Strategies adopted by oral physicians, oral and maxillofacial surgeons, and oral pathologists in patient education on oral cancer: A Nigerian study.

BACKGROUND: The burden of oral cancer in Nigeria is increasing. Different studies have shown how public education on oral cancer have increased knowledge of oral cancer across populations, however, it is not known if these practices are adopted by oral physicians, oral and maxillofacial surgeons, and oral pathologists in Nigeria. AIMS: To investigate the patient oral cancer education strategies adopted by oral physicians, oral and maxillofacial surgeons, and oral pathologists in Nigeria. METHODS: This study adopted an analytical cross-sectional study design. This study surveyed practicing oral physicians, oral and maxillofacial surgeons, and oral pathologists in Nigeria. An e-questionnaire was used for this study. The data were analyzed using the SPSS Version 20 software, and a p-value of <.05 was used to determine the level of statistical significance. RESULTS: The study's response rate was 46.6% (75/161). The 75 participants were from the six geopolitical zones in Nigeria responded to the survey questionnaire. Even though more than half (43/75, 57.3%) of the respondents have never received any training since their post-bachelor's degree qualification on the strategies that can be used in educating patients on oral cancer, majority (54/75, 72.0%) of them knew at least one education strategy; also, the most known (36/54, 66.7%) and utilized (33/54, 61.3%) strategy among those respondents who were aware of patient education strategy was health talk. Only 38.7% (29/75) of the respondents reported that health learning materials (posters, leaflets, fliers, and flipcharts) are available in their clinics, all of which were in insufficient quantities. Also, 93.3% (70/75) of the respondents opined that it is worthwhile that dental clinics/hospitals in Nigeria invest in the provision of oral cancer learning materials for patient use. Inferential statistical analysis did not reveal any significant relationship between the respondents' characteristics and their awareness and practice on patient oral cancer education strategies. CONCLUSION: This study identified that many oral physicians, oral and maxillofacial surgeons, and oral pathologists in Nigeria lack the needed capacity to educate their patients on oral cancer. There is a need to strengthen their capacity by giving them training on patient oral cancer education strategies, and by providing them with good quality and enough teaching aids.

The use of Qigong and Tai Chi in the management of temporomandibular joint dysfunction: A systematic review.

Background and Aims: Qigong and Tai Chi (QTC) are mind-body exercises involving a sequence of graceful movements, which promote self-healing, meditation, and self-cultivation. There is growing evidence that Qigong and/or Tai Chi therapy may improve the physical and psychological health among adults with multiple health conditions including joint movement. This systematic review aims to synthesize the available evidence on the type and effectiveness of QTC therapies used in the management of temporomandibular joint (TMJ) dysfunction. Methods: This systematic review followed the AMSTAR-2 guideline, and it was reported based on guidelines in the PRISMA checklist. The review involved a systematic search of nine electronic databases. After deduplication and screening of the literature retrieved from the search, only one article was included based on the review's inclusion criteria. Data was extracted from this article and synthesized. Results: The only included article was on a non-randomized control trial which investigated the role of Tai Chi Qigong (a form of Qigong) therapy in improving joint mobility and alleviating trismus among 52 survivors of nasopharyngeal carcinoma who had TMJ disorders. The study reported, at different time intervals (at pretest; at mid-intervention; at posttest; and at follow-up posttest), that no significant difference (p > 0.05) was observed concerning mouth opening capacity between the intervention group and the control group. However, over time, less severe deterioration in mouth-opening was noted among the participants in the intervention group (p = 0.181) as compared to the control group (p < 0.001). Conclusion: The role of QTC therapies in improving joint mobility and alleviating trismus is not yet fully understood, but it seems promising. The available evidence is inadequate to categorically conclude on the efficacy of these therapies. Further studies will be required to fully assess the effectiveness of QTC therapies in the management of TMJ dysfunction.

Management of unerupted anterior teeth an audit of treatment outcomes

Anterior teeth are valuable for aesthetics, speech and mastication . Their absence, impaction and/or delayed eruption create significant distress often leading to early presentation to the dental office. This study presents an audit of the management of impacted anterior teeth that presented at a tertiary level dental clinic. The periodontal outcomes of the aligned teeth were also reported. Methods : This is an observational study spanning a nine-year period. Demographic data, clinical presentation as well as post alignment dental and periodontal status of the impacted teeth were assessed. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 26. Fisher's exact test and paired samples T-test were used for categorical and continuous variables respectively. Significance was set at P < 0.05. Results: Twenty-eight (1.76%) cases presenting with failed eruption of thirty-two anterior teeth were found during the period under review. Eight patients were treated by extraction, orthodontic treatment and space closure or prosthetic replacement with a mean treatment time of 2.83 ± 2.66 years. Thirteen patients completed treatment by orthodontic alignment with mean alignment time of 1.4 ± 1.5 years and treatment time of 3.6 ± 2.5 years. There was significant difference in the post-operative root length of aligned teeth compared to their normal antimeres (p < 0.005). Conclusion: Patients with impacted anterior teeth presented later than was beneficial for spontaneous alignment of their teeth. The average 1.5mm loss of root length observed was not detrimental to the anatomical retention or function of the aligned teeth. There is need for more enlightenment with regards to early presentation for dental problems to avoid expensive and time-consuming treatments.

Decreased Annexin A1 expression enhances sensitivity to docetaxel, cisplatin and 5-fluorouracil combination induction chemotherapy in oral squamous cell carcinoma.

BACKGROUND: Annexin A1, a member of the Annexin superfamily, has been shown to play a vital role in a broad range of molecular and cellular processes. This study aims to explore the relationship between the Annexin A1 expression and the clinical response to cisplatin, docetaxel and 5-fluorouracil (TPF) as induction chemotherapy in patients with oral squamous cell carcinoma (OSCC). METHODS: This study recruited two hundred thirty-two patients from a III/IVA OSCC trial. Immunohistochemistry was used to assess the level of Annexin A1 expression. Overexpression and knockdown methods in HB96, HN4 and CAL27 cell lines were used to assess the role of Annexin A1 in the neoplastic cellular response to chemotherapy. RESULTS: We found that reduced expression of Annexin A1 conferred a prognostic benefit from induction chemotherapy based on the TPF drug combination in patients with moderately/poorly differentiated disease. Using an in vitro model, we found that low Annexin A1 enhanced cellular proliferation by activating the EGFR/AKT signalling pathway and inhibiting p27 expression. Furthermore, low Annexin A1 initiated a significant decrease in cell viability after treatment with TPF agents. In addition, downregulation of Annexin A1 promoted apoptosis induced by docetaxel, cisplatin and 5-fluorouracil, and upregulation of Annexin A1 inhibited apoptosis. CONCLUSION: Annexin A1 may be of prognostic value in patients with locally advanced OSCC who are managed with TPF chemotherapy, as low Annexin A1 promotes chemosensitivity to TPF chemotherapy in oral cancer cells via enhanced caspase-dependent apoptosis.

Burdens and predictors of the Burden experienced by Family Caregivers of Patients with Oral and Maxillofacial Tumours.

Aim: There is a dearth of knowledge on the burden of family caregivers of patients with maxillofacial tumours in Nigeria. This burden may be influenced by racial peculiarities and the disease entity of the patient. The aim of this study is to assess and document the burdens and predictors of burdens experienced by family caregivers of patients with oral maxillofacial tumours presenting at a tertiary health facility in South Western Nigeria. Materials and Methods: A descriptive cross-sectional study that included 110 consenting family caregivers of patients diagnosed with oral and maxillofacial tumours. A semi-structured questionnaire was used to collect information on their sociodemographic characteristics and caregiving burden using the Zarit burden interview tool. Data were analysed using descriptive and inferential statistics with Statistical Package for Social Sciences version 21.0. Result: The most frequent group of caregivers was patients' children (32.0%), aged 30-39 years (28.2%), females (54.5%), with secondary education (41.8%), and traders (38.2%), who earned less than national minimum wage (55.5%). Majority (42.7%) experienced mild-to-moderate burden; coping strategy was mainly prayers (76.4%), while the greatest need expressed was financial assistance (93.6%). The significant predictors of caregiver burden were the presence of pain (adjusted odds ratio [AOR] = 2.961; 95% confidence interval [CI] = 1.165-7.526; P = 0.023) and severe clinical condition (AOR = 3.342; 95% CI = 1.133-9.853; P = 0.029). Conclusion: The most common category of the burden of family caregivers of patients with maxillofacial tumours was the mild-to-moderate category, and the most significant predictors were the presence of pain and severity of clinical condition. The greatest need expressed was financial assistance. Therefore, an emphasis on adequate pain control and alternate sources of funding may appreciably relieve the burden of family caregivers of patients with maxillofacial tumours.

Knocking down B7H3 expression enhances cell proliferation of SHEDs via the SHP1/AKT signal axis.

B7H3 is a member of B7 family of immunoregulatory transmembrane glycoproteins associated with maintaining immune tolerance, tumor cell proliferation, migration, invasion and metabolism, drug resistance, and stem cell differentiation. Neural crest-derived Multipotent Stem Cells (MSCs) from the dental pulp has become a good choice for tissue regeneration because it is easily obtainable and has strong regeneration potentials. Although there have been many studies investigating the role of B7H3 in cancer cells and immune cells, its role in the dental pulp stem cells regeneration is unknown. In this study, we chose SHEDs (stem cells from human exfoliated deciduous teeth) as a research model to analyze the expression and function of B7H3. The result showed that SHEDs were B7H3/CD90, B7H3/CD73, B7H3/CD105 double positive, and the expression of B7H3 is primarily located within the membrane. Downregulation of B7H3 expression significantly accelerated the expansion of SHEDs through the SHP1/AKT signal axis while upregulation of B7H3 expression decreased the proliferation of SHEDs. Hence, this study indicates that B7H3 is a stem cell surface molecule and might be used as a SHEDs marker whereby its downregulation enhances the proliferation of SHEDs via the activation of B7H3/SHP1/AKT signaling pathway.

Diagnostic Accuracy of Fine-Needle Aspiration Cytology in Head and Neck Lesions from a Tertiary Health Facility in Southwestern Nigeria.

BACKGROUND: Fine-needle aspiration cytology (FNAC) is widely employed as an initial investigative tool in the diagnosis of various lesions in the body, however, it is limited in the provision of precise architectural detail of lesions. This is said to be responsible for the wide variation in the documented usefulness and accuracy relative to histopathology. This study aimed to correlate cytopathological and histopathological examination (HPE) of head and neck lesions, and assess the usefulness and accuracy of FNAC in our center. MATERIALS AND METHODS: This was a retrospective study that utilized historical data obtained from case notes and histopathology records of 91 patients that had both FNAC and HPE done for head and neck lesions in our center during the study. The FNAC results were correlated with that of the histopathological diagnosis to obtain the accuracy of the FNAC diagnosis. Diagnostic validity of FNAC in terms of sensitivity, specificity, and predictive value were also evaluated. RESULTS: A total of 91 FNAC-HPE sample pairs were included. The Sensitivity and specificity for benign lesion was 95.4% and 42.3%, respectively, while for sensitivity and specificity for malignant lesion was 31.8% and 96.9%, respectively. The overall Sensitivity and specificity for cytology was 96.8% and 30.4%, respectively. CONCLUSION: FNAC appears to be a useful tool in the initial assessment of head and neck lesions in our center, however, the high rate of missed diagnosis especially as concerned malignancies has dire negative treatment implications. There is need to develop capacity for improved skill in making cytopathologic diagnoses among anatomical pathologists involved in the use of FNAC as diagnostic and screening tool.

Effect of Dental Treatment on the Quality of Life of Children with Traumatic Dental Injuries in Ibadan, Nigeria.

Background: Anterior dental trauma is known to be common in our environment as well as the complications that come with it. These injuries have been seen to impact the quality of life (QoL) of children significantly due to the fact that they compromise their dental health. This leads to aesthetic, psychological, social, and therapeutic problems impacting both the children and their parents. Treatment of these injuries has also been severely neglected possibly due to lack of awareness of where or how to access treatment as well as fear of dental treatment. However, treatment may on the other hand bring about a substantial improvement on the QoL of children in terms of their daily living. Aim: To assess the effect of dental treatment on the QoL of 12- to 15-year-old Nigerian school children previously identified as having had traumatized anterior teeth. Design: This is a follow-up study where secondary data were extracted from a cross-sectional study involving 1575 children attending public and private secondary schools in Ibadan, Nigeria. One hundred and ninety-six adolescents with evidence of dental trauma, previously identified as having their QoL negatively affected as a result of dental trauma, were called to take part in the follow-up study. The Child Perception Questionnaire (CPQ11-14) was used in assessing the QoL of participants with dental trauma before and after treatment. Data were analysed using the IBM® SPSS® Statistics version 20.0, and the effect of dental treatment on the QoL of the participants was assessed using the McNemar's test. Statistical significance was set at P < 0.05. Results: Fifty-one (26.0%) out of the 196 invited children participated; there were 31 males and 20 females. The mean age was 13.4 years (standard deviation 1.1 years). Eighty traumatized anterior teeth were involved, with the maxillary centrals being the commonest (68, 85%). Twenty-three (45.1%) participants had more than one traumatized tooth. The commonest dental trauma was enamel fracture, which involved the dentine (39, 48.8%). The main treatments given were composite build-up (36, 45%) and root canal treatment (42, 52.5%). With the CPQ11-14, in the oral symptoms domain, the number adversely affected before treatment fell from 30 (58.8%) to 3 (5.9%) (P < 0.001); in the emotional well-being domain, the number dropped from 35 (68.6%) to 10 (19.6%) (P < 0.001); and in the social well-being domain, the number fell from 34 (66.7%) to 22 (43.1%) (P = 0.004). However, in the functional limitation domain, the number adversely affected increased from 24 (47.1%) before to 46 (90.2%) after treatment (P < 0.001). Conclusion: Treatment resulted in a significant improvement in the QoL of participants, especially regarding their oral symptoms, and emotional and social well-being. However, there was worsening in the functional limitation domain. There is the need to introduce oral health into the school curriculum in order to encourage early reporting and prompt treatment of traumatic dental injuries.

Contexte: Les traumatismes dentaires antérieurs sont connus pour être fréquents dans notre environnement ainsi que les complications qui en découlent. Ces blessures ont un impact significatif sur la qualité de vie des enfants en raison du fait qu'elles compromettent leur santé dentaire. Cela conduit à des problèmes esthétiques, psychologiques, sociaux et thérapeutiques affectant à la fois les enfants et leurs parents. Le traitement de ces blessures a également été gravement négligé, peut-être en raison du manque de connaissance de l'endroit et de la manière d'accéder au traitement ainsi que de la peur des soins dentaires. Cependant, le traitement peut en revanche apporter une amélioration substantielle de la qualité de vie des enfants au niveau de leur vie quotidienne. Objectif: Évaluer l'effet d'un traitement dentaire sur la qualité de vie d'écoliers nigérians âgés de 12 à 15 ans précédemment identifiés comme ayant eu des dents antérieures traumatisées. Conception: Une étude de suivi où les données secondaires ont été extraites d'une étude transversale portant sur 1575 enfants fréquentant des écoles secondaires publiques et privées à Ibadan, au Nigéria. Cent quatre-vingt-seize adolescents présentant des signes de traumatisme dentaire, précédemment identifiés comme ayant une qualité de vie affectée négativement à la suite d'un traumatisme dentaire, ont été appelés à participer à l'étude de suivi. Le Questionnaire de perception de l'enfant (CPQ11-14) a été utilisé pour évaluer la qualité de vie des participants ayant subi un traumatisme dentaire avant et après le traitement. Les données ont été analysées à l'aide d'IBM® SPSS® Statistics version 20.0 et l'effet du traitement dentaire sur la qualité de vie des participants a été évalué à l'aide du test de McNemar. La signification statistique a été fixée à P < 0,05. Résultats: Cinquante et un (26,0%) des 196 enfants invités ont participé; il y avait 31 hommes et 20 femmes. L'âge moyen était de 13,4 (SD 1.1) ans. Quatre- vingt dents antérieures traumatisées ont atteinte, les centrales maxillaires étant les plus fréquentes (68, 85%). Vingt-trois (45,1%) participants avaient plus d'une dent traumatisée. Le traumatisme dentaire le plus fréquent était la fracture de l'émail impliquant la dentine (39, 48,8%). Les principaux traitements administrés étaient la reconstitution de composite (36, 45%) et le traitement canalaire (42, 52,5%). Avec le CPQ11-14, dans le domaine des symptômes oraux, le nombre de patients atteints avant le traitement est passé de 30 (58,8%) à 3 (5,9%) (P < 0,001); dans le domaine du bien-être émotionnel, le nombre est passé de 35 (68,6%) à 10 (19,6%) (P < 0,001) et dans le domaine du bien-être social, le nombre est passé de 34 (66,7%) à 22 (43,1%) (P = 0,004). Cependant, dans le domaine de la limitation fonctionnelle, le nombre de personnes atteintes est passé de 24 (47,1%) avant à 46 (90,2%) après traitement (P < 0,001). Conclusion: Le traitement a entraîné une amélioration significative de la qualité de vie des participants, en particulier en ce qui concerne leurs symptômes buccaux et leur bien-être émotionnel et social. Cependant, il y avait une aggravation dans le domaine de la limitation fonctionnelle. Il est nécessaire d'introduire la santé bucco-dentaire dans le programme scolaire afin d'encourager le signalement précoce et le traitement rapide des blessures dentaires traumatiques.

Syngnathia.

Syngnathia is a congenital fusion of the upper and lower jaws. Its occurrence poses a significant challenge to feeding and its management is challenging to both the surgeon and the anaesthetist. Reports in the literature are mainly clinical reports or case series. To the knowledge of the authors and from the available literature, this is only the fourth report from Nigeria. The presentation and successful management of a Nigerian female neonate with congenital syngnathia is described and reviewed with literature.

Clinical Parameters and Challenges of Managing Cervicofacial Necrotizing Fasciitis in a Sub-Saharan Tertiary Hospital.

INTRODUCTION: Necrotizing fasciitis is a severe soft tissue infection. In our environment, patients presenting with this infection are usually financially incapacitated and, therefore, their management can be challenging. This paper aimed to document the pattern and challenges encountered in the management of cervicofacial necrotizing fasciitis (CNF) in the University College Hospital, Ibadan. MATERIALS AND METHODS: Information such as biodata, site of infection, systemic conditions, widest span of defect, management provided, hospital stay, and outcome of management was prospectively collected on all patients with CNF who presented at the Department of Oral and Maxillofacial Surgery between January 2007 and December 2013. The patients were managed according to a devised protocol of antibiotic therapy, serial debridement and honey dressings. RESULTS: Twenty-four cases of CNF were seen. There were 9 males and 15 females while 70.9% of the patients belonged to the low socioeconomic class. The mean span of wound defect was 12.2 (±8.844) cm. The mean hospital stay was 27.8 (±23.1) days, and scar formation was the most common complication encountered. CONCLUSION: Our study represents the largest series of CNF from a Nigerian health facility presently. The management of necrotizing fascitis in the maxillofacial region poses a significant challenge to both the surgeon and the patient. However, the mortality rate of CNF in our center appears comparatively low.