Evaluation of the Efficacy of Platelet-Rich Plasma versus Platelet-Rich Fibrin in Alleviating Postoperative Inflammatory Morbidities after Lower Third Molar Surgery: A Double-Blind Randomized Study.

BACKGROUND: Postoperative morbidities following impacted lower third molar (M3) surgery is of concern. The influence of platelets concentrates on postoperative inflammatory sequelae of M3 is promising. However, the comparative efficacy of platelet-rich fibrin (PRF) to platelet-rich plasma (PRP) in ameliorating postoperative morbidities remains controversial. OBJECTIVE: The study aimed to compare the bioactive effects of PRP and PRF on postoperative pain, swelling, and trismus after impacted M3 surgery. SUBJECTS AND METHODS: A randomized, parallel-group study of 50 subjects was designed. Preoperative and postoperative swelling, degree of mouth opening and pain were assessed on days 1, 3, and 7. Linear mixed model analysis was used to compare the effects of treatment, time-point assessment within the group, and treatment with time interaction. RESULTS: Interaction estimates show statistically significant pain reduction with PRF (p = 0.00, 95% CI [-0.95, -0.25]. Trismus based on a time-point assessment within the PRP and PRF groups was significantly reduced (p =0.01, 95% CI [0.06, 0.38]) and (p = 0.00, 95% CI [0.12, 0.44]) respectively. Facial swelling within the PRP and PRF groups were significantly decreased (p = 0.00, 95% CI [-0.30, -0.06]) and (p = 0.00, 95% CI [-0.37, -0.13) respectively. There were no statistically significant differences between the groups for trismus and swelling. Age was a significant predictor of trismus in both groups (p = 0.04, 95% CI [-0.07, -0.01]). CONCLUSION: PRF was more effective in reducing postoperative pain compared to PRP. Furthermore, the study shows that platelet concentrates positively modulate post-inflammatory sequelae of impacted M3 surgery.

CONTEXTE: Les morbidités postopératoires consécutives à une chirurgie de la troisième molaire inférieure (M3) impactée sont préoccupantes. L'influence des concentrés plaquettaires sur les séquelles inflammatoires postopératoires de M3 est prometteuse. Cependant, l'efficacité comparative de la fibrine riche en plaquettes (PRF) et du plasma riche en plaquettes (PRP) dans l'amélioration des morbidités postopératoires reste controversée. OBJECTIF: L'étude visait à comparer les effets bioactifs du PRP et du PRF sur la douleur, l'enflure et le trismus postopératoires après une chirurgie M3 impactée. SUBJETS ET MÉTHODES: Une étude randomisée en groupes parallèles de 50 sujets a été conçue. Le gonflement préopératoire et postopératoire, le degré d'ouverture de la bouche et la douleur ont été évalués les jours 1, 3 et 7. Une analyse de modèle mixte linéaire a été utilisée pour comparer les effets du traitement, l'évaluation ponctuelle au sein du groupe et le traitement avec l'interaction temporelle. RÉSULTATS: Les estimations d'interaction montrent une réduction statistiquement significative de la douleur avec le PRF (p = 0.00, IC à 95 % [­0.95, ­ 0.25]. Le trismus basé sur une évaluation ponctuelle dans les groupes PRP et PRF a été significativement réduit (p = 0.01, 95 % IC [0.06, 0.38]) et (p = 0.00, IC 95 % [0.12, 0.44]) respectivement Le gonflement du visage dans les groupes PRP et PRF a été significativement diminué (p = 0.00, IC 95 % [­0.30, ­0.06 ]) et (p = 0.00, IC 95 % [­0.37, ­0.13) respectivement. Il n'y avait pas de différences statistiquement significatives entre les groupes pour le trismus et le gonflement. L'âge était un prédicteur significatif du trismus dans les deux groupes (p = 0.04, 95 % IC [­0.07, ­0.01]). CONCLUSION: Le PRF était plus efficace pour réduire la douleur postopératoire que le PRP. De plus, l'étude montre que les concentrés plaquettaires modulent positivement les séquelles postinflammatoires de la chirurgie M3 impactée. Mots clés: concentrés plaquettaires, douleur, gonflement, trismus, troisième molaire.

Do the bioactive effects of platelet-rich plasma and platelet-rich fibrin influence the oral health related quality of life following impacted third molar surgery? A randomized comparative study.

AIM: To compare the effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) on oral health-related quality of life (OHQoL) following impacted mandibular third molar (M3) surgery. PATIENTS AND METHODS: A prospective, randomized study of 50 subjects was designed. Participants were divided equally into the PRP and PRF groups. The OHQoL was assessed using the OHQoL-UK instrument preoperatively and on postoperative days (PODS) 1, 3, and 7. Categorical variables were presented as frequencies and proportions. The linear mixed model analysis was used to determine the effects of PRF and PRP on overall OHQoL with respect to time, treatment, and treatment by time-point interaction. The analysis was also performed for the physical, social, and psychological domains. RESULTS: Fifty subjects were analyzed. The time-point assessment of the overall OHQoL was significant within the PRP and PRF groups (P-values of 0.01 and 0.000002, respectively). The time-point analysis was also significant in both study groups at all domain levels (P < 0.05). A comparison of treatment by time-point interaction for the overall OHQoL between the study groups was insignificant (P = 0.217). Treatment by time-point interaction for OHQoL between the study groups at social and psychological domain levels was insignificant, however, at the physical domain level, PRF had a significantly better effect on OHQoL (P = 0.016). CONCLUSION: The study showed that the overall OHQoL was not significantly different between the PRP and PRF groups after M3 surgery. However, PRF had a significant influence on OHQoL at the physical domain level.

A Clinical Audit of Histopathologically Diagnosed Ossifying Fibroma of the Jaws in a Nigerian Population.

BACKGROUND: Ossifying fibroma (OF) is a benign tumor of the jaws, which belongs to the group of fibro-osseous lesions, and exhibits slowly progressive growth leading to jaw expansion with well-defined borders. OBJECTIVE: To evaluate the clinical and radiological characteristics of OFs and their treatment. MATERIALS AND METHODS: A 5-year retrospective study was done. The case notes of subjects were retrieved, analyzed, and evaluated. Relevant information about patients was categorized into bio-data, clinical, and radiological. The diagnosis of lesion was made histopathologically by the oral pathologist. RESULTS: Forty- five patients' case notes were retrieved and analyzed and the patients' age ranged from 2 to 70 years (mean 29.4 ± 16.9). Majority of the patients (55.5%; P = 0.23) were 10-29 years. There were 16 (35.6%) males and 29 (64.4%) females giving a male: female ratio of 1:1.8 (P = 0.01). The cross-sectional dimension of the tumors measured vertically and horizontally ranges from 1 cm2 to 420 cm2 (mean = 54.7 cm2 ± 82.9). There were 60% in the maxilla and 40% in the mandible (P = 0.014). Most of the lesions (68.9%; P = 0.01) showed patchy opacity and cotton wool appearances. Majority of the lesions were extirpated by enucleation alone (P = 0.01). CONCLUSION: The prevalence of OF among the fibro-osseous lesions was 51.0% while against other benign lesions, it was 16.0%. In conclusion, contrary to most other reports across the globe, this lesion in southeast Nigeria occurred more frequently in the maxilla than mandible.

Cultural constraints in the use of dental implants and orthodontic mini-implants in Benin City, Nigeria.

BACKGROUND: Dental implants and orthodontic mini implants or temporary anchorage devices (TAD) have been used for tooth replacement and as adjuncts to orthodontic treatment in anchorage control and retraction of segments of teeth respectively. They are manufactured from various materials with titanium being the currently used material. The patients in our environment have diverse cultural acceptances and constraints with some prohibiting the use of certain materials in their oral cavity. AIM: The aim of this study therefore was to determine the existence of cultural constraints in the use of dental or orthodontic min-implants and compare them in the management of patients. MATERIALS AND METHODS: Four groups of dental patients were selected to determine if cultural constraints exist. Groups 1 and 2 were patients with either anterior or posterior missing teeth requiring replacement with dental implants (implant group) or partial dentures (denture group), respectively. Group 3 were orthodontic patients requiring TAD (orthodontic group) and group 4 were patients with other dental problems and served as the control (normal group). Associations between frequencies, gender, educational, and cultural differences were evaluated with the Chi-square test. Significant values of P < 0.05 were applied where applicable. RESULTS: A total number of 192 participants were recruited for the study. Group 1 had the highest number of culturally constrained participants (n = 21, 10.9%). A significantly higher number from the group was seen (n = 11, 52.4%) among the African Traditional worshippers (ATR). Although a total number of 58 (30.2%) patients replaced their missing teeth, 37 (19.3%) utilized partial dentures in group 2 with no cultural constraints. Orthodontic implants were not rejected (n = 0, 0%) by all the four groups. Group 4 demonstrated a low level of constraints (n = 7, 4.2%). Of the four religious groups identified, ATR demonstrated the highest level of constraints with Christians and Muslims showing fewer constraints to the use of implants (n = 7, 33.3%) and (n = 2, 9.5%), respectively. Participants with the highest educational levels and social classes were more culturally constrained in the use of dental implants. CONCLUSION: Cultural constraints exist in the use of dental implants in our environment among African Traditional religion worshippers. There was, however, no cultural constraint to the use of orthodontic implants by any of the religious groups.

A study on shotgun injuries to the craniomaxillofacial Region in a Nigerian Tertiary Health Center.

CONTEXT: Short-range shotgun wounds of the craniomaxillofacial region are life-threatening and are as devastating as military rifle wounds. AIMS: This study aimed to evaluate the pattern of presentation of craniomaxillofacial shotgun injuries, types of shotgun injuries, and the outcome of treatments in our environment. SETTING AND DESIGN: This is a prospective observational study. Materials and Methods: This is a prospective observational study conducted from February 2006 to March 2012. All patients with shotgun wounds to the craniomaxillofacial region were included in the study by convenient sampling method. Glezer's shotgun classification scheme was used to categorize the patients into short-, intermediate-, and long-range shotgun wounds. Data collected were analyzed using SPSS version 16. STATISTICAL ANALYSIS USED: Descriptive statistics were used to calculate the data. Mean and standard deviation (SD) were calculated for all quantitative variables such as age. Frequency and percentages were presented for qualitative variables. RESULTS: A total number of 28 patients were seen. Ages ranged from 19 to 64 years with a mean (±SD) of 32.7 (±11.4) years. The two most commonly used shotguns were locally made pistol (25, 42.9%) and the cut-size gun (10, 35.7%) and the least commonly used was Dane gun (1, 3.6%). Close-range injury to the face was 17 (60.7%) while that of intermediate- and long-range injuries were 6 (21.1%) and 5 (17.9%), respectively. CONCLUSION: Wounds sustained from close-range shotguns to the face were the most common in this environment. The outcome of treatment was satisfactory when treated with conservative debridement and early reconstruction.

A comparative analysis of the level of cortisol and the number of teeth extracted among patients undergoing routine dental extraction.

BACKGROUND AND OBJECTIVE: A postextraction comparative (cohort) study was carried out to determine whether the number of teeth extracted has an effect on salivary cortisol and by extension on stress. SUBJECTS AND METHODS: Sixty-three consecutive patients comprising 27 males (42.9%) and 36 females (57.1%) with a male: female ratio of 1:1.3, divided into two groups of A and B with a mean age of 25.8 ± 4.9 years, and age range of 18-37 years took part in the study. Fifty (79.4%) of them in group A (22 males and 28 females) each had a tooth extracted while 13 (20.6%) in group B (5 males and 8 females) had two teeth removed. One ml of resting saliva was collected from each patient 10 minutes after the procedure and analyzed for cortisol. All extractions and sample collections were done between 10 am and 2 pm to standardize the study and control for the diurnal variation of cortisol. Statistical analysis of the generated data was performed by using Student's t-test on SPSS version 17.0. The level of significance was set at 0.05 with P< 0.05 regarded significant. RESULT: The result showed mean salivary cortisol level of 12.914 ± 2.4684 ng/ml for group A and 12.108 ± 1.7192 ng/ml for group B though not statistically significant (P > 0.05). Females had more extractions in the two groups when compared with males. Male gender had a statistical significance difference (P < 0.05). CONCLUSION: This study shows that the number of teeth extracted did not have effect on mean salivary cortisol, as a result two teeth extraction does not impart more stress to the patient when compared with one, and as such no additional adjuvant stress relieving measures are needed in two teeth extractions.

Honey and wound dehiscence: a study of surgical wounds in the mandibular bed.

BACKGROUND: There is a paucity of literature on the use of honey in wound healing after oral and maxillofacial surgical procedures. OBJECTIVE: To evaluate the efficacy of the healing properties of Obudu honey in patients who developed wound dehiscence after segmental mandibular resections. PATIENTS AND METHODS: This was a prospective study of 72 patients who had benign lesions of the mandible, and were treated by segmental mandibular resection, with the surgical wounds developing dehiscence. The subjects were randomized into two treatment groups of A (control, n = 36) and B (experimental, n = 36). Unlike the control, the wounds in the experimental group were dressed in honey after debridement. RESULTS: The ages of the patients ranged from 21 to 73 years with a mean age of 46.3 ± 2.1 years while the male: female ratio was 3:1. There was no significant demographic difference about age ( P = 0.44) and gender (P = 0.38) between the two groups. The smaller the initial circumference of the surgical wound, the shorter the duration of healing and this was significant (P = 0.001) in either of the treatment groups. Numerically, more healing was completed in the first 5 weeks in subjects in the experimental group (n = 19, 52.8%) than the control (n = 13, 36.1%). However, the duration of healing between the subjects in the control and experimental groups at the end of 9 weeks showed no significant difference (P = 0.23). CONCLUSION: Honey speeds up the healing of dehiscence wounds of resected mandible when used as dressing more than the control.

Complications of mandibular fracture: study of the treatment methods in calabar, Nigeria.

OBJECTIVE: The plethora of techniques available for the treatment of mandibular fractures suggests that there is controversy regarding their definitive outcome. The purpose of this study was to clinically study the complications associated with the different treatment methods of mandibular fractures at the University of Calabar Teaching Hospital (UCTH), Nigeria. METHODS: This was a three-year prospective study carried out at the Dental and Maxillofacial Clinic of the hospital. Patients who met the inclusion criteria had their data recorded in a proforma questionnaire. RESULTS: Out of the 256 patients studied, 17.2% developed complications. Complications were commoner (70.5%) between ages 21 and 50 years. Thirty-five (79.5%) were males while nine (20.5%) were females with a male:female ratio of 4.9:1. Following treatment by closed reduction, conservative and open reduction, 16.6%, 17.2% and 20.7% had complications, respectively. Whereas occlusal derangement was the most common complication, numbness of the cheek and lower lip was recorded following all treatment methods. CONCLUSION: Although the complications recorded in this patient population were managed during postoperative follow-up period, the methods of treatment available give good results, are cost-effective and patient compliance is good. This suggests that the older methods of treatment of mandibular fractures can still be used with reliability in contemporary dental practice.

A prospective clinical evaluation of the longevity of resorbable sutures in oral surgical procedures.

INTRODUCTION: The objectives of this prospective randomized study were to clinically evaluate the longevity of resorbable sutures (chromic catgut and vicryl) and determine the effect of chlorhexidine mouth wash on their absorption time in oral surgical procedures. Both sutures were of size 3/0 with round body needle and were placed using the standard technique. METHODS AND MATERIALS: One hundred patients selected for the study were divided into two groups of 50 patients each (vicryl and chromic catgut groups). Each group was subsequently subdivided into chlorhexidine (17 cases); warm saline mouth wash (17 cases) and warm water mouth wash (16 cases (control). RESULTS: The sutures were placed during various minor surgical procedures e.g. third molar surgery (65 cases), incisional biopsy (7 cases), excisional biopsy (8 cases), sutured lacerations (10 cases) and malar elevations through intraoral upper buccal sulci approach (8 cases) and 2 cases of cystic enucleations. The mean longevity of chromic catgut for chlorhexidine was 11.4 days with a range of 5-16 days. The patients, who used warm saline mouth wash, had a mean longevity of 11.7 days with a range of 7-24 days. The mean longevity of vicryl in patients that used chlorhexidine was 22.7 days, with a range of 14-36 days and that of warm saline mouth wash was 24.5 days with a range of 14-47 days. CONCLUSION: The resorbable sutures investigated have a mean longevity, which was slightly shorter than the figure stated by the manufacturer. Chlorhexidine was found to have no appreciable effect on absorption time of the sutures.

Melanin pigmented periradicular lesions of extracted teeth: a report of 3 cases and review of the literature.

This article reports 3 cases of melanin pigmented lesions among 75 histologically diagnosed periradicular lesions of extracted teeth. Case 1 was a 25-year old male who presented with one week history of toothache involving a tender carious left mandibular second molar tooth (37), with periapical radiolucency and diagnosed clinically as acute apical periodontitis. The lesion was diagnosed histologically (using Haematoxylin and Eosin) as periapical granuloma, while histochemical examination (using Masson-Fontana technique) showed the presence of round/oval shaped melanin pigmented macrophages (melanophage) in the lesion. Case 2 was a 54-year old male with one week history of toothache associated with tender carious right maxillary first molar tooth (16) with periapical radiolucency. A clinical diagnosis of acute apical periodontitis was made, but histological and histochemical examination showed a melanin pigmented periapical granuloma with spindle shaped melanophage. Case 3 was a 28-year old female who presented with 4 days history of toothache, involving the tender left mandibular first molar tooth (36). The lesion had periapical radiolucency and a clinical diagnosis of acute apical periodontitis. On examination histologically and histochemically, the lesion was diagnosed as an intraosseous melanocytic naevi with dark-brown nests of round naevus cells. In conclusion, this article shows the rarity of melanin pigmented periradicular lesions in the jaws. The cases reported suggest that the trigger for formation of melanin-pigmented cells in the periradicular lesions may be related to the acute phase of the lesions. Further study is recommended to determine if the remnants of the migratory neural crest cells are the precursors of melanin-pigmented cells in the periradicular region.

Periradicular burkitt's lymphoma: a report of 2 cases from Nigeria and review of the literature.

This article reports two cases of periradicular Burkitt's lymphoma from Nigeria, to emphasize the difficulties in differentiating the early lesion from other periradicular lesions with similar clinical and radiological findings Case 1, is a 4-year-old boy who presented with a one-month history of a painless, hard, posterior mandibular swelling (right), which was causing loosening and displacement of deciduous teeth (84 and 85). Histopathological examination of periradicular tissues from extracted tooth (85), confirmed the diagnosis of early periradicular B urkitt's lymphoma. Case 2, is a 6-year-old boy who presented with one-week history of a loose, extruded right mandibular first molar tooth (46) and an exfoliated left mandibular first molar tooth (36). After two weeks of follow-up, the patient developed bilateral mandibular swelling at the molar region, as well as peri-orbital and bilateral pedal oedema. Incisional biopsy of the oral lesion at the region of exfoliated left first mandibular molar (36) was useful for histopathological diagnosis of early Burkitt's lymphoma of the jaw. In the face of limited diagnostic tools such as clinico-radiological assessment, cytology or incisional biopsy for incipient periradicular lesions, a high index of suspicion of Burkitt's lymphoma of the jaw may be helpful in early diagnosis and treatment of a lesion, presenting in a child as periradicular radiolucency or mixed radiolucency and radiopacity, with associated loosening and displacement of teeth.

Aneurysmal bone cyst: a primary or secondary lesion?

OBJECTIVES: To emphasize the origin of aneurysmal bone cyst as "primary" or "secondary" to other lesions of the jaws and 2. Report two cases of the cyst that illustrate its controversial origin in the hope that it will add to the literature on the subject in Africa. REPORT: Two cases of aneurysmal bone cyst occurring in the mandible and maxilla are reported. One of the cysts that occurred in a 13-year-old was a primary lesion while the other in a 5-year-old was associated with a cementifying fibroma. METHOD: The diagnoses of both lesions were confirmed by biopsy. The lesion that occurred in the 13-year-old was treated by curettage while the other in the 5-year-old was treated by excision under general anaesthesia respectively. RESULT: While the lesion in the 13-year-old was haemorrhagic with 'welling up' of blood, the second lesion though haemorrhagic was not associated with this phenomenon. Both patients were transfused with 2 pints and 1 pint of blood respectively. There has not been recurrence of the lesions after two years post operatively. CONCLUSION: Aneurysmal bone cyst can arise as a primary lesion or associated with a fibro-osseous lesion as demonstrated by these two cases. There is a need to serially section biopsy specimens of the cyst to detect coexisting lesions.

Spontaneous bone regeneration after segmental mandibular resection: a retrospective study of 13 cases.

The aim of this study was to evaluate the clinical characteristics of cases of spontaneous bone regeneration of the mandible after segmental resection. This retrospective study covered a 23-year period and used data obtained from the hospital records; patient data were entered into a pro-forma questionnaire. Overall, the cases of 636 patients with mandibular lesions treated by segmental resection were reviewed; 13 (2.0%) had spontaneous bone regeneration. The time post-surgery at which bone regeneration was first noticed ranged from 9 to 17 weeks. Seven patients were male (53.8%) and six were female (46.2%), giving a male to female ratio of 1.2:1. The patients ranged in age from 16 to 51 years (mean 26.6±3.6 years). The periosteum was completely excised after resection in eight patients (61.5%), while it was partially preserved in five (38.5%). The younger the patient, the earlier the spontaneous bone regeneration occurred in the defect (P=0.001), particularly in those who had complete excision of the periosteum. Radiographically, the new bone formed was observed to have the same appearance as the cortical bone of the mandibular stumps, but lacked height. This study suggests that bone graft reconstructions may still be necessary for this group of patients who show spontaneous bone regeneration.

The effect of anesthesia on the ventilatory functions of patients with Maxillo-mandibular fixation.

BACKGROUND: Maxillo-mandibular fixation (MMF) is a procedure still routinely practiced in developing countries. AIM: To determine the variations in pulmonary functions readings between cases treated under general anesthesia (GA) and those treated under local anesthesia (LA). METHODOLOGY: A descriptive hospital-based study of 106 patients was carried out from January 2011- December 2012. Information was obtained using a questionnaire and all study subjects had their baseline lung functions and their post-operative daily lung function parameters measured for the first week and then weekly for the next five weeks. The data obtained were analyzed using SPSS version 16 and a P-value of ≤0.05 was considered significant. RESULTS: A total of 85 males and 21 females participated in the study. The means for age was 30.62±8.06, weight 63.92± 9.96 and BMI 23.21± 3.14 while the means for the pre-operative FVC, FEV1, and PEFR were 3.71 ± 0.70, 3.14± 0.51 and 8.18± 1.61 respectively. There was a statistically significant drop (p< 0.05) in the FVC, FEV1 and PEFR in the first post operative week. The drop in the lung function parameters were similar between the GA group and the LA group. CONCLUSION: Maxillo-mandibular fixation causes a significant fall in pulmonary function parameters especially in the first 48 hours post-operatively irrespective of whether general or local anaesthesia was used at surgery. The pulmonary functions should be further monitored for more than 48 hours after surgery.

A prospective clinical evaluation of the effects of chlorhexidine, warm saline mouth washes and microbial growth on intraoral sutures.

INTRODUCTION: Post operative care of sutured wound is important after surgery. Sutured wounds within the oral cavity are kept clean through frequent rinses with either normal saline, chlorhexidine mouth rinses, hydrogen peroxide diluted with saline, or fresh tap water. PATIENTS AND METHODS: The patients were randomised into 3 groups (A, B and C). The container used had 34 chlorhexidine, 34 warm saline and 32 warm water mouth rinses. The latter served as control. All selected patients had scaling and polishing done preoperatively when needed. All participants in each group did not receive antibiotics but received analgesics (paracetamol 1 g 8 h for 5 days,). RESULTS: There were 49 females and 51 males, in the age range between 18 and 50 years. Microorganisms were found to grow on sutures with streptococcus viridians predominating followed by staphylococcus epidermides. The effects of chlorhexidine, warm saline and warm tap water mouth washes were not statistically significant. CONCLUSION: Chlorhexidine, warm salt water and warm tap water averagely produced the same number of colony forming units of bacteria, which shows that the three different mouth washes are equally effective as post-operative mouth rinses after oral surgery.

Evaluation of cortisol concentrations in saliva as a measure of stress in patients having routine dental extractions.

We measured changes in the salivary concentrations of cortisol as an index of stress, and to find out if patients were stressed during routine intra-alveolar dental extractions. A total of 126 patients (63 experimental and 63 controls) matched for age and sex with a mean (SD) age of 26 (5) years (range 18-40) were recruited. Samples of saliva from patients whose glands had not been stimulated were collected twice from the study group (30minutes before, and 10minutes after, the procedure) and once from the control subjects. All samples were collected between 10.00 and 14.00hours to standardise the method and control for the diurnal variation of cortisol. There was a slight but not significant increase in the mean salivary concentration of cortisol between the preoperative samples (mean (SD) 12.3 (1.5)ng/ml and the postoperative samples 12.8 (2.3)ng/ml in the study group) and the control 8.7 (1.0)ng/ml. However, there was no difference between the sexes. The study highlights a simple but effective way of evaluating stress in patients having intra-alveolar dental extraction, and emphasises the invaluable role of salivary cortisol in the evaluation of stress (particularly in our environment).

Hepatitis B surface antigen and antibody to hepatitis C virus among accident and emergency patients.

OBJECTIVE: To determine the sero-prevalence and epidemiology of antibody to hepatitis C virus (anti-HCV) and hepatitis B surface antigen in accident and emergency patients. DESIGN: A descriptive study was performed on 150 accident and emergency patients. Sera was screened for anti-HCV and HbsAg, using enzyme linked immunosorbent assay. Personal information and risk factors involved were obtained using a questionnaire. SETTING: Haematology laboratory of the University of Benin Teaching Hospital, Nigeria. SUBJECTS: One hundred and fifty adults consisting of 122 males and 28 females who were above the age of 21 years. Patients were randomly selected from all adults including dental patients attending the emergency department for both surgical, dental and medical emergencies. The age range was between 21-58 years. In order to ascertain the epidemiology of both viruses a questionnaire was used detailing the possible risk factors for transmission. These included history of previous blood transfusion; history of life time occurrence of multiple sexually transmitted diseases; history of heterosexual exposure to partners at risk (for example prostitutes); history involving the use of unsterilized blades; presence of scarification marks and tattooing; low socio-economic status (low annual income or unemployed): history of intravenous drug use and heterosexual activity. Anti-HCV and HBsAg were both assayed using different assay kits, based on the enzyme linked immuno absorbent assay (ELISA) tests from different manufacturers. RESULTS: The sero-prevalence of anti-HCV was 14% and 29.3% for HBsAg. Anti-HCV positivity was significantly associated with a past history of blood transfusion and heterosexual exposure to partners at risk. The study also revealed a significant association between HBsAg positivity and all the risk factors. CONCLUSION: The high prevalence rate for anti-HCV and HbsAg in accident and emergency patients increases the likelihood of further spread from patients to health care providers especially if adequate precautions are not observed.

Influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes [corrected].

The objective of this study was to determine the influence of positions on the incidence and severity of maxillofacial injuries in vehicular crashes. Two hundred and fifty cases of RTA were seen and studied from October 1999 to May, 2000. They comprised 72.8% males and 27.2% females with a male to female ratio of 2.7:1. The age range was 1 to 80 years with a mean age of 40 years. The most common vehicle involved in RTA was the mini bus, 34.3% followed by motorcycle, 26.5%. Middle seat passengers, drivers and motorcycle passengers and riders sustained more and severe injuries during crashes. The mandible was more frequently fractured at the symphysis (24.6%) than at any other site while the maxilla was frequently fractured at the zygomatic bone and arch (10.8%). More injuries occurred in the age range of 20-30 years and these accounted for 31.8% of the cases. Only 6 occupants of motor vehicles wore seat belts before accident while no motorcycle rider or passenger wore any helmet. In conclusion, drivers, middle seat occupants of a vehicle, motorcycle passenger and riders sustained more and severe injuries than back seat occupants.

A review of 156 odontogenic tumours in Calabar, Nigeria.

BACKGROUND: Odontogenic tumours occur in our environment and because of late treatment, cause considerable disabilities. OBJECTIVE: To review cases of odontogenic tumours in our centre in order to obtain a baseline data and subsequently compare the results with that obtained elsewhere. PATIENTS AND METHODS: Using hospital case files and register, we carried out a 15-year retrospective study of odontogenic tumours at the Dental and Maxillofacial Clinic, University of Calabar Teaching Hospital, Nigeria. The data documented include age, gender, duration of lesion, type of tumour, socio-economic class, type of surgery, and complaints during follow-up reviews. RESULTS: Majority of the patients (n=49, 31.4%) were in the third decade of life. There were 85 (54.5%) males and 71 (45.5%) females, giving male to female ratio of 1.2:1. There was a significant association between the type of odontogenic tumour and the age of occurrence (p=0.000). The longer the duration of symptoms before presentation, the larger the tumours (p=0.000). The benign odontogenic tumours were 151 (96.8%), ameloblastoma (n=74, 47.4%) being the commonest. Jaw resection (54.5%) was the predominant treatment. Majority (58.0%) of the complications following treatment were Facial deformity, malocclusion and impaired mastication. CONCLUSION: Majority of the patients was in the lower socio-economic class, presented late for treatment and a few with aesthetic and functional impairment returned for secondary surgery. The intervention of agencies of government and non-governmental organizations is required to assist these patients if we are to accomplish the core healthcare system values in our environment.

Reasons and pattern of tooth mortality in a Nigerian Urban teaching hospital.

BACKGROUND: Studies from Nigeria have documented different reasons for tooth mortality and regular follow-up studies to determine any changes in reasons and pattern among Nigerians appears not to be common. The purpose of this study was to determine the reasons and pattern of tooth mortality among Nigerians and the changes that might have occurred after 38 years of the first report. MATERIALS AND METHODS: The case records of patients seen at the Oral Surgery clinic of the University of Benin Teaching Hospital between March 2007 and February 2008 were retrieved from the Medical Records Department and analyzed for age, gender, reasons for extraction, tooth extracted, frequency of extraction, and mode of extraction. RESULTS: A total of 990 patients were referred for exodontia and 1050 teeth were extracted from 397 (40.1%) males and 593 (59.9%) females of age 14--89 years. The reasons for extraction include caries and its sequelae (n = 905, 86.2%), periodontal disease (n = 69, 6.6%), trauma (n = 41, 3.9%), orthodontics (n = 24, 2.3%), failed endodontics (n = 5, 0.5%), prosthetics (n = 4, 0.4%), pericoronitis (n = 2, 0.2%). The most frequently extracted teeth were the lower right first molars (n = 109, 10.4%) and the lower left first molars (n = 95, 9.0%), respectively. Molar teeth (n = 830, 79.0%) were more frequently extracted while canines (n = 13, 1.2%) were the least. The lower molars were more commonly extracted (n = 479, 45.6%) followed by upper molars (n = 351, 33.4%). The age range of 21-30 years was more commonly referred for extraction with the most frequently extracted teeth being the lower left first molars (n = 32, 3.0%) in females and (n = 27, 2.7%) in males, respectively. CONCLUSION: Tooth mortality in Nigerians is significantly associated with dental caries and its sequelae especially in younger patients.