Tooth Loss: The Nigerian Experience - A Narrative Review.

BACKGROUND: Tooth loss is an irreversible condition and it is an indicator of overall dental health. Tooth loss impairs speech, aesthetics, mastication, and deglutition, affecting an individual's oral health related quality of life. This study aimed to review the pattern of tooth loss in Nigerians over a forty-one-year period. MATERIALS AND METHODS: A literature search for articles on tooth loss and related subjects was performed on databases (NICB PubMed, Medline and Cochrane). Keywords used for the search included "tooth loss" and "Nigeria' as well as partial edentulousness, partial denture, implant and prosthodontics. The articles included were studies published between 1972 and 2019, written in English language and involving human subjects. A self-developed proforma was used to extract clinical and demographic data from the articles. RESULTS: All the studies assessed were observational. Most studies were conducted in tertiary hospitals. There was a marginal difference in the prevalence of tooth loss between males and females. The mean age of persons presenting in hospitals across Nigeria for extraction of their teeth was identical across several studies. Most of the studies reported the molars as the teeth most frequently lost. CONCLUSION: In younger adults, tooth loss was more common in 20-29-year-old subjects, while among the elderly it peaked in the 60-70-year-old group. Dental caries was the predominant cause of tooth loss over the years. Community based studies may provide more accurate information on the extent of tooth loss in Nigerians.

CONTEXTE: La perte de dents est un état irréversible et un indicateur de la santé dentaire globale. La perte de dents nuit à l'élocution, à l'esthétique, à la mastication et à la déglutition, affectant ainsi la qualité de vie d'un individu liée à sa santé bucco-dentaire. Cette étude avait pour but d'examiner le profil de la perte de dents chez les Nigérians sur une période de quarante et un ans. MATÉRIEL ET MÉTHODES: Une recherche documentaire d'articles sur la perte de dents et les sujets connexes a été effectuée sur des bases de données (NICB PubMed, Medline et Cochrane). Les motsclés utilisés pour la recherche comprenaient "perte de dents" et "Nigeria" ainsi que édentation partielle, prothèse partielle, implant et prosthodontie. Les articles inclus étaient des études publiées entre 1972 et 2019, rédigées en langue anglaise et impliquant des sujets humains. Un proforma auto-développé a été utilisé pour extraire les données cliniques et démographiques des articles. RÉSULTATS: Toutes les études évaluées étaient observationnelles. La plupart des études ont été menées dans des hôpitaux tertiaires. Il y avait une différence marginale dans la prévalence de la perte de dents entre les hommes et les femmes. L'âge moyen des personnes se présentant dans les hôpitaux du Nigeria pour l'extraction de leurs dents était identique dans plusieurs études. La plupart des études ont indiqué que les molaires étaient les dents les plus fréquemment perdues. CONCLUSION: Chez les jeunes adultes, la perte de dents était plus fréquente chez les sujets âgés de 20 à 29 ans, tandis que chez les personnes âgées, elle atteignait un pic dans le groupe des 60-70 ans. Les caries dentaires étaient la cause prédominante de la perte de dents au fil des ans. Des études communautaires pourraient fournir des informations plus précises sur l'étendue de la perte de dents chez les Nigérians. Mots clés: Perte de dents, Édentation, Prévalence, Nigeria.

Microwave disinfection of maxillary and mandibular denture bases contaminated with Candida Albican.

BACKGROUND: Oral environment is not sterile, and dentures worn by the patients can be infected and therefore needs disinfection. Solution disinfectants such as sodium hypochlorite and glutaraldehyde can be used but they have side effects. Microwave disinfection method is more recent, however, there are conflicting reports at the moment on the appropriate power and time regimen for disinfection of denture. OBJECTIVE: To determine the power and time regimen at which the disinfection of dentures can be achieved using microwave. METHOD: Forty-five acrylic denture bases were fabricated for each of the jaws and infected with solution of a stock Candida albicans and 30 infected bases were employed as control. These were placed in normal saline and then subjected to different microwave power and time regimen. Aliquots from these post-microwave solution were titrated against sabauraud agar which was subsequently incubated at 37 degrees C for 48 hours. The agar were examined for candida growth. RESULT: The denture bases subjected to microwave disinfection at 350W showed Candida growth after microwave treatment irrespective of the time employed. Conversely, those microwaved at 650W and 690W for four and six minutes showed no microbial growth. CONCLUSION: The microwave regimen of 650W at 4 and 6 minutes completely disinfected the denture bases. Disinfection at higher microwave energy should be done with caution as distortion of the denture may occur.

The influence of the design of mandibular major connectors on gingival health.

BACKGROUND: The objective of this study was to assess the influence of lingual bar and lingual plate major connectors on plaque retention and gingival health among patients who presented in University College Hospital (UCH), Ibadan, Nigeria. METHODS: This comparative intervention study was carried out among fifteen patients aged 28 to 60 years with Kennedy class III lower edentulous arch. Two metal dentures with different major connector designs (lingual plate and lingual bar) were fabricated for each patient. After professional scaling and polishing, a baseline score of the oral hygiene was done using the plaque index of Sillness and Loe and the gingival health using the gingival index of Loe and Sillness. Each patient was randomly assigned either a denture with the plate or bar design to use for three months and then recalled for reassessment of oral hygiene and gingival health. Professional scaling and polishing was done post removal and a new baseline assessment of oral hygiene and gingival health recorded. The dentures were now exchanged and the second major connector design inserted. Each patient was recalled for reassessment of the oral hygiene and gingival health after three months. The level of plaque accumulation and gingival inflammation with the use of lingual plate and bar dentures were determined and compared. RESULTS: There was no statistically significant difference in the mean plaque index score for the lingual bar design at three months and the mean plaque index score at three months for the lingual plate (p > 0.05). However, a statistically significant lower mean gingival index score was noted three months post insertion for lingual bar designs when compared to plate designs. CONCLUSION: Within the limitation of this study, better gingival health was noted with the bar designs when compared with the plate designs.

Maxillectomy defects: a suggested classification scheme.

INTRODUCTION: The term "maxillectomy" has been used to describe a variety of surgical procedures for a spectrum of diseases involving a diverse anatomical site. Hence, classifications of maxillectomy defects have often made communication difficult. This article highlights this problem, emphasises the need for a uniform system of classification and suggests a classification system which is simple and comprehensive. METHODS: Articles related to this subject, especially those with specified classifications of maxillary surgical defects were sourced from the internet through Google, Scopus and PubMed using the search terms maxillectomy defects classification. A manual search through available literature was also done. The review of the materials revealed many classifications and modifications of classifications from the descriptive, reconstructive and prosthodontic perspectives. RESULTS: No globally acceptable classification exists among practitioners involved in the management of diseases in the mid-facial region. There were over 14 classifications of maxillary defects found in the English literature. CONCLUSION: Attempts made to address the inadequacies of previous classifications have tended to result in cumbersome and relatively complex classifications. A single classification that is based on both surgical and prosthetic considerations is most desirable and is hereby proposed.

An assessment of interocclusal space in a dentate Nigerian population.

AIMS AND OBJECTIVES: To determine the average interocclusal space values in a dentate Nigerian population,and to examine the effect of gender, age and different molar relationships on the values obtained. SUBJECTS AND METHODS: Three hundred and fifty one subjects mainly of Yoruba extraction with ages ranging from 16 to 78 years were involved in the study. They included 165 males and 186 females. Inclusion criteria in the study included the presence of a stable posterior occlusion with all first molars present and the absence of moderate to deep wear facets suggestive of parafunction. Subject's occlusal dimensions were measured with a calliper at rest and in occlusion. Interocclusal distances were determined by subtracting the occlusal vertical dimension from the rest vertical dimension. The Angles molar relationship was then recorded for each subject. RESULTS: The average freeway space was 2.93 mm with a standard deviation of 1.38; with the females having marginally higher values. The mean values according to age groups were 15-25 years: 3.15 mm, 26-35 years: 2.68 mm, 36-45 years: 2.66 mm, 46-55 years: 3.2 2mm, 56-65 years: 2.74 mm and 66 years and over: 3.10mm.Class Imolar relationship predominated in the sample with 312 patients (88.9%).Nineteen patients (5.4%) had Class II and 20 patients (5.7%) had Class III.Mean freeway space values for Class I, Class II and Class III were: 2.84 mm, 3.88 mm and 3.37 mm respectively. The difference in values was statistically significant. CONCLUSION: The average interocclusal space amongst the population assessed was 2.93 mm; a value which is similar to that previously reported for Nigerians. Marginally higher values were observed in females while the 26-35 and 36-45 year old groups had lower values than the other age groups. Angle's Class II and III subjects had higher values when compared to class I subjects and was statistically significant. A multi-centre study is recommended to assess possible ethnic variations in these values.

Interim prosthetic rehabilitation of postmandibulectomy defect using a single piece acrylic denture: a case report.

INTRODUCTION: Prosthetic rehabilitation of mandibular discontinuity defects poses a great challenge to prosthodontists especially when surgical reconstruction is not carried out prior to rehabilitation. METHOD: A 25-year-old young man was referred to the prosthetic unit of the Dental Centre, University College Hospital Ibadan with an anterior discontinuity defect following resection of a mandibular tumour. After clinical and laboratory procedures, the prosthesis used to rehabilitate the patient is unique because it is simple, made of heat cure acrylic resin, affordable and aesthetically pleasing. It is essentially a single piece removable acrylic partial denture retained with wrought wire clasps. RESULT: Patient was satisfied with the prosthesis. DISCUSSION: Although a number of studies have reported procedures for prosthetic rehabilitation of mandibular discontinuity defects, there is a dearth of information on single piece acrylic prosthesis in the management of discontinuity defects. The effect of acrylic denture on residual soft tissue was weighed against the quality of life of patient if left untreated. CONCLUSION: It is recommended that the National Health Insurance Scheme includes simple interim prostheses as part of its package to improve the quality of life of the people.

Coronal tissue loss in endodontically treated teeth.

AIM: To categorize the endodontically treated teeth according to the extent of coronal tissue loss in order to determine the appropriate restoration required. MATERIAL AND METHODS: A two year descriptive study was done at the Conservative Clinic of the Department of Restorative Dentistry, Dental Centre, University College Hospital, Ibadan. Successful endodontically treated teeth were assessed and categorized according to the extent of tissue loss based on standard criteria proposed by Smith and Schuman. RESULTS: Two hundred and ninety endodontically treated teeth were assessed for success both clinically and radiographically. Eighty (27.6%) were anterior teeth, 78 (26.9%) were premolars while 132 (45.5%) were molars. Dental caries was found to be the most common (61.4%) indication for endodontic treatment and caused more coronal tissue damage (moderate and significant) when compared with other indications for endodontic treatment. Two hundred and twenty seven (78.3%) endodontically treated teeth had moderate coronal tissue loss, 41 (14.1%) had minimal damage while 22 (7.6%) had significant tissue damage. Dental caries was the most common indication for endodontic treatment of the posterior teeth while trauma was the most common indication for the anterior teeth. CONCLUSION: Majority of the endodontically treated teeth that were evaluated for tissue loss had moderate coronal tissue damage. It is therefore recommended that proper and prompt evaluation of the remaining coronal tooth tissue following successful endodontic treatment be carried out in order to determine the appropriate definitive restoration required that will be easy for the clinician and less expensive to the patients.

The prevalence and severity of dental fluorosis among secondary school children in Ibadan, Nigeria.

OBJECTIVES: This study was conducted to determine the prevalence and severity of dental fluorosis among secondary school children in Ibadan, Nigeria. MATERIALS AND METHODS: A multi-stage sampling technique was employed to select the participants who consisted of children aged 12-14 years taken from eleven randomly selected secondary schools in the five local government areas of Ibadan Metropolis. The children were examined by the Principal Investigator after submitting parental administered questionnaires. The diagnosis of dental fluorosis was based on the TF index. RESULTS: The mean age of the 1372 participants (825 males and 547 females) was 13.15 ± 0.80 years. Dental fluorosis was diagnosed in 157 (11.4%) children (98 males and 59 females). There was no statistically significant difference between age or gender and the occurrence of fluorosis. Most of the cases were very mild with greater than 90% of the affected teeth having a TF score of ≤3. The most severely affected were the maxillary molars. Severe disfiguring cases of dental fluorosis were not common among the secondary school children examined. CONCLUSION: The prevalence of dental fluorosis was found to be low, with majority of the cases being very mild.

Tooth loss: are the patients prepared?

BACKGROUND AND AIM: Tooth loss is associated with esthetic, functional, psychological, and social impacts on the life of individuals. This study was designed to find out how Nigerians feel about losing their teeth and what effects, if any, this has on their lives. Most of the problems presented to the dentist as difficult denture tolerance could be as a result of the emotional effects of tooth loss rather than problems from the denture itself. MATERIALS AND METHODS: The study was carried using a self-administered questionnaire to consenting adult patients undergoing tooth extraction at the Oral and Maxillofacial Clinic, University College Hospital, Ibadan, Nigeria. The data collected were analyzed using SPSS, version 15.5. RESULTS: A total of 90 respondents completed the questionnaires; 35 (27.6%) were males while 55 (43.3%) were females. The respondents were aged 0-70 years. Immediate acceptance of tooth loss was noted in 88 (69.3%) cases, but 6 (47%) accepted the loss only after 1 year, while 8 (6.3%) of the cases found it difficult to accept losing their teeth and incidentally, all of them were 30 years and above. Only 52 (40.9%) of the patients were prepared for the emotional effect of losing their teeth. A feeling of relief immediately following tooth extraction was expressed by 75 (43.9%) cases and of these 32 (47.8%) were females. The emotional effects following teeth loss were sadness 22 (12.9%) cases, depression in 11 (6.4%), feeling of losing body part in 24 (14%), feeling of aging in 4 (2.3%), while 13 (7.6%) respondents felt unconcerned. CONCLUSION: We observed that emotional effects of tooth loss are also experienced among our patients with a range of emotions quite similar to those observed by previous authors from the developed world. The significant number of patients that failed to come to terms with their tooth loss indicates that the effect of tooth loss on self-esteem and self-image is not short lived as it has been assumed.

THE EFFECT OF RIDGE HEIGHT ON RETENTION OF ACRYLIC AND FLEXIBLE DENTURES IN PATIENTS WITH COMPLETE EDENTULOUS MAXILLARY ARCH: A PILOT STUDY.

Introduction: Removable denture still stands as the preferred option in the management of completely edentulous arch in the developing society. The prosthodontist is challenged with providing a retentive denture to the patient, alleviating the effect of tooth loss. The retention of these prostheses is influenced by the material used for it fabrication and the edentulous ridge height, hence the need to assess the retention of acrylic and flexible complete denture and the effect of edentulous ridge height. Aim: This study was to assess and compare the effect of ridge height on retention of flexible and acrylic complete upper dentures. Materials and Methods: Ten patients with complete upper edentulous arches were recruited and randomly allocated into two groups (A and B). Acrylic and flexible, complete maxillary dentures were fabricated for each participant. Group A wore the acrylic denture first, while group B wore the flexible denture first. Each participant was recalled after using the denture for one week, one month, and three months for data collection.At cross over time (3 months after wearing the first denture), individuals in group A were given flexible dentures, while those in group B received acrylic dentures. The patients were recalled again for data collection by one of the researchers. Kapa Intra examiner reliability test was 83.3%. Information related to denture retention were obtained and entered into IBM SPSS software version 23 for analysis. Paired t-test and linear regression were used to test for association between quantitative variables. A P-value of 0.05 was regarded as significant. Results: Ten individuals with mean age of 66.5±9.7 years and mean anterior ridge height of 15.5 ± 2.95 mm participated in this study. The subjective and objective assessments of the dentures showed that acrylic denture possessed a better retention than flexible denture. The effect of anterior ridge height on retention, showed a statistically significant difference (p= 0.006 for acrylic denture, p = 0.001 for flexible denture). Conclusion: This study suggested that acrylic denture possesses better retention compared to the flexible type and far better in situation with lower ridge heights.

Characteristic features of impacted denture cases in Nigeria.

OBJECTIVE: The study was designed to determine the characteristic features of impacted dentures, the patients presenting with them and to determine the pattern of distribution of cases in a cross-section of Nigerian Teaching Hospitals. MATERIALS AND METHODS: Self-administered questionnaire was distributed among Ear Nose and Throat (ENT) resident doctors during an update course at University College Hospital (UCH), Ibadan, Oyo State, Nigeria. Demographic variables, number of cases encountered over a 10-year period and characteristics of impacted dentures and those of the victims were requested. RESULT: 62.5% of the respondents indicated that the patients were males in the 30-65 years age bracket and that most of them were not satisfied with their dentures at the time of impaction. All the respondents indicated that the cases involved were partial dentures, most of which were upper acrylic dentures without clasps. The highest self-reported number of denture impaction cases (22) was recorded in Lagos University Teaching Hospital (LUTH). CONCLUSION: The preliminary report shows that cases of denture impaction usually involve upper partial dentures without clasps in dissatisfied male denture wearers within 30-65 years age bracket.

PROSTHODONTIC REHABILITATION OF MAXILLOFACIAL DEFECTS IN A NIGERIAN TEACHING HOSPITAL: A 9-YEAR REVIEW.

OBJECTIVE: The objective was to review patients treated with maxillofacial prostheses in a Nigerian teaching hospital to assess the types of prostheses provided for them. METHODOLOGY: This was a retrospective study of patients treated with maxillofacial prostheses over a period of nine years. The socio-demographic data of the patients, types of defect, causes of defects, location of defect, types of maxillofacial prostheses and the indications for prostheses were obtained from the patients' case records. Case records with incomplete information were excluded. All data generated were analysed using the IBM SPSS version 20. Fisher's exact test was used to test for statistical significance. RESULTS: Case records of eighty-two patients treated with maxillofacial prostheses were reviewed. Forty-three (52.4%) of the patients were males while 39 (47.6%) were females. The age ranged from 6 to 76 years with the mean age being of 38.76 (SD±18.3) years. The majority, 58 (70.7%) of the patients were of lower social-economic class. Sixty-six (80.5%) patients had prostheses for maxillary defects, while only one (1.2%) patient had prosthesis for nasal defect. Twenty (30.3%) of the 66 patients that had maxillary defects had definitive obturators, while only three (4.5%) had all the three types of obturator. Surgical recession of tumours of the jaw was the major cause (85.4%) and mastication (70.7%) was the major indication for the prescription of obturators. CONCLUSION: The majority of the patients were of the lower social class and maxillary obturator was the major form of maxillofacial prostheses provided for patients in this study. Most of the defects are caused by surgical recession of tumours of the jaw and mastication was the major indication for the prescription of obturators.

Agenesis of a mandibular canine: a case report.

BACKGROUND: Hypodontia is one of the most common developmental anomalies in man. The most frequently missing tooth is the third molar. Agenesis of canine in the secondary dentition is rarely reported . OBJECTIVE: To report a very rare form of missing tooth in the secondary dentition due to agenesis. METHODS: A 49-year Nigerian male consulted with a desire to have a dental check-up. Extra- and intr-oral exminations were carried out. Following observation of a a missing tooth orthopanthomograph was carried out. with a missing lower right canine. All other teeth were well formed and have all erupted into the oral cavity. RESULTS: There was no history of systemic disease or family history of oligodontia and was generally well. Systemic examination was essentially normal. Intra oral examination revealed that he had full complement of teeth but for a missing lower right canine. There was a gap of about 2mm between the lower right lateral incisor and the lower right first premolar and a buccal displacement of the upper left second molar as well as a carious lesion on the upper first left molar. The orthopanthomograph showed that the tooth was not within the mandible in this patient. CONCLUSION: The cause of the aplasia resulting in this rare condition is not clear but may be due to inadequate secretion of some of the signaling molecules or localized absence of their receptors in the ectomesenchye destined to differentiate into the right canine tooth.

The fluoride content of drinking water and caries experience in 15-19 year old school children in Ibadan, Nigeria.

Fluoride, a trace element with anticariogenic benefit may either occur naturally or be added to drinking water sources. This study aimed at determining the fluoride level of the different drinking water sources in Ibadan, Oyo State, Nigeria and to relate this with the caries experience of secondary school children in the city. Sixteen samples of the drinking water sources from various locations in the five local government areas of the city were analysed for fluoride concentration. The locations were selected around the vicinities of the secondary schools used for caries study. Nine hundred and fifty five students aged 15-19 years randomly selected from eleven secondary schools in Ibadan metropolis were examined for dental caries over a period of 4-5 months. Only teeth with obvious cavitations were recorded as being carious using the WHO standard method. Teeth grossly covered with calculus and third molars were excluded. No radiograph was taken. The fluoride level of the different water sources was between 0.02 and 0.03 ppm. Forty-four (4.6%) of the children had dental caries. There was no statistically significant difference between either DMFT and gender (t = 0.67, p = 0.91) or DMFT and age (F = 1.488, p = 0.224). However, females had a slightly higher mean DMFT than males and the highest mean DMFT (2.67 +/- 1.15) was found among the 19-year-old children. Twenty-three (52.3%) of the students with caries had only one carious tooth while only two had four carious teeth each. In conclusion, both the fluoride level and caries prevalence were low.

Causes and pattern of fracture of acrylic dentures among patients seen in a Nigerian teaching hospital.

There is little information on the causes and pattern of fracture of acrylic dentures in Nigerian patients despite being the most frequently employed design in Nigeria. The aim of this study was to determine the average life span of acrylic dentures before fracture, the causes and pattern of fracture of acrylic dentures in a Nigerian population. All consecutive patients that presented with fractured acrylic dentures at the Dental Centre, University College Hospital, Ibadan between January and July 2006 and were willing to participate were recruited into the study. A structured interviewer-administered questionnaire was used to record data from the patients. The questionnaire focused on patients' demographic data, age of acrylic denture as at the time of fracture, causes and pattern of fractures. The data were analysed using SPSS Version 11. A total of sixty-two patients were included in the study. They presented with sixty-nine fractured dentures. Five were complete dentures while 64 were partial dentures. The average life span was 7.4 years +/- 6.6 (SD) years. Early fracture was seen in 9 (13.4%), intermediate fracture in 29 (42%), and late fracture in 31 (44.9%) cases. The commonest cause of fracture was mastication as seen in 30.4% of the cases while the least cause was fight (4.3%). The commonest site of fracture (34.8%) was the palatal plate around the crest of the edentulous ridge while fracture of wrought metal clasps was the least, occurring in 1.4% of cases. We recommend proper design with balanced articulation and more emphasis on compliance to post insertion instructions by patients to prevent early fracture of acrylic dentures. Also, reinforcing the acrylic denture base especially in stress bearing area may prolong the life span of these prostheses.

Prosthetic management of soft palate cleft--a case report.

The treatment of cleft in the soft palate can be achieved essentially by surgical reconstruction or prosthetic obturation. The goals of prosthetic intervention are to prevent food and liquid leakage into the nose and to improve speech intelligibility by ensuring functional velopharyngeal port closure. In this report, the prosthetic management of a 5-year-old child with soft palatal cleft is presented. The impression of the cleft was taken with tissue conditioner, Visco -gel, TM (De Trey, Amalgamated Dental London) and the pharyngeal obturator (speech bulb) was made in clear acrylic resin. Patient tolerated the appliance well and was referred to speech therapist for speech articulation.

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation.

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.

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.

Hepatitis B and C in doctors and dentists in Nigeria.

We surveyed a random sample (n = 75) of doctors and dentists at University College Hospital, Ibadan, Nigeria. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis Be antigen (HBeAG), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV), by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. The majority of the doctors and dentists use universal precaution for protection against viral hepatitis on < 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons, dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) had not received prior HBV vaccination. Unvaccinated personnel were more likely to be surgeons, dentists, < 37 years of age, and have fewer years of professional activity (p < 0.05). After logistic regression, only fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). To reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when the doctors and dentists carry out procedures on their patients, and all health-care workers should be vaccinated with HBV vaccine and the HCV vaccine, when it becomes available.

Prevalence and epidemiological characteristics of hepatitis B and C infections among doctors and dentists in Nigeria.

A random sample of seventy five doctors and dentists at the University College Hospital, Ibadan, Nigeria, was surveyed. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV) by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. Most of the doctors and dentists use universal precaution for protection against viral hepatitis less than 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons and dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) of these health care workers had not received prior HBV vaccination. The unvaccinated personnel were more likely to be surgeons, dentists, less than 37 years of age and have fewer years of professional activity (p < 0.05). After logistic regression, only the fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). We conclude that to reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when doctors and dentists carry out procedures on their patients. It is necessary that these health care workers are vaccinated with HBV vaccine and the currently anticipated HCV vaccination, if not immune. No recent study exists that exclusively addresses this problem in health care workers in tropical Africa.