TEMPOROMANDIBULAR PAIN DYSFUNCTION SYNDROME IN PATIENTS ATTENDING LAGOS UNIVERSITY TEACHING HOSPITAL, LAGOS, NIGERIA.

BACKGROUND: Temporomandibular joint pain dysfunction syndrome (TMJPDS) is the most common temporomandibular disorder. This condition presents with symptoms of pain, restricted jaw movement and joint noise. Other symptoms include otalgia, headache, neck pain and trismus. AIM: To determine the pattern of Temporomandibular joint pain dysfunction syndrome patients managed at the Lagos University Teaching Hospital, Lagos, Nigeria. METHODOLOGY: A descriptive study of patients with signs and symptoms of Temporomandibular joint pain dysfunction syndrome attending the Oral Medicine Clinic of Lagos University Teaching Hospital. RESULTS: Twenty-one patients with Temporomandibular joint pain dysfunction syndrome were enrolled into the study, out of which 10(48%) were females and 11(52%) were males. The age range was 23-81years with a mean of 45.2 ± 18.9 years. Majority of the patients 20(95.2%) complained of pain around the joint, in the pre-auricular region, in the muscles of mastication and the ear. While 7(35%) complained of clicking sounds, 10(47.6%) complained of pain on mouth opening and during mastication only. In all 5(23.8%) had impaired movement of the jaws, mouth opening was normal in 18(85.7%) but reduced in 3(14.3%) patients. Over half of patients 12(57%) experienced clicking sounds, there was tenderness around the temporomandibular joint in 16(76.2%) cases, pain in the ear of 7(33.3%) patients and 13(61.9%) people presented with tenderness of the muscles of mastication. Conservative management of all the cases resulted in resolution of the symptoms. CONCLUSION: Temporomandibular joint pain dysfunction syndrome has diverse clinical presentation and though distressing, it responds to prompt and effective conservative management.

Clinical correlates of a lateral-flow immunoassay oral risk indicator.

BACKGROUND: The aim of the present study is to investigate the clinical correlates of a novel lateral-flow immunoassay with bleeding on probing (BOP), oral hygiene, and periodontal probing depth. This report offers a simple, rapid, and highly sensitive tool that addresses two issues important to periodontists: 1) detecting active periodontitis, and 2) predicting chronic periodontitis. METHODS: Seventy-six of 86 males requiring seminal fluid analysis as part of a separate study were serially recruited into the study. After basic dental and periodontal examination under natural light and with the use of the community periodontal index of treatment needs (CPITN) probe, debris and calculus indices were recorded per participant. Participants were subsequently grouped into "good," "fair," and "poor" oral hygiene categories based on a simplified oral hygiene index. BOP was assessed with the ball-ended tip of the probe, and periodontitis was assessed with pocket probing as well as a lateral flow of neutrophil collagenase-2 immunoassay, which measures levels of matrix metalloproteinase-8. RESULTS: Neutrophil collagenase-2 immunoassay was 96% sensitive for poor oral hygiene, 95% sensitive for chronic periodontitis (defined as at least two sites with periodontal pockets), and 82.6% sensitive for at least two sites with BOP. CONCLUSION: Neutrophil collagenase-2 immunoassay had a high sensitivity for at least two sites with BOP and two sites with periodontal pockets but a lower relationship for single-site pockets and BOP.

Immune Suppression and Oral Manifestations of HIV in a Group of Nigerian Children.

BACKGROUND: Oral manifestations are common in HIV positive children and have been reported as possible predictors of HIV disease progression. This study assessed the prevalence of oral manifestations of HIV/AIDS and its association with immune suppression in a group of HIV positive Nigerian children. STUDY DESIGN: One hundred and twelve HIV positive children were examined for oral manifestations of HIV. The manifestations were compared with CDC Immune suppression categories using age specific CD4 lymphocyte counts. RESULTS: A total of 85 (76%) children had oral lesions. Oral candidiasis (65.2%) and parotid gland swelling (33%) were the most common lesions. Presence of oral lesions was significantly associated with declining immune status, p<0.05. CONCLUSION: The presence of oral lesions was significantly associated with lower immune status.

Knowledge and Attitude of PLWHA concerning oral lesions of HIV/AIDS among patients of PEPFAR clinic in Lagos University Teaching Hospital (LUTH) Lagos, Nigeria.

INTRODUCTION: Oral manifestations in Human Immunodeficiency virus/Acquired Immunodeficiency Disease Syndrome (HIV/AIDS) are associated with adverse effects on quality of life such as pain, difficulty in eating, bad breath, altered taste and sometimes altered appearance. There is also a predisposition to poor nutrition which confers an additional burden on the body's immune defences and the ability to fight off infections. Knowledge of the oral lesions will enable People Living with HIV/AIDS (PLWA) to seek dental treatment on time. AIMS AND OBJECTIVES: To assess the general knowledge of HIV/AIDS, its oral manifestations and willingness to know more about its oral lesions among people living with HIV/AIDS (PLWHA) in Lagos, Nigeria. PATIENTS AND METHODS: A structured questionnaire was administered to two hundred and thirty-five patients (235) who were randomly selected from attendees at an NGO clinic supporting PLWHA in Lagos. RESULTS: Majority of the participants exhibited poor knowledge of the oral manifestations of HIV/AIDS although many of them had fair knowledge of the general symptoms of HIV/AIDS. The high educational status of the subjects seemed to play little role in awareness of oral manifestations in HIV/AIDS as only 45(21.4%) of the participants had good overall knowledge having a range of 25-31 correct answers out of 210 participants. Many of the respondents (145, 69%) wish to know more about oral lesion of HIV/AIDS. CONCLUSION: Although there is a high awareness of the general symptoms of HIV/AIDS in the study group, there is poor awareness of the oral manifestations, their presentations and management. The study also showed that PLWHA would be willing to know more about the oral manifestations of HIV/AIDS and seek dental care for their management.

Dental caries status of HIV infected children in Nigeria.

BACKGROUND: HIV positive children may be prone to developing Dental Caries due to prolonged and frequent use of sucrose containing medications and poor feeding practices. OBJECTIVE: To determine the caries status of primary and permanent dentition in HIV positive Nigerian children using dmft/DMFT indices. METHODS: One hundred and twelve HIV positive children aged 4 months to 13 years attending two dedicated HIV outpatient clinics were examined for dental caries of primary and permanent dentition using the WHO criteria. Carious lesions were recorded using the dmft and DMFT indices in the primary and permanent dentition respectively. RESULTS: Forty four [39.3%] of the 112 children examined had dental caries mainly in the primary dentition in 96.7% of the cases. Mean dmft was 1.15 +/- 1.88, mean DMFT was 0.17 +/- 0.57. Dental caries was not significantly associated with the immune status of HIV positive children; chi2 = 2.58, P = 0.275. CONCLUSIONS: Dental caries experience in the primary dentition of these HIV positive children was greater than in the Nigerian paediatric population. Dental caries prevalence in these HIV positive children although lower than that seen in developed countries was however higher than in other reports of healthy Nigerian children. There was no significant association between dental caries and immune status of HIV positive children.

A review of temporomandibular joint disorders (TMD's) presenting at the Lagos University Teaching Hospital.

OBJECTIVE: To evaluate the patterns of presentation of Temporomandibular joint Disorders (TMDs) in our institution in a 6 year period. PATIENT AND METHODS: A retrospective study of patients who presented in the Oral Medicine and Oral and Maxillofacial surgery clinics of the Lagos University Teaching Hospital (LUTH) between January 2000 and December 2005 with TMDs was done. Case files of these patients were retrieved and data collected included patients' age, sex, presenting complains and history of associated risk factors. Also collected were findings on clinical examination and mode of treatment. The data collected were evaluated and descriptive analysis was used as appropriate. RESULT: A total of 94 patients were seen. There were 55 males (58.5%) and 39 female (41.5%), male to female ratio was ratio was 1.5:1. The age ranged from 13 to 98 years (mean age 42.7 +/- 16.4 years). Majority, 59 (62.8%) of the patients seen were between the ages of 20 and 49 years. Nine (9.6%) had a previous history of stress, 18 (19.1%) a previous history of trauma while 5 (5.3%) had a history of associated habits. Pain was the most common presenting complaint. It occurred as a singular presenting complaint in 66 (70.2%) patients and in association with other complaints in 10 (10.6%) patients. Conservative management was the treatment of choice in all cases. CONCLUSION: Most patients with TMD in the studied environment are middle aged in agreement with the literature. However, there were more reported cases in males in contrast to previous studies. Previous history of trauma and stress were important risk factors elicited from patients with TMD in this study.

A case report of body dysmorphic disorder and literature review.

BACKGROUND: Body dysmorphic disorder (BDD) is an obsessive preoccupation with a perceived defect in one's physical appearance which the individual persistently seeks medical attention to correct surgically. BDD often goes unrecognized and undiagnosed, due to patients' reluctance to divulge their symptoms because of secrecy and shame. OBJECTIVE: To present the case of a patient who presented with an extreme form of dysmorphophobia. METHODS: A 22-year-old university graduate presented with complaints of not "looking like herself any more" and of looking ugly. Patient was fully clinically and psychologically assessed. Psychological and dental surgical treatment were offered to the patient. RESULTS: She was a young woman who was complaining seriously of how her teeth made her ugly and of hating herself. She chiseled and filed her tooth to make them appear better but to no avail. She had thought of committing suicide. She appeared distressed, tearful and remorseful of her actions. The teeth were chipped and stained. She refused treatment modalities offered, and would not accept a psychological support. CONCLUSION: The case highlights the need for the dentist to be educated on these disorders so that they can recognize and refer accordingly. There is also need for interdisciplinary interactions between the dentists and the psychologist.

Oral health status of 12-year-old Nigerian children.

UNLABELLED: BACKGROUND STUDY: The World Health Organization has set some goals for the oral health of the 12-year olds'. This study, which is being carried out in a developing nation, will add to the accumulating data worldwide on this index age group. STUDY DESIGN: One thousand six hundred 12-year-old public and private secondary school pupils were examined in six local government areas of Lagos State. The objective of the study was to assess their oral health status and treatment needs. RESULTS: In this study caries prevalence was found to be 24.6% with a mean DMFT of 0.46. The "D" component formed the greater proportion indicating low dental care in the population. The oral hygiene status (OHIS) of the students was generally fair. The girls had better oral hygiene and lower prevalence of gingivitis and calculus than the boys. The difference was however not significant (p > 0.05). The treatment needs of the students revealed that 72.7% required periodontal treatment, 34.6% required restorative treatment and 10.3% required orthodontic treatment. CONCLUSION: This study concludes that even though caries level in this age group was low, oral hygiene was fair and the utilization of oral health services was poor.

Oral health status of 12-year-old Nigerian children

Background study: The World Health Organization has set some goals for the oral health of the 12-year olds1. This study; which is being carried out in a developing nation; will add to the accumulating data worldwide on this index age group. Study design: One thousand six hundred 12-year-old public and private secondary school pupils were examined in six local government areas of Lagos State. The objective of the study was to assess their oral health status and treatment needs. Results: In this study caries prevalence was found to be 24.6with a mean DMFT of 0.46. The ""D"" component formed the greater proportion indicating low dental care in the population. The oral hygiene status (OHIS) of the students was generally fair. The girls had better oral hygiene and lower prevalence of gingivitis and calculus than the boys. The difference was however not significant (p0.05). The treatment needs of the students revealed that 72.7required periodontal treatment; 34.6required restorative treatment and 10.3required orthodontic treatment. Conclusion: This study concludes that even though caries level in this age group was low; oral hygiene was fair and the utilization of oral health services was poor

Oral lesions as indicators of HIV infection among routine dental patients in Lagos, Nigeria.

OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.

Group II and III lesions in HIV positive Nigerians attending the General Hospital Lagos, Nigeria.

OBJECTIVE: To document the prevalence of Group II and Ill oral lesions of HIV in adult seropositive Nigerians. STUDY DESIGN: A longitudinal study of 100 HIV infected adult Nigerian patients attending the HIV Clinic of the General Hospital, Lagos, Nigeria. STUDY PERIOD: January 2001 to October 2002. METHOD: Oral lesions were diagnosed based on documented diagnostic criteria by GREENSPAN et al, for oral manifestation of HIV. WHO classification of oral lesions based on the degree of association with HIV infection was also used. Oral lesions were treated using established treatment protocols. RESULTS: Seventy patients had oral lesions of HIV, of these fourteen (20%) patients had Group II and III oral lesions of HIV infection: Five (7%) patients had recurrent aphthous ulcers (RAU), 4 (6%) had herpes zoster of the trigeminal nerve. Majority of patients presented with oral symptoms severe enough to require use of appropriate medication. Recurrence of oral lesions occurred in all cases of RAU seen. CONCLUSION: Group II and III lesions are less prevalent than group I lesions in HIV infected adult Nigerians. They may be the presenting oral lesions of HIV/AIDS. These oral lesions of HIV are associated with a lot of pain, morbidity and may also compromise aesthetics. By compromising adequate nutrition and practice of good oral hygiene, they may lead to further deterioration of the health of the patient and can accelerate the course of the disease. Early recognition and diagnosis of these lesions by the oral clinician and/or trained dental practitioner affords the patient the opportunity of receiving prompt and appropriate medical treatment as well as counseling.

Facial neuralgias: analysis of the different types seen at Lagos University Teaching Hospital, (Luth).

OBJECTIVE: To highlight the presentations, characteristics. the difficulties in diagnosis, treatment and response to treatment types of facial neuralgias seen at Lagos University Teaching Hospital. METHODS: Twelve patients with facial neuralgias diagnosed and treated in dental clinic of the Lagos University Teaching Hospital were studies. Using strict for diagnosis, patients were categorized into: trigeminal, glosspharyngeal and post herpetic neuralgias. RESULTS: Eight patients had trigeminal neuralgia; three patients had post -herpetic neuralgia and one patient had glossopharyeal neuralgia. In six patients with Trigeminal neuralgia. mandibular branch was affected, while in the two patients maxillary branch was affected. Six patients with Trigeminal neuralgia responded to carbamazepine alone and 2 had additional drugs. The only patients with glosspharyngeal neuralgia responded to carbamazepine. One patient with post herpetic neuralgia tested positive for HIV. All the post herpetic neuralgia responded poorly to carbamezepine. CONCLUSION: Facial neuralgias are uncommon and usually present in the dental clinic. They can easily be misdiagnosed with resulting inappropriate. Correct diagnosis and treatment with carbamezepine is beneficial in majority of patients.

Traumatic fracture of anterior teeth in 12-year old Nigerian children.

INTRODUCTION: The WHO has chosen the 12year-old age group as one of the sentinel groups for the monitoring of oral health of the population. Tooth loss in 12year olds is significant because the dentition is still developing and any disruption will affect the development of the arch, occlusion and patient's aesthetic. MATERIALS AND METHODS: 1600 12-year-old secondary school pupils were examined in six local government areas of Lagos State. The WHO pathfinder methodology was used. RESULTS: In this study, more boys 86 (10.8%) had various degrees of trauma to their anterior teeth compared to 71 girls (8.9%)(M:F Ratio is 1.2:1). The overall prevalence of tooth fractures was 9.8%. The most frequent injury was class II fractures (52.2%) and there were more fractures to the maxillary teeth than mandibular teeth, the difference is statistically significant p<0.0 1. The central incisors were the teeth most frequently fractured in both sexes. DISCUSSION: The prevalence of fractured anterior teeth in this study, even though is lower than earlier studies can be said to be high for this age group because the greatest number of injuries occur at about 14 years of age. Maxillary incisors in this study have a higher prevalence of fractures. A significant finding in this study is that none of the students with fractured anterior teeth have received dental treatment for the fractures CONCLUSION: There is a high prevalence of fractured anterior teeth in 12year- olds and this problem has not received the necessary attention of the dental profession. Oral health education with the provision of school dental services is recommended as means of solving this problem.

Oral health knowledge, attitude and practices of primary school teachers in Lagos State.

School teachers are known to exert considerable influence on their pupils and to an extent on the larger community. They have however been shown to have a disappointingly poor knowledge of oral health and disease. This study sought to assess the knowledge, attitude and practices of primary school teachers in Lagos State, Nigeria. A cross-sectional, questionnaire-based survey was carried out on 100 primary school teachers drawn from 10 randomly-selected primary schools in Lagos State. The results revealed that majority of them have a poor attitude to oral health issues. The few of them who have attended a dental clinic mostly had extractions done. It was also found that there is a need for improved knowledge of oral health disease and their prevention among the teachers for an effective school based oral health education programme. The paper suggests ways in which this can be achieved.

Oral health status and treatment needs of pregnant women in Lagos State.

The oral health status and treatment needs of 250 pregnant women attending the antenatal clinic at Randle Health Centre was investigated. A coded questionnaire was administered to the pregnant women followed by their oral examination in the dental clinic. The mean oral hygiene index score increased progressively throughout pregnancy viz 1st trimester 0.72, second trimester 1.06 and third trimester 1.23. Community Periodontal Index of Treatment Needs (CPITN) revealed that 50% required scale and polish and oral hygiene instruction, 13.60% required oral hygiene instruction only and 32.2% did not require any treatment. Decayed Missing and Filled (DMF) recorded was 1.54. 51.72% of the pregnant women required amalgam fillings, 23.27% required extraction due to caries and 16.38% required partial dentures.