A Comparative Study of Palatal Rugae Patterns among Igbo and Ikwerre Ethnic Groups of Nigeria: A University of Port Harcourt Study.

Background. Palatal rugae pattern of an individual is species specific and is said to be as unique as finger print. Aims and Objectives. The aim of this study was to identify and compare the rugae pattern of Igbo and Ikwerre populations in Nigeria for human identification purposes. Materials and Methods. The present study was conducted from random sampling of University of Port Harcourt students. A total number of 140 subjects (70 Igbos and 70 Ikwerres) of age bracket of 18-30 were used. Results. The different shapes of rugae were obviously observed with varying degrees of predominance among the two tribes. The most predominant patterns are wavy and curvy followed by straight. The Igbos were predominantly wavy while the Ikwerres were predominantly of curve and straight patterns. The Igbo males and females had more wavy pattern with percentage values of 51.6% and 59.9% which is significantly higher in proportion (P < 0.05) as compared to the Ikwerre males and females with percentage values of 35.6% and 40.6%. On the other hand, Ikwerre males and females proved to be curve dominant with percentage values of 45.2% and 34.4% and this showed significant difference in proportion (P < 0.05) as compared to the Igbo males and females with percentage curve values of 27.9% and 26.1%. Conclusion. The result obtained from this study is clear evidence of ethnic differences in relation to sex; hence the incidence of predominance is population dependent.

Transferability of clinical skills acquired on simulator to real life clinical practice.

AIM: The aims of this study were to determine the relationship between performances of students in clinical skills laboratory and real life clinical practice and to determine the experiences and views of instructors as it relates to teaching in skills laboratory. METHODS: The performances of two randomly selected sets of graduates in the operative examinations conducted in skills laboratory were compared with the performances of the same sets of graduates in the operative examinations conducted on life patients two years later using Spearman's rank test. Experiences and views of two teachers from each of the six dental schools in southern Nigeria as it relates to teaching in clinical skills laboratory were obtained using a structured questionnaire. RESULTS: There was an insignificant correlation between the outcomes at both examinations (p value was 0.18). Most of the respondents (62.5%) agreed that teaching in skills laboratory was tiresome and most (75.0%) strongly agreed that the number of students constitutes a serious challenge to learning. Most of the respondents regarded their role in skills laboratory as that of an expert as against that of a facilitator. CONCLUSION: There was a weak correlation between performances in skills laboratory and real life environment. Students' number appears to make teaching in skills laboratory unpleasant and teachers had a wrong perception of their role.

Evaluation and treatment of failed amalgam restorations at Ibadan, Nigeria.

OBJECTIVE: Failure of tooth restoration is a major clinical problem of interest to patients, dentists and employers of labour. This study was designed to find out the average life span of amalgam as well as causes and management of failed amalgam restorations at the dental center, University College Hospital, Ibadan. The distribution of new caries in patients with this condition was also investigated. MATERIALS AND METHODS: This was an interventional study conducted among consenting patients who presented with failed amalgam restoration in our conservative clinic over a three-year period. Oral examination was conducted to detect primary caries and causes of failure of the restoration. Bitewing radiograph was taken where necessary. The following data were recorded: socio-demographic variables of the patients and their complaints; life span of the failed restorations and the treatment given. Summary statistics was generated. RESULTS: One hundred and forty three patients (54 males, 89 females) presented with 198 defective restorations. Sixty five (45.5%) of these had 118 new carious lesions which were majority occlusal cavities (66.9%). Fractured restoration was the commonest cause of failure. Management was variable, but replacement with amalgam was the commonest treatment. The average life span of restoration was 8.3 years. CONCLUSION: The average life span of amalgam restoration was 8.3 years and the major cause of failure was amalgam fracture. Replacement with amalgam was the commonest treatment.

A case of quackery and obsession for diastema resulting in avoidable endodontic therapy.

BACKGROUND: Perception of midline diastema differs among individuals and cultures. To some, it is a feature of beauty, while to others it is aesthetically appalling. From a scientific point of view, midline diastema is a deviation from normal adult dentition. It is not uncommon among some African natives to find individuals demanding for artificially created midline diastema from dental practitioners. OBJECTIVE: To present a rare case of pulpal necrosis involving maxillary and mandibular central incisors as a result of poorly executed teeth modification in a bid to create upper and lower midline diastemata. RESULT: A 23-year old lady presented with history of spontaneous, sharp, persistent pain associated with palatal swelling and discharging sinus of two weeks duration in relation to maxillary central incisors (11, 21). The complaint was preceded by a history of recurrent pain in relation to 11, 21, 31 and 41 which started soon after obtaining artificially created maxillary and mandibular midline diastemata from a dental quack. Periapical x-ray revealed periapical radiolucency in relation to 21 and 41. Vitality test confirmed necrotic pulp in the lower central incisors. The affected teeth were scheduled for root canal therapy (RCT) and porcelain fused to metal crown. The RCT of 11 and 21 had been completed but further treatment stalled due to financial constraint. CONCLUSION: This is a case of obsession for midline diastema, poor dental health education, and illegal dental practice.

Attitude and perception of mouth odour in 213 respondents.

AIMS AND OBJECTIVES: To determine respondents' perception of their breath odour and their attitude to halitosis, a symptom with social, psychological and medical implications. PATIENTS AND METHODS: Cross-sectional survey of 213 participants at an oral health education programme organised by a female non-governmental organization, at Ibadan, Nigeria. Socio-demographic variables, individual assessment of breath odour, attitude, experience and knowledge of halitosis were evaluated using a structured questionnaire. RESULTS: About 67.1% (143) did not perceive foul odour from their oral cavity at any time of the day while one respondent perceived a persistently foul breath. 83.1% would like to be told if their breath smells foul and were of the opinion that such information was helpful. 25 respondents considered such remarks embarrassing/insulting, preferring not being told. Seventy-seven (36.2%) would consult the dentist, while 13% (27) would use agents such as chewing gums and candies to mask oral malodour if their breath odour was foul. 80 respondents had been in contact with individuals with foul breath but only 38.8% of them informed the individuals with malodour that their breath odour was foul. CONCLUSIONS: Most respondents had a good impression of their breath odour and would appreciate it when informed that their breath is offensive. A few individuals were reluctant to inform people with bad breath while some took exception to such information. To reduce the present stigma and reluctance to discuss bad breath, steps must be taken to re-orientate people through public enlightenment programmes on the aetiology, available remedy for halitosis and how to convey sensitive information to people.

The prevalence and severity of dental fluorosis among secondary school children in Ibadan, Nigeria.

OBJECTIVES: This study was conducted to determine the prevalence and severity of dental fluorosis among secondary school children in Ibadan, Nigeria. MATERIALS AND METHODS: A multi-stage sampling technique was employed to select the participants who consisted of children aged 12-14 years taken from eleven randomly selected secondary schools in the five local government areas of Ibadan Metropolis. The children were examined by the Principal Investigator after submitting parental administered questionnaires. The diagnosis of dental fluorosis was based on the TF index. RESULTS: The mean age of the 1372 participants (825 males and 547 females) was 13.15 ± 0.80 years. Dental fluorosis was diagnosed in 157 (11.4%) children (98 males and 59 females). There was no statistically significant difference between age or gender and the occurrence of fluorosis. Most of the cases were very mild with greater than 90% of the affected teeth having a TF score of ≤3. The most severely affected were the maxillary molars. Severe disfiguring cases of dental fluorosis were not common among the secondary school children examined. CONCLUSION: The prevalence of dental fluorosis was found to be low, with majority of the cases being very mild.

Barriers to oral health care utilization in Ibadan, South West Nigeria.

BACKGROUND: Barriers to oral health utilization are many, but those that are significant for our environment are not yet clear. The current study was designed to identify and graduate the barriers to receipt of oral health care among a cross-section of patients attending our centre. We also investigated the influence of socio demographic factors on the highly rated barriers. METHODS: This cross-sectional study was conducted among patients visiting UCH, Ibadan using a self-administered questionnaire. Socio-demographic variables and oral health care seeking behaviour were requested and in addition, the respondents were asked to rank 11 listed barriers to receipt of oral health care and any other barriers they may think of in order of strength. Factor analysis was employed in order to identify four factors with the highest loading. The mean scores were compared using t-test and one-way ANOVA and the level of significance was set at 0.05. RESULTS: Only 400 questionnaires were properly filled (84.9%) out of the 471 that were administered. The mean age of these participants was 37.85±15.38 years. Most of the respondents (55.8%) consulted the dentists only when there was pain while 109(27.3%) had never visited the dentist. Fear of dental injection, cost of treatment, feeling of insecurity when the dentist is operating and disturbing noise from dental drill were the major barriers. There was a statistically significant association between age groups and feeling of insecurity (p=006). CONCLUSION: The major barriers to oral health care utilization among our patients were fear related.

Knowledge of medical house officers about dental specialties.

BACKGROUND: Some patients with oral diseases present initially to a general medical practitioner who is expected to refer the patients to the appropriate dental specialist for management. Thus they are expected to have a good knowledge of the different specialties in dentistry. This study was designed to determine the knowledge of medical house officers about the specialties in dentistry and how this will influence their ability to make appropriate referral. METHODS: Two hundred structured questionnaires were distributed to medical house officers in six teaching hospitals in Nigeria. The questionnaire items include: age, sex, university attended, extent of dental education received and the knowledge of oral diseases. Responses were scored and transferred to a microcomputer and analyzed with SPSS. RESULTS: Response rate was 146 (73.0%), 83 respondents (56.8%) had exposure to dentistry, while 64 (43.2%) did not. Majority of the respondents scored below 39.0%. When the responses were analyzed, the best performance was in the identification of oral diseases managed by the oral and maxillofacial surgeon (31.7%). The worst performance was recorded in the area of preventive dentistry (9.0%). The proportion of those who scored 50% and above was more among those who were exposured to dentistry. CONCLUSION: The knowledge of medical house officer about oral diseases and the specialties that manage such diseases was poor. Exposure to dental education appears to have some benefit.

Patients' attitude towards anterior teeth extraction an prosthetic replacement at the UPTH Dental Center, Port Harcourt.

AIM: The purpose of this study was to assess the attitude of patients towards anterior teeth extraction and prosthetic replacement of same at the Dental center of the University of Port Harcourt Teaching Hospital (UPTH). METHODS: A retrospective review of the data of patients who presented for anterior teeth extraction and prosthetic replacement or anterior teeth extraction only over a two-year period was done using the records of the oral surgery and prosthetic clinics of UPTH Dental centre. Demographic and clinical information were retrieved and analyzed using the SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Ninety-two patients comprising 58 males(63%) and 34 females (37%), giving a male to female ratio of 1.7:1, were involved. The age range was 6 to 86 years with a median age of 34.5 years. Forty- three patients (46.7%) had both extraction and replacement within the study period while 49 patients (53.3%) had extraction without replacement. Trauma was the major cause of anterior tooth loss, especially among males and young individuals. Plastic removable partial denture was the main type of replacement offered. Fifty percent of the females (17/34) had replacement compared to 44.8% of the males (26/58). Among those who had both extraction and replacement, majority (74.4%, 32/43) requested for replacement within a month post extraction. Also, 86.2%t of the patients below 40 years either had immediate dentures or replacement within a month compared to 50% of those above 40 years. CONCLUSION: Most of the patients, surprisingly, tolerated anterior edentulousness. However, it appears that anterior edentulousness was more abhorent to female patients and younger individuals.

HIV/AIDS and clinical dentistry: assessment of knowledge and attitude of patients attending a university dental centre.

BACKGROUND: A comprehensive test of knowledge of the public about HIV/AIDS, particularly as it relates to dentistry is not common in the literature. The objectives of this study are: to determine the current knowledge of dental patients about HIV/AIDS and its relationship with clinical dentistry; and to determine the general attitude and practice of dental patients as it relates to HIV infection. MATERIALS AND METHODS: This clinic study was conducted in the outpatient clinics, Dental Centre, University College Hospital, Ibadan. A structured anonymous questionnaire was used to collect data from randomly selected respondents. The formula n= z2pq/d2 was employed to determine the sample size. The items requested includes: educational background, awareness of HIV infection and source of knowledge, features of AIDS, high risk groups, HIV prognosis and routes of infection. Others include attitudes of respondents to HIV epidemics, infected patients, and safe sexual practices. RESULTS: Majority of the respondents (96.6%) was aware of HIV infection and the commonest source of information was TV and radio. Weight loss was the only feature of AIDS known to most of the respondents and only very few of them were aware of oral features like bleeding and painful gum (HIV gingivitis) and Kaposi's sarcoma. Most of the respondents were not aware that intravenous drug abusers and long distance drivers were high risk groups and most were not aware of the types of dental procedures during which infection could occur. Most of the respondents were aware that HIV infection has a good prognosis and most (64.3%) would like infected patients to have a special designated dental clinic for treatment of infected persons. Only about one-third use condom regularly or occasionally. CONCLUSION: Knowledge of the general and oral features of AIDS, the high risk groups and the routes of infection in dental clinical practice were not satisfactory. A cross-section of the respondents showed negative attitudes to infected patients and infection prevention strategies.

Prevalence of Dental Caries among Adult Patients Attending a Tertiary Dental Institution in South-South Region of Nigeria

Background: Oral health is an important component of the general health and dental caries status of a community is a good indicator of oral health status of that community. Epidemiological studies on dental caries are rare in the Niger Delta region of Nigeria. Aim: To determine the prevalence of dental caries among adult patients attending University of Port Harcourt Teaching Hospital Dental centre and to compare it with previously reported results. Methods: A cross-sectional study of all patients aged 18years and above presenting with dental caries at the centre over a one-year period was conducted. A self-administered anonymous questionnaire was used to get the socio-demographic data of the patients. The patients were all examined and caries was diagnosed using the WHO criteria (1997). Decay; missing and filled teeth (DMFT) were recorded and restorative index was calculated (F/F+D percent). SPSS version 15 was used to generate summary statistics and student t-test was used to compare means between two groups. Results: Out of 1;927 patients that presented during the study period; only 435 had dental caries or one of its sequelae giving a prevalence of 22.6. The mean DMFT score for the group was 3.57; that of females was 3.88 while that for males was 3.08. The difference in the mean DMFT scores between the two sexes was statistically significant (p=0.026). The restorative index was 25.3. Conclusion: The prevalence of dental caries in our centre (22.6) falls within the previously reported 4-30rates for Nigeria. The mean DMFT score was 3.51 and the restorative index is 25.3

Characteristic features of impacted denture cases in Nigeria.

OBJECTIVE: The study was designed to determine the characteristic features of impacted dentures, the patients presenting with them and to determine the pattern of distribution of cases in a cross-section of Nigerian Teaching Hospitals. MATERIALS AND METHODS: Self-administered questionnaire was distributed among Ear Nose and Throat (ENT) resident doctors during an update course at University College Hospital (UCH), Ibadan, Oyo State, Nigeria. Demographic variables, number of cases encountered over a 10-year period and characteristics of impacted dentures and those of the victims were requested. RESULT: 62.5% of the respondents indicated that the patients were males in the 30-65 years age bracket and that most of them were not satisfied with their dentures at the time of impaction. All the respondents indicated that the cases involved were partial dentures, most of which were upper acrylic dentures without clasps. The highest self-reported number of denture impaction cases (22) was recorded in Lagos University Teaching Hospital (LUTH). CONCLUSION: The preliminary report shows that cases of denture impaction usually involve upper partial dentures without clasps in dissatisfied male denture wearers within 30-65 years age bracket.

Microhardess and depth of cure of a spectrum of light-cure composite resins: a comparative study.

AIMS AND OBJECTIVES: To determine the proportion of composite resin materials that is capable of bulk or large incremental cure. MATERIALS AND METHODS: This study was carried out at the Dental Biomaterials and Biomechanics Laboratory, Dental School, University of Manchester, England. Six randomly selected composite resins and one experimental sample were employed for this study. The technique employed by Watts et al. was employed for the study. Knoop hardness number (KHN) was measured as a function of depth of the material at 0.2 mm intervals. One-Way ANOVA test and linear regression were used for statistical analysis. RESULTS: Clearfil Majesty Posterior has the highest value for microhardness and depth of cure while Els extra low shrinkage A3 has the lowest value for micro hardness and depth of cure. Estelite 0 and Clearfil Majesty Posterior (28.6%) have depths of cure greater than 3.0 mm and may, therefore, be capable of large incremental cure. Gradia Dentin and Els extra low shrinkage A3 (28.6%) have depths of cure lesser than 2.0 mm while Filtek Silorane (experimental material) has a depth of cure of 2.4 mm. NEUN and Els extra low shrinkage A2 have depths of cure of 2.3 and 2.5 mm respectively. CONCLUSIONS: It appears that Clearfil Majesty Posterior and Estelite 0 (28.6%) can effectively be cured in bulk or large increments. It is imperative to investigate the depth of cure of composite resin materials before using them in bulk or large increments.

Knowledge and self-perception of breath odour amongst house officers at the University College Hospital, Ibadan, Nigeria.

OBJECTIVE: This study assessed the knowledge and perception of house officers on halitosis in the University College Hospital, Ibadan. PATIENTS AND METHODS: Questionnaires including items relating to knowledge of halitosis, awareness and timing of bad breath, oral hygiene habits and opinions on other issues related to bad breath were administered to the subjects. RESULTS: Only seventeen (15.5%) of the 110 respondents knew that halitosis refers to malodour originating from the oral and nasal cavities while five (5%) were of the opinion that halitosis is only a cosmetic problem. Furthermore, thirty nine (35.5%) preferred not being told by a friend or colleague if their breath smells badly. CONCLUSION: The knowledge and perception of the newly qualified doctors to halitosis in this study is unsatisfactory. Therefore, concerted efforts should be made to improve them. This could be achieved by more emphasis on this subject during their undergraduate training.

Attitudes and perception of Nigerian dentists about shortened dental arch therapy (SDAT).

OBJECTIVE: The shortened dental arch therapy (SDAT) is a strategy to reduce complex restorative treatment in the molar area. By offering the partially dentate patients, a treatment option that ensures oral functionality, improved oral hygiene, comfort and possibly reduced costs, the SDA treatment approach appears to provide an advantage without compromising patient care. Despite these encouraging reports, it has been stated that there are few papers in the literature addressing clinical attitudes to SDAT. The current study is, therefore, designed to determine the attitude and perception of dentist in Nigeria about the concept. MATERIALS AND METHODS: A cross-sectional study was conducted using a self-administered structured questionnaire. The questionnaire employed by Sarita et al. was modified and employed as the instrument for data collection. The respondents were requested to provide information about their socio-demographic variables and their attitudes and perception of SDAT. The questionnaires were randomly distributed among general dental practitioners and residents (postgraduate doctors) in dental training institutions in Nigeria. RESULT: The clinical experience of most of the respondents was < or = 10 years. Most of the respondents were working in government institutions. Few of the respondents (36.1%) indicated that the concept was good for developing country like Nigeria and only few of the respondents (38.0%) agreed with the problem-oriented approach. Most respondents indicated that patients with shortened dental arches are not nutritionally less healthy and that, the oral functions and TMJ health of these patients is acceptable. CONCLUSION: It appears the attitude and perception of dentists in Nigeria as it relates to shortened dental arch concept is not impressive at the moment.

Dental Anxiety: Investigative and Management Techniques often Employed in a Cross Section of Nigerian Specialist Dental Clinics

Background: Information on the pattern of dental anxiety management in Nigeria is currently not available. Aim: The study was designed to determine the awareness and frequency of application of dental anxiety assessment questionnaires as well as the current pattern in the management of dental anxiety in Nigeria. Methods: The cross-sectional study was conducted using structured questionnaires distributed among dental residents and house officers in Nigerian dental schools. Information requested included demographic variables; frequency of presentation of dental anxiety; awareness and frequency of application of dental anxiety questionnaires. The respondents were also asked to rate the frequency of application of the outlined dental anxiety management techniques on a 5-point Likert scale. The median score and the range for each technique was determined and compared between the male and female respondents. Results: A total of 96 questionaires were sent out to dental surgeons of all grades. Response was obtained from 86 giving a response rate of 90. Only 23 (26.7) respondents were aware of dental anxiety questionnaires while only 13 (15.1) have seen the instrument applied. The percentage of patients with dental anxiety was estimated by the respondents to be 20. Behaviour therapy was the most frequently employed dental anxiety management technique. The female respondents employ behaviour therapy and intramuscular sedation more frequently. Conclusion: The awareness and frequency of application of dental anxiety questionnaires appeared poor. Behaviour therapy was the most frequently employed dental anxiety management technique. It appears the female respondents employ behavior therapy and intramuscular sedation more frequently

Implications of antibiotics and oral contraceptive interactions: knowledge and practice of dental surgeons.

OBJECTIVES: Unplanned pregnancies may result if antibiotics are prescribed for women using combined oral contraceptive (COC).The current study is designed to determine: the rate and pattern of antibiotic prescription during a normal week, the awareness of Nigerian dentists about possible drug interaction between antibiotics and oral contraceptives, and to determine the knowledge of Nigerian dentists about additional preventive measures to be employed by patients on combined oral contraceptive being placed on broad spectrum antibiotics. MATERIALS AND METHODS: A cross-sectional study was conducted in 3 tertiary and 2 secondary health institutions in Nigeria using dental House Officers and Residents as subjects. Medical House officers were employed as control. An open and close ended questionnaire that sought for information about types and number of times antibiotics are prescribed per week, influence of some medical conditions and drugs like contraceptive on choice of antibiotics and knowledge of relevant advice to be given to patients on oral contraceptive being given broad spectrum antibiotics was employed. RESULTS: Antibiotics are prescribed 1-3 times per week by most dental graduates during a normal week. The antibiotics frequently prescribed by both the cases and the control include: Amoxicillin and Metronidazole. The dentists' decision to select appropriate antibiotics is influenced by the presence of pregnancy (90.52%) and penicillin allergy (85.34%). Only 59.48% of the dentists admitted being so influenced by current history of contraceptive use. Two respondents knew and gave relevant advice on additional preventive measure to be employed by patients on pills being given antibiotics CONCLUSION: This initial report suggests that Nigerian dentists are not well informed about the potential interaction between antibiotics and combined oral contraceptive and the extra precautions to be taken when antibiotics is prescribed for women on COC pills. A cross-section of Nigerian dentists prescribed antibiotics 1-3 times during a normal week.

Bilaterally impacted supplemental premolar: a case report and review of the literature.

BACKGROUND: It has been described as interesting to encounter supplemental teeth, as the condition rarely occurs. The purpose of this report is to add to the scanty literature on the subject of supplemental teeth and to emphasize the significance of full-mouth radiograph for every patient at the initial dental consultation. METHOD: A case of an 18 year old young lady with incidental finding of bilaterally impacted supplemental premolar is presented together with a review of the literature. RESULT: The patient presented with a recurrent history of toothache and palatal swelling of 1 year duration in relation to a slightly discoloured upper left central incisor. Examination revealed an incidental finding of bilaterally impacted supplemental premolar causing pressure effect on adjacent teeth. CONCLUSION: A full mouth clinical and radiological examination of every patient presenting at the dental clinic for the first time should not be taken for granted.

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation.

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.