Predictive and Relative factors of Dental Anxiety among Third Molar Disimpaction Patients in a Northern Nigerian Hospital.

INTRODUCTION: Various factors influence the expression of dental anxiety (DA) among patients. Knowledge of these factors may aid the management of mandibular third molar (M3) dis-impaction patients. AIM: The study aimed to determine the predictive and relative factors of DA among Mandibular third molar (M3) dis-impaction patients at the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. METHODOLOGY: The study was a cross-sectional type conducted at the Oral Surgery clinic of AKTH, Kano among M3 dis-impaction patients between September 2016 and August 2017. Biodata and information on the past dental history of the participants were collected and recorded. The level of anxiety of participants was assessed with the Modified Dental Anxiety Scale (MDAS). Data were analyzed using Statistical Package for Social Sciences (SPSS) for windows (IBM SPSS statistic version 23). The significance level in the study was set at p ≤ 0.05. RESULTS: One hundred and sixteen patients comprising 62(55.2%) males and 54(44.8%) females were recruited. The sample's median age was 27 years and the majority of the participants were students (n=49,42.2%). The participants' MDAS scores ranged from 5 to 22 with a median score of 11. Females (median MDAS score of 12.50) were significantly (p<0.0001) more anxious than males (median MDAS score of 9.00). Bivariate analysis showed statistically significant differences in DA of the categories of the following independent variables - gender (p<0.0001), ethnicity (p=0.041), occupational status (p=0.044), previous surgical extraction experience (p=0.006), previous bad dental treatment experience (p<0.0001) and history of postponement of dental treatment due to anxiety(p<0.0001). Binary logistic regression analysis with these variables as independent predictors of DA showed that only gender (p=0.013) and previous surgical extraction experience (p=0.042) had statistically significant odds of predicting dental anxiety among the patients. Females had significantly higher odds of being anxious than males [adjusted odds ratio (OR) = 4.180, 95% Confidence Interval (CI)=1.359 to 12.852] and patients with previous surgical extraction experience had higher odds of being anxious than those without surgical extraction experience [adjusted OR=3.65, 95% CI=1.02 to 13.03]. CONCLUSION: The predictors of DA in the study are female gender and previous surgical extraction experience. These and other DA-related factors such as patients' occupation and previous bad dental treatment experiences should be considered preoperatively to identify and manage anxious M3 dis-impaction patients.

INTRODUCTION: Divers facteurs influencent l'expression de l'anxiété dentaire (AD) chez les patients. La connaissance de ces facteurs peut aider à la prise en charge des patients subissant l'extraction des troisièmes molaires mandibulaires (M3). OBJECTIF: L'étude visait à déterminer les facteurs prédictifs et relatifs de l'AD chez les patients subissant l'extraction des troisièmes molaires mandibulaires (M3) à l'Hôpital Universitaire Aminu Kano (AKTH) de Kano, au Nigeria. MÉTHODOLOGIE: L'étude était de type transversal et a été menée à la clinique de chirurgie buccale de l'AKTH, à Kano, auprès de patients subissant l'extraction des M3 entre septembre 2016 et août 2017. Les données biométriques et les antécédents dentaires des participants ont été recueillis et enregistrés. Le niveau d'anxiété des participants a été évalué à l'aide de l'Échelle d'Anxiété Dentaire Modifiée (MDAS). Les données ont été analysées à l'aide du logiciel Statistical Package for Social Sciences (SPSS) pour Windows (version IBM SPSS 23). Le seuil de signification de l'étude a été fixé à p ≤ 0,05. RÉSULTATS: Cent seize patients, dont 62 (55,2 %) hommes et 54 (44,8 %) femmes, ont été recrutés. L'âge médian de l'échantillon était de 27 ans et la majorité des participants étaient des étudiants (n=49, 42,2 %). Les scores MDAS des participants variaient de 5 à 22, avec un score médian de 11. Les femmes (score MDAS médian de 12,50) étaient significativement (p<0,0001) plus anxieuses que les hommes (score MDAS médian de 9,00). L'analyse bivariée a montré des différences statistiquement significatives dans l'AD des catégories des variables indépendantes suivantes : le sexe (p<0,0001), l'ethnicité (p=0,041), le statut professionnel (p=0,044), l'expérience d'extraction chirurgicale antérieure (p=0,006), l'expérience antérieure de mauvais traitement dentaire (p<0,0001) et l'histoire du report du traitement dentaire en raison de l'anxiété (p<0,0001). L'analyse de régression logistique binaire avec ces variables comme prédicteurs indépendants de l'AD a montré que seul le sexe (p=0,013) et l'expérience d'extraction chirurgicale antérieure (p=0,042) avaient des cotes de prédiction statistiquement significatives de l'anxiété dentaire chez les patients. Les femmes avaient des chances significativement plus élevées d'être anxieuses que les hommes [rapport de cotes ajusté (OR) = 4,180, intervalle de confiance à 95 % (IC) = 1,359 à 12,852] et les patients ayant déjà subi une extraction chirurgicale avaient des chances plus élevées d'être anxieux que ceux n'ayant pas d'expérience d'extraction chirurgicale [OR ajusté = 3,65, IC à 95 % = 1,02 à 13,03]. CONCLUSION: Les facteurs prédictifs de l'AD dans l'étude sont le sexe féminin et l'expérience antérieure d'extraction chirurgicale. Ces facteurs liés à l'AD et d'autres facteurs tels que l'occupation des patients et les expériences antérieures de mauvais traitement dentaire devraient être pris en compte en préopératoire pour identifier et prendre en charge les patients anxieux subissant l'extraction des M3. Mots-clés: anxiété dentaire, facteurs, troisième molaire, extraction.

The effect of dental anxiety on surgical time of mandibular third molar disimpaction.

BACKGROUND: Dental treatment of anxious patients induces stress due to the patients' expectation of pain. This may prolong treatment due to such patients' inability to cooperate during treatment. AIM: The aim of the study was to determine the effect of dental anxiety on surgical time of mandibular third molar (M3) disimpactions at a Nigerian hospital. SUBJECTS AND METHODS: A prospective study was conducted at the Oral Surgery clinic of Aminu Kano Teaching Hospital, Kano, between October 2016 and September 2017 to assess the effect of dental anxiety on surgical time of M3 disimpactions using the Modified Dental Anxiety Scale (MDAS). The Patients' biodata, clinical and M3 radiologic data were recorded. Surgical durations were also recorded. Data were analyzed with Statistical Package for Social Sciences for Windows (IBM statistics 23 software). RESULTS: One hundred and sixteen subjects (64 males, 52 females) were studied. Forty-two subjects (36.2%) were mildly anxious, 67 (57.8%) were moderately anxious, and 7 (6.0%) were highly anxious. The females were more anxious and the overall surgical time (OST) of disimpaction correlated with the anxiety levels of the subjects. The OST increased by approximately 0.8 min with every unit rise in the anxiety score. Other factors that affected OST in the study were M3 depth, type of impaction, and root curvature. CONCLUSION: The patients' dental anxiety increased the surgical time of M3 disimpactions. Clinicians should consider the patients' anxiety among the factors that affect the surgical time of M3 disimpactions. Verbally soothing anxious patients and administering anxiolytic when necessary, may help to reduce the patients' anxiety, and hence, prevent surgical time prolongation.

REASONS FOR LOSS OF THE PERMANENT TEETH IN PATIENTS IN KANO, NORTH WESTERN NIGERIA.

BACKGROUND: Loss of permanent dentition is often of great concern to patients, apart from the aesthetic consequences in the anterior region of the mouth, such loss has no natural form of replacement. AIM: To determine the pattern of tooth loss among patients attending the Dental Clinic at a Nigerian teaching hospital. MATERIAL AND METHODS: The case files of patients who attended the Dental Clinic of Aminu Kano Teaching Hospital, Kano between January and December 2012 with one or more missing tooth were retrospectively analyzed. The information collected included age, gender, educational level, residential area, missing tooth/teeth and reasons for the loss. The data were analyzed using SPSS version 13.0 (Chicago, Illinois). A p-value of less than 0.05 was considered significant. RESULTS: A total of 1100 missing teeth were recorded involving 960 patients within the period of one year. Males comprises 520(54.2%) and females 440(45.8%). The most predominant age group was the 21-30 years with a mean of 29.53 +12.41 years and this comprised 48.2% of the cases. Caries related extractions (65.6%) were the most common cause of tooth loss followed by periodontal disease in 13.1% of cases and symptomatic impacted tooth in 9.8%. Gender affects the etiology of tooth loss was significant with males having more tooth loss (X2=52.93, df=6, P=0.001). There was a significant association between age and the pattern of tooth loss with tooth loss due to periodontal diseases occurring in the older age groups (X2=1071.67, p=0.001). CONCLUSION: Dental caries and periodontal diseases still remain the main causative factors for tooth loss in this environment, more common in men and rural dwellers.

Associated anomalies in cleft lip and palate: Analysis of 811 consecutive patients

Introduction: Clefts are common birth defects and may be associated with oro-facial congenital anomalies. It has not been established if specific types of anomalies are frequently related with clefts, or which organ is most commonly affected. This study aimed to assess the prevalence of associated anomalies in consecutive cleft lip and palate patients treated at two referral centres in Northern Nigeria.Methods: Cleft lip and palate at two referral hospitals in Northern Nigeria from January 2012 to December 2015 were studied. Data were analysed using Statistical Package for Social Sciences (SPSS) version 16.Results: A total of 811 cleft lip and palate patients were managed. Fifty-five percent (447) were male and 45% (364) were female while 71% (578) were children and 29% (233) were adults. The prevalence of associated anomalies was 11.5%. The most common associated anomaly among cleft patients was facial anomaly (64% of cleft patients). Associated anomalies were most prevalent in patients with isolated cleft palate. Hypertelorism was the commonest type of facial anomaly recorded.Conclusion: Our study showed a low incidence of associated anomalies with a higher incidence in isolated cleft palate cases

Prospective study of the quality of life after treatment of mandibular fractures.

Health-related quality of life (QoL) has become increasingly important, but few studies have dealt with that of patients who have been treated for mandibular fractures. Our aim was to assess this. Patients with mandibular fractures (n=148) were studied prospectively and QoL after treatment was assessed using the General Oral Health Assessment Index (GOHAI). The male-female ratio was 8.3:1 and their ages ranged from 14 to 70 years. QoL after treatment of the fractures declined initially (on the first postoperative day) but thereafter improved steadily. There was no significant difference between the mean QoL of those treated by closed, and those treated with open, reduction. Limitations in the options of food to eat, and difficulty in chewing and swallowing, were identified as their most important concerns in the early postoperative period. The improvement in QoL after the first postoperative day was similar however the patients were treated.

Management of Odontogenic Fibromyxoma in Pediatric Nigerian Patients: A Review of 8 Cases.

Odontogenic fibromyxoma (OFM) is a benign, locally invasive and aggressive nonmetastasizing neoplasm of jaw bones. They are considered relatively rare and known to be derived from embryonic mesenchymal elements of dental origin. Treatment of OFM depends on the size of the lesion and on its nature and behavior. Varying treatment modalities ranging from curettage to radical excision have been documented. Aim; This paper is a review of management of 8 pediatric patients with histologically diagnosed OFM at a Nigerian tertiary health care facility. This was a retrospective study of all patients aged 15 years and below who presented to the Oral and Maxillofacial Surgery Clinic of Aminu Kano Teaching Hospital, Kano, over a 5-year period (January 2008 to December 2012), with a histologic diagnosis of OFM. The information obtained included patients' demographics, as well as their clinical characteristics such as the anatomical site and side of lesions. Other information collated included presenting features, the onset of symptoms, type of treatment carried out, as well as treatment outcome. The data were analyzed and the results presented as frequencies and percentages. Among the 8 patients with OFM, more males (n = 5/8; 62.5%) were affected than females (n = 3/8; 37.5%). The mandible (n = 5/8; 62.5%) was the most frequent site of occurrence, and the anterior mandible was the most favored location (n = 4/8; 50%). Seven patients had excision of the lesion with peripheral ostectomy of the underlying bone while only one patient had a bone resection. These patients have been followed up for at least 1 year, and no recurrence was observed throughout the follow-up period. OFM causes gross facial disfigurement and may result in the destruction of the entire jaw bone; the impact of which may be grave for a growing child. Prompt surgical intervention and follow-up have proven to be adequate management protocol.

EXPERIENCE WITH miniplate osteosynthesis in THE MANAGEMENT OF mandibular fractures IN NORTHWEST NIGERIA.

BACKGROUND: Fractures of the mandible are the commonest facial fractures and various treatment modalities exist like wire osteosynthesis and the use of miniplates and screw with most of the industrially developed world leaning towards the use of miniplates in the treatment of these fractures. The use has however been limited in developing countries (including Nigeria) mostly due to the cost of the plates and screws. AIM AND OBJECTIVES: To identify the versatility of miniplates in the treatment of mandibular fractures at a tertiary care centre in a developing country. METHODS: All Subjects aged 16 years and above in whom mandibular fractures were diagnosed were recruited over a two year period. Patients were treated under general anesthesia using either the miniplates and screws or wire osteosynthesis while some patients had both miniplates and maxillo-maxillary fixation. RESULTS: A total of 94 patients were recruited for the study of which 89.4% were males while the age group 16 to 25 years constituted the majority. Though 29.8% of the study population was involved in business, only 9.6 % were professional motorcyclists. Motorcycle-related road traffic crashes constituted the commonest aetiologic agent with 41.5%, while combination fractures were the commonest fracture types seen in 54.3% of the study participants. Of the 94 patients, 77.7% had treatment of mandibular fractures by open reduction and immobilization with mini plates, while 7.4% had mini plates with Maxillo-maxillary fixation and 14.9% had wire osteosynthesis only. The site of fracture was significantly associated with the treatment modality (p= 0.02). CONCLUSION: This study showed that the choice of fixation appliances in mandibular fractures was influenced by the number of fractures and the multiplicity of fracture sites. Miniplates offered functionally stable fixation with minimum complications.

Pediatric maxillofacial injuries at a Nigerian teaching hospital: a three-year review.

AIM: To determine the nature of pediatric maxillofacial injuries, according to etiology and characteristics of patients. MATERIALS AND METHODS: The records of patients aged 15 years and below who presented with maxillofacial trauma to the Maxillofacial Clinic of Aminu Kano Teaching Hospital, Kano, Nigeria over a 3-year period were retrospectively examined. Patients' demographic and etiologic factors were obtained and analyzed. A P value of <0.05 was considered significant. RESULTS: A total of 160 patients comprising males, 102 (63.8%) and females 58 (36.2%), were seen over the period of study. The age of patients range from 4 months to 15 years, mean 7.07 ± 4.52 years. There was no gender difference in terms of age (P < 0.05). Road traffic accident (RTA) was the most common etiologic factor accounting for 45.0% of cases. This was followed by fall (40.6%). Animal related injury and violence accounted equally for 3.8%. Soft tissue injuries in the form of abrasion, laceration and avulsion accounted for 70.0% of cases. Other anatomical sites included the mandible (16.3%), dento-alveolar fractures(12.5%), and midface (1.3%). CONCLUSION: Road traffic accident and falls still remains the leading cause of maxillofacial injuries in children in this part of the globe. There is a need to reinforce existing traffic laws that aimed at minimizing the menace of RTA-related accidents.