Africans and particularly in the head and neck region. STUDY DESIGN: We describe the case of a 66-year old Nigerian with haemangiopericytoma of the maxilla, who presented with a recurrent but painless jaw mass. RESULTS: Surgical resection of this tumour is potentially bedevilled with the risk of torrential haemorrhage and high rate of recurrence. This risk may be substantially reduced by wide surgical resection with a careful microscopical examination of the resection margins and the institution of adjuvant radiotherapy in incompletely resected tumours. Chemotherapy has no known role in the management of haemangiopericytoma. Postoperative radiation therapy appears to be effective against tumour recurrence. CONCLUSION: Even then, long-term follow-up is essential in all cases. To our knowledge, this is the first report of this entity in an African.

Gunshot injuries of the orofacial region in Nigerian civilians.

The dearth of information from Africa on gunshot injuries to the orofacial region in a civilian population prompted this retrospective survey. Sociodemographic data, manifestations at admission, type of firearm inflicting injuries, mechanism of injury, radiographs, treatment and complications were reviewed. All injuries occurred in the civilian population. The majority of patients (95.5%) were males, involved mainly in recreational hunting expeditions. The Dane gun was mostly used (86.4%) and accidental discharge of the weapon was recorded in 59.1% of the cases, 40.9% of these being accidentally self-inflicted. Overall, the left half of the face received more of the missiles. Complications were seen in 63.6% of the patients and the most common of these was loss of sight. The mortality rate was 22.7%. Late presentation was a frequent occurrence. It is suggested that Nigerian law enforcement agencies devise strategies to monitor the sale, acquisition and use of such firearms.

A study of orofacial bacterial infections in elderly Nigerians.

This retrospective study was designed to determine the pattern of occurrence, and principles of management of orofacial bacterial infections in elderly Nigerians. Ninety-two patients aged 55-90 years (mean +/- SD 62.4 +/- 7.5 years), were admitted into the study (male:female ratio 1.1:1). The origin of orofacial infection was predominantly odontogenic and the lower face was three times more commonly involved. The percentage of patients with underlying systemic disease was 16.2%. Patients with underlying disease had a 3.5 times greater risk of developing orofacial infections. Similarly, a significant correlation was demonstrated between both sexes of patients with orofacial infections and underlying illness (P < 0.05). There was a general delay before presenting for treatment (average 19.5 weeks) and the mortality rate was 3.3%. The study findings demonstrate that a significant relationship exists between elderly Nigerians with orofacial infections and systemic disease.

Dental radiographic features of impacted third molars and some management implications.

The objective of the study was to determine the principal dental radiographic features of impacted third molars and to highlight some management implications, 255 periapical radiographs belonging to 197 patients with the clinical records were examined. The age of the subjects, sex, and degree of impaction, inclination, depth, mesiodistal space and associated pathology were documented as well as the number of roots and their relationship to the neurovascular bundle. The mean age was 23.4 years with more female teeth (152, 59.6%) than male (103, 40.4%). Majority were partially erupted (223, 91.4%) with vertical impaction most commonly seen in 80 teeth (31.4%). Over half of the teeth (135, 52.9%) had no obvious relationship with the inferior alveolar neuro-vascular bundle and where this existed, darkening of the root was the most common radiographic indicator (55 teeth, 21.6%). Most of the teeth (54.9%) had no obvious pathologic changes associated. In those with pathologic changes, periodontal bone loss and a wide follicle were most commonly observed (44 teeth or 17.3% in both cases). Older subjects had significantly more periodontal bone loss (p = 0.001). Periapical radiographic examination can reveal vital information for treatment planning of impacted teeth and the monitoring of asymptomatic teeth.