Evaluation of the scope and practice of oral and maxillofacial surgery in Nigeria

Background: Oral and maxillofacial surgery is still evolving; with the scope of practice in Nigeria inadequately determined. Aims and Objectives: This study aims to ascertain the level of practice in various parts of the country vis-a-vis the global trend and factors influencing the scope in Nigeria. Design of the Study: Cross-sectional. Setting: The study was carried out at the University of Ibadan. Participants included all the maxillofacial surgeons on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons and Practicing in Nigeria as at December; 2012. Materials and Methods: Structured questionnaires were delivered to all on the mailing list of the Nigerian Association of Oral and Maxillofacial Surgeons. Respondents were asked to provide information about their demographics; years of practice; areas of practice and factors influencing the choice of practice among others. Nonresponders were reminded a month after initial contact. Data were entered into a personal computer and variables analyzed using descriptive statistical analysis. Results: Thirty-two (56) of the 57 questionnaires were returned. Most respondents were aged 41-45 years ( n = 11; 34.4). Twenty-six (81.3) were males; whereas 6 (18.8) were females. Twenty respondents (62.5) practiced in the teaching hospitals. Eighteen respondents (56.3) practiced in the south-west geopolitical region. Twelve respondents (37.5) were the only maxillofacial surgeons in their centers. 81.3 routinely practiced traumatology against 15.6 for implantology. Seventy-eight percent ( n = 25) had satisfactory facilities for traumatology; dentoalveolar surgery; and cleft repair surgery; while facilities were least satisfactory in implantology and orthognathic surgery (15.6 and 12.5; respectively). The highest single factor influencing choice/area of practice was financial reward (100 of respondents). Fifty percent ( n = 16) claimed not to have had adequate training in their area of interest. Most respondents (93.8) believe the greatest challenge facing oncological maxillofacial surgery in Nigeria was late presentation of patients. Conclusion: The scope of practice of oral and maxillofacial surgery is largely limited in the country relative to what obtains globally

Incidence and risk factors for nerve injuries in mandibular third molar surgery

Background: The inferior alveolar (IAN); lingual (LN) and long buccal nerves (LBN) are the three terminal branches of the trigeminal nerve which are susceptible to injury during surgical extraction of impacted mandibular third molars. While it is not always possible to accurately predict the patients that will be affected with these complications; understanding and identifying the risk factors may allow the adoption of appropriate technique and expertise for specific cases. We embarked on this study to document the incidence and duration of injury to the inferior alveolar nerve (IAN); lingual nerve (LN) and long buccal nerve (LBN) following the operative removal of impacted mandibular third molars and to identify the associated radiographic and operative risk factors. Method: Pre- and postoperative neurosensory tests were performed for seventy nine patients who had surgical extraction of unilateral impacted mandibular third molars to determine the incidence and duration of complicating nerve injuries. The risk factors for nerve injury were determined among the radiographic variables and documented operative events. Results: The incidence reported were 6.6for IAN; 2.6for LN and 4.0for LBN; all but one of the nerve injuries resolved within 2 weeks. Depth of impaction (Pellet Gregory Level C) and linguo-version were the significant risk factors for IAN and LN injuries respectively while no risk factors was detected for LBN injury. Some significant operative events were associated with nerve injuries Conclusion: Nerve injury in third molar surgery can be predicted based on some radiographic risk factors and some unforeseen intraoperative events. Most of the injuries are transitory in nature

Evaluation of correlations between socio-demographics and oral health seeking among patients

Background: It is commonly reported that individuals at higher socioeconomic class have greater health awareness culminating in better care-seeking from orthodox facilities. It is yet to be ascertained whether this reflect in attitudes of patients toward seeking oral health care. Aim: This study was designed to evaluate the effect of certain socio-demographic indices on oral health care-seeking in an urban society where adequate facilities are available. Methods: A one point observational study of the patients attending the Dental Clinic of the University College Hospital; Ibadan; was conducted using a questionnaire which sought to document the levels of education; income; marital status and the oral health seeking practice of the patients. The appropriate treatments for individual patients were also documented. Results: One hundred and three patients participated in the study that spanned three months (1st April- 30th June; 2006). Fifty-six (54.4) of the patients were males while 47(45.6) were females with age range of 19-85 years and average of 39 years. Eighty-six (83.4) patients had at least secondary school education of which 65 (63.1) actually had tertiary education. There was no significant correlation between oral health seeking behaviour and level of education; level of income; and marital status. Seventy -four (71.8) of the patients had tooth extractions while the remaining patients had non-surgical treatments. The reasons for preponderance of surgical treatment needs were discussed. Conclusion: Although a larger proportion of the dental patients were well educated and had better income; this did not reflect in their oral health seeking behaviour