Study protocol for a pilot quasi-experimental study on oral health education for nurses and community health workers in Nigeria.

Introduction: The primary health care system provides an ideal setting for the integration of oral health into general health care as well as equitable access to oral health care. However, the limited oral health knowledge of primary health care workers necessitates appropriate training before they can participate in health promotion efforts. This pilot training was designed to examine the impact of the Oral Health Education module for Nurses and Community Health Care Workers on their oral health awareness and referral practices. Methods: This study will utilize a quasi-experimental design (pre-and post with a non-equivalent control group) to assess the impact of a five-day pilot oral health education program on the knowledge and referral practices of Nurses and Community Health Workers in primary health care centers in three states in Nigeria-(Lagos, Oyo, and Kano). The training modules were developed based on the six iterative steps described in the intervention mapping framework - needs assessment, highlighting program objectives and outcomes, selection of theory and mode of intervention, designing program based on theory, designing implementation plans, and developing an evaluation plan. Only the intervention group will participate in the full educational training sessions but both groups will complete the pre-and post-intervention questionnaires. Discussion: This pilot training combined the standardized training modules from the recently launched "Oral Health Training Course for Community Health Workers in Africa" and a newly developed maternal and child oral health module by our group using an evidence-based approach. To the best of our knowledge, this is the first program to examine the impact of the standardized OpenWHO modules. The success of this training will lay the foundation for developing a sustained channel for providing oral health education at the primary health care level in Nigeria, West Africa, and Africa.

Oral Health Policy and Research Capacity: Perspectives From Dental Schools in Africa.

INTRODUCTION AND AIMS: The prioritisation of oral health in all health policies in the WHO African region is gaining momentum. Dental schools in this region are key stakeholders in informing the development and subsequent downstream implementation and monitoring of these policies. The objectives of our study are to determine how dental schools contribute to oral health policies (OHPs) in this region, to identify the barriers to and facilitators for engaging with other local stakeholders, and to understand their capacity to respond to population and public health needs. METHODS: We developed a needs assessment survey, including quantitative and qualitative questions. The survey was developed electronically in Qualtrics and distributed by email in February 2023 to the deans or other designees at dental schools in the WHO African region. Data were analysed in SAS version 9.4 and ATLAS.ti. RESULTS: The capacity for dental schools to respond to population and public health needs varied. Most schools have postgraduate programs to train the next generation of researchers. However, these programs have limitations that may hinder the students from achieving the necessary skills and training. A majority (75%) of respondents were aware of the existence of national OHPs and encountered a myriad of challenges when engaging with them, including a lack of coordination with other stakeholders, resources, and oral health professionals, and the low priority given to oral health. Their strengths as technical experts and researchers was a common facilitator for engaging with OHPs. CONCLUSION: Dental schools in the region face common challenges and facilitators in engaging in the OHP process. There were several school-specific research and training capacities that enabled them to respond to population and public health needs. Overall, shared challenges and facilitators can inform stakeholder dialogues at a national and subnational level and help develop tailored solutions for enhancing the oral health policy pipeline.

Self-reported halitosis and oral health related quality of life in adolescent students from a suburban community in Nigeria.

BACKGROUND: Halitosis is an important cause of impaired quality of life in adolescents. Little is known about the prevalence of self-reported halitosis in adolescents in Nigeria and the extent to which self-reported halitosis impairs their oral health related quality of life. OBJECTIVES: To determine the prevalence and impact of self-reported halitosis on the oral health related quality of life of adolescent students in a suburban community in Nigeria. METHODS: An analytical cross-sectional study. Pre-tested self-administered pro-forma was used to obtain the adolescents' demographic data and their self-perception of halitosis. The Oral Health Impact Profile (OHIP-14) was used to assess the adolescents' OHRQoL. The Mann-Whitney U test was used to compare the median OHIP-14 scores between adolescents who reported halitosis and those who did not. The level of significance was set at p < 0.05. Ethics approval for this study was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital. RESULTS: A total of 361 adolescents aged 10 - 19 years (mean age 14.1 ± 1.79 years) took part in the study. Of these, 32.7% (n=118) had self-reported halitosis. The median OHIP-14 score among adolescents with self-reported halitosis was 3 (0-9) while those who did not report halitosis had a median OHIP-14 score of 0 (0 - 5). This difference was statistically significant (p < 0.0001). CONCLUSION: Self-reported halitosis significantly impaired the oral health related quality of life of the adolescents.

Correlates of illness behaviour related to orofacial infections of odontogenic origin among adults in a semi urban community in Nigeria.

BACKGROUND: Infections of facial spaces in the maxillofacial region occur in most cases as a complication of odontogenic infections. It often results in substantial morbidity, with serious and potentially life threatening outcomes if allowed to progress without prompt medical attention. OBJECTIVE: To identify factors that determine illness behaviour related to maxillofacial space infections. METHOD: This was a descriptive cross-sectional study of adult residents of pakoto community, Ifo local government area, Ogun state. The study was conducted using an interviewer administered questionnaire which included key information about respondents' awareness of predisposing factors of maxillofacial space infections; common actions taken with regards to treatment, and the factors that influenced their utilization of the available oral health care service. RESULTS: A total of 187 individuals were sampled, mean age was 30.5(SD 11.7) years with majority being females (59.4%) The proportion of the total respondents who reported a history suggestive of orofacial space infection was 20.3% (n=38). Visiting a patent medicine dealer (26.3%) along with visiting a dentist (31.6%) were the illness behaviours most frequently engaged in by respondents who have had an orofacial swelling following a toothache, with majority (73.7%) indicating the action they took was based on what was most convenient. CONCLUSION: This study has revealed that engagement in unorthodox practises by individuals in a semi-urban community studied is prevalent, and influenced by factors such as age, gender, level of education and occupation. FUNDING: None.

Effect of health education intervention conducted by Primary Health Care workers on oral health knowledge and practices of nursing mothers in Lagos State.

Educational interventions on oral health care is traditionally carried out mainly by oral health workers in Nigeria. Despite the introduction of the National Oral Health Policy, oral health services/education is virtually non-existent in PHC centres in Nigeria. This study sought to determine the effect of a health education intervention delivered by Community Health Officers (CHO) on the oral health knowledge and practices of mothers attending a PHC centre in Lagos State. A pre-experimental, Before- After study design was employed. An interviewer- administered questionnaire was administered at baseline to assess the oral health care knowledge and practices of 267 mothers who enrolled in the programme. After enrolling the participants, CHO's previously trained commenced a health education intervention on oral health. The intervention, which consisted of 2 lecture sessions, a demonstration session and a return demonstration session, utilising flipcharts and health information leaflets spanned a six-month period. Oral health knowledge and practices of participating mothers was evaluated 3 and 6 months after the intervention commenced using a standardised checklist. Data entry and analysis was done using SPSS version 20, P-value of <0.05 was considered significant. The mean oral health knowledge score at baseline was 4.58 (±1.37) while at 3-month and 6-month postintervention the mean scores were 4.68 (±0.97) and 4.96 (±0.49), respectively. There was a statistically significant increase (P=0.000) in the mean knowledge scores at 6 months post-intervention. Mothers who were 36 years or older and those with more than 12 years education displayed significantly better knowledge scores (P<0.05). Most (78.3%) reported using cotton wool or foam with water for their infants' oral hygiene. By the second post-intervention visit, there was a significant change in the perception of the mothers on correct oral hygiene tool for infants (52.3%; P=0.000). Furthermore the percentage of mothers actually using toothbrush to clean their child's mouth (98.1%; P=0.000) had increased. The oral health knowledge of the participants increased significantly following the intervention especially at the 6-month evaluation. PHC workers can successfully carry out oral health educational interventions at PHC level. The greatest value will occur with reinforced repetition of the messages.

Impact of an educational intervention on smoking counseling practice among Nigerian dentists and dental students.

INTRODUCTION: Oral health professionals are important in smoking cessation and prevention as their role is very crucial given the impact of smoking on oral health. Therefore, dental professionals need adequate education in tobacco use prevention and cessation skills to increase their confidence and be able to help patients to quit smoking. This study was aimed at determining the impact of an educational intervention on the attitudes, willingness, and perceived barriers of a group of Nigerian dental students and dentists to smoking cessation counseling in the dental clinic. METHODS: A self-administered questionnaire-based study was conducted in September 2007 at the Lagos University Teaching Hospital Idi Araba, Lagos. This was followed by a series of lectures and seminars using the brief intervention strategies for patients willing to quit using the Ask, Advise, Assess, Assist, and Arrange of cessation. A repeat study was conducted in January 2009 using the same questionnaire. Post intervention attitudes were significantly improved over pre intervention values for each parameter used in the assessment. RESULTS: A significantly higher proportion of the respondents were interested in providing cessation services after the intervention (P = 0.00002). Most (83.1%) of the respondents were willing to undergo training with a slight increase in the post intervention group from 80.9% to 86%. All the reported barriers were significantly reduced after the intervention (P = 0.000). CONCLUSION: This study has shown that educational interventions such as didactic instructions and practical training in tobacco use cessation can help to increase the willingness, confidence, and ability to provide information, during encounters with patients.

Descriptors of permanent teeth with cariously exposed pulp in patients presenting at a Nigerian hospital.

AIM: To describe the pattern of presentation of carious permanent teeth with pulp exposure and to determine factors associated with choice of treatment for such teeth. MATERIALS AND METHODS: All patients presenting at the oral diagnosis clinic of Lagos University Teaching Hospital Dental centre between January 2009 and June 2009 were examined and those with carious lesion involving the pulp were included in the study. The history and character of pain from teeth, extent of tooth structure lost, proposed treatment and reason for proposed treatment was recorded. RESULTS: The tooth most affected by pulp exposure due to caries is the lower first molar (17.5%). Extraction was the treatment of choice for many patients due to the following reasons: obliterated root canals (30%), patients' preference (30%) and non-restorable teeth (22%). CONCLUSION: Extraction was the predominant treatment chosen for cariously exposed permanent teeth due to the condition of the tooth.

Smoking cessation counseling in dentistry: attitudes of Nigerian dentists and dental students.

The study was aimed at assessing the awareness, attitude, practices, willingness, and perceived barriers of dental students and dentists in Lagos University Teaching Hospital, Lagos, Nigeria, in relation to smoking cessation in the dental care setting. An anonymous self-administered questionnaire that contained questions relating to attitudes, views, and perceived barriers to smoking cessation activities in the dental clinic was hand-delivered to all dentists and clinical dental students in 2007. One hundred and thirty-six respondents took part in the study (response rate=81.9 percent). Although 95 percent of the respondents believed that smoking affects the dental management of the patient, only 65 percent always ask their patients about their smoking habits, and only 30 percent have heard about smoking cessation programs. A significantly higher proportion of students always ask patients about their smoking habits compared with dentists (p=0.0017). Also, a significantly higher proportion of dentists (97 percent) advised their patients against tobacco use compared with 77 percent of students (p=0.0000). Only 2 percent and 3 percent agreed that it is their professional responsibility to educate or encourage patients to quit smoking, respectively. Also, 98 percent strongly disagreed that it is within the scope of dental practice to ask about tobacco use, and 86 percent disagreed that tobacco counseling can be effective in helping patients quit tobacco use. Perceived barriers reported were lack of time (88 percent), lack of necessary materials (81 percent), and lack of knowledge of smoking cessation (74 percent). However, 81 percent of the respondents said they are willing to undergo training in tobacco use cessation. Since most of the dentists and dental students had poor attitudes and negative perceptions of smoking cessation activities, possibly due to lack of training and resources to carry it out in the clinics, there is need to include smoking cessation training in the dental curriculum in Nigeria.

Coping with oral pain: lay management strategies adopted by patients prior to presentation.

OBJECTIVES: To identify lay measures taken by patients in response to oral pain before seeking professional care and to determine factors leading to demand for professional oral health care. METHODS: A cross-sectional survey of patients aged 16 years and above who presented with oral pain at the oral diagnosis clinics of the Lagos University Teaching Hospital and the Lagos State University Teaching Hospital was carried out. Data was collected by means of questionnaires which sought information on onset and duration of pain, character, aggravating and relieving factors and actions taken by the patients before presentation at the dental clinic. RESULTS: A total of 215 patients participated. More than half of them described their pain as severe to very severe with 106 (49.3%) and 21 (9.8%) reporting sleep disruptions and severe agony respectively. Delay in presentation range from over a month in 56 (26%) patients to years in 85 (39.5%). Responses to pain symptoms included, communication with different persons for advice in 192 (89.3%) and application of at least one lay measure in 183 (85.1%) patients. Duration and persistence of pain was associated significantly with the use of more than one measure. There was no association between gender or age and the use of lay measures. Use of measures with possible adverse effects like petrol and acid was reported in 5 (2.7%) of the respondents. CONCLUSION: Lay strategies in response to oral pain are common in this Nigerian population and appear to be used as an alternative to professional oral health care.

Occupational exposure to bloodborne pathogens and management of exposure incidents in Nigerian dental schools.

The goal of this study was to determine the frequency of occupational exposures to bloodborne pathogens amongst Nigerian clinical dental students, their HBV vaccination status, and reporting practices. A cross-sectional study of all clinical dental students in the four Nigerian dental schools was carried out by means of an anonymous self-administered questionnaire that asked questions on demography, number and type of exposure, management of the exposures, personal protection against cross infection, and the reporting of such exposures. One hundred and fifty-three students responded (response rate of 84.5 percent). Only thirty-three (37.9 percent) were fully vaccinated against HBV. Ninety (58.8 percent) of the students have had at least one occupational exposure. There was no significantly associated difference between sex, age, location of school, and exposure. Most of the exposures (44.4 percent) occurred in association with manual tooth cleaning. There was inadequate protection of the eyes. None of the exposures were formally reported. It is the responsibility of training institutions to ensure the safety of the students by mandatory HBV vaccination prior to exposure and adequate training in work safety. Written policies and procedures should be developed and made easily accessible to all workers to facilitate prompt reporting and management of all occupational exposures.

Assessment of the compliance of Nigerian dentists with infection control: a preliminary study.

OBJECTIVE: To assess the compliance of a group of Nigerian dentists with standard infection control practices. METHOD: A confidential self-administered questionnaire survey was conducted among dentists engaged in active clinical practices in public hospitals in Lagos, Nigeria (n = 185). RESULTS: One hundred forty-six questionnaires were returned (response rate, 78.9%). Most (70.6%) of the dentists always wore gloves when treating patients, whereas 29.4% sometimes did. Regarding facemasks, 45.9% always wore them, 52.7% sometimes wore them, and 1.4% never wore them. Protective eye wear was always worn by 4.8% of the dentists, sometimes worn by 52.7%, and never worn by 42.5%. Approximately half (50.7%) of the respondents had received hepatitis B vaccination. Sterilization was performed using a combination of methods, including autoclaving (84.1%), boiling (19.3%), dry heat (17.5%), and chemicals (29.7%). Nonavailability of materials was the major reason for noncompliance with infection control practices. CONCLUSIONS: Nigerian dentists need continuous education regarding infection control. Also, Nigerian hospitals urgently need adequate funding for up-to-date and functional equipment and materials.