Nigerian dentists' knowledge of the current guidelines for preventing infective endocarditis.

OBJECTIVE: This study assessed Nigerian dentists' knowledge of current guidelines for the prevention of infective endocarditis. MATERIAL AND METHODS: A self-administered questionnaire surveyed a cross-section of Nigerian dentists gathering information on respondent demographics, awareness of the American Heart Association current guidelines on preventing infective endocarditis and sources of knowledge regarding that guidance. Respondents indicated: a) whether or not they would prescribe antibiotics before dental treatment in 10 cardiac conditions, b) if antibiotic prophylaxis was reasonable before 10 dental procedures in an endocarditis high-risk patient, and c) a prescription for oral antibiotics for an endocarditis high-risk non-allergic adult about to undergo a dental procedure. RESULTS: Respondents numbered 173 and 41% were aware of the guidelines. Most commonly the sources of this knowledge were undergraduate/postgraduate education. Overall, the correct responses for the 10 cardiac conditions was very low (33%), ranging from 94% for prosthetic heart valves (94.2%) down to 4% for previous coronary artery bypass (3.5%). For clearly invasive procedures, 80% to 96% of respondents indicated that a prophylactic antibiotic was reasonable. For clearly non-invasive procedures, 89% to 92% indicated that antibiotics were not reasonable. Correct antimicrobial agent, dose and timing of administration were prescribed by 89%, 9%, and 57% respectively. CONCLUSIONS: A low level of knowledge of the current guidelines was found among Nigerian dentists. Although, most prescribed the correct antimicrobial agent, the numbers prescribing correct dose and time of administration were quite low. Therefore, attempts should be made to teach the current guidelines in Nigerian undergraduate/postgraduate dental education.

Knowledge and practice of alternatives to the conventional inferior dental block amongst dentists in Lagos.

BACKGROUND: The conventional inferior alveolar nerve block (IANB) has been used for mandibular anaesthesia for many years. It is associated with a number of complications including failure of anaesthesia. Alternative techniques were therefore developed for the mandibular anaesthesia. OBJECTIVE: This study is to evaluate the knowledge and practice of alternatives to the conventional inferior alveolar nerve block (IANB) amongst dentist in government owned hospitals in Lagos, Nigeria. METHODS: Self administered questionnaires to assess the knowledge and practice of alternatives to the conventional inferior dental block for mandibular anaesthesia were sent to dentists in clinics situated in General hospitals and Teaching hospitals in Lagos. The information recorded included demographics (age and sex), institution of practice, and length of practice. The knowledge and practice of alternatives to the conventional IANB were also recorded. RESULTS: Of the 90 questionnaires sent out, only 66 (73.3%) were returned. Most respondents 43 (65.5%) practiced in the tertiary institutions. All respondents used the conventional IANB as their primary technique. Difficulty to achieve anaesthesia due to trismus 22 (34.4%) and pain on injection 20 (32.3%) were the most common complications/difficulty associated with the IANB. Forty (60.6%) of the respondent practiced the Akinosi/Varzirani technique (AVT) as a secondary technique while only 1 had ever attempted the Gow-Gate technique (GGT). Both the knowledge and practice of the alternative techniques had a statistically significant relationship to both formal training and primary training institution (P < 0.05). CONCLUSION: Formal training in the use of alternative techniques to the IANB in achieving mandibular anaesthesia was a very important factor that determined the practice and knowledge of these techniques. Although the IANB was still the primarychoice for all of our respondents, there are claims by a lot of the respondents that with more formal training the alternatives will used more regularly.

Indications for extraction of third molars: a review of 1763 cases.

OBJECTIVE: Third molars have been described as different from other teeth in the oral cavity. They have the highest rate of developmental abnormalities and, most importantly, are last in the eruption sequence. We investigated reasons for third molar teeth extraction in patients attending the outpatient oral surgery clinic of the Lagos University Teaching Hospital, Nigeria. MATERIALS AND METHODS: A retrospective review of patients who had third molar extractions between January 2001 and June 2006 was conducted. Data retrieved and analysed were: age and sex of patients, indication for extractions, type of teeth extracted, technique of extractions (surgical and non-surgical) and angulations of impaction in case of impacted lower third molars. RESULTS: A total of 1763 patients (mean age +/-SD, 33.74+/- 13.3 years; range 15 - 92 years) had their third molars extracted during the period. Majority (58%) of them were females. Surgical extraction was carried out in 506 (28.7%) patients while 1257 (71.3%) patients had non-surgical extractions. Caries and its sequela (63.2%) was the major reason for teeth extraction followed by recurrent pericoronitis (26.3%) and periodontitis (9.2%). Only 11 (0.6%) cases were removed for prophylactic reason. Patients who had their teeth removed for caries were significantly younger than those for periodontitis (P=0.000) but older than those for pericoronitis (P=0.000). CONCLUSIONS: Caries and periodontal diseases occurring in relatively older age group were the major reasons for non-surgical extraction of third molars while recurrent pericoronitis occurring in relatively younger age was the major reason for surgical extraction of impacted third molars. Prophylactic surgical extraction of third molars is not a common practice in our environment.

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.