Oro-dental and maxillofacial trauma in epilepsy at a tertiary hospital in Lagos.

BACKGROUND: Seizure-related injuries are common and are a major cause of morbidity in subjects with epilepsy. OBJECTIVE: To determine the frequency and types of oro-facial injuries in epileptic patients attending a tertiary hospital. METHODS: A structured questionnaire was used to obtain information about injuries to the oral and maxillofacial region in epileptic patients at the Neurology Clinic of the Lagos University Teaching Hospital over a period of two years. Information sought included patient's sociodemographics, type of seizure, self-management of seizures, and history of injuries during seizures. RESULTS: Of the 138 epileptic patients seen, 87 (63.0%) reported the occurrence of oral and maxillofacial injuries. Mean age of these patients (29.6±12.1 years) was not significantly different from that of those who had no injuries (33.5±15.6 years). Prevalence of seizure-related injuries was not significantly different in males and females (50 [58.8%] vs 37 [71.2%]). Injuries were more likely in those who had convulsive seizures than in those who had non-convulsive seizures. Patients who had hard objects forced between their clenched teeth during seizure episodes were more likely to sustain injuries. Soft tissue injuries were more common than injuries to the facial bones and teeth. Of these, the tongue was the most commonly injured. Majority of those with soft tissue injuries did not receive treatment in hospital. Although fractures of the cheek and jaw bones were not so common, all such cases received surgical treatment in hospital. CONCLUSION: A high proportion of epileptic patients in Lagos appear to suffer seizure-related oro-facial injuries. Measures for the prevention and management of these injuries are needed to help reduce the morbidity caused by such injuries.

Bacteriologic features and antimicrobial resistance of organisms associated with extracted teeth: findings from a Nigerian university teaching hospital.

BACKGROUND: Empirically prescribed antibiotics are widely employed in the management of odontogenic infections. OBJECTIVE: To characterise the infections associated with extracted teeth and assess effectiveness of the antibiotics prescribed empirically following tooth extraction. METHODS: The study was cross-sectional and consisted of 41 consecutively recruited subjects who required extraction for infections associated with the tooth. Appropriate clinical specimens were collected aseptically from each patient and transported in Stuart's transport medium for processing in the laboratory. Isolation, identification, and susceptibility pattern of anaerobic and facultative organisms were done employing standard bacteriologic techniques. Antimicrobial susceptibility testing was performed by the disc diffusion technique. RESULTS: There were positive cultures for 37 patients. Twenty-eight aerobic (45.9%) bacteria and 32 anaerobic (54.1%) bacteria were isolated, an approximation of two microorganisms per patient. Staphylococcus was the most predominant aerobe (25.0%) whereas Bacteroides fragilis was the most predominant anaerobe (34.2%). All the bacteria isolated showed in vitro resistance to cephalexin, cloxacillin and metronidazole. Eighteen (64.3%) different aerobic bacteria and 13 (40.6%) different anaerobic bacteria were sensitive to ciprofloxacillin and these included staphylococcus and Bacteroides fragilis. Sensitivity pattern for amoxycillin was very poor with 3.6% and 6.3% for aerobes and anaerobes respectively. CONCLUSION: Odontogenic infections from our centre are polymicrobial in nature with anaerobes predominating. High resistance to most of the antibiotics routinely prescribed in our centre is common. Ciprofloxacillin demonstrated the highest sensitivity pattern.

Indications for extraction of permanent teeth in a Nigerian teaching hospital: a 16-year follow-up study.

AIM: The aim of the present study was to investigate reasons for permanent tooth extraction at the Lagos University Teaching Hospital, Lagos, and compare this with a study done 16 years previously in the same institution, with a view to evaluating trends in reasons for tooth extractions in the studied environment. METHODS: A retrospective review of patients who had nonsurgical extraction of their teeth at the Lagos University Teaching Hospital, Nigeria between January and December, 2006 was carried out. The following data were retrieved: Age and sex of patients, reason for the extraction and types of tooth removed. The data obtained was compared with similar study done 16 years previously in the same institution. RESULTS: Caries and its sequelae and periodontal diseases were the main reasons for tooth extraction in both study periods. Caries and its sequelae as a reason for dental extraction in the second period increased by a factor of 1.2 in comparison with the first period, whereas periodontal disease as a reason extraction in the second period decreased by a factor of 2.7. In addition, orthodontic reasons and tooth impaction as a reason for dental extraction increased by a factor of 4 and 1.3 in the second period respectively. In both study periods, most extractions were carried out in patients within age group 11-40 years (1990, 77%; 2006, 62.3%). Teeth most frequently extracted were posterior teeth (1990, 89.2%; 2006, 89.4%). CONCLUSIONS: Dental caries and its sequelae, and periodontal disease despite being preventable diseases, still remain the two most common reasons for dental extraction in our environment. Therefore, efforts must be made to improve the dental health awareness and status of Nigerian populace to reduce the morbidity associated with the two preventable causes of tooth loss.

Miniplate osteosynthesis of mandibular fractures at the Lagos University Teaching Hospital.

OBJECTIVE: To report the clinical outcome of the treatment of mandibular fractures with miniplate osteosynthesis alone, at Lagos University Teaching Hospital (LUTH). METHOD: 30 patients who presented with 41 mandibular fractures at the Lagos University Teaching Hospital between May 2005 and June 2006 were selected for treatment with miniplate osteosynthesis according to the principles of Champy et al. They were grouped according to the time lapsed from injury to treatment as: early (< 24 hours), delayed (> 24 hours - < 7 days) and "late" (> or = 7 days) osteosynthesis groups. Data collected included: age and gender distribution, the aetiology of trauma, site of fractures, pre and postoperative body weight and interincisal distance and postoperative complications. RESULTS: Only 28 of the 30 selected patients received miniplate osteosynthesis and were therefore included in the final analysis. In 25 of these patients (89%) miniplate osteosynthesis without maxillomandibular fixation (MMF) was used. In 3 patients (11%), supplementary MMF was combined with miniplate osteosynthesis. The male - female ratio was 5:1 and the most frequently affected age group was the 20 - 29 years age group (53%). The most frequent cause of fracture was fight and assault. The body of the mandible was the most fractured site. 14 patients (50%) each were classified as delayed and "late" osteosynthesis respectively. The time lapsed before patients attained a postoperative mouth opening of 35mm was 5 weeks while it took 6 weeks to regain lost weight. 46.4% of the patients had postoperative complications; the most frequent complication was malocclusion (23.3%). Patients in the late osteosynthesis group had a higher complication severity score (2.3) than those in the delayed osteosynthesis group (1.5). CONCLUSION: This study suggests that most of the mandibular osteosynthesis in our environment would be delayed or "late" and would develop higher complication rate.

Bacterial infections of the head and neck fascial spaces in Nigerians.

BACKGROUND: Bacterial infections of the head and neck region remain a major public health concern in Nigeria despite the availability and widespread use of antibiotics in the country. OBJECTIVE: This study was conducted to determine the pattern, aetiology, management and outcome of head and neck fascial space infections at Ife. METHODS: All consecutive patients who presented with fascial space infections between January 1995 and July 2004 at the Maxillofacial Unit of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria were admitted into the study. A structured questionnaire was completed for each patient and analyzed in respect of patients' demographics, source of infection, predisposing factors, location of infection; treatment and outcome. RESULTS: One hundred and three patients were managed during the study period. There were 55(53.4%) males and 48(46.6%) females with age ranging from 1-85 years. Submandibular space was the most common single space involved followed by the buccal space. The fascial spaces around the mandible were more involved those around the maxillae and scalp for all age groups. Four patients presented with Ludwigs' angina. Odontogenic infections arising from pulpitis, periodontitis and pericoronitis caused over 70% of the space infections. Microbial cultures showed mixed aerobic and anaerobic bacteriology. Management was by incision and drainage/decompression, removal of the source, use of antibiotics and supportive care. Two deaths were recorded in the course of this study. CONCLUSION: Bacterial infections of the head and neck region remain a major health hazard among Nigerians with spread of infection commonly involving the submandibular and the buccal spaces.

Public and professional perception of oral and maxillofacial surgery (a pilot study).

BACKGROUND: In the advanced countries, the awareness of Oral and maxillofacial surgery by both the public and medical specialties has led to rapid development and expansion of Oral and Maxillofacial surgery specialty with management of diverse and complex problems within a well defined anatomical region. In the developing countries like Nigeria, the trends are slow and this explains why majority of our patients present at very late stage when only palliative measures are the option. OBJECTIVE: The study aims to assess the level of public and professional (GMP and GDP) knowledge and awareness of oral and Maxillofacial surgery specialty. DESIGN: A questionnaire was devised to assess the knowledge and awareness about the specialty of oral and maxillofacial surgery . Ninety one members of the public who were office workers, civil servants, hospital worker in Yaba local government area of Lagos state were the public respondents. The inclusion criteria was that all respondents had attained at least secondary school educational level. They were randomly chosen and had the questionnaires applied to them. Additionally, 40 General medical practitioners and 40 General dental practitioners were picked randomly from 7 local government areas of Lagos state (Yaba, Ebutte Meta, Surulere, Lagos Island, Shomolu, Kosofe and Ikeja) and the questionnaire was applied to them. RESULTS: Only 5.4% of the public had heard of oral and maxillofacial surgeon before. By comparison, the corresponding figures for ENT and plastic surgeons were 40.0% and 23.1% respectively. Only 4.4% of the public had a prior treatment by an oral and maxillofacial surgeon while 86.2% did not know what a maxillofacial surgeon does. The professionals (GMP and GDP) are quite aware of who a maxillofacial surgeon is, but are less knowledgeable of new areas/subspecialties of maxillofacial surgery such as cleft lip and palate surgery, cosmetic and orthognathic surgery, implantology, craniofacial surgery. Also general Medical Practitioners (60%) views of maxillofacial surgeons work are mainly dento-alveolar in horizon. CONCLUSION: These figures are low and it is an indication of low awareness of the specialty by the public and the professionals. While regular auditing ,publications, flow of information, leaflets about oral and maxillofacial surgery to the public, health service personnel, providers and government will improve the trends, continuous professional development Programmes (CPDP) for GDP and GMP will keep them abreast of developments in the specialty.

Impacted mandibular third molars: presentation and postoperative complications at the Lagos University Teaching Hospital.

AIM: Surgical extraction of impacted Mandibular third molar is one of the commonest dentoalveolar surgeries. This study aims to investigate the pattern of presentation of impacted Mandibular third molars, the indications for extraction and the post operative complications after this procedure at the Lagos University Teaching Hospital. PATIENTS AND METHODS: A prospective study of patients who required surgical extraction of impacted Mandibular third molars between October 2003 and May 2006 at the Lagos University Teaching Hospital (LUTH) was carried out. Data collected included Patients' age, sex, indication for extraction, tooth/teeth extracted. Also collected were the types of impactions and surgical morbidity (postoperative complications). The data collected were evaluated using the SPSS for windows (version 11.0: SPSS Inc, Chicago, IL) descriptive analysis was used as appropriate. RESULTS: Three hundred and thirty one (331) Mandibular third molars were extracted from 329 patients. The ages ranged from 17 to 55 years with a mean of 26.63 (+/- 7.39). There were 153 males and 176 females; with male to female ratio was 1:1.15. Recurrent Pericoronitis was the most common indication for extraction (209 extractions; 63.1%), while the mesioangular impaction was the most common angulation (117 impactions; 53.4%). 47 (14.2%) of the extractions had postoperative complications and dry socket which occurred in 25 (53.2%) cases was most common. CONCLUSION: The pattern of presentation of impacted Mandibular third molars is similar to earlier reports. The morbidity is however higher than the average value in the literature, it however does not seem to increase with increasing age.

Evidence-based dental practice: part I. Formulating clinical questions and searching for answers.

Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. Evidence-based care is now regarded as the "gold standard" in health care delivery worldwide. EBD involves tracking down the available evidence, assessing its validity and relevance, and then using the "best" evidence to inform decisions regarding care. Although, the concept of evidence-based dentistry is not new, however, anecdotal evidence suggests that the awareness of this concept among Nigerian dental practitioners is low. This first of three articles on evidence-based dental practice discusses the historical background of evidence-based medicine/evidence-based dentistry, how to formulate clear clinical questions and how to track down (search) the available evidence in the literature databases.

Evidence-based dental practice: Part II. Levels and quality of evidence, and research designs.

The ability to make a sound clinical decision is based largely on the quality of evidence and the practitioner's ability to evaluate this evidence. Clinical evidence are categorized and ranked according to the strength of their freedom from the various biases that beset medical research. Randomized controlled trials (RCTs) are the "gold standard" by which all clinical research is judged. Systematic reviews/meta-analysis of randomized controlled trials where available are considered the highest level in the evidence hierarchy (clinical questions related to therapy or interventions). However, this hierarchy of evidence can not answer all clinical questions especially the ones regarding diagnosis, aetiology or prognosis. For questions related to diagnosis, prognosis or causation, other study designs such as longitudinal studies, cohort studies or case-control studies are more appropriate. The present article discusses the levels and quality of evidence, and basic concepts of clinical research design in evidence-based dental practice based on review of existing literature.

Evidence-based dental practice: part III. Critical appraisal of the literature, relevance and application of the evidence.

Evidence-based dentistry involves defining a question focused on a patient-related problem and searching for reliable evidence to provide an answer. Once potential evidence has been found, it is necessary to determine whether the information is credible and whether it is useful in one's practice by using the technique of critical appraisal. This article discusses the guidelines that have been developed to guide clinicians in assessing the validity and the relevance of published studies (randomized control trials, systematic reviews, cohort studies and case-control studies). The concept and tools of "critical appraisal" of published research works were developed by the evidence-based medicine group at McMaster University, Canada.

Orofacial tumours in suburban Nigerian children and adolescents.

We report the type and distribution of orofacial tumours in south-western Nigerian children and adolescents. The 512 records of patients with oral and maxillofacial tumours in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from 1991 to 2001, were searched and the 146 records (28%) of patients aged 19 years and less were reviewed. Their mean age was 10 years (female:male ratio 1:1.4). Of the 146 tumours 74 (51%) were malignant and 72 (49%) were benign. Of the latter 31 were from soft tissue and 41 were from the jaw (20 odontogenic and 21 non-odontogenic). The most common benign soft tissue and jaw tumours were gingival epulis and ameloblastoma respectively. Of the malignant tumours 67 were lymphomas, 5 sarcomas and 2 carcinomas.

Facial dog bites in Southwestern Nigerian children: an analysis of eight cases.

This paper analyses the prevalence, pattern and treatment outcome of eight cases of facial dog bite in Nigerian children seen and managed at the Obafemi Awolowo University Teaching Hospital's Complex, a tertiary hospital located in Southwestern Nigeria. During the study period of 18 months (July 1996-December 1997), a total of 174 cases of facial soft tissue injuries in children were managed, two of which resulted in rabies and death of the patients. Based on the findings of this analysis, we suggest that unprovoked facial dog bites inflicted by familiar domestic dogs may be complicated by rabies. Ignorance about the risk of uncompleted treatment, financial constraints and scarcity of the vaccine may be implicated in the outcome. The need to improve community knowledge of rabies and the availability and affordability of rabies vaccine are highlighted.

Pattern of soft tissue injuries to the oro-facial region in Nigerian children attending a teaching hospital.

OBJECTIVE: This study was designed to determine the aetiological factors and pattern of oro-facial soft tissue injuries among children in a suburban Nigerian population. The problems encountered in the management of the patients are also highlighted. SETTING: Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Osun State Nigeria. SAMPLE AND METHODS: This prospective study was carried out in children aged < or = 15 years who presented with oro-facial soft tissue injuries between July 1996 and December 1997. Data was collected from a clinical examination of the child and a questionnaire completed by the parent or carer. RESULTS: During the study period, 174 children were managed for oro-facial soft tissue injuries, an incidence of 1.1%, out of a total of 15 582 child admissions. A male preponderance was found (1 : 0.74). The mean age +/- SD was 7.3 +/- 4.2 years and the range was 9 months-15 years. Falls were the most common aetiology followed by road traffic accident. The forehead was the most frequently injured site. A mortality of 3.4% was found. Although animal bites and burns accounted for only 13.8% of all injuries, all the deaths were a result of these aetiologies. Road traffic accidents and burn victims had the longest hospital stay. CONCLUSION: Although falls and road traffic accidents are frequent causes of oro-facial soft tissue injuries, less common causes, like burns and dog bites are more likely to result in death.

Anaplastic carcinoma of the parotid gland: a case report of a patient disease free after nine years. Follow-up.

A case of massive anaplastic carcinoma of the left parotid gland in a 29-year old female Nigerian, of Yoruba tribe, for which radical left parotidectomy with external carotid artery ligation and post-operative radiotherapy was performed is presented Nine years post-operatively, no evidence of recurrence or metastasis was found. The patient is in apparent good health, despite the amount of tumour spillage that was experienced intra-operatively. As far as we have been able to check, it is to our knowledge the first of such from Nigeria.

Comparative evaluation of surgical and conservative treatment modalities of juvenile periodontitis patients.

In a comparative evaluation of the effectiveness of two treatment modalities for juvenile periodontitis, 12 patients aged between 15 years and 23 years were recruited into a six months longitudinal study. The split mouth design was used such that one side (upper and lower quadrants) received conservative treatment. Each side was randomly assigned one of the two treatment modalities. Standardized probing attachment level (PAL) measurement and degree of mobility of the teeth were taken at recruitment (baseline), one, three and six months postoperation. Tetracycline capsules 250mg, 6 hourly, was administered for 2 weeks at baseline and at 3 months follow-up. Initial thorough scaling and polishing of the whole mouth was done for all the patients. At follow-up, there were marked improvements seen with both treatment modalities. The mean probing depth for surgical treatment (3.57mm +/- 0.78) was significantly lower than that of conservative treatment (4.11mm +/- 0.74) P < 0.05 at 3 months. Also, this significant difference continued up to 6 months (2.70mm +/- 0.57, 3.55mm +/- 0.65; P < 0.05 ). For the degree of mobility, significant difference was only evident at 6 months of follow-up (0.48 +/- 0.29, 0.98 +/- 0.523; P < 0.05 ) for surgical treatment and conservative treatment respectively. It was therefore concluded that surgical debridement with systemic administration of tetracycline is more effective than the conservative technique in the treatment of juvenile periodontitis, although both gave improvement.

Oral health status and treatment needs of pregnant women in Lagos State.

The oral health status and treatment needs of 250 pregnant women attending the antenatal clinic at Randle Health Centre was investigated. A coded questionnaire was administered to the pregnant women followed by their oral examination in the dental clinic. The mean oral hygiene index score increased progressively throughout pregnancy viz 1st trimester 0.72, second trimester 1.06 and third trimester 1.23. Community Periodontal Index of Treatment Needs (CPITN) revealed that 50% required scale and polish and oral hygiene instruction, 13.60% required oral hygiene instruction only and 32.2% did not require any treatment. Decayed Missing and Filled (DMF) recorded was 1.54. 51.72% of the pregnant women required amalgam fillings, 23.27% required extraction due to caries and 16.38% required partial dentures.

Epithelial jaw cysts: analysis of 126 Nigerian cases.

One hundred and twenty-six Nigerian cases of epithelial jaw cysts were retrieved from case notes and biopsy records of the Department of Oral and Maxillofacial Surgery and Department of Oral Pathology and Oral Biology of the Lagos University Teaching Hospital. The cases were analysed for age, sex, site and methods of management. Results show that developmental odontogenic cysts (57.14%) were more common than inflammatory odontogenic cysts (26.94%). Dentigerous cyst (22.22%) was the most common epithelial jaw cyst, followed by radicular cyst (21.43%). Developmental non-odontogenic cysts were more than twice as common in females as in males. Sixty-eight per cent of epithelial jaw cysts were treated by enucleation, 10% by marsupialisation, 13% by jaw resection and 9% by surgical excision.

Immunohistochemical localization of Epstein-Barr virus receptor on hyperplastic gingiva of kidney allotransplant patient immunocompromised by cyclosporin A.

The strong association between Epstein-Barr Virus (EBV) and certain tumours of the oro-maxillo-laryngeal region aroused our present interest. A pre-requisite for the molecular interplay of oncogenesis by EBV is the expression of the EBV receptor on the target cell of the host. As a possible contribution to this concept, we adopted immunohistochemical technique to examine a hyperplastic gingival tissue obtained from a subject on kidney allotransplant immunosuppressed with cyclosporin A (CSA). Our results demonstrate expression of EBV/C3d receptor on the superficial layers of the hyperplastic gingiva but absent in the basal/parabasal layers. It is suggested that the superficial layer expression of EBV/C3d receptor could be due to direct acquisition from the environment of the oral cavity rather than a systemic extension from the deep layers of the same epithelium.