Early childhood caries: Are maternal psychosocial factors, decision-making ability, and caries status risk indicators for children in a sub-urban Nigerian population?

OBJECTIVE: Early childhood caries (ECC) is caries in children below the age of 72 months. The aim of the study was to determine the association of maternal psychosocial factors (general anxiety, dental anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), decision-making abilities, education, income and caries status with the prevalence and severity of ECC among children resident in Ile-Ife, Nigeria. METHODS: A dataset of 1549 mother-child (6-71-months-old) dyads collected through examinations and a household survey, using validated psychometric tools to measure the psychosocial factors, were analyzed. The DMFT for the mothers and the dmft for the child were determined. The association between maternal psychosocial factors, education, income, and decision-making ability, the prevalence of maternal caries, and the prevalence of ECC was determined using logistic regression analysis. RESULTS: The prevalence of maternal caries was 3.3%, and the mean (standard deviation-SD) DMFT was 0.10 (0.76). The ECC prevalence was 4.3%, and the mean (SD) dmft was 0.13 (0.92). There was no significant difference between the prevalence and severity of maternal caries and ECC by maternal age, education, income, or decision-making abilities. There was also no significant difference in maternal caries, ECC prevalence and ECC severity by maternal psychosocial factors. The only significant association was between the prevalence of caries in the mother and children: children whose mothers had caries were over six times more likely to have ECC than were children with mothers who had no caries (AOR: 6.67; 95% CI 3.23-13.79; p < 0.001). CONCLUSION: The significant association between ECC and maternal caries prevalence suggests that prenatal oral health care for mothers may reduce the risk for ECC.

Validation of maternal report of early childhood caries status in Ile-Ife, Nigeria.

BACKGROUND: To determine the validity of maternal reports of the presence of early childhood caries (ECC), and to identify maternal variables that increase the accuracy of the reports. METHODS: This secondary data analysis included 1155 mother-child dyads, recruited through a multi-stage sampling household approach in Ile-Ife Nigeria. Survey data included maternal characteristics (age, monthly income, decision-making ability) and maternal perception about whether or not her child (age 6 months to 5 years old) had ECC. Presence of ECC was clinically determined using the dmft index. Maternally reported and clinically determined ECC presence were compared using a chi-squared test. McNemar's test was used to assess the similarity of maternal and clinical reports of ECC. Sensitivity, specificity, positive and negative predictive values, absolute bias, relative bias and inflation factor were calculated. Statistical significance was determined at p < 0.05. RESULTS: The clinically-determined ECC prevalence was 4.6% (95% Confidence interval [CI]: 3.5-5.0) while the maternal-reported ECC prevalence was 3.4% (CI 2.4-4.6). Maternal reports underestimated the prevalence of ECC by 26.1% in comparison to the clinical evaluation. The results indicate low sensitivity (9.43%; CI 3.13-20.70) but high specificity (96.9%; CI 95.7-97.9). The positive predictive value was 12.8% (CI 4.3-27.4) while the negative predictive value was 95.7% (CI 94.3-96.8). The inflation factor for maternally reported ECC was 1.4. Sensitivity (50.0%; CI 6.8-93.2) and positive predictive value were highest (33.3%; CI 4.3-77.7) when the child had a history of visiting the dental clinic. CONCLUSIONS: Mothers under-reported the presence of ECC in their children in this study population. The low sensitivity and positive predictive values of maternal report of ECC indicates that maternal reporting of presence of ECC may not be used as a valid tool to measure ECC in public health surveys. The high specificity and negative predictive values indicate that their report is a good measure of the absence of ECC in the study population. Child's history of dental service utilization may be a proxy measure of presence of ECC.

Association between nutritional status and early childhood caries risk profile in a suburban Nigeria community.

BACKGROUND: Malnutrition is associated with oral health problems. AIM: To determine the association between malnutrition (undernourished and over-nourished) and early childhood caries (ECC) in a suburban population in Nigeria. DESIGN: Data were extracted from a database of a household survey of 1549 under 6-year-old children. Explanatory variables were nutritional status (normal, undernourished [wasted, stunted and underweight], or over-nourished). The outcome measure was the prevalence of ECC. Children's sociodemographic characteristics (socio-economic status, sex, age) and caries-risk variables (frequency of sugar consumption in-between-meals, oral hygiene status) were the confounders. Association between ECC and malnutrition was determined using the Poisson regression analysis. Statistical significance was set at P ≤ .05. RESULTS: About one-third (31.4%) of children had expected height/weight for age; 848 (54.7%) were undernourished; and 215 (13.9%) were over-nourished. Nutritional status was not significantly associated with the prevalence of ECC. Children who consumed sugar in-between-meals three or more times a day were twice as likely to have ECC as were those who consumed sugar less often in-between-meals (APR: 2.23; 95% CI: 1.30-3.81; P = .003). Children 3-5 years old were more likely to have ECC than were those 0-2 years old (APR: 2.40; 95% CI: 1.10-5.22; P = .03). CONCLUSIONS: ECC was not associated with undernourished and over-nourished in a suburban population in Nigeria.

Screening Children for Caries: An Ethical Dilemma in Nigeria.

Dental caries is the main oral health challenge for children in Nigeria. Concern about its negative impact makes screening for caries in children an attractive public health strategy. The ability to detect the preclinical phase of caries, the availability of screening tools with high accuracy, and the possibility of treatment before onset of clinical symptoms with significant cost and health benefits, makes it appropriate for screening. However in Nigeria, the poor availability of highly specific and sensitive screening tools, poor access to oral health care and concerns with pre-screening consent, raise the question of the appropriateness of conducting screening programmes for children. We argue that a number of structural challenges associated with poor uptake of oral health care services need to be addressed before screening for caries can be considered ethically appropriate. These include facilitating access of children to quality oral health care and a systematic national approach to oral health implementation. Failure to address challenges associated with dental service utilization by children in Nigeria increases the risk of screening programmes promoting inequitable access to oral health care services.

Self-reported dental pain and dental caries among 8-12-year-old school children: An exploratory survey in Lagos, Nigeria.

BACKGROUND: Dental pain is considered an important public health problem because it affects the daily life of children. This study was designed to assess the prevalence, associated factors, and impact of dental pain among 8-12-year-old school children in Lagos, Nigeria. SUBJECTS AND METHODS: A cross-sectional survey to determine self-reported dental pain among 8-12-year-old school children using an interviewer-administered questionnaire was conducted. This was followed by a clinical examination to determine the child's oral hygiene status and dental caries status. Chi-square and Fisher's exact tests were used for comparing proportions. Binary logistic regression analysis was also conducted. Statistical significance was set at P < 0.05. RESULTS: Of the 414 children included in the survey, 254 (61.4%) children and 103 (24.9%) children reported experiencing dental pain 3 months and 4 weeks before the survey, respectively. Caries prevalence was 21.0%, whereas mean decayed, missing, and filled tooth index score was 0.4420 (±1.078). A report of pain up to 3 months before the survey was significantly associated with the child's age [odds ratio (OR) = 1.254; confidence interval (CI) = 1.037-1.516; P = 0.019], whereas the type of school attended (OR = 1.786; CI = 1.124-2.840; P = 0.014) and the presence of dental caries (OR = 1.738; CI = 1.023-2.953; P = 0.041) were significantly associated with reporting pain 4 weeks before the survey. CONCLUSION: The prevalence of self-reported dental pain was high among the children surveyed. Report of dental pain was associated with the presence of dental caries. The provision of school oral health services could be useful in reducing the level of untreated caries and possibly dental pain among school children.

Integrated oral, mental and sexual health management for adolescents: a call for professional collaboration.

BACKGROUND: Globally, young people account for 15.5% of the total global disability-adjusted life-years burden for all age groups. They face mental health, nutritional problems, accidental and intentional injuries, sexual and reproductive health problems, and substance abuse. These health challenges have effects on their oral health. This paper discusses the oral health problems adolescents face and suggests approaches for providing integrated oral and general health care for adolescents. DISCUSSION: Oral health issues linked with adolescent health concerns include: malocclusion and esthetic concerns linked with mental health status; oral and maxillofacial injuries linked with accidental and intentional injuries; oral manifestations of sexually transmitted infections; oral leukoplakia and oral cancers linked with alcohol, tobacco and psychoactive substance abuse; and oral manifestations of anemia resulting from nutritional problems. Training oral health care providers on adolescent health and care could promote prompt diagnosis, management and prevention of complications associated with major health challenges affecting adolescents. CONCLUSION: Adolescent oral health care needs focused attention: as a possible route for early diagnosis and management of general health problems and for promoting adolescent oral health care. Oral health care should be integrated into adolescent friendly services and oral health care providers should learn how to handle adolescents' health needs.

Association between alcohol consumption and periodontal disease among older Nigerians in plateau state: a preliminary study.

OBJECTIVE: To report the periodontal status of older adults in Plateau State, Nigeria, and determine its Association with alcohol consumption. BACKGROUND: Periodontal disease is common among Nigerians, and the prevalence increases with age. The role that alcohol consumption plays in the occurrence of the disease among Africans is uncertain. MATERIALS AND METHODS: Sample selection was performed using a multistage cluster sampling technique among older adults in Plateau State, Nigeria. Interviews, using structured questionnaires, were conducted for each of the participants. Clinical examinations were then carried out to determine the occurrence of periodontal disease, assessed by clinical attachment loss and probing depth. RESULTS: The prevalence of periodontal disease was 79%, being severe in 46% of the population. Almost half of the participants (46.7%) examined were still actively consuming alcohol, among which 48% reported a history of intoxication. There was no statistically significant relationship between periodontal disease and the frequency of alcohol consumption, or quantity consumed on each occasion. However, alcohol consumption was highly correlated with periodontal disease among those who reported intoxication from the drink (r = 0.095; p = 0.033). A history of intoxication with alcohol was the only significant predictor of periodontal disease, after adjusting for age and gender. CONCLUSION: Periodontal disease was highly prevalent among older Nigerians in this study. Apart from those who reported intoxication from alcohol, there was no statistically significant relationship between the prevalence of periodontal disease and the frequency of alcohol consumption or the quantity consumed on each occasion.

Programme guidelines for promoting good oral health for children in Nigeria: a position paper.

BACKGROUND: The objective of this paper is to draw attention to the oral health needs of children in Nigeria, and promote the use of appropriate interventions for disease prevention in the population. It also evaluates the value of the ongoing twice-daily tooth brushing campaign, which focuses on promoting good periodontal health and its relevance for children in Nigeria. DISCUSSION: The main oral health burden for children in Nigeria is untreated dental caries, attributable to low utilization of oral health facilities. While there is a strong association between oral hygiene status and caries occurrence, no research had established an association between frequency of tooth brushing and caries in children in Nigeria. Prevalence of caries and gingivitis is low, despite the fact that a majority of children brush once a day and most of them have fair oral hygiene. Campaigns that promote twice daily brushing to prevent chronic periodontitis in children are not driven by evidences supporting the local epidemic, and therefore cannot be considered as efficient use of the limited resources available. SUMMARY: Existing evidences show that the main oral health need of children in Nigeria is the management of untreated caries. Promoting the treatment of caries should be the primary focus of oral health programmes for children in Nigeria, as this would reduce further risks of developing new carious lesions. Public health campaigns should focus efforts at creating demand for oral health care services, for both preventive and curative purposes.

Appraisal of the national response to the caries epidemic in children in Nigeria.

BACKGROUND: This article reviews the caries profile for children in Nigeria and proposes an appropriate framework for addressing the silent caries epidemic. DISCUSSION: We reviewed the caries prevalence among children in Nigeria, assessed the existing responses to the caries epidemic including the national oral healthcare delivery situation in the country and discussed the current caries management in children. We then proposed a response framework for Nigeria. We argue that successful interventions will require the adoption of a socio-ecological model. This would ensure that the micro-, meso-, exo- and macrosystems required to support the behavioural, structural and biological interventions for promoting caries prevention are addressed. National oral health surveys are required to help understand the epidemiology, social determinants of and factors that undermine the ability of children to access oral health care. A global caries prevention agenda for children would help get the government's support for a national response agenda. Currently, there is no global call for action on the caries epidemic in children. This lack of an agenda needs to be urgently addressed. SUMMARY: A combination of approaches for the prevention of caries in children in Nigeria is needed. A national survey is needed to generate the needed evidence for the planning of community relevant responses to the national caries epidemic in children. The design of a global health agenda for children is an important first step that can facilitate the development of a national oral health programme for children in Nigeria.

Determinants of preventive dental practice for children among final-year dental students in Nigeria.

BACKGROUND: This study aims to identify the determinants of caries prevention-oriented practice for children among final-year dental students in Nigeria. METHOD: A questionnaire was distributed to 179 final-year dental students in six dental schools in Nigeria. It requested information on age, gender, knowledge of caries prevention measures, self-perceived competency in providing caries-preventive care for children, and caries prevention-oriented practice for two hypothetical cases with high and low risk of caries. Chi-squares tests and logistic regression analysis were done. RESULTS: Between 24% and 41% of the respondents indicated their inability to determine the appropriate treatment modality for children with high and low caries risk. Majority of the students failed to differentiate between the caries-preventive practice for children with high and low risk of caries: preventive strategies for children with high caries risk were also used for those with low caries risk. Age, gender, knowledge of caries prevention measures, and self-perceived competency in providing caries-preventive care were not associated with student's capacity to provide caries-preventive practice for children. CONCLUSION: Caries-preventive practice among dental students in Nigeria could be improved. It may be important to explore the possible role of problem-based learning approach in addressing this challenge.

An appraisal of the oral health care system in Nigeria.

OBJECTIVES: This study aimed to assess the strengths and weaknesses of the oral health care system in Nigeria and to outline broad policy options for strengthening the system. METHODS: A critical appraisal of the oral health care system in Nigeria was conducted. The Maxwell criteria were used to assess performance. RESULTS: There has been some progress and growth in the oral health care system in Nigeria. However, it is clear that the system falls short on many desirable attributes. The system is neither effective nor efficient and the resources available are grossly inadequate and are overstretched in many areas. The oral health care system is unresponsive to the needs of the populace and there is little stewardship of the system. CONCLUSIONS: Urgent action in the Nigerian oral health care system is required on the part of all stakeholders. The first step should involve the provision of adequate resources for the immediate implementation of the national oral health policy. There is also a need for more research on oral health-related issues in the country. Efforts towards improving the system must be properly coordinated by the Federal Ministry of Health and involve all stakeholders in the sector in order to achieve success.

Prevalence and pattern of dental caries among a sample of nigerian public primary school children.

PURPOSE: To determine the prevalence and pattern of dental caries among public primary school children in Lagos State, Nigeria. MATERIALS AND METHODS: A cross-sectional survey of pupils in randomly selected public primary schools in Lagos State Nigeria was conducted. Dental examinations were carried out on 2835 children and caries diagnosis was based on the WHO diagnostic criteria (1999). RESULTS: Overall caries prevalence in the study population was 13.1% with the highest caries prevalence recorded among eight-year-old children (17.7%), boys (13.5%) and those of the Hausa tribe (15.0%). The DMFT score ranged between 0 and 11 with a mean score and standard deviation of 0.344 ± 0.937. Children aged 5-10 years had slightly higher caries prevalence (14.8%) than those aged 11-16 years (10.6%). The first molars were the worst affected teeth in both the deciduous and permanent dentitions. The mandibular left first molar had the highest caries prevalence (4.7%) in the deciduous dentition, while the right mandibular first molar had the highest tooth-specific caries prevalence (3.5%) in the permanent dentition. The restorative index for the study population was 0.3% while the treatment index was 5.7%. CONCLUSION: While the caries prevalence in the study population is very low, the treatment and restorative indices are unacceptably low. There is a need for early preventive strategies and treatment services in terms of restorative care for this important age group.

Current pattern of cleft lip and palate deformities in Lagos, Nigeria.

OBJECTIVE: To evaluate the current pattern of cleft lip and/or palate deformities in Lagos, Nigeria. Design : Descriptive epidemiology. SETTING: Statewide survey of patients. PARTICIPANTS/METHODS: All patients with cleft lip and palate deformities that were seen during a screening program for individuals with orofacial deformities in Lagos, Nigeria, between June 2006 and May 2008 participated in this study. Demographic data were collected and physical examinations carried out. Cleft lip and/or palate deformities were classified using the Kernahan classification for common cases and the Tessier classification for the atypical cleft defects. RESULTS: A total of 225 patients were enrolled and completed the study. Cleft lip and palate was the most common presentation and was found in nearly 45% of the patients. Cleft lip was found in 61 (27%) patients. Twenty patients (8.89%) with different types of rare orofacial cleft deformities were seen. Cleft lip with or without cleft alveolus deformities occurred more commonly among males; whereas, cleft palate was more common among females. Cleft lip and/or palate occurred more frequently among males. Cleft lip with or without cleft alveolus was found predominantly on the left side. CONCLUSIONS: The pattern of cleft lip and/or palate deformities in Lagos, Nigeria, is different from those of other parts of Nigeria in some aspects. The proportion and varieties of atypical orofacial deformities in the study are striking. The prevalence of cleft lip and/or palate deformities in the study was 2.25 per 100,000. There may be an association between the prevalence of atypical deformities and the high level of environmental pollutants in the Lagos area.

Dental status of patients with mental disorders in a Nigerian teaching hospital: a preliminary survey.

Although individuals with mental disorders are reported to experience dental problems similar to the general population, evidence suggests they actually have higher risks of dental disease and increased oral health needs. This study describes the dental status of 105 psychiatric outpatients in a Nigerian hospital. Information was obtained from subject interviews, medical records, and an oral examination to determine their dental caries and periodontal disease status. The oral hygiene status of the study participants was poor; the mean oral hygiene index score was 2.7 ± 1.20. The decayed, missing, and filled teeth ranged from 0 to 9 with a mean of 2.3 ± 2.28. Only five subjects (4.9%) had restorations and the mean number of filled teeth was .14 ± .67. The subjects' age was significantly related to the mean oral hygiene score (p= .005), the mean gingival score (p= .006), and caries occurrence (p= .047). The oral health status of psychiatric patients in Nigeria is poor, indicating the need to provide oral health education and increase access to dental care for these patients.