Comparison of normative and self-perceived dental needs among adolescents in Lagos, Nigeria.

AIMS AND OBJECTIVES: Professionally determined needs as well as self-perceived oral health needs play significant roles in the assessment of needs for dental care. The aim of this study was to compare the self-perceived oral health needs by the adolescents with professionally determined needs by the oral health-care giver. SUBJECTS AND METHODS: This was a community-based cross-sectional study involving 504 adolescents who were selected through multistage random sampling from secondary schools in Lagos State. Self-assessed oral health needs was measured by the participants' response to the question(s): How can you describe the condition of your teeth/gum? Their response was compared to the findings of an intra-oral examination of the participants (after an informed consent) carried out under field conditions by one examiner employing DMFT and CPITN indices for Dental Caries and Periodontal status respectively. RESULTS: The prevalence of Dental Caries was 11.9% while that of Periodontal disease was 60.4%. The Sensitivity, Specificity, Positive and Negative Predictive Values for Dental Caries were 30%, 85%, 21.4% and 89.9% respectively; and 21.7%, 80.9%, 63.4%, and 32.9% respectively for Periodontal status. CONCLUSION: Self-perceived oral health needs assessed by questionnaire among adolescents was found to be at variance with the clinically determined needs. Promotion of oral health awareness among adolescents with emphasis on recognition of signs and symptoms of common dental diseases using the school as a base is strongly advised.

Prevalence and severity of dental caries among pensioners in Benin City, Nigeria.

UNLABELLED: The aim of the current study was to describe the prevalence and severity of dental caries among a cross section of elderly pensioners from three groups of different work background in Benin City, Nigeria, as part of a general assessment of their oral health status. SUBJECTS AND METHODS: A cross-sectional descriptive survey of two hundred and fifty-two pensioners (182 males and 70 females) aged 50-85 years selected by stratified and systematic random sampling were studied. A self-administered structured questionnaire was used to obtain demographic data. The subjects were examined clinically for dental caries by a calibrated examiner using the diagnostic criteria described by the World Health Organization. RESULTS: The mean age of the pensioners was 61 years (SD = 6.19) and the total mean values for DMFT 1.45 (SD = 2.28) with 48% caries-free subject (females 51.4% and males 46.7%). Males had a higher mean DMFT (1.56) than females (1.18). The teaching hospital pensioners had lower DMFT (0.90, SD = 1.15) than university (1.46, SD = 2.42) and general (1.70, SD = 2.53) pensioners. 64% of the pensioners had very low caries severity. CONCLUSION: In conclusion the prevalence of dental caries is moderate and the severity is very low with high burden of untreated caries. There is an urgent need to set up caries control programmes including the use of atraumatic restorative treatment to protect the oral health of the growing number of the elderly pensioners.

The need for orthodontic treatment in a school and referred population of Nigeria using the index of orthodontic treatment need (IOTN).

OBJECTIVES: To determine the objective orthodontic treatment need of a group of school children and a referred population using the Index of Orthodontic Treatment Need (IOTN) and establish the relationship between subjective and objective orthodontic treatment need. PARTICIPANTS AND METHODS: The study groups were 250 school children and 157 children referred to the orthodontic unit of the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). They assessed their need for treatment, their dental casts were also assessed by the examiner (K.A.K) using the IOTN. RESULTS: The professional assessment of treatment need of the children in the school population based on the Aesthetic Component of IOTN were 62.8% no need, 30% moderate need and 7.2% great need for orthodontic treatment, the referred population had 19.7%, 36.3% and 43.9% respectively. The Dental health component resulted in 66% no need, 20% moderate need and 14% great need for treatment in the school population. These percentages were 20.4%, 16.6% and 63% respectively in the referred population. Statistically significant differences were found between subjective and professional assessment of orthodontic treatment need in both populations. There were no significant gender differences in objective orthodontic treatment need. CONCLUSION: The results of the study indicate that there is a difference of opinion on orthodontic treatment need between laypersons and professionals. The IOTN reliably records deviant occlusal traits can be used to prioritize treatment need.

Patterns of oral manifestation of HIV/AIDS among 225 Nigerian patients.

OBJECTIVE: The purpose of this study was to determine the prevalence of the oral manifestations of HIV/AIDS and to correlate the prevalence of these lesions with the stages of the disease in the Ife-Ijesa zone, Nigeria. No comprehensive data were available for correlating it with the staging of HIV/AIDS in this region. SUBJECTS: The pattern of oral HIV lesions as classified by the EC-Clearinghouse was studied in 225 confirmed consecutive HIV-infected patients in this zone. METHODS: Clinical dental examinations were conducted under natural daylight on all consenting HIV patients, sitting in an upright chair, using dental mirrors and probes. RESULTS: The prevalence of oral HIV lesions was 84.0%, with lesions ranging in number from one to six. The commonest HIV lesion was pseudo-membranous candidiasis (43.1%) followed by erythematous candidiasis (28.9%), angular cheilitis (28.9%), linear gingival erythema (24.0%) and ulcerations (8.9%). Lesions less commonly found were oral hairy leukoplakia (1.3%) and salivary gland swellings (1.3%). Heterosexual intercourse was the most common mode of transmission (94.7%) and HIV-1 (96.9%) the most prevalent pathogen among the study population. The majority of the patients were in the WHO clinical stage III (59.1%) and presented late. CONCLUSIONS: The prevalence of oral HIV lesions in the present study was high.

Self-perceived and unmet general health need among PLWHA in Nigeria.

OBJECTIVE: This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population. METHODS: A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife and General Hospital, Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medication, Dental, Mental, Home care, Hospital admission, access to antiretroviral therapy and emergency services. RESULTS: One or more unmet needs were reported by 79.4% of the sample. Needs for medication, home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p < 0.05). CONCLUSIONS: Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs.

Self-perceived and unmet general health need among PLWHA in Nigeria

Objective: This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population. Methods: A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex; Ile-Ife and General Hospital; Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medica- tion; Dental; Mental; Home care; Hospital admission; access to antiretroviral therapy and emergency services. Results: One or more unmet needs were reported by 79.4of the sample. Needs for medication; home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p0.05). Conclusions: Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs

Performance at the national postgraduate medical college fellowship examinations in dental surgery- a 23 year review.

OBJECTIVES: This study evaluates the performances at various levels of examinations from inception as a guide to the assessing how far the Faculty has been able to meet the objectives for which it was established and offer recommendations for repositioning the Faculty for future development. MATERIALS AND METHODS: Results of the Fellowship examinations of the Faculty of Dental Surgery in the three examination levels from 1979 to 2002 (FMCDS) were retrieved. The data were analysed for gender, sub specialties of preference, number of attempts at Parts I and II levels and average duration of completion of the Fellowship programme. RESULTS: Between 1979-2002, 633 candidates sat for the Primary FMCDS examination, 262 (41%) were successful. In the Part I FMCDS examination 330 candidates sat for the examination from 1980-2002. 128 (39%) were successful, while at the Part II level 77 candidates sat for the examination, 43 (56%) were successful and 34 (44%) failed. 57(44.5%) and 30 (69.8%) passed the Part I & II respectively at first attempt, while 27 (21.1%) and 10 (23.3%) were successful in the Parts I and II respectively at the 2nd attempt. 39 (30.5%) and 5 (3.9%) were successful in the Part I examination at 3rd and 4th attempts, while 3(7.0%) were successful in the Part II FMCDS at 3rd attempt. The duration of training ranged from 6-7 years in over 50% of the candidates, mean of 7.5 years overall. CONCLUSION: The Faculty of Dental Surgery has had tremendous impact on the dental manpower need of the nation within the period under review.

Oral health status of 12-year-old Nigerian children.

UNLABELLED: BACKGROUND STUDY: The World Health Organization has set some goals for the oral health of the 12-year olds'. This study, which is being carried out in a developing nation, will add to the accumulating data worldwide on this index age group. STUDY DESIGN: One thousand six hundred 12-year-old public and private secondary school pupils were examined in six local government areas of Lagos State. The objective of the study was to assess their oral health status and treatment needs. RESULTS: In this study caries prevalence was found to be 24.6% with a mean DMFT of 0.46. The "D" component formed the greater proportion indicating low dental care in the population. The oral hygiene status (OHIS) of the students was generally fair. The girls had better oral hygiene and lower prevalence of gingivitis and calculus than the boys. The difference was however not significant (p > 0.05). The treatment needs of the students revealed that 72.7% required periodontal treatment, 34.6% required restorative treatment and 10.3% required orthodontic treatment. CONCLUSION: This study concludes that even though caries level in this age group was low, oral hygiene was fair and the utilization of oral health services was poor.

Perceived sources of stress in Nigerian dental students.

The objective of this study was to identify sources of stress among dental students at the University of Lagos, Lagos, Nigeria. A modified Dental Environment Stress (DES) questionnaire was used to study the 137 students in years 3-6, of which 105 (76.6%) responded. Results show that the year 5 students indicated the highest level of stress overall on items relating to pre-clinical training with 21 (70%) recording aggregate DES score over the cut-off point for high stress. For clinical items, nearly all the students - 27(90%) of year 5 and 24 (100%) of year 6 recorded aggregates over the cut-off point. The most important stressors were those related to the lack of provision of a well-supported system of dental education in Nigeria in terms of availability of materials for clinical training and study materials. There were no significant differences in stress perception between genders. However, students who chose Medicine as their first choice for admission with Dentistry as an alternative experienced significantly higher overall mean and higher mean scores for most items. In conclusion, it appears there is a need to improve support for dental education in Nigeria.

Oral health status of 12-year-old Nigerian children

Background study: The World Health Organization has set some goals for the oral health of the 12-year olds1. This study; which is being carried out in a developing nation; will add to the accumulating data worldwide on this index age group. Study design: One thousand six hundred 12-year-old public and private secondary school pupils were examined in six local government areas of Lagos State. The objective of the study was to assess their oral health status and treatment needs. Results: In this study caries prevalence was found to be 24.6with a mean DMFT of 0.46. The ""D"" component formed the greater proportion indicating low dental care in the population. The oral hygiene status (OHIS) of the students was generally fair. The girls had better oral hygiene and lower prevalence of gingivitis and calculus than the boys. The difference was however not significant (p0.05). The treatment needs of the students revealed that 72.7required periodontal treatment; 34.6required restorative treatment and 10.3required orthodontic treatment. Conclusion: This study concludes that even though caries level in this age group was low; oral hygiene was fair and the utilization of oral health services was poor

Traumatic fracture of anterior teeth in 12-year old Nigerian children.

INTRODUCTION: The WHO has chosen the 12year-old age group as one of the sentinel groups for the monitoring of oral health of the population. Tooth loss in 12year olds is significant because the dentition is still developing and any disruption will affect the development of the arch, occlusion and patient's aesthetic. MATERIALS AND METHODS: 1600 12-year-old secondary school pupils were examined in six local government areas of Lagos State. The WHO pathfinder methodology was used. RESULTS: In this study, more boys 86 (10.8%) had various degrees of trauma to their anterior teeth compared to 71 girls (8.9%)(M:F Ratio is 1.2:1). The overall prevalence of tooth fractures was 9.8%. The most frequent injury was class II fractures (52.2%) and there were more fractures to the maxillary teeth than mandibular teeth, the difference is statistically significant p<0.0 1. The central incisors were the teeth most frequently fractured in both sexes. DISCUSSION: The prevalence of fractured anterior teeth in this study, even though is lower than earlier studies can be said to be high for this age group because the greatest number of injuries occur at about 14 years of age. Maxillary incisors in this study have a higher prevalence of fractures. A significant finding in this study is that none of the students with fractured anterior teeth have received dental treatment for the fractures CONCLUSION: There is a high prevalence of fractured anterior teeth in 12year- olds and this problem has not received the necessary attention of the dental profession. Oral health education with the provision of school dental services is recommended as means of solving this problem.

Awareness of periodontal diseases amongst Nigerian diabetics.

This prospective study sample consisted of 261 Nigerians made up of 155 diabetics seen at the medical outpatient clinic of Lagos University Teaching Hospital, Lagos and general hospital, Ikeja, Lagos, Nigeria and 106 health controls randomly selected. The subjects were required to complete a questionnaire containing the biographic data and occupation, and assessment of their knowledge, attitude and practice towards periodontal health and utilisation of appropriate professional care. They were then examined and assessed using the CPITN code. Their ages ranged from 5 to 65 years. Close to three-quarters of the subjects (73.5% for diabetics and 74.5% for controls) were 45 years or older. Furthermore, 6% of the low skilled diabetics new about periodontal disease while only 27.2% of those in the medium and highly skilled group had some knowledge of periodontal disease. This relationship was found to be statistically significant (X2 = 12-22 ; df = 2, p < 0.05). Similarly, statistically significant relationship was demonstrated between diabetics and controls with regards to knowledge about the demonstrated between diabetic and controls with regards to knowledge about the cause/s of periodontal disease and awareness of gum bleeding. 73.6% of the controls had never been to the dentist before unlike 62.1% of diabetics. All subjects in either group who claimed not to bleed scored at least the minimum on the CPITN code. While 52.3% of diabetics and 22.5% of control had a CPITN score of 2,54% of those in the control group and 30% of diabetics recorded a score of 3 on the CPITN code. In conclusion, the level of awareness of periodontal disease is quite low amongst both groups, hence there is a need to promote periodontal health awareness in the general populace as well as clinics.

Minimum practicable and acceptable infection control recommendations for dental practice in Nigeria.

The advent of HIV/aids has led to a renewed interest in infection control and occupational safety in dentistry. The full implementation of "Universal Precautions" to prevent cross-infection of HIV, hepatitis B, and other blood borne pathogens would have a heavy financial implication on developing countries like Nigeria which are faced with the arduous problem of coping with scarce resources. Dentistry is bound to cost more when effective infection control is practised. This paper therefore proposes recommendations for minimum, practicable and acceptable infection control standards which are not only cost effective but also attainable.

Dental caries status of primary school children aged 4-16 years in southwest Nigeria.

OBJECTIVE: To assess the dental caries status of primary schoolchildren aged 4-16 in both urban and rural areas of Lagos State, Southwest Nigeria. DESIGN: Cross sectional and descriptive. METHOD: Sample comprised of primary school children (n = 1,829) selected from five urban non-fee paying schools and three fee-paying schools as well as five rural fee-paying schools. Caries was diagnosed based on the WHO caries diagnostic criteria (1997). RESULTS: Caries prevalence was 14.4% in the urban area and 5.7% in the rural area (p < 0.01). Children from the fee-paying schools had a caries prevalence of 21% while those from the non-fee paying schools had a caries prevalence of 8.1% (p < 0.01). There was no significant difference in dft score among 4-6 year-olds, which was 0.33 and 0.32 in both the urban and the rural areas respectively but there was a significant difference in dft and DMFT score in the older age groups. Most of the caries were unrestored, only 3 (0.16%) had filled teeth. 9.1% required restorative treatment, 2.4% had teeth for extraction. CONCLUSION: The prevalence of caries is low in the Nigerian population studied. Treatment rate is very low.

Periodontal health of the elderly people in South East local government area in Ibadan, Nigeria.

Health problems involving physical and mental conditions directly or indirectly affect the oral health of the elderly. Other ways in which physical and mental health conditions influence their health result from the various drug prescriptions given for these ailments. Periodontal health is the most affected. Various studies have demonstrated that the elderly have the highest rate of gingival bleeding, calculus deposits and periodontal pocketing. It is the aim of this study to determine the health of the supporting tissues of the teeth using periodontal indices such as the C.PI.T.N and mobility index. The study was carried out on 690 elderly individuals (403 males and 287 females) who were 65 years and above living in various wards in the South East Local Government Area of Ibadan (S.E.L.G.A). A multistage sampling technique was used to select elderly individuals for the study. Two interviewers, 2 record clerks and 2 examiners were trained and the examiners were calibrated. The elderly individuals were interviewed and examined concurrently. The results highlighted the high prevalence of periodontal disease in the elderly in this local government area. Only 5.2% were free from periodontal disease. 94.8% had one or another stage of periodontal disease. It also demonstrated the poor oral cleanliness among these elderly. More than 42% had gross accumulation of calculus. Among the elderly in this local government area, 21.6% and 28.8% had shallow and deep pockets, respectively whilst 39.3% had one or more mobile teeth. Pockets and excessive mobility of the teeth represent advance stages of periodontitis. Majority (70.4%) of the elderly in the study claimed they use chewing sticks to maintain oral hygiene. The pattern of deposit of calculus along the interdental surfaces, mesio and distobuccal surfaces as well as lingual surfaces, question the effectiveness of the chewing stick in cleaning these surfaces. This study confirms findings of other authors, on oral hygiene in Nigeria. There is an urgent need to establish a community based outreach programme to prevent and treat periodontal disease among the elderly in this local government area.

Oral hygiene and periodontal treatment needs of urban school children compared with that of rural school children in Lagos State. Nigeria.

OBJECTIVE: To assess the oral hygiene methods being used by the children in the urban and rural areas studied, the effect on their oral hygiene and the periodontal treatment needs of urban and rural school children. SETTING: An urban and a rural local government area in Lagos State, Southwest Nigeria. DESIGN: Cross-sectional and descriptive. METHOD: 1829 primary school children from primary one to six were selected from thirteen fee-paying and non fee-paying schools using a multistage random sampling. One thousand, and twenty-three (1023) children were examined in the urban area and eight hundred and six (806) children were examined in the rural area. The simplified oral hygiene index of Greene and Vermillion and the Community Periodontal Index of Treatment needs (CPITN) were used to assess the oral hygiene status and Periodontal treatment needs respectively. RESULTS: 205 (20%) of the children in the urban area use the toothbrush and toothpaste only and 84 (10.4%) of those in the rural area use only the toothbrush and toothpaste. 255 (31.6%) of the children in the rural area use only the chewing stick compared with 5 (0.5%) of the children in the urban area. Majority of the children use a combination of methods based on what is available. Children in the urban area had significantly better oral hygiene than those in the rural area but children from low social class in the urban area had significantly poorer oral hygiene than those from the high social clans. Majority of the children from the rural area and the low class urban area needed scaling and polishing. It was concluded that there is a need for improvement in oral hygiene of the children via oral health education. There is a greater need for middle level oral health manpower as the majority required scaling and polishing with oral hygiene instructions.

Oral health knowledge, attitude and practices of primary school teachers in Lagos State.

School teachers are known to exert considerable influence on their pupils and to an extent on the larger community. They have however been shown to have a disappointingly poor knowledge of oral health and disease. This study sought to assess the knowledge, attitude and practices of primary school teachers in Lagos State, Nigeria. A cross-sectional, questionnaire-based survey was carried out on 100 primary school teachers drawn from 10 randomly-selected primary schools in Lagos State. The results revealed that majority of them have a poor attitude to oral health issues. The few of them who have attended a dental clinic mostly had extractions done. It was also found that there is a need for improved knowledge of oral health disease and their prevention among the teachers for an effective school based oral health education programme. The paper suggests ways in which this can be achieved.

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 education in Africa with special reference to Nigeria.

Over the years, the dental profession in most of the developing countries of the world has given the education of the dentist greater priority over the education of dental auxiliaries. There has also been a great tendency on the part of the profession in these countries to think that dental education involves the training of dentists alone. The training of dental auxiliaries forms an important core of dental education for the training of oral health workers in the developing countries. The training of dentists in the developing countries, especially Africa, seems to have been lopsided with excessive emphasis on restorative procedures. The dental undergraduate training programme in a representative Nigerian dental school is investigated and suggestions made on the appropriate mode of training needed for the future Nigerian, and indeed the future African dentist. The need for effective parallel training of dental auxiliaries, especially in large numbers, is also emphasised.