Linking the demographic, socio-economic and oral health status to oral health-related quality of life of the sudanese older adults: a cross sectional study.

BACKGROUND: Oral Health-Related Quality of Life (OHRQoL) is an important measure of patients' needs and progress. Identifying the links between clinical and non-clinical factors with OHRQoL in a specific population will facilitate the development of effective preventive strategies. The aim of the study was to assess the OHRQoL of Sudanese older adults, and to identify the possible relations between clinical and non-clinical predictors with OHRQoL using Wilson and Cleary model. METHODS: This cross-sectional study was conducted among older adults attending the out-patient clinics in Khartoum State's Health Care Centers, Sudan. OHRQoL was assessed using the Geriatric Oral Health Assessment Index (GOHAI). Two modifications of Wilson and Cleary's conceptual model were tested using structural equations modeling including: oral health status, symptom status, perceived difficulty of chewing, oral health perceptions, and OHRQoL. RESULTS: 249 older adults participated in the study. Their mean age was 68.24 (± 6.7) years. The mean GOHAI score was 53.96 (± 6.31) and trouble biting/chewing was the most commonly reported negative impact. Wilson and Cleary models showed that pain, Perceived Difficulty Chewing (PDC), and Perceived Oral Health had a direct effect on OHRQoL. In model 1, age and gender had direct effects on oral health status, while education had direct effects on OHRQoL. In model 2, poor oral health status is associated indirectly with poor OHRQoL. CONCLUSIONS: The OHRQoL of the studied Sudanese older adults was relatively good. The study partially confirmed Wilson and Cleary model as Oral Health Status was related directly to PDC and indirectly to OHRQoL through functional status.

Oral health status and associated factors among Sudanese older adults: A cross-sectional study.

OBJECTIVES: The aim was to assess the oral health status, prosthetic needs and the associated factors among older adults living in Khartoum State, Sudan. BACKGROUND: Understanding the extent of the oral health problems and the associated factors in the older population is important for the determination of treatment needs and future planning of dental services. MATERIALS AND METHODS: A cross-sectional study among individuals ≥60 years attending Health Care Centers. Two calibrated examiners examined participants according to the WHO oral health examination form for adults. DMFT, periodontal conditions, oral mucosal lesions, tooth wear, prosthetic status and prosthetic needs were reported. Risk indicators investigated include age, gender, socioeconomic status, general health, oral hygiene practices, tobacco use and utilisation for dental services. RESULTS: Two hundred forty-nine older adults participated in the study, and 64.3% were males. The mean age was 68.4 years (SD ±6.7). The mean DMFT was 15.9 (SD ±9.1), with 85.3%, 94.8% and 19.3% of the participants having decayed, missing or filled teeth respectively. Periodontal pockets were present in 41.9%, mucosal lesions in 14.9% and tooth wear in 46.2% of the participants. Although only 5.2% were completely edentulous, 93.2% need prosthetic replacement. Risk indicators for poor oral health were being female, oral hygiene practices, frequency and reason of dental visits. CONCLUSION: Old adults showed a high experience of missing and decayed teeth, periodontal inflammation and prosthetic treatment needs. Future oral health policies need to consider the different needs between men and women, exposure to risk factors and barriers to access dental care.

Prevalence of TMJ Disorders among Patients Attending the King Faisal University Dental Clinics, KSA.

AIM: To assess the prevalence of signs and symptoms of temporomandibular disorders (TMDs) in a sample population of Al-Hasa by Fonseca's questionnaire. MATERIALS AND METHODS: A group of 240 patients was randomly selected from outpatients, attending the dental clinical complex of King Faisal University. The participants were grouped based on gender and age-groups: 14 to 20, 21 to 40, 41 to 60, and 61 ≤ years. Each participant was provided with a questionnaire and points were given accordingly for each question. The sum of points was used to classify the severity of TMD. The obtained data were analyzed with SPSS 21 and the significance level of p was fixed at ≤ 0.05. RESULTS: Among all participants examined, 131 participants had no TMD (54.6%), 79 had mild TMD (32.9%), 19 had moderate TMD (7.9%), and 11 had severe TMD (4.6%). TMD problem increases with age and significance level (p = 0.007) and females had more TMD problems than males (p = 0.008). CONCLUSION: The Fonseca's questionnaire is an effective tool for screening the signs and symptoms of TMDs, in a short period, and classifies patients according to their severity. According to the study results, approximately 45.4% of the patients had some degree of TMD problems. The present study is cross-sectional with a limited number of participants and it should be followed by a longitudinal study in the near future to validate. CLINICAL SIGNIFICANCE: Early detection of TMD problems will help in treatment planning and prognosis.

Exposure to the advertisement of toombak at the point-of-sale among adolescents in Khartoum State, Sudan: A cross-sectional study.

INTRODUCTION: This study aimed to assess the association between toombak (smokeless tobacco) advertisement at point-of-sale (PoS) and its use among adolescents in Sudan. METHODS: A cross-sectional school-based and self-administered questionnaire study was conducted. Schools were randomly selected using a one-stage stratified sampling procedure, during 2013-2014, as part of a larger research project focusing on the use of toombak among secondary school students in Khartoum State, Sudan. The sample size was 1526 students. Data were collected on exposure to toombak advertisement, social acceptability, perceived accessibility to toombak, susceptibility, and toombak use. RESULTS: A total of 41.8% of the adolescents were exposed to an advertisement at PoS, while 12.5% perceived direct access to toombak, 5.3% reported that they were susceptible to use toombak, and 10.9% were ever toombak users. Exposure to the advertisement of toombak at PoS was found to be associated with the older age group (44.3%) (p≤0.05). Males were more than females (45.2% vs 38.8%; p≤0.05). Those exposed to toombak advertisements at PoS reported more social acceptability towards toombak (48.9% vs 37.6%; p≤0.001) and direct accessibility to toombak (68.8% vs 47.2%; p≤0.05). Ever toombak users reported higher exposure to advertisements than non-users (54.5% vs 40.3%; p≤0.001). CONCLUSIONS: Exposure to toombak advertisements at PoS was found to be high and associated with increased toombak use in Khartoum State, Sudan, in addition to increasing social acceptability to its use and perceived easy accessibility. The current law, which bans toombak advertisement and promotion at PoS, needs to be enforced.

Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect.

OBJECTIVES: (a) To compare levels of pro- and anti-inflammatory mediators in saliva and gingival crevicular fluid (GCF) in children with and without congenital heart defects (CHD cases and controls) and to test whether a systemic component exists in CHD cases by controlling for gingivitis and plaque scores. (b) To correlate the levels of pro- and anti-inflammatory mediators in GCF and saliva with plaque bacterial composition among CHD cases and controls. MATERIALS AND METHODS: Whole un-stimulated saliva and GCF samples were collected (60 CHD cases, 60 controls [Sudan]) and were analysed for levels of prostaglandin E2 (PGE2), interleukin-1ß (IL-1ß), tumour necrosis factor-α (TNF-α), interleukin-1ra (IL-1ra) and interleukin-10 (IL-10) levels. These levels were correlated with the previously reported levels of four red complex bacteria. RESULTS: Significantly elevated levels of PGE2 and IL-1ß in GCF and IL-1ß and TNF-α in saliva were detected among CHD cases compared with controls. General linear model (GLM) analyses revealed that PGE2 and IL-1ß levels remained significantly higher in GCF and saliva samples, respectively, among CHD cases after controlling for gingivitis and plaque score, whereas TNF-α and IL-10 levels were significantly lower in their GCF samples. Additionally, IL-1ß level was significantly positively correlated to the counts of the four red complex species in their GCF. CONCLUSION: In addition to higher levels of some pro-inflammatory mediators in saliva and GCF corresponding to more gingivitis in CHD cases, also a systemic inflammatory component exists and is reflected in these two oral fluids.

Perception of health professions students of their role model status in Toombak cessation: A cross-sectional study from Sudan.

INTRODUCTION: Health professionals are to play an essential and effective role in tobacco control. Toombak is a popular form of smokeless tobacco, locally made and used among Sudanese. It is associated with oral and systemic health hazards, particularly oral cancer. This study was set out to assess health professions students' perception of their status as future role models for their patients and the public regarding Toombak use cessation and to explore socio-cognitive covariates of perceived role model status. MATERIALS AND METHODS: A cross-sectional study was conducted in 2013-2014 using a self-administered questionnaire among health professions students enrolled in Medicine, Pharmacy, Dentistry and Nursing colleges in Khartoum state, Sudan. A total of 1530 participants were recruited from colleges using a cluster stratified sampling procedure. RESULTS: The majority of the participants (88.2%) were 19-22 year old, females showed predominance (66.1%). Most of the participants (69.7%) scored good knowledge of Toombak-related therapies. The majority (97%) had a positive attitude towards banning Toombak use in public. Half of the participants (50.4%) confirmed availability of Toombak control policy in their college, while 66% reported receiving training in Toombak cessation. Only 9.2% of the participants reported that they have ever used Toombak; among them, 69.5% were current daily users. Less than half (47.8%) reported a positive perception of their status as a role model. Logistic regression model revealed that tobacco cessation training, availability of college policy and positive attitudes towards banning Toombak use in public were strong predictors of with a positive perception of role model status. CONCLUSION: Imposing Toombak control policies within colleges combined with formal training in cessation methods, would reinforce the positive perception of health professions students as a role model, particularly the students themselves seem to be ready for such systematic training.

School workers' knowledge, attitude and behaviour related to use of Toombak: a cross sectional study from Khartoum state, Sudan.

BACKGROUND: Toombak is a form of smokeless tobacco (SLT) that is locally made and consumed in Sudan and contains several carcinogenic elements. Use of Toombak has been etiologically linked to various oral diseases including oral cancer. This study aimed to obtain baseline information about the Toombak use among Sudanese school workers, as well as their knowledge about Toombak related health hazards and attitude towards their role in Toombak control. In addition, this study assessed the availability and effectiveness of control policies and preventive practices in the schools. METHODS: A cross-sectional school-based study using one-stage stratified random sampling procedure; four schools were selected randomly from each of seven localities. A total of 239 school workers' were recruited (census) from the selected schools in Khartoum State, Sudan. RESULTS: Of the school workers, 63% (147) were ≤40 years, half were females and 79.2% (187) were teachers. A total of 9.6% (22) school workers confirmed ever use of Toombak and the percentage of daily users amounted to 64.7% (11). Moreover, 76.2% (16) of ever Toombak users were ≥40 years and all of them were males (p < 0.001). Most of the school workers reported good knowledge, positive attitude towards their role in Toombak control and good preventive practice. Female school workers were more likely to report positive attitude towards their role in Toombak control (p < 05), and to report good knowledge. Those reporting good preventive practice in schools reported good knowledge more than two times than their counterpart (p < 0.001). Age was the strongest predictor of ever Toombak use among school workers (p < .001). CONCLUSIONS: The use of Toombak among school workers was associated with poor knowledge, negative attitude towards their role in Toombak control and poor preventive practice, Therefore, school workers use of Toombak may reduce their motivation and use of their potential in the prevention of a major health problem caused by Toombak use and affects their role model behaviour. On the other hand, school workers engagement with preventive practices in schools' was associated with good knowledge which in turn empowers their positive attitude towards their role in Toombak control.

Cytokine profile in gingival crevicular fluid and plasma of patients with aggressive periodontitis.

OBJECTIVE: This study aimed to determine the content of cytokines in gingival crevicular fluid (GCF) as well as in plasma of Sudanese patients with aggressive periodontitis (AgP) and healthy controls (HC). MATERIALS AND METHODS: Nineteen AgP patients and 19 HC were included. The mean probing pocket depth and clinical attachment level of the GCF sampled sites in patients were both ≥5 mm. The GCF and plasma levels of 27 cytokines were determined using 27-multiplex fluorescent bead-based immunoassays. Ratios were calculated among cytokines of the T-helper cell subsets Th1 and Th2. Descriptive statistics, the Mann-Whitney U-test and Spearman's rho rank correlation coefficient analysis were used. RESULTS: Interferon-γ was the only cytokine found in significantly lower levels in GCF of patients compared with HC. Levels of interleukin (IL)-10, IL-13, IL-1Ra, monocyte chemoattractant protein-1 (MCP-1), regulated on activation normal T-cell expressed and secreted (RANTES), granulocyte-colony-stimulating factor (G-CSF), and granulocyte-macrophage-CSF (GM-CSF) were significantly lower in plasma of AgP compared with HC. The ratios of Th1:Th2 in GCF and Treg:Th17 in plasma were significantly lower in AgP. CONCLUSIONS: The lower levels of cytokines detected systemically in plasma of AgP patients may have an impact on the immune response. The lower ratio of Th1:Th2 cytokines in GCF samples of AgP patients suggests a role for Th2 at the local site of disease.

Dental plaque microbial profiles of children from Khartoum, Sudan, with congenital heart defects.

Few studies have focused on the bacterial species associated with the deterioration of the dental and gingival health of children with congenital heart defects (CHD). The aims of this study were (1) to examine the dental plaque of children with CHD in order to quantify bacterial load and altered bacterial composition compared with children without CHD; and (2) to investigate the correlation between the level of caries and gingivitis and dental biofilm bacteria among those children. In this cross-sectional study, participants were children (3-12 years) recruited in Khartoum State, Sudan. A total of 80 CHD cases from the Ahmed Gasim Cardiac Centre and 80 healthy controls from randomly selected schools and kindergartens were included. Participants underwent clinical oral examinations for caries (decayed, missing, and filled teeth indices [DMFT] for primary dentition, and DMFT for permanent dentition), and gingivitis (simplified gingival index [GI]). Pooled dental biofilm samples were obtained from four posterior teeth using paper points. Real-time quantitative polymerase chain reaction was used for the detection and quantification of Streptococcus mutans, Streptococcussanguinis, and Lactobacillus acidophilus. Checkerboard DNA-DNA hybridization was used for the detection of 40 additional bacterial species. CHD cases had a significantly higher caries experience (DMFT = 4.1 vs. 2.3, p < 0.05; DMFT = 1.4 vs. 0.7, p < 0.05) and a higher mean number of examined teeth with gingivitis (4.2 vs. 2.0; p < 0.05) compared with controls. S. mutans counts were significantly higher among the CHD cases (p < 0.05). Checkerboard results revealed that 18/40 bacterial species exhibited significantly higher mean counts among CHD cases (p < 0.01). Correlation analyses revealed that among CHD cases, the detection levels of Tannerella forsythia, Campylobacter rectus, Fusobacterium nucleatum subsp. vincentii, F. nucleatum subsp. nucleatum, and F. nucleatum subsp. polymorphum were highly positively correlated with GI. CHD cases harbor more cariogenic and periodontopathogenic bacterial species in their dental plaque, which correlated with higher levels of caries and gingivitis.

Putative periodontopathic bacteria and herpes viruses interactions in the subgingival plaque of patients with aggressive periodontitis and healthy controls.

The microbial profile of aggressive periodontitis patients is considered to be complex with variations among populations in different geographical areas. The aim of this study was to assess the presences of 4 putative periodontopathic bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) and 2 periodontal herpes viruses (Epstein-Barr virus type 1 [EBV-1] and human cytomegalovirus [HMCV]) in subgingival plaque of Sudanese subjects with aggressive periodontitis and healthy controls. The study group consisted of 34 subjects, 17 aggressive periodontitis patients and 17 periodontally healthy controls (14-19 years of age). Pooled subgingival plaque samples were collected and analyzed for detection of bacteria and viruses using loop-mediated isothermal amplification. Prevalence of subgingival A. actinomycetemcomitans, HCMV, and P. gingivalis were significantly higher among aggressive periodontitis patients than periodontally healthy controls. Coinfection with A. actinomycetemcomitans, HCMV, and/or EBV-1 was restricted to the cases. Increased risk of aggressive periodontitis was the highest when A. actinomycetemcomitans was detected together with EBV-1 (OD 49.0, 95% CI [2.5, 948.7], p = .01) and HCMV (OD 39.1, 95% CI [2.0, 754.6], p = .02). In Sudanese patients, A. actinomycetemcomitans and HCMV were the most associated test pathogens with aggressive periodontitis.

Presence of plaque, gingivitis and caries in Sudanese children with congenital heart defects.

OBJECTIVES: The objective of this study is to assess the presence of plaque, gingivitis, and caries in a group of Sudanese children with congenital heart defects CHDs (cases) and compare them to children without CHDs (controls). MATERIALS AND METHODS: This analytical cross-sectional study included cases (N = 111, with a mean age of 7.2 ± 3.0 years) and controls (N = 182, with a mean age of 7.2 ± 2.8 years) from Khartoum, Sudan. Examinations were done by two calibrated dentists using plaque index, gingival index, and WHO (World Health Organization) caries diagnostic criteria (dmft/DMFT index: decayed, missing, and filled teeth). RESULTS: Children with CHDs (cases) had statistically significantly higher mean number of sites with plaque and gingivitis than children without CHDs (controls), although almost all children experienced plaque. Cases also experienced significantly higher mean dmft/DMFT than controls (age group 1, 3-7 years: 3.7 vs 2.3 and age group 2, 8-12 years: 1.3 vs 0.6). The Significant Caries Indices in cases (age groups 1 and 2) were also significantly higher than among controls (SiC 8.2 vs 5.9 and 1.8 vs 0.8, respectively). Fillings were totally lacking among cases and scarce among controls. CONCLUSIONS: The findings clearly showed that this group of Sudanese children with CHDs was more severely affected with gingivitis and caries than the control group without CHDs. These results are cause for concern in children at risk of developing systemic infections and serious complications related to poor oral health. CLINICAL RELEVANCE: These findings provide important baseline data for planning appropriate dental preventive strategies for Sudanese children with CHDs.

The Sudanese female face: normative craniofacial measurements and comparison with African-American and North American White females.

BACKGROUND: Ethnic differences in craniofacial dimensions and proportional relationships means that ethnicity-specific data is required for both diagnosis and treatment planning. This investigation establishes normative craniofacial anthropometric values for the Sudanese female (SF) population, compares with North American White (NAW) and African-American females (AA), and analyses the occurrence of neoclassical norms within the study sample. METHODS: Standardized frontal and profile facial photographs were taken of 100 female participants. Five vertical and five horizontal anthropometric measurements were determined. RESULTS: Significant differences were found between the 3 populations. The sample showed very poor compliance with the neoclassical norms. The upper face height of the SF was ∼ 20-mm taller than the AA faces (p < 0.001). Midface, nasal and lower face heights were also significantly taller, by 15-mm, 10-mm and 10-mm respectively (p < 0.001). SF showed significant reduction in bizygomatic width (∼ 30-mm), compared to NAW and AA (p < 0.001). Eye width was ∼ 5-mm less than the AA sample and 3-mm less than the NAW sample (p < 0.001). Mouth width was ∼ 5-mm less in SF than the other two groups (p < 0.001). The SF exhibited a reduced interalar width compared with AA (p < 0.001), but wider than the NAW (p < 0.001). CONCLUSIONS: The average SF face is significantly taller and narrower than the AA or NAW female face. The neoclassical proportional norms appear to be unreliable guides in relation to the SF face, and should not be used in comparative diagnosis and treatment planning. Use of the normative anthropometric data presented in this article, both linear and proportional values, should be considered in the diagnosis and treatment planning of young adult female patients of Sudanese descent.

Clinical and histological characterization of oral pemphigus lesions in patients with skin diseases: a cross sectional study from Sudan.

BACKGROUND: Pemphigus is a rare group of life-threatening mucocutaneous autoimmune blistering diseases. Frequently, oral lesions precede the cutaneous ones. This study aimed to describe clinical and histological features of oral pemphigus lesions in patients aged 18 years and above, attending outpatient's facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan. In addition, the study aimed to assess the diagnostic significance of routine histolopathology along with immunohistochemical (IHC) examination of formalin-fixed, paraffin-embedded biopsy specimens in patients with oral pemphigus. METHODS: A cross-sectional hospital-based study was conducted from October 2008 to January 2009. A total of 588 patients with confirmed disease diagnosis completed an oral examination and a personal interview. Clinical evaluations supported with histopathology were the methods of diagnosis. IHC was used to confirm the diagnosis. Location, size, and pain of oral lesions were used to measure the oral disease activity. RESULTS: Twenty-one patients were diagnosed with pemphigus vulgaris (PV), 19 of them (mean age: 43.0; range: 20-72 yrs) presented with oral manifestations. Pemphigus foliaceus was diagnosed in one patient. In PV, female: male ratio was 1.1:1.0. Buccal mucosa was the most commonly affected site. Exclusive oral lesions were detected in 14.2% (3/21). In patients who experienced both skin and oral lesion during their life time, 50.0% (9/18) had oral mucosa as the initial site of involvement, 33.3% (6/18) had skin as the primary site, and simultaneous involvement of both skin and oral mucosa was reported by 5.5% (1/18). Two patients did not provide information regarding the initial site of involvement. Oral lesion activity score was higher in those who reported to live outside Khartoum state, were outdoor workers, had lower education and belonged to Central and Western tribes compared with their counterparts. Histologically, all tissues except one had suprabasal cleft and acantholytic cells. IHC revealed IgG and C3 intercellularly in the epithelium. CONCLUSIONS: PV was the predominating subtype of pemphigus in this study. The majority of patients with PV presented with oral lesions. Clinical and histological pictures of oral PV are in good agreement with the literature. IHC confirmed all diagnoses of PV.

Ratio of pro-resolving and pro-inflammatory lipid mediator precursors as potential markers for aggressive periodontitis.

Aggressive periodontitis (AgP) is a rapidly progressing type of periodontal disease in otherwise healthy individuals which causes destruction of the supporting tissues of the teeth. The disease is initiated by pathogenic bacteria in the dental biofilm, and the severity of inflammation and attachment loss varies with the host response. Recently, there has been an increased interest in determining the role of lipid mediators in inflammatory events and the concept of pro-inflammatory and pro-resolution lipid mediators has been brought into focus also in periodontal disease. The present study aimed to determine the profile of omega-3 or n3- as well as omega-6 or n6- polyunsaturated fatty acids (PUFAs) and PUFA-metabolites of linoleic acid, arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in gingival crevicular fluid (GCF), saliva and serum in AgP patients and healthy controls. In total, 60 selected n3- and n6-PUFAs and various PUFA metabolites were measured using high performance liquid chromatography-tandem electrospray ionisation mass spectrometry (HPLC-ESI-MS-MS). Of these, 51 could be quantified in this study. The concentrations of the majority were low in saliva samples compared with serum and GCF, but were mainly higher in AgP patients compared with healthy controls in all three kinds of sample. Ratios of n3- to n6-PUFAs (DHA + EPA)/AA were significantly lower in the GCF of AgP patients than in the healthy controls. Furthermore, various ratios of the direct precursors of the pro-resolution lipid mediators (precursors of resolvins and protectins) were calculated against the precursors of mainly pro-inflammatory lipid mediators. These ratios were mainly lower in GCF and saliva of AgP patients, compared with healthy controls, but only reached significance in GCF (P<0.05). To conclude, the ratios of precursors of pro-resolution/pro-inflammatory lipid mediators seem to be more relevant for describing the disease status of AgP than the concentration of specific lipid mediators.

Influence of oral mucosal lesions and oral symptoms on oral health related quality of life in dermatological patients: a cross sectional study in Sudan.

BACKGROUND: There are only few studies considering the impact of oral mucosal lesions (OML) on the oral quality of life of patients with different dermatological conditions. This study aimed to assess the relationship between oral health-related quality of life (OHRQoL) and OML and reported oral symptoms, perceived general and oral health condition and caries experience in adult skin diseased patients attending an outpatient dermatologic clinic in Sudan. METHODS: A cross-sectional survey was carried out with 544 diagnosed skin diseased patients (mean age 37.1 years, 50% females), during the period October 2008 to January 2009. The patients were orally examined and OML and caries experience was recorded. The patients were interviewed using the Sudanese Arabic version of the OIDP. OHRQoL was evaluated by socio-demographic and clinical correlates according to number of types of OML diagnosed (no OML, one type of OML, > one type of OML) and number and types of oral symptoms. RESULTS: An oral impact (OIDP > 0) was reported by 190 patients (35.6%) (mean OIDP total score 11.6, sd=6.7). The prevalence of any oral impact was 30.5%, 36.7% and 44.1%, in patients with no OML, one type of OML and more than one type of OML, respectively. Number of types of OML and number and types of oral symptoms were consistently associated with the OIDP scores. Patients who reported bad oral health, patients with ≥ 1 dental attendance, patients with>1 type of OML, and patients with ≥ 1 type of oral symptoms were more likely than their counterparts in the opposite groups to report any OIDP. The odds ratios (OR) were respectively; 2.9 (95% CI 1.9-4.5), 2.3 (95% CI 1.5-3.5), 1.8 (95% CI 1.1-3.2) and 6.7 (95% CI 2.6-17.5). Vesiculobullous and ulcerative lesions of OML disease groups associated statistically significantly with OIDP. CONCLUSION: OIDP was more frequently affected among skin diseased patients with than without OML. The frequency of the impacts differed according to the number of type of OML, oral symptoms, and OML disease groups. Dentists and dermatologists should pay special attention to skin diseased patients because they are likely to experience oral impacts on daily performances.

Oral mucosal lesions in skin diseased patients attending a dermatologic clinic: a cross-sectional study in Sudan.

BACKGROUND: So far there have been no studies focusing on the prevalence of a wide spectrum of oral mucosal lesions (OML) in patients with dermatologic diseases. This is noteworthy as skin lesions are strongly associated with oral lesions and could easily be neglected by dentists. This study aimed to estimate the frequency and socio-behavioural correlates of OML in skin diseased patients attending outpatient's facility of Khartoum Teaching Hospital - Dermatology Clinic, Sudan. METHODS: A cross-sectional hospital-based study was conducted in Khartoum from October 2008 to January 2009. A total of 588 patients (mean age 37.2 ± 16 years, 50.3% females) completed an oral examination and a personal interview of which 544 patients (mean age 37.1 ± 15.9 years, 50% females) with confirmed skin disease diagnosis were included for further analyses. OML were recorded using the World Health Organization criteria (WHO). Biopsy and smear were used as adjuvant techniques for confirmation. Data were analysed using the Statistical Package for Social Science (Version 15.0.1). Cross tabulation and Chi-square with Fisher's exact test were used. RESULTS: A total of 438 OML were registered in 315 (57.9%, males: 54.6% versus females: 45.6%, p < 0.05) skin diseased patients. Thus, a certain number of patients had more than one type of OML. Tongue lesions were the most frequently diagnosed OML (23.3%), followed in descending order by white lesions (19.1%), red and blue lesions (11%) and vesiculobullous diseases (6%). OML in various skin diseases were; vesiculobullous reaction pattern (72.2%), lichenoid reaction pattern (60.5%), infectious lesions (56.5%), psoriasiform reaction pattern (56.7%), and spongiotic reaction pattern (46.8%). Presence of OML in skin diseased patients was most frequent in older age groups (62.4% older versus 52.7% younger, p < 0.05), in males (63.2% males versus 52.6% females, p < 0.05), patients with a systemic disease (65.2% with systemic versus 51.9% without systemic disease, p < 0.05) and among current users of smokeless tobacco (toombak) (77% current use versus 54.8% no use, p < 0.00). CONCLUSIONS: OML were frequently diagnosed in skin diseased patients and varied systematically with age, gender, systemic condition and use of toombak. The high prevalence of OML emphasizes the importance of routine examination of oral mucosa in a dermatology clinic.

Ethnic disparities in the prevalence of periodontitis among high school students in Sudan.

BACKGROUND: There are limited data on the epidemiology and risk factors of periodontitis in young populations in developing nations. This study assesses the prevalence of periodontal attachment loss and aggressive periodontitis and the association with ethnicity among high school students in Sudan. METHODS: The study sample consisted of 1,200 students, 13 to 19 years old, selected from 38 public and private high schools using a multistage, stratified sampling design. The subjects were interviewed and examined clinically. Periodontal parameters were assessed at six sites per tooth. Subjects with aggressive periodontitis were identified. RESULTS: A total of 3.4% of the subjects had aggressive periodontitis, and 16.3% and 8.2% of the subjects had at least one tooth with > or = 4 and > or = 5 mm attachment loss, respectively. A significantly higher percentage of subjects of African tribal ethnicity had attachment loss > or = 4 and > or = 5 mm compared to Afro-Arab tribes (19.8% versus 14.7%, P = 0.02; and 12% versus 6.4%, P = 0.004, respectively), and had a higher prevalence of aggressive periodontitis (6% versus 2.3%; P = 0.01) and higher risk of being diagnosed with this disease (odds ratio = 2.7; P <0.0001). African ethnicity was also associated with a significantly higher number of teeth with attachment loss than in Afro-Arabs (P <0.01). Comparison by gender showed a significantly higher percentage of males with aggressive periodontitis (4.9% versus 2%; P <0.01) and a higher risk for this disease (odds ratio = 2.5; P = 0.01) than in females. However, the prevalence of subjects with attachment loss > or = 4 and > or = 5 mm was comparable in the two gender groups. CONCLUSIONS: Our results show that aggressive periodontitis is highly prevalent in this population. African ethnicity (versus Afro-Arab) and male gender were risk factors for aggressive periodontitis.

Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan.

BACKGROUND: HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors. METHODS: Dental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview. RESULTS: A total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8). CONCLUSION: Disparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.

Oral health status of 12-year-old school children in Khartoum state, the Sudan; a school-based survey.

BACKGROUND: Few studies have investigated the prevalence of dental caries among school children in the past decades in Sudan rendering it difficult to understand the status and pattern of oral health. METHODS: A school-based survey was conducted using stratified random cluster sampling in Khartoum state, Sudan. Data was collected through interviews and clinical examination by a single examiner. DMFT was measured according to WHO criteria. Gingival index (GI) of Loe & Silness and Plaque index (PI) of Silness & Loe were used. RESULTS: The mean DMFT for 12-year-olds was found to be 0.42 with a significant caries index (SiC) of 1.4. Private school attendees had significantly higher DMFT (0.57) when compared to public school attendees (0.4). The untreated caries prevalence was 30.5%. In multivariate analysis caries experience (DMFT > 0) was found to be significantly and directly associated with socioeconomic status. The mean GI for the six index teeth was found to be 1.05 (CI 1.03 - 1.07) and the mean PI was 1.30 (CI 1.22 - 1.38). CONCLUSION: The prevalence of caries was found to be low. The school children with the higher socioeconomic status formed the high risk group.

Salivary microbiota levels in relation to periodontal status, experience of caries and miswak use in Sudanese adults.

OBJECTIVES: The purpose of the present investigation was to assess the salivary levels of 25 oral bacteria in relation to periodontal status and experience of caries, and to compare the levels of these bacteria between habitual miswak and toothbrush users in adult Sudanese subjects. MATERIAL AND METHODS: The study subjects consisted of 56 individuals with age range 19-53 years (mean 35.2 years) and included 30 miswak and 26 toothbrush users. The periodontal status and presence of dental caries were assessed clinically. Whole saliva was collected from all subjects, and the levels of 25 selected bacterial species in saliva were assessed by the checkerboard DNA-DNA hybridization method using whole genomic DNA probes. RESULTS: A high percentage of the subjects had detectable levels (> or = 105 bacterial cells) of several bacterial species in saliva. Between 12% and 16% of the subjects showed high (> or = 106 cells) salivary levels of the periodontitis-associated bacteria A. actinomycetemcomitans, P. melaninogenica, P. intermedia, C. rectus and E. corrodens, whereas only two (3.6%) and four (7.1%) subjects had high levels of P. gingivalis and F. nucleatum, respectively. There were no significant differences in the levels of all or most bacterial species by age group, gender or periodontal status. Presence of > or = 105 L. acidophilus bacterial cells in saliva was associated with high caries scores (p = 0.02). There were significantly higher levels of A. actinomycetemcomitans, P. melaninogenica, C. rectus, P. micros, V. parvula, S. mutans, S. anginosus, A. israelii, C. sputigena, and C. gingivalis, and significantly lower levels of P. intermedia, F. nucleatum, S. sputigena, E. corrodens, L. acidophilus, S. sanguis, S. salivarius, S. oralis, and S. mitis in the miswak than in the toothbrush group. CONCLUSIONS: : The findings suggest that miswak may have a selective inhibitory effect on the level of certain bacteria in saliva, particularly several oral streptococci species. This is the first report that the checkerboard DNA-DNA hybridization method can be useful for assessing the levels of a wide range of bacterial taxa in saliva.