Dental Practitioners' Knowledge, Attitude, and Practice in Caries Risk Assessment and Management: A Cross-sectional Survey in Kampala Metropolitan, Uganda.

AIM: The objective of this study was to determine the knowledge, attitude, and practices regarding caries risk assessment (CRA) and management among dental practitioners in Kampala Metropolitan, Uganda. MATERIALS AND METHODS: This cross-sectional study was conducted among 270 dental practitioners in Kampala Metropolitan, Uganda, in May 2021. The participants were dental surgeons and public health dental officers. A self-administered structured questionnaire was used to collect data. The questionnaire included items about participants' sociodemographic characteristics, knowledge, attitude, and practices in CRA and management. Attitude and practices were rated using different Likert scales. Descriptive statistics, Chi-square/Fisher's exact and one-way analysis of variance (ANOVA) with post-hoc Bonferroni tests were used to analyze the data. The significance level was set at p <0.05. RESULTS: About 60.7% of the participants were public health dental officers with a median age of 30 years (interquartile range [IQR], 27-60). Overall, the participants were familiar with the current concepts regarding CRA and management. More than 70% of the participants correctly identified risk factors and indicators of dental caries. Most participants (98.5%) had a positive attitude toward performing CRA. However, their practices regarding caries management were inadequate as majority (>75%) of participants reported that they never or occasionally recommended evidence-based products like topical fluoride, probiotics, or xylitol products in the prevention and management of dental caries. Dental surgeons had significantly better knowledge and practices than public health dental officers (p <0.05). CONCLUSION: In the present study, the participants were familiar with the current concepts about CRA and had a positive attitude toward CRA. However, their practices regarding caries prevention and management were inadequate. CLINICAL SIGNIFICANCE: The study provided baseline data about knowledge, attitude, and practices regarding CRA and caries management among dental practitioners in Uganda. It is recommended to design training courses in evidence-based protocols in the prevention and management of dental caries for dental practitioners in Uganda.

Prevalence, pattern and perceptions of cleft lip and cleft palate among children born in two hospitals in Kisoro District, Uganda.

BACKGROUND: Cleft lip with or without cleft palate is one of the most common congenital anomalies that affect the oro-facial region. The aim of the study was to determine the period prevalence, pattern and perceptions of cleft lip and cleft palate in children born between 2005 and 2010 in two hospitals in Kisoro District, Uganda. METHODS: The study involved a retrospective review of medical records of mothers who delivered live babies between January 2005 and December 2010 in Kisoro Hospital and St. Francis Hospital, Mutolere in Kisoro District. Key informant interviews of mothers (n = 20) of the children with cleft lip and/or clip palate and selected medical staff (n = 24) of the two hospitals were carried out. The data were analysed using descriptive statistics. RESULTS: Over the 6 year period, 25,985 mothers delivered live babies in Kisoro Hospital (n = 13,199) and St. Francis Hospital, Mutolere (n = 12,786) with 20 babies having oro-facial clefts. The overall period prevalence of the clefts was 0.77/1,000 live births. Sixty percent (n = 12) of children had combined cleft lip and palate and the same proportion had clefts on the left side of the face. More boys were affected than girls: 13 versus 7. About 45% of mothers were hurt on realizing that they had delivered a child with an oro-facial cleft. Forty percent of mothers indicated that a child with oro-facial cleft was regarded as an outcast. About 91.7% (n = 22) of the medical staff reported that these children were not accepted in their communities. Surgical intervention and psychosocial support were the management modalities advocated for by most respondents. CONCLUSION/RECOMMENDATIONS: The period prevalence of combined cleft lip and palate in two hospitals in Kisoro District was comparable to some findings elsewhere. Cleft lip and cleft palate are a medical and psychosocial problem in Kisoro District that calls for sensitization and counseling of the families and communities of the affected children. The policy makers need to strategically plan for provision of rehabilitation with feeding obturators to facilitate easy feeding to gain weight before surgical intervention of the affected children.

Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda.

BACKGROUND: Literature reports have indicated an increase in research evidence suggesting association between periodontal disease and the risk of pre-term birth (PTB) and low birth weight (LBW). Periodontal diseases in Uganda have been documented as a public health problem, but their association to adverse pregnancy outcomes is unknown. This study was conducted to assess the association between periodontital diseases in postpartum mothers and PTB and LBW of babies in Mulago and Mbarara referral hospitals. METHODS: This was a cross sectional study using medical records, clinical examination and oral interview of mothers at the two tertiary health facilities. Mothers with singleton babies from Mulago (n = 300) and Mbarara Hospital (n = 100) were recruited for the study. The women were clinically examined for periodontal disease by 2 trained and calibrated dentists. Data on PTB and LBW were retrieved from medical records. The data were analyzed to determine the relationship between the four parameters for periodontal disease (bleeding gingiva, periodontal pockets, gingival recession and calculus with plaque deposits) and the adverse pregnancy outcomes. Frequency distribution was used to describe the data. Bivariate and multivariate analyses were used to study the association between the periodontal diseases and adverse pregnancy outcomes. RESULTS: Approximately 26% and 29% of the postpartum mothers examined had bleeding gingiva and periodontal pockets of 4 mm or more deep, respectively. Advanced periodontitis i.e. pocket depth ≥ 6 mm was recorded in 13 (3.6%) of the mothers. Calculus with plaque deposits were recorded in 86% (n = 343) of the mothers. Gingival recession was recorded in 9.0% of the mothers and significantly and directly related to birth weight (p < 0.05). CONCLUSION: Periodontal conditions of postpartum mothers in this study were found to be better than previously reported amongst the Ugandan population. Bivariate analysis showed a significant association only between gingival recession and low birth weight. However, this finding should be interpreted with caution as it could have occurred by chance.

Weight, height and eruption times of permanent teeth of children aged 4-15 years in Kampala, Uganda.

BACKGROUND: Tooth eruption is a continuous biological process by which developing teeth emerge through the jaws and the overlying mucosa to enter into the oral cavity. Tooth eruption time and sequence are important factors in dental treatment planning, particularly in orthodontics, but also in forensic dentistry to estimate age of a child. Tooth eruption time is influenced by many factors. In this study we set out to determine the timing of eruption of permanent teeth and assess its association with the height and weight of school children aged 4-15 years in Kampala, Uganda. METHODS: This was a cross sectional study comprising of 1041 healthy Ugandan children: boys/girls (520/521) who were consecutively selected from two primary schools in Kampala. The children were clinically assessed for tooth emergency through the oral mucosa as well as measuring their weight and height. The mean and standard deviation of tooth eruption time was estimated for boys and girls. Bivariate analysis was used to assess any significant association between tooth eruption time and demographic variables. Pearson and partial correlation analyses were used to assess any significant association between the tooth eruption time and anthropometric measurements of the children. RESULTS: Generally, the mean eruption times for girls were lower compared to boys except for three teeth (#25, #32 and #42) which erupted earlier in boys. The average difference in mean eruption times of all teeth between boys and girls was found to be 0.8 (range, 0-1.5) years. In partial correlation analysis, mean tooth eruption times were positively, but not significantly associated with height while controlling for weight except for the mandibular left central incisor (#31). On the other hand, in partial correlation analysis, mean tooth eruption times were positively associated with weight while controlling for height except for tooth #11, #16, #26 and #41. The weight of the child was significantly correlated with mean eruption times in 50% of the teeth. CONCLUSION: In the present study, the mean tooth eruption times for girls were lower compared to boys except for three teeth (#25, #32 and #42). The height of the child did not show any significant influence on the tooth eruption times while the influence of weight on tooth eruption times was non-conclusive.

Prediction of width of un-erupted incisors, canines and premolars in a Ugandan population: a cross sectional study.

BACKGROUND: Accurate prediction of the space forms an important part of an orthodontic assessment in the mixed dentition. However the most commonly used methods of space analysis are based on data developed on Caucasian populations. In order to provide more accurate local data we set out to develop a formula for predicting the widths of un-erupted canines and premolars for a Ugandan population and to compare the predicted widths of the teeth from this formula with those obtained from Moyers' tables, and Tanaka and Johnston's equations. METHODS: Dental casts were prepared using mandibular and maxillary arch impressions of 220 children (85 boys/135 girls) aged 12-17 years recruited from schools in Kampala, Uganda. The mesio-distal width of the mandibular incisors, mandibular and maxillary canines and premolars were measured with a pair of digital calipers. Based on regression analysis, predictive equations were derived and the findings were compared with those presented in Moyers' probability tables, and Tanaka and Johnston's equations. RESULTS: There were no statistically significant differences between the tooth widths predicted by our equations and those from Moyers' probability tables at the 65th and 75th percentile probabilities for the girls and at 75th level in boys in the mandibular arch. While in the maxillary arch no statistically significant differences at the 75th and 95th levels were noted in girls. There were statistically significant differences between predicted tooth sizes using equations from the present study and those predicted from the Tanaka and Johnston regression equations. CONCLUSIONS: In this Ugandan population, Moyers' probability tables could be used to predict tooth widths at specific percentile probabilities, but generally, Tanaka and Johnston technique tends to overestimate the tooth widths.

Assessment of factors associated with dental caries in rural communities in Rakai District, Uganda.

To assess factors associated with dental caries in rural communities in Rakai District, Uganda. This was a cross-sectional survey in 18-62 year olds, randomly selected from three sub-counties: Kyalurangira (n = 121), Kabira (n = 133), and Kacheera (n = 67). The participants were clinically examined for caries using Decayed Missing Filled Teeth (DMFT) index and were administered to a structured questionnaire. In the whole material, caries prevalence (DMFT score > 0) was 57.3% and the mean DMFT score was 2.3. The M-component contributed 61% of the DMFT scores. Using bivariate analyses, age, consumption of sugared snacks and tobacco smoking were directly and significantly associated with development of dental caries. Tooth cleaning and previous dental visits were indirectly and significantly associated with dental caries. In binary logistic regression analyses, the participants who were older were four times and those who consumed sugared snacks were 11 times more likely to develop dental caries as compared to their counterparts. The participants who cleaned their teeth or who had visited the dentists were less likely to develop dental caries as compared to their counterparts. The odds ratios were 0.6 and 0.5, respectively. Based on stepwise multiple linear regression analyses, age, previous dental treatment, consumption of sugared snacks, tooth cleaning and tobacco smoking explained a total of 46% of the variations in DMFT scores. Caries prevalence and severity were relatively low in this population. Although a number of independent variables were significantly associated with caries they gave a modest overall multivariate model.

Prevalence and factors associated with dental caries among children and adults in selected districts in Uganda.

OBJECTIVE: The aim was to determine the prevalence and factors associated with dental caries among adults and children in seven districts of Uganda. METHODS: Participants aged 11-13 (n=1230) and 35-44 years (n=648) were randomly selected from urban and rural areas of Gulu, Soroti, Jinja, Masaka, Kabale, Kabarole and Hoima districts. They were examined by 4 trained and calibrated dentists for dental caries using Decayed, Missing and Filled teeth index as described by World Health Organisation. RESULTS: Overall mean DMFT score was 0.73 for children and 4.71 for adults. Generally, there was a higher mean DMFT score in the rural (2.19) compared to urban areas (1.97). In all the districts, except Hoima, there was a higher mean DMFT score of children in rural compared to urban. In adults, similar trend was mainly registered in Masaka, Hoima and Gulu districts. Most participants (79.9%, n=1309) occasionally ate sugared snacks. Overall, 95% (n=1795) of the participants cleaned their teeth with plastic tooth brushes (71.7%) and chewing sticks (8.3%). CONCLUSION: Although the severity of dental caries was low, the disease was widespread in the study population. A high proportion of participants reported consumption of sugared snacks and drinks, which calls for oral health education.

Oral Manifestations in HIV/AIDS-Infected Children.

OBJECTIVES: To assess factors influencing the distribution of oral manifestations in HIV/AIDS-infected children attending the Paediatric Infectious Disease Clinic in Mulago Hospital, Kampala. METHODS: This was a cross-sectional study comprising 237 children (males/females: 113/124) aged 1 to 12 years. The parents/guardians were interviewed to obtain demographic information, oral hygiene practices, dietary habits and health seeking behaviours as well as any medications taken. The children were clinically examined for oral lesions based on World Health Organization criteria with modifications. RESULTS: About 71.7% of the children cleaned their teeth. About 16.9% of the children had visited a dentist since birth, mainly for emergency care. One or more oral lesions were recorded in 73% of the children of whom 19.0% experienced discomfort during oral functions. Cervical lymphadenopathy, oral candidiasis and gingivitis were the most common soft tissue oral lesions: 60.8%, 28.3% and 19.0%, respectively. Except for dental caries, the overall frequency distribution of soft tissue oral lesions was significantly lower in children on highly active antiretroviral therapy (HAART) as compared to their counterparts not on HAART. The prevalence of dental caries in deciduous and permanent dentitions was 42.2% and 11.0%, respectively. Tooth brushing and previous visits to the dentist were indirectly and significantly associated with dental caries. About 5.9% (n=14) of the children had <200 CD3 + CD4 T-lymphocyte cells per µl of blood. CONCLUSIONS: The majority of the children had one or more oral lesions, particularly in the group not on HAART. Some of the lesions were associated with discomfort during oral functions.

Root and canal morphology of mandibular first and second permanent molar teeth in a Ugandan population.

We investigated root and canal morphology of permanent mandibular molar teeth in a Ugandan population. Mandibular first (n = 224) and second (n = 223) molars were collected from patients visiting dental clinics in Kampala and prepared by a clearing technique. An endodontic access cavity was prepared in each tooth. The teeth were consecutively immersed in 5% sodium hypochlorite, 10% nitric acid, and 99% methyl salicylate. India ink was coronally injected into the pulp chamber and withdrawn apically by suction. The teeth were viewed under a magnifying lens and the numbers of root canals and their configurations, lateral canals, intercanal communications, and multiple apical foramina were recorded, along with the number of roots and their morphology. Student's t test for independent samples was used to assess significant differences in the root canal system. All specimens were two-rooted with one mesial and one distal root. Root fusion was more frequent in the second than in the first molar: 3.2% versus 0.4%. Vertucci type IV canal configuration was most frequently recorded in the mesial root of the first (44.6%) and second (49.8%) molars. Type 1 canal configuration was predominant in the distal root in first (84.8%) and second (94.2%) molars. Multiple apical foramina were more frequent in the first than in the second molar, as were intercanal communications and lateral canals. Type I and IV canal configurations were predominant in the distal and mesial roots, respectively, of both the first and second molars.

Prevalence of oral diseases/conditions in Uganda.

OBJECTIVES: The aim was to report the prevalence of oral diseases/conditions among a Ugandan population. METHODS: Subjects aged 12 (n=696) and 35-44 years (n=396) were chosen from randomly selected urban and peri-urban areas of Arua, Mbale, Kampala and Mbarara districts. They were clinically examined by 4 trained and calibrated dentists for oral diseases/conditions using criteria described by World Health Organisation. RESULTS: Dental caries (DMFT >or=1) was recorded in 40% and 62.5% of the children and adults, respectively. The overall mean DMFT score was 0.9 for children and 3.4 for adults. Caries was significantly more severe in females as compared to males in children (p<0.05), whereas in adults, there was no significant gender difference. Kampala had a significantly higher mean DMFT score compared to other districts in all age groups (p>0.05). Culculus deposits were generally, more prevalent in adults as compare to children except in Mbarara district. Gum bleeding was also significantly more prevalent among children as compared to adults (p<0.05). Significantly higher prevalence of gum bleeding in both children and adults was recorded in Arua district as compared to other areas (p<0.05). Each of the age groups had a prevalence of malocclusion of 61%. However, the severity of malocclusion varied between age groups and districts. The prevalence of dental fluorosis was 3% and 4% for children and adults, respectively. All subjects in Arua district were fluorosis-free. Tetracycline enamel staining was less than 1% in both age groups. Enamel attrition was more prevalent in adults as compared to children: 19% versus 1%. CONCLUSION: The prevalence of oral diseases/conditions was generally low among the study population. Caries experience was significantly higher in the Kampala (urban) district as compared to rural districts in all age groups; the D - component being the major contributor.