Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report.

In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.

Determinants of Oral Diseases in the African and Middle East Region.

Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual and community. Interventions in health promotion programs in the AMER need more research on the epidemiology of oral diseases and the role played by the social determinants of oral diseases, especially with regard to poverty. The high levels of poverty and low gross domestic product in most countries in the African region make it difficult to fund high-quality, affordable, accessible oral health services.

Knowledge, attitudes and practices of oral health professionals with regard to the hepatitis B virus in their workplace, Harare.

Objective: To assess the knowledge, attitudes and practices of Harare oral health professionals regarding Hepatitis B Virus (HBV) in the workplace. Design: A cross sectional study was conducted using a structured 36 item interviewer administered questionnaire to collect data from consenting participants. Setting: The study was conducted at private and public dental practices in Harare. Participants: Oral health professionals comprising dentists, dental therapists and technicians were purposively sampled and interviewed. Results: Eighty nine study participants were interviewed. Seventy four (83%) and 69 participants (77.5%) knew about the potential transmission through contact with blood and saliva respectively. Forty seven (52.8%) participants knew that HBV infection is incurable. Thirty five participants (39.3%) were unaware of the ability of HBV to remain infective in dried blood. Although 22 participants (25%) stated that there was potential for transmission of HBV to patients at their workplace, 81participants (92%) felt they were at risk of contracting HBV infection at work. Sixty one participants (69%) reported being vaccinated, but on verifying the vaccine doses the participants received, 35 (39.3%) received three doses, 15(17%) two doses and 11 (12.4%) one dose. Forty six per cent of the fully vaccinated participants (16 of 35) had a post-HBV vaccination test. Seventy nine (87%) and 83(93.3%) professionals stated consistent use of face masks and gloves during procedures respectively. Conclusion: Although the oral health professionals in Harare appreciated the risk of HBV transmission in dental settings, they had incomplete knowledge of HBV infection and there was poor uptake of HBV vaccination among these professionals.

Osteosarcoma of the jaws: a 23 year retrospective review.

OBJECTIVE: To review 31 cases of osteosarcoma of the jaws in Zimbabwe, and to retrospectively study the age, gender, site distribution, clinical features and treatment outcome ofjaw osteosarcoma in Zimbabwe. DESIGN: Descriptive. SETTING: Oral and Maxillofacial surgical clinics at two specialist referral hospitals, Harare Central Hospital and Parirenyatwa Government Hospital, Harare, Zimbabwe. SUBJECTS: 31 cases ofosteosarcoma of the jaws. METHOD: Clinical records of patients who presented with osteosarcoma of the jaws during the period January 1981 to December 2003 were reviewed for age, gender, site of lesion, radiology, histopathology, treatment outcome and follow up. RESULTS: There were 31 cases of jaw osteosarcoma during the 23 year period: 45.2% (n=14) males and 54.8% (n=17) females, mean age 27 years. Of the cases 83.9% occurred in the mandible and 16.1% in the maxilla. Surgery was the treatment of choice. The majority of patients were lost to follow up within 12 months. CONCLUSION: Jaw osteosarcoma is most common in the mandible with an equal male and female affliction in a relatively young age group.

Acinic cell carcinoma of the submandibular salivary gland presenting as a large cyst.

Acinic cell carcinomas are rare tumours of salivary gland origin, most commonly seen in middle-aged women and predominantly in the parotid gland. The case of a long-standing, predominantly cystic, acinic cell carcinoma located in the submandibular gland of a child is presented here. The tumour was successfully removed and there has been no recurrence.

Sarcomas of the oral and maxillofacial region: a review of 88 cases in Zimbabwe.

We reviewed the case notes of 88 patients who were treated for sarcomas of the oral and maxillofacial region over a period of 24 years. There were 51 men (mean age 23 years) and 37 women (mean age 29). Forty-six tumours were in the mandible. Osteosarcoma accounted for 31 cases, and rhabdomyosarcoma 21 (usually under the age of 10 years).

Oral malignant neoplasia: a survey of 428 cases in two Zimbabwean hospitals.

A review of oral malignant neoplasms biopsies accessioned in the pathology services of Harare Central Hospital and Parirenyatwa Hospital, Harare, Zimbabwe, during the 10year period January 1982 to December 1991 was carried out. Clinical records of 428 patients with histologically diagnosed oral malignant neoplasms by ICD-O type and site (COO.O-CO6.9) were retrieved and analyzed for gender, age, history of tobacco and alcohol usage, neoplastic type and histologic differentiation of squamous cell carcinoma (8000/3). Oral malignant neoplasms constituted 24.8% (n = 428) of the 1723 biopsies accessioned in the department during this period. There was a male to female ratio of 1.9:1, with lesions being most common in the 41-60 year age group. Squamous cell carcinoma, (8070/3) 73.1%, was the predominant oral malignancy most common in the 61-70 year age group with 21.1% on the mandibular gingivae (CO3.1), 20.5% on the tongue (CO1.9-CO2.9), 18.5% on the floor of the mouth (CO4.9) and 10.5% each on the maxillary gingivae (CO3.O) and buccal mucosa (CO6.O). The hard palate (CO5.9) had 9% of the lesions. Lip malignancy (COO-COO.9 and C44.0), inclusive of mucosa of lip, vermilion and skin, constituted 3.3% and minor salivary gland (CO6.9) malignancy (M-8940/3) 4.9%. The remaining oral malignancies, 11%, included Burkitt's lymphoma (M-9687/3) 4.7%; Kaposi's sarcoma (M-9140/3) 3.7%; osteosarcoma (M-9180/3) 2.6% and malignant melanoma (M-8720/3) 1.9%. Fourty five percent of the patients admitted tobacco and alcohol consumption, of whom 95% were males. Oral malignant neoplasms were more common in males than females and occurred in a relatively young age group. Well-differentiated squamous cell carcinoma (M-8070/31) was the most common oral malignant neoplasm and was most frequently found on the mandibular gingivae (CO3.1), tongue (CO1.9-CO2.9) and floor of the mouth (CO4.9). The lip (COO-COO.9) was least affected with a high palatal (CO5.9) involvement.

Mandibular fracture in a neonate: report of a case.

Neonatal mandibular fractures are rare and are mostly due to traumatic delivery. Attempted infanticide has also been reported as a cause. A case of a fractured mandible in a neonate assaulted by its mother suffering from postpartum psychosis is presented.

Lip cancer in Zimbabwe. Report of 14 cases.

Lip cancer, relatively common among fair-skinned males, is uncommon among Black-skinned males. In a 10-year review period of 358 Black African patients with orofacial squamous cell carcinoma, 3.9% (n = 14) were found on the lip with a male to female ratio of 2.5:1. Fifty percent (n = 7) of the patients were albinos and two were children with xeroderma pigmentosum. The lower lip was most commonly affected (78.6%). The well-differentiated and moderately differentiated histopathologic types each comprised 42.9% of the lesions. Alcohol consumption and tobacco usage was admitted to in 42.9% (n = 6) of the patients.

Treatment of median cleft of the lower lip, mandible, and bifid tongue with ankyloglossia. A case report.

A case of complete median cleft of the lower lip and mandible and bifid tongue with ankyloglossia is presented. Unlike other reported cases of similar disorders, no other abnormalities were present. A satisfactory result was achieved with early surgical correction of both hard- and soft-tissue defects.

Salivary gland tumours in Zimbabwe: report of 282 cases.

Tumours of the salivary glands are relatively uncommon. In a review of 282 black patients seen at Harare Central Hospital, Zimbabwe, the relative incidence of various tumour types and the age and sex distribution were similar to those reported in other series. There were more tumours of the minor salivary glands than in reported Western series. There were more tumours of the minor salivary glands than in reported Western series. Pain and rapid growth were significant in distinguishing malignant from benign tumours. Malignant tumours were more common in elderly than in young patients.

Ameloblastoma in children. The Zimbabwean experience.

A retrospective study of 20 patients aged 18 years and younger with ameloblastoma seen over a 10-year period at Harare Central Hospital, Harare, Zimbabwe, was carried out. Males and females were equally affected. The mandible was the most commonly involved bone (95%); the premolar/canine incisor area was commonly affected (69.1%). Incision biopsy was done before wide surgical resection of the involved bone. No currettage or enucleation was used as a mode of treatment. Immediate reconstruction was performed with metallic implants. Twenty percent of the lesions had a unilocular radiologic appearance that resembled a dentigerous cyst. Follow-up was poor.

Pleomorphic adenoma of the salivary glands. Clinicopathologic study of 206 cases in Zimbabwe.

A review of 206 pleomorphic adenomas seen over a 10-year period was carried out. Fifty-eight percent of the tumors were in females. The tumor was common in the 3rd, 4th, and 5th decades with 39.8% of the tumors occurring in the parotid gland.

Ameloblastoma: the Zimbabwean experience over 10 years.

OBJECTIVES: A review of 117 ameloblastomas treated over a 10-year period was carried out. STUDY DESIGN: Clinical records of 117 patients treated for histologically diagnosed ameloblastoma were retrieved and analyzed for age, sex, anatomic distribution, duration of lesions, clinical features, and treatment methods with results and complications. RESULTS: Men and women were equally affected. The average age at the time of presentation was 28 years; 95.7% of the ameloblastomas occurred in the mandible; and 59% occurred in the premolar/incisor/canine region. CONCLUSION: Ameloblastoma occurs predominantly in the anterior mandible with equal frequency in men and women. Wide resection reduces recurrence.

Temporomandibular joint ankylosis: review of thirty-two cases.

I have reviewed aetiology, sex, age at time of treatment, clinical features, radiographic findings, anaesthetic techniques, surgical treatment, complications, and results in 32 patients with ankylosis of the temporomandibular joint. Trauma and infection were the commonest causes of ankylosis: 50% and 41%, (n = 13), respectively. The 21-30 year age group had the most trauma cases. Twenty (63%) of the patients presented with bilateral ankylosis. Failing to do jaw-opening exercises was the main cause of relapse.

Mandibular fractures, analysis of 541 cases.

A retrospective analysis of 541 patients with mandibular fractures seen at Harare Central Hospital, Harare, Zimbabwe, was undertaken. The aetiology, sex incidence and anatomical sites of fractures are different from those in other series; with 89.8 per cent of the fractures due to assaults, 5.6 per cent due to road traffic accidents; 90.9 per cent of the patients were males, the body of the mandible being most commonly fractured, 42.3 per cent.

Congenital melanotic neuroectodermal tumour of infancy: report of a case.

A case of a congenital melanotic neuroectodermal tumour in a male neonate is described. Management consisted of wide excision of the tumour as opposed to simple enucleation.

Supernumerary teeth: literature review.

A review of the literature on supernumerary teeth in general and supernumerary molars in particular was carried out on prevalence, aetiology, complications and the treatment of supernumerary teeth. Additional teeth are relatively common and are usually of simple conical shape (supernumerary teeth) but may resemble teeth of the normal size and shape. The aim of this review is to provide reference material for dental practitioners in Zimbabwe.

Orofacial biopsies: a survey of 1,723 cases seen over a 10 year period.

OBJECTIVES: To determine the distribution pattern of orofacial lesions according to age, sex, anatomic location and to compare the findings with reported African and Western series. DESIGN: A survey of 1,723 orofacial biopsies over a 10 year period. SETTING: The Oral and Maxillofacial Surgery Department of Harare Central Hospital, Harare, Zimbabwe, the major referral centre in the country. SUBJECTS: Records of 1,723 patients who had orofacial biopsies were surveyed. RESULTS: Males were relatively more frequently affected (54.5pc) than females. Non-odontogenic lesions were seen relatively frequently and these constituted 55.9pc of total cases; 39.3pc of the non-odontogenic lesions were epidermoid carcinoma. Ameloblastoma comprised 79.1pc of odontogenic lesions; 22.9pc of cystic lesions were dentigerous cysts. CONCLUSION: The distribution pattern of oro-facial lesions is similar to that in other reported studies. Ameloblastoma is the most frequently seen odontogenic tumour. Minor salivary gland neoplasms were seen in relatively large numbers and in a younger age group compared to reported series. This finding is similar to other African series.

Odontogenic tumours: analysis of 148 cases in Zimbabwe.

OBJECTIVE: To review the histopathological and clinical data on odontogenic tumours. DESIGN: A retrospective study of 148 odontogenic tumours seen over a 10 year period. SETTING: Department of Oral and Maxillofacial Surgery at Harare Central Hospital, Harare, Zimbabwe. SUBJECTS: Histopathologic records of patients with odontogenic tumour. MAIN OUTCOME MEASURES: Age and sex distribution of the various tumours. Frequency distribution of tumours. RESULTS: From a total of 1723 biopsies over a 10 year period, 8.6pc were tumours of odontogenic origin. Ameloblastoma comprised 79.1pc of the odontogenic tumours. CONCLUSION: Odontogenic tumours are uncommon lesions,8,6pc. Ameloblastoma is the commonest odontogenic tumour, 79.1pc. The only malignant odontogenic tumour noted was ameloblastic fibro-sarcoma, 0.7pc.