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.

Geographical mapping of fluoride levels in drinking water sources in Nigeria.

BACKGROUND: Knowledge of fluoride levels in drinking water is of importance in dental public health, yet this information is lacking, at national level, in Nigeria. OBJECTIVE: To map out fluoride levels in drinking water sources in Nigeria. MATERIALS AND METHODS: Fluoride levels in drinking water sources from 109 randomly selected Local Government Areas (LGAs) in the 6 Nigerian geopolitical zones were determined. From the results, maps showing LGAs with fluoride concentrations exceeding 0.3 ppm, were drawn. ANOVA and t-test were used to determine the significance of the differences between the fluoride levels in the drinking water sources. RESULTS: Fluoride levels were low in most parts of the country, being 0.3 ppm or less in 62% of the LGAs. Fluoride concentrations were generally higher in North Central geopolitical zone, than the other zones in the country (p<0.05). In a few drinking water sources, fluoride concentrations exceeded 1.5 ppm, but was as high as 6.7 ppm in one well. Only 9% of the water sources were from waterworks. CONCLUSION: Most of the water sources in Nigeria contained low fluoride levels; but few had excessive concentrations and need to be partially defluoridated, or else alternative sources of drinking water provided for the community.

Primary head and neck cancers in North -Western Nigeria.

BACKGROUND: Reported epidemiological studies on oro-facial cancers in Nigeria over the last four decades showed nonstandardized inclusion criteria and an overlap of study periods, resulting in conflicting findings. OBJECTIVE: To document the pattern of reportable primary head and neck cancers in North-Western Nigeria and analyse Methods: A review of both clinical and histopathology records of head and neck cancers diagnosed by histopathology at the ABUTH, Zaria, was undertaken. Socio-demographic information and history of cancer management, which followed the pattern of the Minimum Cancer Dataset developed by the British Association of Head and Neck Oncologists, were retrieved from pathology and medical records of patients diagnosed of cancers of the head and neck at the hospital from January 1972 to December 2002. RESULTS: A total of 2611 cases were diagnosed, 730 (28%) occurred in children, 1775 (68%) in adults, with 64% occurring at or below 40 years of age. The eye, 564(21.6%) and the mouth, 251(9.6%) were the most commonly affected sites. Carcinomas (55%), lymphomas (23%) and retino-blastomas (10%) were the most common cancers. Cancers of viral origin constituted 18% of head and neck cancers and AIDS-defining cancers were 6%. A significant increase was noted in the occurrence of conjunctival squamous cell carinoma (SCC) and Non-Hodgkins Lymphoma NHL when comparing the periods pre- and post- advent of HIV/ AIDS in Nigeria in 1986. Comparing the two periods, there was a reduction in the ages of occurrence of conjunctival SCC; Non-Hodgkins Lymphoma (NHL), Kaposis sarcoma (KS) and nasopharyngeal carcinoma, a rise in the occurrence of nasopharyngeal carcinoma and a significant drop in the occurrence of Burkitt lymphoma. CONCLUSION: Reduced age at presentation and the rising prevalence of several virus-associated cancers suggests the role of immuno-suppression in the pathogenesis of these cancers. Further studies into nutritional and viral epidemiology in the population are desirable as the implication for prevention and public health policies are profound.

Discriminatory attitudes towards patients with HIV/AIDS by dental professionals in Nigeria.

AIMS AND OBJECTIVES: The study sought to investigate whether there are discriminatory practices towards HIV/AIDS patients among dental professionals in Nigeria, how receptive are dental professionals and institutions to treating People Living With Aids (PLWA), and what underlying factors if any that may contribute to any discriminatory practices. METHODS AND MATERIALS: It was a cross-sectional study conducted in one randomly selected State in each of the six geo-political zones of Nigeria. Data collection was by self administered questionnaire. The questionnaire asked about demographic information, general knowledge of HIV/AIDS, adequacy of infection control, fear of occupational exposure, attitudes towards HIV positive patients and areas of need for further training. A total of 75 dental professionals participated in the study. RESULTS: The results of the study suggest that significant number of dental professionals in Nigeria reported attitudes and behaviour towards HIV patients which are discriminatory. CONCLUSION: Further efforts should be made to promote accessibility of discrimination-free quality oral and dental care to this population.

Primary head and neck cancers in Jos, Nigeria: a re-visit.

BACKGROUND: To document the pattern of primary head and neck cancers in Jos, Nigeria. STUDY DESIGN: A record-based study of head and neck cancers histologically diagnosed at the Jos University Teaching Hospital (JUTH), Jos, between January 1987 and December 2002. RESULTS: A total of 710 cases (over 44 cases per year) were diagnosed, with a rising trend. The most common sites for cancer were the eyes (15.4%), lymph nodes (12.4 %), thyroid gland (11.8%) and the oral cavity (7.6%). Carcinomas 432(60.8%), lymphomas 119(16.8%) and sarcomas 105(14.8%) were the commonly reported cancers. Carcinomas were most commonly reported in the thyroid gland (19.2%), oral cavity (10.2%) and the eyes (9.5%). AIDS-related cancers constituted 12.3% of all head and neck cancers and were commonly reported in the 3rd decade of life. This is higher than the 10.9% and 7.6% previously reported for Jos (p=0.89) and Maiduguri (p=0.034) respectively. Carcinomas were associated with alcohol use and tobacco smoking (p<0.001), while kaposi sarcoma was more associated with HIV-positive patients than squamous cell carcinoma (p=0.016). The duration of symptoms for cancers varied with sites and cancer type but ranged from 6.5-89.7 months (mean= 37.7 +/- 51.1 months). 59 (93.7%) of the staged cancers reported in the late stages (III & IV). 48 (43.2%) of the treated cancers had primary surgery, while most lymphomas were treated with primary chemotherapy. CONCLUSION: There is a rising trend in the occurrence of head and neck cancers in Jos, with a considerable proportion of the patients being below 30 years. The late presentation of patients, late stage at presentation, the rising profile of HIV/AIDS in the area and the non-availability of relevant specialists in the hospital could adversely affect the prognosis of these cancers.

Oral manifestation of HIV/AIDS in Plateau state indigenes, Nigeria.

BACKGROUND: To investigate the prevalence of oral manifestations of HIV/AIDS involving HIV positive Plateau State indigenous adults attending a Special Treatment Clinic serving referred cases and in-patient cases hospitalized in the Medical wards in JUTH, Jos. STUDY DESIGN: A cross-sectional study. RESULTS: A total of 261 patients confirmed for HIV infection were examined. The age range was 17 - 80 years, mean = 35.6 +/- 9.27 (SD). 59.4% were females and 40.6% were males. Oral lesions attributable to HIV/ AIDS infection were found in 109 (41.8%) patients, 38 (34.9%) of these patients had multiple lesions. Oral lesions were diagnosed more frequently in women (59.6%) than in men (p=0.945). Oral candidiasis was the most common presentation (35.7%) with pseudomembraneous candidiasis (23%) and angular cheilitis (10%) being the most common variants. All the cases of erythematous candidiasis (n=7) were exclusively seen in the female population. Oral hairy leukoplakia and xerostomia were present in 4.6% and 3.8% of cases respectively. Kaposi's Sarcoma was in 5 (1.9%) patients. CONCLUSION: The prevalence of HIV-related oral lesions (HIV-ROL) in a hospital based adult population of Plateau State indigenes in Jos is 41.8%. Oral Candidiasis is the most common HIV-ROL detected and this agrees with most reported findings.

Primary head and neck cancers in Jos; Nigeria: A re-visit

Background: To document the pattern of primary head and neck cancers in Jos; Nigeria. Study Design: A record-based study of head and neck cancers histologically diagnosed at the Jos University Teaching Hospital (JUTH); Jos; between January 1987 and December 2002. Results: A total of 710 cases (over 44 cases per year) were diagnosed; with a rising trend. The most common sites for cancer were the eyes (15.4); lymph nodes (12.4); thyroid gland (11.8) and the oral cavity (7.6). Carcinomas 432(60.8); lymphomas 119(16.8) and sarcomas 105(14.8) were the commonly reported cancers. Carcinomas were most commonly reported in the thyroid gland (19.2); oral cavity (10.2) and the eyes (9.5). AIDS-related cancers constituted 12.3of all head and neck cancers and were commonly reported in the 3rd decade of life. This is higher than the 10.9and 7.6previously reported for Jos (p=0.89) and Maiduguri (p=0.034) respectively. Carcinomas were associated with alcohol use and tobacco smoking (p0.001); while kaposi sarcoma was more associated with HIV-positive patients than squamous cell carcinoma (p

Intra-oral carcinomas in Maiduguri, north-eastern Nigeria.

OBJECTIVE: To document the pattern of intra-oral carcinomas diagnosed in north-eastern Nigeria. DESIGN AND SETTING: A retrospective clinical and histopathological review seen in a tertiary care hospital (January 1987-December 2002). MATERIALS AND METHODS: Information on socio-demographic characteristics of patients and details of cancer management were retrieved from the files and histopathology records of cases diagnosed at the hospital. RESULTS: A total of 378 biopsies, 317 primary cancers including 279 carcinomas of the head and neck were diagnosed during the study period. Intra-oral carcinomas constitute 43 (15.4%) of all head and neck carcinomas reported, with no occurrence in children. The overall mean age of occurrence was 51.2 +/- 15.6 years (male = 56.2 +/- 13.7 years; females = 47.5 +/- 16.2 years) and an overall male-female ratio of 3:4. Carcinomas were commonly reported in the palate 19 (44.2%) and lip six (13.9%) and floor of mouth four (9.3%). Squamous cell carcinoma 28 (65.1%), adenoidcystic carcinoma seven (16.3%) and mucoepidermoid carcinoma five (11.6%) were the commonly reported carcinomas. Squamous cell carcinoma was the most common carcinoma in all sites, in the sixth decade of life, of equal gender distribution and commonly reported in users of kola nuts and tobacco. The occupation of patients diagnosed with oral carcinoma and squamous cell carcinoma was farming (50%, 61.5%). All the staged cancers patients (n = 7) reported in the late stages (III/IV) of the disease. The mean interval between symptoms and presentation for the different carcinomas ranged between 9 and 25 months, with the least interval reported for mucoepidermoid carcinoma. CONCLUSIONS: Squamous cell carcinoma was the most common oral carcinoma, commonly reported in the palate, among farmers and in the sixth decade of life. Its occurrence in under 40 year olds is three to six times greater than reported for the USA and Europe and may be associated with poor diet and the habitual use of kola nuts and tobacco. The survival rates of patients diagnosed with intra-oral carcinomas, although not available, would be expectedly low in view of the prognostic indicators recorded in this series. The routine oral cancer screening of each patient, and counselling of patients with high-risk habits, by dentists is recommended to improve the prognosis of the disease.

Salivary gland neoplasms in Maiduguri, north-eastern Nigeria.

OBJECTIVE: To document the pattern of salivary gland neoplasia in Maiduguri, Nigeria. DESIGN AND SETTING: A retrospective clinical and histopathological review (January 1987-December 2002) of cases diagnosed at a tertiary care hospital. MATERIALS AND METHODS: Information on demographics, diagnosis and cancer management in the hospital were retrieved from biopsy reports and case notes of patients. RESULTS: The palatal (71.9%) and parotid (78.3%) glands were the most common minor and major salivary glands involved, with a benign-malignant ratio of 1:1 and 1.4:1, respectively. Pleomorphic adenoma (44.3%) was the most common salivary gland neoplasm recorded. It was commonly reported in the third decade (mean 30.4 years) and among males (M:F, 1.4:1). Ectopic lesions (17.1%) were reported in the neck, nose and cervical nodes. Mucoepidermoid carcinoma (10.1%) was the most common salivary gland malignancy, occurring in the second and sixth decades; of equal gender distribution and predominantly in the palate (50%). The squamous cell carcinoma (10.9%) and adenoidcystic carcinoma (21.9%) were the most common malignancies in the major and minor glands respectively. There was a higher prevalence of malignancies of the parotid than previously reported for northern Nigeria (P = 0.036). CONCLUSION: Pleomorphic adenoma and mucoepidermoid carcinoma were the most commonly reported benign and malignant neoplasia in this series. The prevalence of mucoepidermoid carcinoma contrasts with reported findings in other African studies.

Prevalence of HIV--related oral lesions in Nigerian women.

BACKGROUND: Human immunodeficiency virus (HIV) infection affects an increasing number of women throughout the world. Oral lesions are among the earliest clinical manifestations of HIV infection and are associated with its progression. We describe the oral manifestations of HIV/AIDS in Nigerian women and its clinical correlates. METHODS: Nigerian women with HIV/AIDS were examined for the presence of oral lesions attributable to HIV/AIDS. These lesions were diagnosed clinically, according to the criteria established by the European Community Clearinghouse (ECC) on oral problems related to HIV infection. RESULTS: Two hundred and sixty-nine seropositive women were examined with a range of 17-60 years (mean of 32.4 years < 8.09). The age group of 21 30 years was the worst affected (n = 125, 46.5%). Of these patients, 109 (40.5%) were married, 67 (24.9%) were single while 47 (17.5%) had multiple sexual partners. One hundred and eighteen (43.9%) had at least an oral lesion associated with HIV/AIDS. The most common was oral candidiasis, which was present in 98 (36.4%) patients. Pseudomembraneous candidiasis (n = 66, 24.5%) and angular cheilitis (n = 23, 8.6%) were the commonest variants seen. The former was the only lesion significantly associated with the clinical stage of the infection (p = 0.002) while necrotizing gingivitis, linear gingival erythema and angular cheilitis were associated with the age of the patients (p < 0.05). CONCLUSION: Oral manifestations are common features of HIV infection among Nigerian women. Oral candidiasis (OC) was the most notable oral lesion associated with HIV/AIDS. It may be a useful clinical indicator of early immune dysfunction mediated by HIV.

Primary head and neck cancers in North Eastern Nigeria.

BACKGROUND: To document the pattern of primary head and neck cancers in North Eastern Nigeria. STUDY DESIGN: A record-based study of primary head and neck cancers histologically diagnosed at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, North Eastern Nigeria between 1987 and 2002. RESULTS: A total of 317 cases (20 cases per year) were diagnosed. The most common cancer sites were the oral cavity (15.1%) and nasopharynx (11.7%). Carcinomas (68.4 %) were the most common cancers reported, mostly affecting the oral cavity (20.3%). Carcinomas were associated with farmers, kola nut chewers and tobacco users in this region, while kaposi sarcoma was the only cancer associated with HIV-positive patients. The overall mean duration of symptoms for cancers was 29.1+/-62.2 months. The mean duration for carcinomas was longer than for sarcomas (p>0.05) and lymphomas (p= 0.05). 81 % of the staged cancers reported in the stage IV; while treated cancers required primary radiotherapy (51 %) or an adjuvant radical surgery and chemotherapy (9.4%). CONCLUSION: Intra-oral carcinomas were the most common histological types of cancers in the head and neck. The delay before and the cancer stage at presentation may be due to the lack of cancer management facilities and manpower in most of the hospitals in the region.

Traditional oral health practices among Kanuri women of Borno State, Nigeria.

A structured questionnaire was administered on 495 women (urban 339, rural 156) from two LGAs of Borno State, Nigeria, using the interviewer method. The age range of the subjects was 12 to 80 years with a mean age (+/- SD) of 35.7 +/- 13.44 years. Majority (83.5%) did not have any formal education. Oral hygiene tools used by the respondents included toothbrush/paste 36 (7.9%), chewing stick 250 (54.9%), charcoal 159 (34.9%) and ordinary water 10 (2.2%). Of those using chewing sticks; 168 (67.2%) use Salvadora persica, 36 (14.4%) use Azadirachta indica and 46 (18.4%) use Eucalyptus camaldulensis. Forty (8.1%) of the respondents do not clean their teeth at all. Strong association was found between choice of teeth cleaning material and educational level (P=0.000). Three hundred and one (60.8%) of the respondents stain their teeth with flowers of Solanum incanum or Nicotania tabacum while, 218 (44.0%) perform tattooing of lip or gingivae and of this number 213 (97.7%) performed tattooing before marriage. Tattooing is usually performed without local anaesthesia with thorns of Balanites aegyptiaca and a mixture of charcoal & seeds of Acacia nilotica var. tomentosa as pigments. It is concluded that traditional oral health practices still constitute important part of the lifestyle in the study population.

National pathfinder survey of dental caries prevalence and treatment needs in The Gambia.

OBJECTIVE: The aim of this study was to assess dental caries status and treatment needs in The Gambia for the purpose of national planning. MATERIALS AND METHODS: 1,235 subjects were obtained with a multi-stage stratified random sampling technique. Clinical examinations were carried out using the criteria suggested in WHO Basic Methods (WHO 1987). The WHO J2 software programme was used for data analysis. RESULTS: More than half of the subjects had caries. Mean DMFT increased from 1.7 in the 7-year-old group to 8.8 in 65-99-year-olds. Mean DT peaked at 5.1 in the 30-34-year-old group before declining to 3.2 among the 65-99-year-olds. Mean filled teeth (FT) was zero in all ages. Missing teeth (MT) increased from 0.1 in 13-year-olds to 5.6 among the 65-99-year group. Mean DMFT was 2.3, 2.8, and 6.6 in 12-year-olds, 15-year-olds and 35-44-year-olds respectively. Unmet treatment need (DT/DMFT) was 90-100% in subjects below 25 years. Need for dental extraction increased from 15% to 63% in 65-99-year-olds. Between 0.3 and 2.8 teeth required extraction, and 46-79% of subjects needed conservative treatment. Dental auxiliaries should be trained to carry out extractions and fillings using the atraumatic restorative treatment (ART).

National pathfinder survey of periodontal status and treatment needs in The Gambia.

OBJECTIVE: The aim of the pathfinder survey was to assess the periodontal status and treatment needs in The Gambia. METHODS: A multistage stratified random sampling technique was used to obtain a sample of 1,235 (or 0.1% of the national population). The study was conducted according to the World Health Organisation's criteria (WHO, 1987). The WHO J2 software programme was used to analyse the data. RESULTS: Not more than 12% of subjects in any age group had healthy periodontal tissues. Two to three sextants were healthy among those under the age of 35 years. Shallow (4-5 mm) pockets were present in all ages. However, less than one sextant was involved among subjects younger than 25 years. Despite the high prevalence of pockets, few sextants were edentulous. The majority of subjects needed oral hygiene instructions and oral prophylaxis. Of the subjects between the ages of 8 and 29 years, 5-28% needed complex treatment in only half of a sextant. Similarly, 38% and 80% of older subjects needed complex treatment in 0.8-1.9 sextants. CONCLUSION: A national oral health plan in The Gambia should focus on health education and provision of oral prophylaxis by trained auxiliary health care workers. In conclusion, there is a need to develop a functional district oral health services system in The Gambia.

Natural fluoride levels in some springs and streams from the late Maastrichtian Ajali formation in Ohafia-Arochukwu area of south eastern Nigeria.

The aim of this study was to provide baseline data on the fluoride levels in waters associated with the late Maastrichtian Ajali formation in Ohafia-Arochukwu area of South Eastern Nigeria. Water samples from 14 artesian, perched springs and eight streams from the formation were collected with plastic containers. Fluoride analysis was carried out with inductively coupled plasma Atomic Emission Spectrometry (ICP-AES) equipment at the laboratories of the Department of Earth Science, University of Leeds, United Kingdom. The results showed that fluoride occurred in only one of the 14 spring water samples. Fluoride level in the sample was 0.03 ppm. The spring water, which contained some fluoride, was possibly associated with another rock formation: namely, the limestone bearing Nsukka formation, which overlies the Ajali formation. No fluoride was observed in all the stream water samples. This study reported the absence of fluoride in spring and stream waters associated with the late Maastrichtian formations in Nigeria.