Dental Caries, Traumatic Dental Injuries and Gingivitis among Street-Children in Kano, Nigeria.

BACKGROUND: Street-children (Almajirai) constitute a significant proportion of the adolescent population in northern Nigeria. They face health challenges, especially oral health, from being inadequately protected, supervised or directed by responsible adults. OBJECTIVES: The objective of the study was to determine the prevalence of dental caries, dental trauma, gingivitis and oral hygiene scores in street-children. METHODOLOGY: Three hundred and sixty-six school-aged children were selected through a multi-stage sampling of 10 to 12-year-old children from four modern and traditional qur'anic schools, and examined for oral conditions using the WHO protocol. The DMFT index, the modified Ellis criteria, the Gingival Bleeding Index and the Oral Hygiene Index-Simplified (OHI-S) were used to assess dental caries, traumatic dental injuries, gingivitis and oral hygiene scores respectively. Chi-squared tests and Odds Ratio were used to compare the difference and test the association between Almajirai groups. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS version 20). Statistical significance was considered when p < 0.05. RESULTS: One hundred and sixty eight (45.9%) traditional Almajirai and 198 (59.4%) modern-type Almajirai, participated in the study. Their mean age was 10.8(±0.8) years. The prevalence of dental caries was 25.4% with mean DMFT and SiC scores of 0.6 (±1.3) and 1.7 respectively. DMFT scores ranged from 0 to 12. The prevalence of traumatic dental injuries and gingivitis were 8.7% and 82.2% respectively, while the OHI-S score was 3.0. The odds for traumatic dental injuries were 41% less in the modern-type Almajirai (p=0.02); the modern-type Almajirai were twice as likely to develop gingivitis (aOR 95%CI =2.0, p=0.01). OHI-S scores showed poorer oral hygiene levels in the modern Almajirai (p=0.02). CONCLUSION: Dental caries, traumatic dental injuries, gingivitis and poor oral hygiene were prevalent among street-children in Kano. There is a high level of untreated dental disease in the study population.

CONTEXTE: Les enfants des rues constituent une proportion importante de la population adolescente du nord du Nigeria. Ils sont confrontés à des problèmes de santé, notamment de santé bucco-dentaire, du fait qu'ils ne sont pas suffisamment protégés, supervisés ou dirigés par des adultes responsables. OBJECTIFS: L'objectif de cette étude était de déterminer la prévalence des caries dentaires, des traumatismes dentaires, de la gingivite et des scores d'hygiène buccale chez les enfants des rues. MÉTHODOLOGIE: Trois cent soixante-six enfants d'âge scolaire ont été sélectionnés par un échantillonnage à plusieurs degrés d'enfants de 10 à 12 ans dans quatre écoles qur'aniques modernes et traditionnelles, et ont été examinés pour les conditions bucco-dentaires en utilisant le protocole de l'OMS. L'indice CAOD, les critères d'Ellis modifiés, l'indice de saignement gingival et l'indice d'hygiène buccale simplifié (IOB-S) ont été utilisés pour évaluer les caries dentaires, les lésions dentaires traumatiques, la gingivite et les scores d'hygiène buccale, respectivement. Les tests du chi carré et l'Odds Ratio ont été utilisés pour comparer les différences et tester l'association entre les groupes Almajirai. L'analyse des données a été réalisée à l'aide du progiciel statistique pour les sciences sociales (SPSS version 20). La signification statistique a été considérée lorsque p < 0,05. RÉSULTATS: Cent soixante-huit (45,9%) Almajirai traditionnels et 198 (59,4%) Almajirai de type moderne ont participé à l'étude. Leur âge moyen était de 10,8 (±0,8) ans. La prévalence de la carie dentaire était de 25,4 % avec des scores moyens de CAOD et de SiC de 0,6 (±1,3) et 1,7 respectivement. Les scores CAOD variaient de 0 à 12. La prévalence des lésions dentaires traumatiques et de la gingivite était de 8,7 % et 82,2 % respectivement, tandis que le score OHI-S était de 3,0. Les risques de lésions dentaires traumatiques étaient 41 % moins élevés chez les Almajirai de type moderne (p=0,02) ; les Almajirai de type moderne étaient deux fois plus susceptibles de développer une gingivite (aOR 95%CI =2,0, p=0,01). Les scores OHI-S ont montré des niveaux d'hygiène buccale plus faibles chez les Almajirai de type moderne (p=0,02). CONCLUSION: Les caries dentaires, les lésions dentaires traumatiques, les gingivites et une mauvaise hygiène bucco-dentaire étaient prévalentes chez les enfants des rues de Kano. Il existe un niveau élevé de maladies dentaires non traitées dans la population étudiée. Mots clés: Caries, enfants des rues, Almajirai, Adolescents, Hygiène buccale, Gingivite.

Dental caries prevalence and bilateral occurrence in premolars and molars of adolescent school children in Ibadan, Nigeria.

The aim of the study was to determine the prevalence of dental caries in premolars and molars of adolescent school children in Ibadan, Nigeria with a view of comparing findings from this study with previous African studies. A cross section of 12-19 year-old school children from the five local government areas in Ibadan were examined over a period of three months by two examiners (OD and DA), using the WHO criteria for diagnosing dental caries. Only premolars and molars were examined but the third molars were excluded because they were not fully erupted in most children. The mean age of the children under study was 16.2 ± 0.83 years. Dental caries was detected in 10.8% of the children. Overall, 225 teeth had dental caries, out of which 13.3% were premolars while 86.67% were molars. Among the molars, first molars were mostly affected by caries (68.72%) while 31.28% second molars were affected. Second premolars were more affected by caries among the premolars. Also bilateral caries occurrence was highest in the mandibular first molars. In conclusion since the first molars were the most vulnerable teeth to decay, caries preventive programs on them need to be drawn up.

Prevalence and pattern of early childhood caries in Ibadan, Nigeria.

BACKGROUND: Early childhood caries is a public health problem in a developing country such as Nigeria where there are limited resources to combat the situation. AIM: The aim of the study is to determine the prevalence and pattern of early childhood caries (ECC) among nursery school children aged 3 to 5 years in Ibadan, Nigeria. METHODS: A cross sectional study was conducted on 540 nursery school children aged 3 to 5 years old in nursery schools within Ibadan. Oral examination was performed and dmft (decayed-missing-filled teeth) indices were recorded. Data was analyzed using SPSS 16.0 and descriptive statistics was applied. The level of significance was taken at p value < 0.05. RESULTS: The prevalence of early childhood caries was 23.5% with a total of 353 carious teeth seen in 127 children. The mean dmft was 0.65 ± 1.49 and the decayed (d) component constituted 100% of the dmft scores (all dmft was due to untreated caries). The second mandibular primary molars were the teeth most affected by caries, accounting for 35.4% of all decayed teeth. Severe ECC prevalence was 2.2%. CONCLUSION: The high caries prevalence observed on the second mandibular primary molars reveals the rampant nature of this disease and the absence of any missing or filled tooth in the dmft indices shows poor dental awareness among the parents/guardians of the children.

Dental students' perception of their interactions with faculty and learning activities in Nigeria.

BACKGROUND: For effective development of policy for faculty advances, it is necessary to know students' views. This study describes the perceptions of clinical students about teaching skills of faculty in the dental schools in Nigeria. METHODS: A validated, self-administered questionnaire adapted from Clinical Education Instructional Quality was used to survey 109 dental students from the three dental schools in Nigeria. Score of > or = 45 and > or = 39 was considered good perceptions for "interaction with clinical instructors" and "involvement in specific learning" respectively. Computed perception scores were compared by year of training. RESULTS: Participants comprised 64 males and 45 females; aged 21.0 to 35.0 years (mean age = 24.2 +/- 2.5 years). Majority (89.0%) of the students had good perception of their interaction with clinical instructors while 89.9% had good perception about their involvement in learning activities. More students in year three than two had positive perception about their interaction with clinical instructors and involvement in activities. CONCLUSION: Overall, dental students in Nigeria had good perception of their interaction with their clinical instructors and involvement in various learning activities but they desired more opportunity to get involve especially in the aspects of dental procedures, patients' vital signs and interpretation of laboratory tests.

THE PREVALENCE OF DENTAL CARIES AMONG CHILDREN IN ORPHANAGES IN IBADAN.

Background: A number of challenges are being faced by children in orphanages, a major one being their oral health as a common unmet need. Studies have shown high prevalence of dental caries and oro-facial trauma. This has been attributed to overcrowding, lack of adequate staff, poor oral hygiene, improper dietary habits, inadequacies in the orphanage system, as well as inadequacies in the healthcare system.This study aimed at assessing the prevalence and factors affecting dental caries and trauma among children in orphanages in Ibadan. Materials and Method: All the children within the age group (7 - 15 years) in all the 18 registered orphanages in the 5 Local Government Areas within Ibadan metropolis were recruited into the study. Intra-oral examination was done under natural light and caries detection was done using tactile and visual method. Sterile mouth mirrors and CPI probes were used for this purpose. Dental caries status and the predisposing factors in each child were assessed. Presence of dental trauma and the predisposing factors were also assessed. Data processing was carried out with the aid of SPSS version 21. Results: One hundred and forty-six children participated in the study, 51.4% of them were males while 48.6% were females. The age range and the mean age of the children were 7 - 15 years 9. 69 ± 3.78 respectively. The prevalence of dental caries among the children was 17.8% while that of dental trauma was 7.5%. The mean DMFT/dmft was found to be 0.42 ± 1.06. Gender and the presence of deep pits and fissures were the statistically significant predictors of dental caries. Conclusion: Oral health is of utmost importance across all ages, much more pertinent among institutionalized children who are prone to dental caries and trauma as revealed by this study. An average child in an orphanage may be affected by both dental caries and trauma, but appears to be more prone to dental caries in this environment.

Parental attitudes to the care of the carious primary dentition experience from a Nigerian tertiary hospital.

OBJECTIVE: To examine the factors associated with parents choices of dental care concerning carious primary teeth of their children. METHODS: A structured, self administered questionnaire was issued to parents of children attending the paediatric dental clinic of the University College Hospital (UCH) Ibadan. Items in the questionnaire included a section on the past dental visit(s) of parents, reason(s) for the clinic attendance and treatment(s) received, the second section contained items on parental treatment preferences under two different clinical scenarios of child dental health; scenario 1, asymptomatic carious primary tooth and scenario 2, symptomatic carious primary tooth. The last section contained items on determinants of parents' choice of treatment. RESULTS: Majority of the accompanying parent were mothers (75.8%) with a mean age of 39.3 +/- 6.81, fathers were 20.8% with a mean age of 45.1 +/- 5.24 while others were 3.4% with a mean age of 51.2 +/- 1.09. Under the two clinical scenarios, majority of the parents preferred the dentist to determine the treatment of their children (scenario 1 = 53.7%; scenario 2 = 62.5%). The accompanying parents and their socioeconomic status had no significant effect on parental preferences under the two clinical scenarios while past parental dental treatment had the greatest influence on parental choice (scenario 1:x2 = 12.93; p = 0.03 for past fillings experience and scenario 2: X2 = 6.881. = X 0.001 for past extraction experience). CONCLUSION: The reliance of parents on dentist for decision on the choice of their children dental treatment and the dependence of parents choice on their past dental treatment experience suggested the need for dental health education to both parents and children on dental caries.

Traditional and emerging oral health practices in parts of Nigeria.

OBJECTIVE: The purpose of this study was to document the beliefs and perceptions and emerging oral health care practices in parts of Nigeria. METHODS: A descriptive study, based in four different locations that were selected to reflect urban-rural and geographical spread, was conducted. Focus group discussions and in-depth interviews were conducted among representative groups and significant gatekeepers in the study areas. The discussions focused on oral health problems frequently encountered in the communities, their dietary and snacking habits as well as the dental remedies commonly employed by the people for prophylactic and therapeutic purposes. RESULTS: It was revealed that in both rural and urban low- to- middle socio-economic classes, periodontitis was the commonest dental problem in adults, while dental caries in children appeared to be also a cause for concern especially in northern Nigeria and the urban south. Most adults ate the local staple carbohydrate diets, however large quantities of cariogenic snacks were reported to be consumed. Chewing sticks and locally prepared toothpastes ranked prominent among the tooth cleaning implements, but many in the cities used toothbrushes. Various dental care remedies were employed ranging from warm saline wash to herbal preparations, antibiotics and battery water. In communities studied, the belief in ill defined "worms" as causative agents of all oral health problems was very firm. Consultation with traditional oral healthcare practitioners was a practice commonly observed in all study sites. CONCLUSION: This study has highlighted specific areas for intervention in disease prevention and oral health promotion in Nigeria.

A comparison of clinical and radiographic caries diagnosis on posterior teeth of children seen at a Nigerian teaching hospital.

Early detection and initiation of therapy for dental caries is the most effective means of ensuring resolution of the condition and its sequelae. The aim of this study was to compare the effectiveness of clinical and radiographic (using bitewing radiograph) methods of caries diagnosis in children. The subjects were 172 children within the age range of 5-12 years attending the Paedodontic Clinic of the University College Hospital for the first time. They were clinically examined for the presence of dental caries using the WHO criteria. Left and right bitewing radiographs were taken following the clinical examination to detect dental caries. Clinical examination found additional 4 occlusal caries (incipient caries) that were not diagnosed radiographically and radiographic examination revealed additional 20 approximal surface caries that were not evident clinically in deciduous teeth. In permanent teeth, 3 additional occlusal caries were diagnosed clinically while only one additional approximal caries was diagnosed radiographically. These observations revealed the additional diagnostic value of bitewing radiograph in the diagnosis of approximal caries in children and the importance of clinical examinations in diagnosis of early occlusal caries (incipient caries) which are difficult to see on dental radiographs. In view of these findings, the use of bitewing radiographs combined with careful clinical examination will be of great advantage in early detection of caries in children.

Tooth size ratios of Nigerian and the applicability of Bolton's analysis.

OBJECTIVE: To establish tooth size ratio of Nigerian, to compare with size ratio among gender and to compare tooth size ratios of Nigerian with that of Caucasians as determined by Bolton's. MATERIAL AND METHODS: Dental casts of 250 subjects (125 males and 125 females) were used for the study. The age range was 12-15 years. All subjects had normal class I occlusion with no history of orthodontic treatment. RESULTS: A mean overall ratio of 92.5 +/- 0.5% and anterior ratio of 79.0 +/- 0.5 were reported for Nigerian teeth. Tooth size ratios among gender was compared using the Student's t-test, there was no significant difference (P > 0.05). Nigerian tooth size ratio was compared with those of Caucasians as determined by Bolton, no statistically significant differences were found (P > 0.05). CONCLUSION: Tooth size ratios among Nigerians have been established. Bolton's formula for tooth size analysis also applies to Nigerian teeth. The tooth size ratios of Nigerian females are higher than those of males.

The fluoride content of drinking water and caries experience in 15-19 year old school children in Ibadan, Nigeria.

Fluoride, a trace element with anticariogenic benefit may either occur naturally or be added to drinking water sources. This study aimed at determining the fluoride level of the different drinking water sources in Ibadan, Oyo State, Nigeria and to relate this with the caries experience of secondary school children in the city. Sixteen samples of the drinking water sources from various locations in the five local government areas of the city were analysed for fluoride concentration. The locations were selected around the vicinities of the secondary schools used for caries study. Nine hundred and fifty five students aged 15-19 years randomly selected from eleven secondary schools in Ibadan metropolis were examined for dental caries over a period of 4-5 months. Only teeth with obvious cavitations were recorded as being carious using the WHO standard method. Teeth grossly covered with calculus and third molars were excluded. No radiograph was taken. The fluoride level of the different water sources was between 0.02 and 0.03 ppm. Forty-four (4.6%) of the children had dental caries. There was no statistically significant difference between either DMFT and gender (t = 0.67, p = 0.91) or DMFT and age (F = 1.488, p = 0.224). However, females had a slightly higher mean DMFT than males and the highest mean DMFT (2.67 +/- 1.15) was found among the 19-year-old children. Twenty-three (52.3%) of the students with caries had only one carious tooth while only two had four carious teeth each. In conclusion, both the fluoride level and caries prevalence were low.

Child abuse and dentistry: a study of knowledge and attitudes among Nigerian dentists.

Child abuse is recognized globally as a major public health issue and in recent years, Nigerian communities have become increasingly aware of this problem. Numerous studies have revealed that the head and oro-facial region are common sites of trauma from child abuse. For this reason, dentists are in a strategic position to recognize and report suspected cases. The aim of the study is to assess the knowledge and attitudes of Nigerian dentists towards child abuse. A descriptive survey was conducted among 175 dentists in Nigeria. Results revealed that physical abuse, neglect and emotional abuse was recognized by 61.7%, 53.1% and 33.1% of the respondents respectively as forms of abuse. A greater proportion of the females (42.3%) in contrast to the males (26.9%) identified emotional abuse (p<0.05). Psychosocial, medical and oro-dental signs were associated with child abuse by 68.0%, 60% and 15.4% of the respondents respectively. More than a third (39.4%) of the dentists claimed to have suspected child abuse in one or more of their young patients however, only 6.9% had actually reported. The possible effects on the child, uncertainty about the diagnosis and fear of litigation were factors which 92%, 81.1% and 64.6% of the dentists respectively claimed could influence their decision to reporting child abuse. This study has demonstrated that some knowledge gaps exist among dentists in recognizing and reporting this problem. There is a need for further information and training at all levels of the dental profession in the recognition and reporting of child abuse.

Socio-economic status and utilisation of orthodontic services in a Nigerian hospital.

OBJECTIVE: To study the influence of socio-economic status on the utilization of orthodontic services and the uptake of orthodontic treatment in a Nigerian teaching hospital. MATERIALS AND METHOD: Relevant information needed for the study had been previously recorded in the patient's case file. A total of 157 patients that presented from December 2002 to December 2004 were reviewed. The socio-demographic data of each patient and all other necessary clinical information were retrieved from the patients case files using a common data abstraction form. The patients were further categorized according to their socio-economic status using a modification of the standard occupational classification system (12). Social Class I represented those with the highest income while social class IV represented those with the lowest income. RESULTS: Out of the 157 patients that presented during the period of review, 86 (54.8%) were from social class I, 42 (26.7%) from social class II, 22 (14.0%) from social class III and 7 (4.5%) from social class IV. Sixty three percent of the patients presented with skeletal Class I, 23.5% presented with Skeletal Class II, while 13.5% presented with Skeletal Class III, 29.3% of the patients presented with normal over jet and 38.8% patients presented with normal overbite. The Social Class of the patients had a significant effect on the skeletal pattern and overbite (p < 0.05) CONCLUSION: Majority of patients utilizing Orthodontic services are from the higher social classes, therefore the uptake of orthodontic treatment is mainly a function of cost and not need or demand.

Oral manifestation of HIV/AIDS.

The Human Immunodeficiency Virus (HIV) infection and Acquired Deficiency Syndrome (AIDS) have become a pandemic with about 40 million infected people world-wide. The virus attacks the immune cells resulting in a defective cell-mediated immune response thus exposing the host to opportunistic infections. Oral and peri-oral lesions are often seen in HIV infections and sometimes, appear as the first indicators of the disease. The appearance of these lesions in a known HIV infected person could also be a signal of the deterioration of the infection into a full-blown AIDS. It is therefore necessary that Health care givers should have a good working knowledge of the possible oral manifestations of the disease. This write-up highlights the clinical features and treatment of oral lesions associated with HIV infections.

Teething myths among community health officers.

Many symptoms are attributed to teething in infants as a result of myths and opinions of people in the community. These myths have given false security with the belief that these symptoms are part of the teething process. The purpose of the study was to investigate the beliefs and practices of Community health Officers about teething. 60% of the respondents whose responses were analyzed believed that children have systemic problems during teething periods. Fever and diarrhea were the most frequent symptoms associated with teething. As health care providers at the community level, there is a need for this cadre of health care providers to separate cultural beliefs from scientific and proven medical practices. This can be achieved by their attendance at regular refresher courses organized for them after their graduation.

Causes and pattern of tooth extraction in children treated at the University College Hospital, Ibadan.

A study of 429 children age 0-15 years who attended the paedodontic clinic of the Department of preventive Dentistry for treatment from January 1995 to December 1995 with a view of assessing causes and pattern of tooth extraction was carried out. 51.52% of the children had extraction. Dental caries and its sequelae accounted for the highest indication for extraction (57.47%) while periodontal disease accounted for the least (0.45%). Deciduous teeth were mostly extracted with the deciduous molars being the teeth frequently extracted. The frequency of extractions shows that a challenging situation exists for those engaged in the organisation of dental health education and emphasis should be on prevention.

Reviewing trends in the incidence of cancrum oris in Ibadan, Nigeria.

The objective of this clinic based retrospective study was to review the trends in the incidence of cancrum oris at the Dental clinic of the University College Hospital, Ibadan, Nigeria. Records of children aged 1 to 16 years diagnosed as having cancrum oris between 1st of January 1986 to 31st December, 2000 were reviewed. Of the six thousand three hundred and ninety (6390) children seen within the period of study, 45 had cancrum oris with the modal age been 3-5 years and the mean age was 4.2 +/- 2.7 years. There was a declining trend in the proportion of children presenting with the disease at five yearly interval within the period of study, although malnutrition was still a common factor in all the children.

Pattern of permanent tooth loss in Nigerian children and their prosthetic replacement.

The pattern of permanent tooth loss and prosthetic replacement in 76 children were studied. Dental caries and its sequelae were the most frequent cause of tooth loss (64.47%) followed by trauma (21.05%). Molars accounted for 64.20% of tooth type lost due to dental caries and its sequelae while loss of incisors (19.75%) was due to trauma. It was observed that only incisors were replaced (81.25%) due to their conspicuous position in the mouth whereas a large number of molars were lost and none was replaced. The need to periodically assess children after tooth loss for prosthetic replacement was emphasised.

Preventive and interceptive orthodontic demand for malocclusion.

Orthodontic unit, University College Hospital, Ibadan is young and in need of baseline data for effective planning. The main aim of this study was to determine the nature of orthodontic demands in the unit that could benefit from preventive and interceptive treatment so as to enhance treatment planning, teaching and further research. Consecutive patients who presented for treatment in the Unit between May 1997 and November 1999 were included in the study. The patients aged 5-19 years with mean age of 8.8 +/- 0.82 years. One hundred and twenty-one (60.5%) of the orthodontic cases that presented for treatment needed one form of preventive and interceptive treatment or the other such as extraction of retained primary teeth, use of upper removable orthodontic appliances to correct teeth in cross bite, extraction of erupted supernumerary teeth and fabrication of oral habit breaking appliances such as goal post appliance. Ninety-three (76.9%) of these children had retained primary anterior teeth while 9.1% had proclination of maxillary anterior teeth with moderate spacing. Based on dental history and clinical examination, nine (7.4%) children were involved with oral habits, seven (5.8%) and one (0.8%) had anterior crossbite and supernumerary teeth, respectively. The remaining 39.5% needed full-blown orthodontic treatments. No sex predilection was found in relation to the various needs (P > 0.05). We suggest a need for more emphasis on preventive and interceptive orthodontic treatment in our environment due to the relatively high prevalence ofthese presenting needs.

Oro-facial soft tissue injuries in Nigerian children: a five-year review.

A review of 64 soft tissue maxillofacial injuries in 50 children seen and managed at the University College Hospital, Ibadan over a five-year period was made. The age range was from 3months to 15years. The highest occurrence was in the 0-5 years old children (60%). The predominant type of soft tissue injuries was lacerations (75.0%). Falls (66.0%) were the most common aetiology followed by road traffic accidents (18.0%). There was a higher involvement of males, than females (M: F of 2.3:1). The tongue (31.3%) was the most commonly affected site of soft injury followed by the lips (29.7%) and cheeks (10.9%). Slightly less than half (46%) of the patients presented within 24 hours of injury. Direct suturing was done in 24% of the children while debridement and conservative management was carried out in 76%.