Weaning practices among some Nigerian women: implication on oral health.

The objective of this study was to document the various weaning diets given by some Nigerian women and consider their implication on the oral health of their children. A cross sectional survey was conducted among 700 volunteer mothers of young children aged between 6-18 months in Ibadan, a city in south-western Nigerian. Results revealed that pap was the most frequently given food to the infants as 607 (86.7%) of them ate it. Chocolate beverages, natural fruit juice and soft drinks were the most commonly given drinks as 88.1%, 79.9% and 70.3% babies were said to be given these respectively. Over 57% of mothers sweetened pap with sugar. Forty seven percent of mothers added glucose to children's drinking water. Over two-third (64.9%) of children ate biscuits several times a day. Soft drinks, commercial fruit juices and squash were consumed by 16.1%, 9.6% and 7.7% of the infants respectively on a daily basis. Judging by the findings of this study, it is evident that many infants are being exposed to a highly cariogenic diet at an early age. In the light of the harmful effect of these foods and drinks on the body and teeth, it is important that oral health care workers initiate moves to discourage this habit via health education programmes. Nurses, community health workers at various levels, pregnant women and mothers of young children should be the targets of such intervention.

Teething myths among community health officers.

Many symptoms are attributed to teething in infants as a result of myths and opinions of people in the community. These myths have given false security with the belief that these symptoms are part of the teething process. The purpose of the study was to investigate the beliefs and practices of Community health Officers about teething. 60% of the respondents whose responses were analyzed believed that children have systemic problems during teething periods. Fever and diarrhea were the most frequent symptoms associated with teething. As health care providers at the community level, there is a need for this cadre of health care providers to separate cultural beliefs from scientific and proven medical practices. This can be achieved by their attendance at regular refresher courses organized for them after their graduation.

Evaluation of a photo-poster on nurses' perceptions of teething problems in South-western Nigeria.

BACKGROUND: Health problems commonly associated with the eruption of teeth in babies continue to pose problems in Nigeria. Even nurses who should be well informed have misconceived views. In order to enlighten mothers and healthcare workers on this issue, a photo-poster was developed as a health-education tool. The objective of this study was to assess the effect of the poster, displayed in the workplace for 18 months, on the knowledge, attitude and reported practice of nurses. The study also aimed to assess the outcome of the inclusion of the photo-poster in training materials in a workshop setting. METHODS: The study was conducted in two parts. In the first part, 542 nurses working in children's units within the city of Ibadan, South-western Nigeria were selected using a stratified sampling technique. A questionnaire was used to gather information on their perceptions of teething problems at baseline. Photo-posters were displayed in the nurses' workplaces for 18 months, and a follow-up survey was conducted using the same questionnaire. In the second part of the study, two groups of nurses (n = 21 and n = 18 nurses) working in similar healthcare facilities in Ibadan participated in two separate workshops. One workshop used the photo-poster in addition to the standard educational materials, and the other workshop did not. Percentage differences between pre- and postintervention responses to perceived health problems were calculated. Intervention effects were the differences between the percentage changes in the intervention (with poster) and comparison (without poster) groups. Statistical differences were determined by Chi-squared test or one-tailed t-test, as appropriate. RESULTS: Five hundred and forty-two nurses (519 female and 23 male) completed the questionnaire survey at baseline and 403 (371 female and 32 male) at follow-up. Their ages ranged between 23 and 56 years, with the greatest percentage aged 25-40 years. At baseline, many respondents indicated that several of the listed health problems were a consequence of tooth eruption. After exposure to the posters at their workplace for 18 months, there were slight changes in their opinions but most were not statistically significant (P > 0.05). The use of posters in a workshop setting revealed percentage changes ranging from -11 to 61% for the different associated health problems. Many of these changes were statistically significant (P < 0.05). CONCLUSION: Displaying photo-posters in the workplace did little to change nurses' perceptions of teething problems; the posters had more influence when they were used in an instructional, interactive atmosphere. It is recommended that the use of photo-posters in health education for such culturally entrenched health issues should be accompanied by discussion of the same subject wherever possible.

Effects of different brands of fluoride dentifrices on dental caries incidence in the rat.

The effectiveness of 3 different brands of fluoride-containing dentifrices on the prevention of dental caries was investigated in molars of young rats. Forty albino Wistar rats weighing 50-80g, 28 males and 12 females were inoculated in the mouth with streptococcus viridans daily from day 1 to day 5 of the experiment. The animals were then divided into four groups and fed with rat pellets containing 60% sucrose added as granulated sugar. All the groups were given water ad libitum. Group I had daily tooth brushing with water and served as the control while groups II, III and IV received daily brushing of their molar teeth with different fluoride--containing dentifrices: (Maxam, Florish and Close-Up respectively. All topical treatments were given for one minute daily per rat from day 6 to day 56 of the experiment. At the end of the experiment the animals were sacrificed, the jaws removed and the teeth were scored for occlusal caries. All fluoride--containing dentifrices tested reduced caries in the following order: Maxam 37.86%, Florish 59.22% and Close-Up 57.28%. This study confirmed that fluoride incorporated in Florish and Close-Up showed significant levels of caries reduction (P <0.01) and (P <0.05) respectively in the rat. It also adds credence to Dental Health Education in the application of various tooth pastes in oral hygiene measures.

Oro-facial lesions and CD4 counts associated with HIV/AIDS in an adult population in Oyo State, Nigeria.

OBJECTIVE: The objective of this study was to define the oro-facial lesions associated with Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) in an adult population in Oyo state, Nigeria and to relate these with the level of immune suppression as measured by the CD4 counts. MATERIALS AND METHOD: The study population consisted of 679 consecutive subjects who were seen at the state-owned blood bank. Information on demography, medical and medication histories were obtained. Oro-facial examinations were carried out according to Greenspan et al [Oral Surg Oral Med Oral Pathol (1992)73:142-144]. HIV sero-prevalence status was determined for all patients. CD4+ T-lymphocyte count was carried out for those sero-positive for HIV and 31 randomly selected HIV-negative subjects. Data were analyzed using the chi-square test, Fisher's exact test, Student's t-test and odds ratio where appropriate. RESULTS: Eighty-one (11.9%) of the entire study sample were confirmed HIV positive. The prevalence of specific oral lesions by HIV sero-status revealed that pseudomembranous oral candidiasis and angular cheilitis occurred significantly and more frequently in HIV-positive subjects (33.3 and 21% respectively) than those who were HIV negative (4.3 and 1.8% respectively, P < 0.05). The mean CD4 count of the HIV-positive subjects was 452 cells mm(-3), s.d. 137, while it was 602 cells mm(-3), s.d. 251, for the HIV negatives. The difference was statistically significant (P = 0.000). Forty-four (66.7%) subjects with CD4 counts <500 cells mm(-3) had oro-facial lesions whereas among those with CD4 counts >500 cells mm(-3) only 22 (33.3%) had oro-facial lesions (OR = 4.57). CONCLUSION: The type of oro-facial lesions most commonly associated with HIV/AIDS in Oyo state, Nigeria, has been shown to be pseudomembranous oral candidiasis. This was followed by angular cheilitis. These lesions, although found in HIV-negative subjects, were in a lower proportion as compared with HIV-positive subjects. Mean CD4 counts were lower in HIV-positive subjects and this was associated with greater prevalence of oro-facial candidiasis and angular cheilitis.

Attitude, beliefs and practices of some Nigerian nurses toward teething in infants.

The objective of this study was to assess the perceptions of some Nigerian nurses on the various societal beliefs about teething. A cross sectional survey was conducted among 542 nurses in the teaching, general and Local Government hospitals and clinics in Ibadan, a city in south western Nigeria. The outcome of the study revealed that the majority of the nurses believed that loss of appetite, crying, increased salivation and general irritability were a necessary part of the teething process. Furthermore, 82,1%, 61,4% and 27,9 % of them implicated fever, diarrhoea and boils respectively as signs of teething. The older and more experienced nurses and males seemed to ascribe symptoms more with the teething process. From this study, it is clearly evident that there are erroneous beliefs concerning teething persistent among Nigerian nurses. Since the societal beliefs may be harmful to the health of the children, there is a desperate need to address them. In doing this, a health education programme should be formulated to educate these misconceptions among the general public and especially target older and more experienced nurses as well as the males. Nursing and expectant mothers should also be

The relationship between dental aesthetic index (DAI) and perceptions of aesthetics, function and speech amongst secondary school children in Ibadan, Nigeria.

OBJECTIVE: The purpose of the study was to investigate the relationship between a professionally derived index, the Dental Aesthetic Index, and some indications for orthodontic treatment as perceived by potential patients. METHODS: An epidemiological survey of 614 secondary school students, 327 males (53.3%) and 287 females (46.7%) was carried out in Ibadan, Nigeria. Children aged 12-18 years (mean age, 14.9+/-2.9 SD) were randomly selected, none of them had received previous orthodontic treatment. One examiner assessed the students using the Dental Aesthetic Index (DAI). Subjects were also asked to complete a questionnaire consisting of three questions concerning appearance, function, and speech, using a 5-point Likert scale. RESULTS: Weak but statistically significant correlations were found for subjective assessments of appearance of teeth and the DAI (r=0.174; P<0.01) and between biting/chewing and appearance of teeth (r=0.095; P<0.05). Statistically significant correlations were found between appearance of teeth and speech (r=0.148; P<0.01) and biting/chewing and speech. The last showed the strongest correlation (r=0.268; P<0.01). CONCLUSION: The study has shown weak but significant correlation between DAI and children's perceptions of the appearance of their teeth. We recommend further study involving both DAI and Index of Orthodontic Treatment Need (IOTN) for comparison in the Nigerian population.

Reviewing trends in the incidence of cancrum oris in Ibadan, Nigeria.

The objective of this clinic based retrospective study was to review the trends in the incidence of cancrum oris at the Dental clinic of the University College Hospital, Ibadan, Nigeria. Records of children aged 1 to 16 years diagnosed as having cancrum oris between 1st of January 1986 to 31st December, 2000 were reviewed. Of the six thousand three hundred and ninety (6390) children seen within the period of study, 45 had cancrum oris with the modal age been 3-5 years and the mean age was 4.2 +/- 2.7 years. There was a declining trend in the proportion of children presenting with the disease at five yearly interval within the period of study, although malnutrition was still a common factor in all the children.

Oral cancer awareness and prevalence of risk behaviours among dental patients in South-western Nigeria.

The present study, based in a tertiary hospital in South western Nigeria, assessed cancer awareness among patients seeking dental treatment. A specially designed questionnaire was used to collect information on the knowledge, beliefs and habits of those attending the dental hospital within a designated period of the year. Almost 61% of the respondents had post-secondary education. The level of oral cancer awareness was remarkably high (72%), but this was low compared to awareness about occurrence of cancer in other parts of the body (89.9%). Awareness was found to be closely associated with educational status. The study also revealed that 50% had previous information on oral cancers from mass media as against 20.1% who were informed through health care professionals. Almost half of the study sample recalled episodes of previous oral ulceration and of these, greater than 50% indulged in either self medication (38.1%) or no medication at all (18.4%). The prevalence of alcohol consumption and smoking habits among the respondents was low being, 16.3% and 4.2% respectively. The lack of association, in this study, between oral cancer incidence and the known risk behaviours, is an obvious indication for investigation into other predisposing factors such as nutrients, genetic predisposition and the role of chronic infections. Perhaps one or more of these might be more relevant in this environment.

The pattern of malocclusion among orthodontic patients seen in Dental Centre, University College Hospital, Ibadan, Nigeria.

The aim of this study was to analyse the malocclusion pattern among patients who presented for treatment in the Orthodontic Unit of the Dental Centre, University College Hospital, Ibadan, as baseline data for proper treatment planning, teaching and further research. A total of 289 subjects aged 5-34 years with mean age of 10.6 +/- 1.5 (S.D.) years were seen. Angle's classification of molar relationships among those seen is as follows: class I - 76.5%, Class II - 15.5% and Class III - 8.0%. There was increased overjet in 16.2% of the patients, reduced overjet in 0.7% while 2.1% had reversed overjet. Other occlusal abnormalities included: increased overbite (3.8%), reduced overbite (1.4%); anterior open bite (5.2%; crossbite (8.4%) and scissorsbite (0.6%). Crowding, spacing and retained primary incisors constituted 29.7%, 1.4% and 40.1%, respectively. Delayed eruption of canine (1.0%), Bimaxillary protrusion (0.7%), incompetent lips (0.7%), supernumerary teeth (0.7%) malformed tooth (0.3%), mandibular deviation on closure (1.0%) and oral habits (4.5%) were other forms of malocclusion diagnosed. Males were found to have significantly more of classes II and III molar relationships than females (P < 0.05). Occurrence of retained primary teeth as well as overjet deviations from normal were significantly higher in females (P < 0.05). No significant sex differences were found in the other occlusal disorders (P > 0.05): The findings were comparable with previous epidemiological surveys in other parts of the country.

Assessing cross infection prevention measures at the Dental Clinic, University College Hospital, Ibadan.

The dental clinic is an environment where disease transmission occurs easily. Prevention of cross infection in the dental clinic is therefore a crucial aspect of dental practice and dental clinic workers must adopt certain basic routines while practising. This study evaluates basic routines in prevention of cross-infection in the dental clinic, University College Hospital Ibadan. The sample comprised 77 dental clinic workers, who completed closed-ended questionnaires. The questionnaires enquired into practices of the workers in the clinic as well as in the laboratories Physical inspection of dental equipment, instruments and materials was also carried out. The results highlight poor compliance of workers, especially the dental surgeons and students, with the hepatitis B vaccination programme of the Hospital. History to identify high risk individuals was often overlooked and was practised by less than 50% of the clinic workers. Barrier technique with the exception of the use of eye shield, was well practised by all the clinic workers. Aseptic technique was well practised in the dental clinic. Inadequate number of dental surgery assistants, faulty sterilizing equipment, poor monitoring of sterilization, coupled with inadequate number of instruments contributed to the poor success of prevention of contamination and instrument processing procedures. Less than 30% of dental surgeons and fewer than 50% of students discarded sharp materials into the yellow/sharp bin. Liquid waste was well disposed off through the drain for onward flow into the sewer, whilst the disposal of solid contaminated waste did not conform to stipulated international standard. The study found that successful infection control in the dental clinic was highly dependent on the dental surgery assistants, because highly technological equipment were lacking. The management/administration also plays an important role in the number of physical and human resources available and in the overall surveillance of nosocomial infections.

Maternal and child's anxiety--effect on child's behaviour at dental appointments and treatments.

The objective of this study was to assess the influence of pre-existing dental anxiety and maternal anxiety on the behaviour of some Nigerian children during dental appointments. Two hundred and sixty children aged 2-15 years participated in this study. They were treated at the three government dental establishments in Ibadan, a city in South Western Nigeria, over a six-month period. The children's behaviour during different stages of treatment was determined by the Frankl's Behaviour Rating Scale. The outcome of the study revealed a high association between the level of pre-existing dental anxiety in the children and their behaviour during various phases of treatment (P<0.05). During initial stages of treatment, prophylaxis, administration of local anaesthesia and tooth extraction, children with high level of anxiety were less cooperative. In addition, a general tendency towards cooperative behaviour was observed among patients whose mothers had low anxiety levels. This study shows the importance of correct assessment of the pre-operative dental anxiety status in children as well as the level of anxiety in their mothers. The level of dental anxiety in children and their mothers appears to be predictive of their behaviour in the oral care setting. In circumstances where the level of pre-operative and maternal anxiety are high, efforts should first be geared toward instituting appropriate behaviour management skills like behaviour shaping and modelling to bring about a higher level of cooperation before embarking on treatment. By paying special attention to these children, it is possible that the dentist would succeed in improving acceptance of treatment in them thereby increasing cooperation at subsequent dental visits.

Dental fluorosis and fluoride mapping in Langtang town, Nigeria.

This study is aimed at measuring the fluoride concentrations of different water supplies in a Nigerian community known to have endemic fluorosis. This is with the view of mapping out a pattern and to investigate the relationship of this pattern with the distribution of dental fluorosis among residents of the community. A representative sample of 475 persons selected on the basis of criteria described in an earlier publication, constituted the study subjects. Clinical examination were carried out after obtaining sociodemographic information from the subjects. Analyses of fluoride concentrations in 136 water samples revealed, in general the highest levels in stream water range: 2.39-3.96 ppm, followed by wells (range: 1.26-2.82 ppm) and the least in pipe-borne water (range: 0.5-0.97 ppm). In plotting specific fluoride readings from the different identified sources on the geographical map of the study area, a distinctive pattern emerged. High fluoride readings were generally in the highland areas from which rivers and streams took origin. Approximately 50% of the town was supplied with water containing fluoride above the optimum. As reported in the earlier publication, the prevalence of dental fluorosis was found to be 26.1%. The age specific prevalence rate indicated the highest occurrence rate among those aged 10-19 years. Six of the participating children had involvement of deciduous teeth. Even though no correlation was established between dental fluorosis and sex on one hand and fluorosis and ethnicity on the other, there was a markedly significant association between fluorosis and source of drinking water (P < 0.05). Those who drank from streams appeared more likely to have fluorosis. It was concluded that though other sources of fluoride ingestion have been documented, it appeared that water may play a very significant role in the aetiology of fluorosis in this community.

Prevalence and distribution pattern of enamel fluorosis in Langtang town, Nigeria.

Dental fluorosis, a defect which causes white flecks or brown staining of the teeth, has been reported in some parts of the world. This study, a descriptive, cross-sectional survey was designed to determine the prevalence and distribution pattern of dental fluorosis in Langtang town, Plateau State of Nigeria between April and June 1997. Community members had recognised the discolouration of teeth as a public health problem for which solution had been sought from the near-by public health agency. A representative sample of 475 persons drawn from the 7 wards of the local government area were interviewed. Information on their age, ethnicity, occupation and source of drinking water were obtained. Intra-oral examinations were conducted to determine the status of participants' enamel using a modified version of Dean's classification of enamel mottling. Results revealed a 26.1% prevalence rate of enamel fluorosis, with 20.6% of the cases classified as mild and 5.5% as severe. While the prevalence rate was not influenced by sex and ethnicity, it was strongly associated with the source of drinking water (P < 0.05). Drinking from streams seemed to increase the likelihood of participants having dental fluorosis. A pattern of distribution with age also emerged with the highest prevalence being among the 10-19 years age group. Six cases were detected in deciduous teeth. In view of the strong indication of an environmental aetiological basis, there is need for the determination of the current levels of fluoride in water, foods beverages and other likely sources of exposure in that community.

Effect of two common Nigerian chewing sticks on gingival health and oral hygiene.

This study was conducted with the objective of assessing the effect on gingival health and oral hygiene of two chewing sticks, commonly used in a Yoruba community in Nigeria. Sixty, 12-year old primary school pupils participated in the study. After baseline data were collected on the status of oral hygiene and gingival health, complete prophylaxis was carried out on all the children. They were then divided into three groups to which toothbrushes, Pako Ijebu (Massularia acuminata) and Orin Ayan (Distemonanthus benthamianus) were assigned. They received instructions and supervision appropriate to the implement they were provided with. At the expiration of the six weeks intervention period, post-intervention readings were taken. There was no significant difference in the oral hygiene status between those using the toothbrush and those using the chewing sticks. Slight improvements were detected in the gingival status of those using the chewing sticks relative to those in the group using toothbrush. The best score was recorded among those using the Orin Ayan (D. Benthamianus). These differences were however not statistically significant. Even though an association between gingival health and use of these chewing sticks could not be drawn, it is suggested that further studies be conducted in this area.

Perception of child oral health needs by antenatal clinic attenders in Ibadan, Nigeria.

One hundred and eighty-three women, attending government owned antenatal clinics in Ibadan, a metropolitan city in the south western part of Nigeria participated in a questionnaire-based survey. The women's opinions on the oral health needs of their children were sought. These included the time of commencement of tooth-cleaning, types of materials recommended for cleaning at different ages, frequency of cleaning children's teeth as well as the perceived effects of certain food items and drugs on the teeth. The results showed that 140 (76.5%) of the respondents advised the use of cotton wool for cleaning babies mouths before the age of 6 months while 12 (6.6%) mentioned the use of polystyrene foam. One hundred and sixty six women (90.7%) felt that children's teeth should be cleaned with toothbrush between the ages of 2 years and 6 years. On the knowledge of the effects of drugs on the teeth, 11 (62.8%) believed that the ingestion of certain drugs, particularly tetracycline, in pregnancy could have adverse effects on the teeth. These findings showed that the majority of those in the study population had appreciable, though inaccurate knowledge of children's oral health needs. Nevertheless, the authors propose a programme of education on oral health for pregnant women which should enlighten them in the prevention disease of the oral cavity in themselves and their children.

Intra-oral squamous cell carcinoma in Ibadan: a review of 90 cases.

Squamous cell carcinoma (SCC) of the oral cavity is considered the commonest of all oral malignancies. Between the period January 1960 and December 1985, 385 cases of oral malignancies were histologically diagnosed at Ibadan; 102 out of these were SCC. There are very few up to date reports in the literature on the incidence of intra-oral carcinoma amongst the Nigerian population, particularly on intra-oral SCC. Therefore, this study analyzed the lesion's incidence according to sex, age, and site prevalence, and also compared the results with studies from other countries.

Ectodermal dysplasia with hypodontia in a set of Nigerian twins--a case report.

A set of Nigerian male twins with features of ectodermal dysplasia born to apparently normal parents are presented. The main findings in both children were hypodontia, abnormally shaped teeth and hypotrichosis. The general treatment modalities of the condition, especially in a tropical environment, are discussed.

Beliefs about prematurely erupted teeth in rural Yoruba communities, Nigeria.

A descriptive study was carried out in two villages: Badeku and Olodo, near the city of Ibadan, between May and November 1990. The objective of the study was to investigate the knowledge, beliefs and attitudes of respondents to premature eruption of deciduous teeth in babies. Of the 622 people interviewed, a large proportion (30.5%) believed that the first deciduous tooth should erupt between the age of 5-7 months; the next commonly mentioned time of tooth eruption was 7-9 months of age; and 50.3% of the respondents claimed to have seen a case of prematurely erupted primary teeth. There was a statistically significant association between age and also between educational status of respondents and having seen premature eruption of teeth (P < 0.01). The majority of the people (53.7%) felt that the condition was an indication of an evil child. Only 22.1% of those interviewed thought it could be just an individual variation. On the recommended remedy or management of the condition, as many as 26 (4.1%) said they would get rid of the child. A high percentage felt that sacrifices should be offered to appease the gods. It is suggested that a transcultural approach be adopted in managing cases in which the parents feel particularly anxious and uncomfortable about prematurely erupted teeth in order to cater for the social well-being of the child and family. It is also recommended that appropriate health education be directed at the society as a whole concerning this condition.

Societal opinions on the eruption of deciduous maxillary central incisors before the mandibular ones in Nigeria.

This paper reports perceptions and beliefs about babies who erupt upper deciduous teeth before the lower in two rural Yoruba communities. 96.5% of respondents expected that the lower incisors should erupt first. The majority (70.4%) believed the eruption of upper teeth before the lower to be a sign of an evil child. This observation was, however, related to educational status and age. The higher the educational level of the respondents, the higher the proportion of respondents who viewed the occurrence as a mere individual variation. Similarly, the older people tended to view the eruption of upper deciduous teeth before the lower as evidence of an evil child. The need for an educational package directed at similar populations in order to reduce anxiety related to this human variation is stressed. It is suggested that a transcultural approach be taken to cater for the child and family welfare in a situation where societal pressure is high.