Targeted polymerase chain reaction-based expression of putative halitogenic bacteria and volatile sulphur compound analysis among halitosis patients at a tertiary hospital in Nigeria.

Halitosis (bad breath) can be a cause of anxiety, depression and psychosocial stress, with pathological changes in the oral microbiota playing an important role in its development. Despite its prevalence, studies on the microbiology of halitosis are rare in Nigeria. This study determines the presence of five putative periodontal pathogens viz: Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola on the tongue dorsa of halitosis and non-halitosis patients using a 16S rDNA-directed polymerase chain reaction assay. Furthermore, an association of these bacteria with oral malodour [as assessed by volatile sulphur compounds (VSC) measurements] with a portable sulphide monitor, the Halimeter (Interscan Corp, Chatsworth, California), was performed. The results showed that the prevalence of halitosis in this environment as defined by VSC level above 160 ppb is 14.9%. Halitosis is affected by gender with males having it more than the females. Males also tend to present more with self-reported complaints of halitosis than females. Age does not appear to contribute to the incidence of halitosis. Fusobacterium nucleatum, P. gingivalis, P. intermedia are responsible for increased production of VSCs in halitosis patients while A. actinomycetemcomitans and T. denticola appear to play no part in the production of VSCs. Evaluation of halitogenic bacteria and VSCs may potentially become a surrogate biomarker for monitoring halitosis. Targeted assessment of putative halitogenic bacteria may provide a rapid point-of-care diagnostic tool for halitosis.

Stoichiometric expression of MMP-2/TIMP-2 in benign and malignant tumours of the salivary gland.

The aim of this study was to determine the expression of matrix metalloproteinase 2 (MMP-2) and tissue inhibitors of matrix metalloproteinase 2 (TIMP-2) and the MMP-2/TIMP-2 expression ratio in salivary gland tumours (SGTs). Forty-three FFPE SGTs were prepared for antibody processing to MMP-2 and TIMP-2. Two investigators utilizing Sinicrope's method scored the uptake of immuno-stains. Cytoplasmic staining was considered as positive. Data was analysed using SPSS version 20. The significance level was set at p < 0.05. In benign SGTs, the mean score for MMP-2 was not significantly lower than that of TIMP-2 (p = 0.37). However, the mean scores for MMP-2 stain intensity and proportion were significantly higher in malignant than benign SGTs (p = 0.01 and p = 0.02 respectively). There was no significant difference in the mean MMP-2/TIMP-2 expression ratio of the malignant SGTs according to histological grade and histogenesis (p = 0.4 and p = 0.19 respectively). The MMP-2/TIMP-2 expression ratio has a higher prognostic value than the separate expressions of MMP-2 and TIMP-2.

Palatal rugae as a tool for human identification.

OBJECTIVE: This study was conducted to assess the accuracy of palatal rugae as a tool for human identification and to determine factors that may limit accuracy. This will serve as a potential basis for advising national health policy formulation on human identification as forensic rugoscopy is unexplored in sub-Saharan Africa. MATERIALS AND METHODS: One hundred consenting participants were recruited; impressions of the upper jaws were taken and cast with dental stone. All the teeth on the models were trimmed off to prevent identification by tooth morphology and the models were coded. Five uncalibrated dentists independently pair-matched the models based on the pattern of the palatal rugae. RESULTS: The overall accuracy for all 50 paired models ranged from 72 to 96%, while the percentage correct match for each of the 50 paired models range from 40-100%. All the examiners properly matched 60% of the models. CONCLUSION: Rugoscopy is a useful technique for human identification due to the unique rugae pattern in every individual. However, without the aid of ancillary aids, visual inspection alone can be challenging. CLINICAL RELEVANCE: This study provides useful information on an additional clinical technique relevant for human identification.

Immunohistochemical expression of oestrogen receptor-α and progesterone receptor in salivary gland tumours.

BACKGROUND: The mammary and salivary glands are tubulo-acinar exocrine glands, sharing similar morphological characteristics and tumour histology. It is logical to postulate that they may have similar tumour biology. This study was carried out to define the expression of oestrogen-α (ER-α) and progesterone (PR) in salivary gland tumours (SGTs) presenting at the University College Hospital, Ibadan. METHODS: Formalin-fixed, paraffin-embedded tissue samples of different salivary gland neoplasms were processed for antibodies to ER-α and PR using the specifications of the manufacturer. Two independent investigators reviewed the slides scoring the pattern and intensity of staining as follows: negative (0), weakly positive (+1), moderately positive (+2) and strongly positive (+3). Data were analysed using version 16 of the Statistical Package for Social Sciences (SPSS16). The level of significance was set at P < 0.05. RESULTS: A total of 40 SGTs from 19 males (47.5%) and 21 females (52.5%) were utilised. There were 15 benign and 25 malignant SGTs. ER expression in benign SGTs was 6.7%, while in malignant SGTs, it was 28.0%. There was no statistically significant difference in the gender and mean age distribution between patients with or without positive ER-α expression (χ(2) = 0.37, P = 0.59 Fisher's exact test; t = 0.054, P = 0.96, respectively). About 66.7% of high-grade SGTs was positive for ER while only 20% of the low-grade lesions were positive. CONCLUSION: This study showed that ER-α was expressed more in the high-grade malignant SGTs compared with the low-grade malignant SGTs and the benign SGTs.

Parotid gland enlargement in pediatric HIV population.

OBJECTIVES: To establish the significance of parotid enlargement, state frequency, cytological features and effect of antiretroviral therapy (ART) on parotid enlargement among a pediatric HIV population. STUDY DESIGN: A 6 month cross sectional survey that utilised clinical features, serial immunological indices and fine needle aspiration cytology. RESULTS: 287 HIV positive children were seen at special paediatric clinic of the University College Hospital, Ibadan, Nigeria, 114 (39.7%) had oral features and among these 24 (8.4%) had parotid involvement comprising of 10 males and 14 females. The overall mean age was 43.4 + 39.7 months compared with 59.6 + 36.5 months in the parotid enlargement group (p = 0.03). Mean ages of parotid enlargement and non enlargement group was significantly different (p = 0.03). The mode of transmission was vertical in (91.7%), 87.5% was bilateral (87.5%) and (75%) presented as a syndrome state with generalised lymphadenopathy. The predominant cytology was lymphoid hyperplasia (62.5%). ART resulted in marked clinical reduction in all the cases and statistically significant improvement in serum indices of CD4 count, CD4% and viral load (p = 0.001, 0.000 & 0.009 respectively). CONCLUSION: HIV positive children often present with bilateral parotid enlargement and the syndrome state with classical clinical and cytological features of lymphoid hyperplasia predominated. ART resulted in satisfactory reduction of the swellings in most of the cases with no need for further intervention.

Immunohistochemical Expression of E-Cadherin and ß-Catenin in Oral Squamous Cell Carcinoma.

Background: The E-cadherin/ß-catenin protein complexes are actively involved in the epithelial-to-mesenchymal transition. Alterations in cadherin or catenin expression or function, play important roles in the development of invasive or metastatic phenotypes of cancers. Objectives: The aim of this study was to assess the expression of E-cadherin and ß-catenin in oral squamous cell carcinoma (OSCC) patients and to compare this with their clinico-pathological parameters. Materials and Methods: This was a cross-sectional study to assess the immunohistochemical expression of E-cadherin and ß-catenin in 41 cases of OSCC. Data were analyzed using version 26 of SPSS software. Qualitative data were compared using chi-square statistics. Quantitative data were summarized using mean, standard deviation, and confidence interval and compared using a one-way analysis of variance test. The level of significance was set at P < 0.05. Results: Overall, 95.1% of the cases had positive membrane expression for E-cadherin, while cytoplasmic staining was seen in 90.2% cases. Positive nuclear staining was seen in 46.3% cases. There was a decrease in the percentage of cytoplasmic and nuclear expression of E-cadherin as the OSCC became more poorly differentiated (χ2 = 13.96, P = 0.016). Also, a decrease in the percentage of nuclear expression of ß-catenin in poorly differentiated cases was seen. However, no statistically significant difference was seen in the expression of ß-catenin between the different histologic grades (χ2 = 4.8, P = 0.4). Conclusion: This study shows a reduction in the expression of E-cadherin and ß-catenin as OSCC becomes less differentiated.

Oral mucosal lesions and temporomandibular joint impairment of elderly people in the South East Local Government Area of Ibadan.

OBJECTIVE: To determine the prevalence of oral mucosal lesions, temporomandibular joint (TMJ) impairment and oral health-related habits in the elderly people in South East Local Government Area (SELGA) in Ibadan. BACKGROUND DATA: SELGA is one of the largest local government areas in Oyo State, Nigeria and has a population of 225,800. DESIGN: A cross-sectional survey. METHODOLOGY: A randomly selected sample of 690 elderly people from 23 wards in SELGA were examined by two trained and calibrated examiners using mirror, probe and natural light. RESULTS: One hundred and fifty-five (22.46%) of the elderly examined had one or more oral pathology lesions, representing infection-related swelling, non-infection-related swelling, pre-malignant lesions, denture stomatitis, non-denture based ulcers, angular cheilitis, geographic tongue, scrotal tongue, lichen planus, hyper-pigmentation and TMJ impairment. Fifty-five (35.5%) of these pathologies were infection-related swellings. Six (3.9%) of the pathologies were denture-related stomatitis, 14(9.03%) were pre-malignant lesions, 14(9.03%) were non-infection-related swelling, while 27 (17.4%) were TMJ impairment. The rest of the lesions constituted the remaining 25.1%. Only 15.9% of the participants had tobacco-related habits, 10.7% drank alcohol, whilst 41.6% chewed kola nuts. CONCLUSION: Oral pathoses prevalence (22.46%) was similar to findings in developed countries (29.9%) but with a reversal of causal factors, infection-related swellings were more common, whereas pre-malignant lesions were less common. The infections were mostly complications from periodontal disease, which culminated in abscess formation. Tobacco-related habits were not highly prevalent among the elderly people in SELGA. However, oral pathoses resulting from nutritional deficiencies were the third most frequent lesions observed.

A geographical analysis of ethnic distribution of jaw ameloblastoma in Nigerians.

INTRODUCTION: Ameloblastoma is the most common odontogenic tumour in Nigeria. A definite geographic variation has been observed in the frequency of odontogenic tumors from different parts of the world. However, there is no study on the regional variations in Nigeria. Hence, this study was designed to document the ethnic and geographical distribution of jaw ameloblastoma in Nigeria. METHODS: Archival data on ameloblastoma from 10 health facilities were obtained. Global Moran's I detected geographic clustering in its distribution while Local Getis Ord indicated the location of ameloblastoma clusters. Chi-square tested associations between variables at 0.05 level of significance. RESULTS: A total of 1,246 ameloblastoma cases were recorded in Nigeria. Besides substantial state variations, a South-North gradient was noticed in its distribution. Significant positive spatial autocorrelation was observed in the three major groups while ameloblastoma hotspots were found in the SouthWestern and Northwestern Nigeria. The Igbos had a higher prevalence of ameloblastoma outside their home region than within. CONCLUSION: The study hypothesized that the geographical distribution of ameloblastoma in Nigeria is the result of all or one of the following: the country's tropical climate, migration patterns and health seeking behavior. Hopefully, these claims should lead to further enquiry on the underlying causes.

Head and neck cancer--a clinicopathological study in a tertiary care center.

Head and neck cancers display diverse patterns of biological behavior and considerable variation in geographical distribution. This study presents an analysis of head and neck cancer in a Nigerian tertiary healthcare center. It comprises cases diagnosed at the University College Hospital, Ibadan, Nigeria, 1991-2005. Out of 1,750 head and neck tumors, 972 (55.5%) were malignant and 778 (44.5%) were benign. Cancers displayed male predominance, with a gender ratio of 1.8:1. The mean age of cancer patients was 43.8 +/- 19.6 years. Carcinomas constituted 71.7% of head and neck cancers, with 2.4% occurring in children and overall mean age of 48.2 years. Squamous cell carcinoma comprised 66.7% of carcinomas and 47.8% of all head and neck cancers. Hematopoietic malignancies constituted 20.4% of head and neck cancers, and comprised mainly lymphomas, which accounted for 19.3% of all head and neck cancers. The mean age of patients with hematopoietic malignancies was 34.9 years. The most common childhood malignancy was Burkitt's lymphoma, which comprised 28.2% of pediatric head and neck cancers. Connective tissue tumors constituted 7.9% of all cancers, the most common being rhabdomyosarcoma, accounting for 44.2% of sarcomas. The mean age of patients with sarcomas was 26.5 years. There is a need for uniformity in the definition of head and neck cancer so as to permit comparison of international studies. In addition, prospective population-based studies are required to determine the national incidence and to identify risk factors for head and neck cancer in the Nigerian population.

Ethnic and gender comparison of rugae patterns among clinical dental trainees in Ibadan, Nigeria.

INTRODUCTION: This study was conducted to compare the rugae patterns between two major ethnic groups in Nigeria to establish any peculiarities. This will serve as basis for population identification especially in mass disasters involving individuals of different races or ethnicities. METHODS: One hundred consenting participants, 50 of south-western Yoruba ethnicity and 50 of south-eastern Igbo ethnicity were recruited; impressions of the upper jaws were taken and cast with dental stone. Two blinded investigators then delineated and recorded the rugae pattern of individual casts. The rugae patterns for the two groups were then analysed using the SPSS version 16. RESULTS: The Yoruba's had more of wavy and straight patterns while there were more of curve and circular among the Ibo's, however, there was no significant differences between the two groups in the mean incidence of the various rugae shapes of wavy, circular, curve and straight (p = 0.843, p = 0.711, p = 0.309 and p = 0.292 respectively). There were more secondary rugae in the Igbo than the Yoruba group and the differences in the mean incidences were significant. CONCLUSION: The study observed several rugae similarities and no significant differences in the primary rugae shapes of the Igbos and Yoruba ethnicities, however, there were significant differences in the sum of secondary and unclassified rugae between the two groups; therefore, rugoscopy may be useful in ethnic differentiation.

Malignant salivary gland tumours of the head and neck region: a single institutions review.

INTRODUCTION: Malignant salivary gland tumours (MSGTs) comprise about 3% of all head and neck cancers; they demonstrate an unpredictable clinical course. The purpose of this study is to review MSGTs seen at a tertiary Health centre, and compare findings with those of previous studies. METHODS: The records of the Department of Oral Pathology and the Department of Pathology, University College Hospital Ibadan were reviewed over a 19 year period and lesions diagnosed as MSGTs according to 2005 WHO histological classification were analysed for age, gender and site using SPSS for Windows (version 20.0; SPSS Inc. Chicago, IL). RESULTS: MSGTs were more common in males (55.2%) than females (44.8%). The mean age of was 47.9 (±17.0) years and peak age was the fifth decade. The parotid gland was the commonest site with 62 (28.1%) cases. The palate was the commonest intraoral site with 61(27.6%). The nose with 19 (8.6%) was the commonest minor extra-oral site. CONCLUSION: The findings were essentially similar to reports from Europe and America. Adenoid Cystic Carcinoma was the most common MSGT in this series. A high proportion of salivary gland tumours in sublingual gland were malignant. The reason(s) for high proportion of MSGTs in sublingual glands requires further investigation.

Immunohistochemical expression of MMP-2 and MMP-8 in oral squamous cell carcinoma.

BACKGROUND: Matrix metalloproteinases (MMPs) are endopeptidases that can degrade extracellular matrix components and affect invasiveness and aggressiveness of oral squamous cell carcinoma (OSCC). The aim of this study was to examine the immunohistochemical expression of MMP-2 and MMP-8 in OSCCs in patients presenting at the Tertiary Health facility in Nigeria. MATERIAL AND METHODS: Formalin-fixed, paraffin-embedded (FFPE) OSCC samples diagnosed between the years 2010 and 2012 were used for his study. The FFPE were processed for MMP-2 and MMP-8 using the specifications of the manufacturer. Two investigators reviewed the slides scoring the pattern and intensity of staining as negative (0), weakly positive (+1), moderately positive (+2) and strongly positive (+3). The data were analysed using version 20 of the SPSS. The level of significance was set at P < 0.05. RESULTS: Twenty-five OSCC consisting of 14 (56%) males and 11 females (44%) were used. The mean age was 54.6 ± 17.9 years. A higher proportion (100%) of poorly differentiated OSCC strongly expressed MMP-2 compared with the well differentiated and moderately differentiated OSSC. There was no significant difference in the expression of MMP-2 amongst the three grades of OSCC (X2 = 2.87; p= 0.17). Only 5 (20%) OSCC cases positively expressed MMP-8. Moderate expression of MMP-8 was only seen in well-differentiated OSCCs. CONCLUSIONS: This study showed that a higher proportion of poorly differentiated OSSC strongly expressed MMP-2. Eighty percent of cases that express MMP-8 were females and moderate expression of MMP-8 was seen only in well differentiated OSCC. Key words:Oral squamous cell carcinoma, MMP-2, MMP-8, immunohistochemistry.

A review of 413 salivary gland tumours in the head and neck region.

OBJECTIVES: Salivary gland tumours (SGTs) are a group of heterogeneous lesions with complex clinico-pathological characteristics and distinct biological behaviours. Previous studies have reported geographic variations in site distribution, incidence and histological types of SGTs. The aim of this study was to describe the demography of SGTs seen at a tertiary health centre and compare findings with previous studies. STUDY DESIGN: Data on SGTs from archives of the Department of Oral Pathology and the Department of Pathology, University College Hospital Ibadan were retrieved. Information about histological types, age, sex and location were analyzed using SPSS for Window (version 20.0; SPSS Inc. Chicago, IL). Reactive and tumor-like lesions such as sialometaplasia, benign lymphoepithelial lesion, lymphoepithelial cyst, mucocele, mucous extravasation phenomenon, ranula, and sialosis were excluded from the study. RESULTS: 413 SGTs consisting of 221 (53.5%) malignant and 192 (46.5%) benign lesions were seen. SGTs occurred more in females (50.6%) than males (49.4%) with a mean age of 43.7 (±16.9) years and peak age in the fifth decade of life. The parotid with 171 (41.4%) cases was the commonest site, followed by palate with 89 (21.5%) cases, while only 7(1.7%) cases were seen in sublingual gland. Pleomorphic adenoma with 169 (40.9%) was the most frequent SGT followed by adenoid cystic carcinoma with 93 (22.5%) cases which also was the most frequent malignant SGT while only 3 (0.7%) cases of Warthin's tumour were seen. CONCLUSION: This report is one of few that showed a higher occurrence of malignant SGTs compared to their benign counterparts. The findings were essentially similar to findings in Africa but showed SGTs to be more common in females. The reason(s) for high occurrence of malignant SGTs in minor salivary glands and the rarity of Warthins tumour in this study and other African series compared to those from America needs further investigation. Key words:Salivary gland tumours, parotid gland, pleomorphic adenoma, adenoid cystic carcinoma, warthin's tumour.

Clinico-pathological profile of head and neck malignancies at University College Hospital, Ibadan, Nigeria.

INTRODUCTION: This retrospective study analysed head and neck malignancies seen over a 19-year period at the University College Hospital, Ibadan. METHODOLOGY: One thousand, one hundred and ninety two patients with head and neck malignancies were analysed according to age, gender, topography and histology. RESULTS: There was an annual hospital frequency of 62 cases per year. The overall mean age for these malignancies was 43.9 (SD ± 19.3) years. The lesions from the respiratory tract were the most frequent (43.2%) of all cases. The palate was the most frequent intra-oral site (13.8%). Epithelial malignancies constituted 73.4% of all cases with a male: female ratio of 2:1, a mean age of 48.1 (SD ± 17.5) years and were mostly located in the larynx (19.7%). Lymphomas constituted 17.5% of all head and neck cancers with a male: female ratio of 1.6:1, a mean age of 35.1 (SD ± 20.6) years and nodal involvement (39.7%) was most common. Sarcomas constituted 8.9% of all malignancies with a male: female ratio of 1.5:1, mean age of 27.1 (SD ± 16.7) years and the maxillofacial bones (42.5%) were most commonly involved. Neuroendocrine malignancies accounted for 0.2% of head and neck malignancies with a male: female ratio of 1:1, a mean age of 28.5 (SD ± 6.4) years and both cases involved the nose. CONCLUSION: This study has further confirmed that carcinomas remain the most frequent cancers of the head and neck region in south-western Nigeria.

Immunohistochemical analysis of undifferentiated and poorly-differentiated head and neck malignancies at a tertiary hospital in Nigeria.

This is a retrospective analysis of poorly-differentiated head and neck malignancies at University College Hospital, Ibadan. Eighty-six poorly-differentiated neoplasms were categorized as carcinomas, sarcomas, lymphomas or neuroendocrine cancers with a panel of 7 antibodies (cytokeratin AE1/AE3, vimentin, desmin, myogenin, leukocyte common antigen and neuron-specific enolase). Immunohistochemical and original hematoxylin-eosin diagnoses were contrasted.The male: female ratio was 2.5:1, with mean age of 38.9 years. Nasopharynx, nose and maxillofacial bones were the most common locations. Immunohistochemistry confirmed 54.8% of carcinomas, 70.6% of sarcomas and 80% of lymphomas.Hematoxylin-eosin was able to distinguish between sarcoma and lymphoma but differentiation between a carcinoma and neuroendocrine lesion was poor. Further studies are required to maximize the role of immunohistochemistry as an ancillary diagnostic tool in the West African sub-region.

A study of the utility of silver nucleolar organizer regions in categorization and prognosis of salivary gland tumors.

BACKGROUND: this study aimed at assessing the utility of silver nucleolar organizer region (AgNOR) staining in categorization and prognostication of salivary gland tumors. METHODS: Twenty-seven malignant salivary gland tumors, 16 benign neoplasms, and 6 chronic sialadenitis lesions were stained using the technique described by Ploton et al. (1986). RESULTS: The mean AgNOR counts for inflammatory lesions (1.67 +/- 0.19) and benign neoplasms (1.67 +/- 0.11), were less than for malignant neoplasms (3.59 +/- 0.55), P < .05. There was no significant difference between the mean AgNOR counts of different specific histological types and grades of malignant neoplasms. In addition, no correlation was found between mean AgNOR counts and the clinical course of malignant or benign salivary gland neoplasms. CONCLUSION: Our results suggest that AgNOR staining is useful for distinguishing benign from malignant lesions, but is neither helpful for discriminating between histological types and grades of malignant neoplasms, nor prognostication of malignant salivary gland neoplasms.