Oral Diseases and Oral Health-Related Quality of Life among Kenyan Children and Adolescents with HIV.

INTRODUCTION: Children and adolescents living with HIV (CALHIV) have a higher risk of hard and soft oral tissue diseases as compared with their healthy peers. It is important to increase awareness regarding the need to integrate oral health within medical care among pediatric HIV populations. Studies on associations of oral diseases with oral health-related quality of life (OHRQoL) in CALHIV are lacking. This study examined the association between oral diseases and OHRQoL in Kenyan CALHIV. METHODS: This cross-sectional analysis was nested in a longitudinal cohort study of CALHIV in Nairobi. CALHIV received oral examinations, and the World Health Organization's Oral Health Surveys and Record Form was administered. OHRQoL was measured with the Parental-Caregiver Perceptions Questionnaire, with the subdomains of global, oral symptoms, function limitations, and emotional and social well-being, with higher scores indicating poorer OHRQoL. Linear regression was used to model associations between OHRQoL and oral diseases, adjusting for age at the time of oral examination, CD4 counts, and caregiver's education. RESULTS: Among 71 CALHIV, the mean age was 12.6 y (SD, 2.9; range, 10 to <21), and the mean composite OHRQoL score was 12.6 (SD, 11.2). Ulcers (not herpes simplex virus or aphthous) were associated with the worst overall OHRQoL (mean, 21.8; SD, 11.1; P = 0.055) and oral symptoms subdomain (mean, 7.0, SD, 2.5; P = 0.003). Children with dry mouth and untreated caries had significantly higher mean global OHRQoL scores than those without disease (P < 0.0001). In the multivariate analysis, the OHRQoL composite score was 6.3 units (95% CI, -0.3 to 12.9) higher for those who had dry mouth and untreated dental caries; dry mouth accounted for the highest percentage of variability of OHRQoL (9.6%) and the global subdomain (31.9%). Ulcers accounted for the highest percentage of variability of the oral symptoms domain (15.4%). CONCLUSIONS: Oral ulcers, dry mouth, and untreated caries were associated with poorer OHRQoL in CALHIV. Integrating oral health into the primary care of CALHIV may improve their OHRQoL. KNOWLEDGE TRANSFER STATEMENT: This study aimed to determine the association of oral diseases with the oral health-related quality of life of children and adolescents living with HIV (CALHIV). The findings will form part of the evidence to incorporate oral health protocols into care programs for CALHIV. Oral health monitoring has the potential to increase the surveillance of HIV clinical status, monitor the effectiveness of antiretroviral therapy, and improve the oral health-related quality of life of CALHIV.

Oral health status and barriers to oral healthcare among children with cerebral palsy attending a health care center in Kampala, Uganda.

BACKGROUND: Cerebral palsy (CP) is a non-progressive neuromuscular condition diagnosed in childhood. CP as a form of disability, does not cause any specific oral disease. However, some oral conditions are more commonly associated with people with CP compared to the general population. The overarching aim of the current study was to determine the oral hygiene status, gingival status, and the prevalence of dental caries in children with CP attending a leading hospital institution for children with disabilities in Kampala, Uganda. Additionally, we determined the barriers faced by children with CP in accessing oral healthcare. METHODS: This cross-sectional study was carried out at the Comprehensive Rehabilitation Services Uganda hospital in Kampala, Uganda. Our study population consisted of a convenient sample of 90 children diagnosed with CP aged 3-17 years and their caregivers. A validated and interviewer administered structured questionnaire was used to collect socio-demographic data of the participants. A modified World Health Organization oral health assessment form for those aged 3-17 years was used to gather data on oral health status (plaque score, gingival bleeding and dental caries.) The data was subjected to statistical tests with critical value set up at 5%. RESULTS: Only 32.2% of the children evaluated had adequate oral hygiene, while 44.4% of the children experienced gingival bleeding. The prevalence of dental caries for both deciduous and permanent dentition was 63.3%, with DMFT values of 3.8 ± 4.5. The most common barrier reported by the caregivers was the challenge in modality of transportation availability from the children's homes to the health facilities (34.4%). CONCLUSIONS: Children with CP in the study population have a significant prevalence of oral diseases and face several barriers to oral healthcare. Results from this study aim to provide relevant support to advocate for a nationwide change in policy to improve access to dental care to decrease the burden of oral diseases in children with special healthcare needs.

GLOBAL DISPARITY IN CHILDHOOD DENTAL CARIES: IS THERE A REMEDY?

OBJECTIVE: To determine risk factors associated with childhood caries, their association withthe widening childhood caries gap between developed and less developed nations and proposition on how the gap could be bridged. DATA SOURCE: Pubmed database was used to retrieve appropriate research literature. STUDY SELECTION: All publications in the English language reporting on prevalence, management strategies and policy matters relating to childhood dental caries for the period 2000 to 2011. DATA SYNTHESIS: The data collected were analysed and the results related to the objective of the study. CONCLUSION: Socio-economic factors, educational factors and human resource factors were found have been associated with childhood caries gap between the developed and less developed nations. The caries gap could be bridged through smart policies by less developed nations, involving multiple strategies geared towards preventive oral health care.

DILEMMA OF MANAGING MULTI-SURFACE DENTAL CARIES IN THE PRIMARY DENTITION USING THE ATRAUMATIC RESTORATIVE TREATMENT: RENAISSANCE OR DIMMING HOPE.

BACKGROUND: A lot of research work has been carried out to determine the effectiveness of using a traumatic restorative treatment (ART) in the management of dental caries, but there are still unresolved issues surrounding the use of the technique particularly in very large carious lesions. OBJECTIVE: To determine the current survival rates of multi-surface ART restorations placed in the primary dentition and any consequences to the restored tooth after premature loss of the restoration. STUDY SELECTION: Using a set of specific key words, a Pubmed/Medline search was carried out to retrieve all publications on ART restorations placed in primary teeth in the period January 2000 to December 2011. Only publications whose studies had multi-surface ART restorations as an item of study were retrieved and relevant data extracted. DATA SYNTHESIS: Twelve studies contained in 12 publications fulfilled the selection criteria and were included in the study. The selected publications were analysed by the author to establish the study follow-up period and the survival rate of the multi-surface ART restorations for the different follow-up periods. Further information was adduced on any other effects of restoration on the tooth after premature loss of the restoration. RESULTS: The search findings indicated that the survival rate for most of the multi-surface restorations were generally very low. Further, there were indications that even after the premature loss of the ART restorations, most of the affected teeth survived for the period of the study with a number of them having shown no signs of secondary caries or associated dental abscessees. CONCLUSION: While the survival rates of multi-surface ART restorations in the studies documented in the review were low, the ART restorations appeared to provide some beneficial effects to the retention-longevity of the restored tooth even after their premature loss.

The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using ART technique.

OBJECTIVE: To determine the examiner's accuracy in selecting proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART) approach. BASIC RESEARCH DESIGN: Intervention study. CLINICAL SETTING AND PARTICIPANTS: A total of 804 six to eight year-olds from 30 rural schools in Kenya participated in the study. INTERVENTION: Three examiners selected a total of 1,280 suitable proximal carious lesions in primary molars after examining 6,002 children from 30 schools randomly selected out of 142 schools in two divisions. Seven operators randomly paired on a daily basis with eight assistants restored the lesions. An explanation was provided for any cavity that was not restored. Pre-and post-operative radiographs of the cavities were also taken for evaluation. MAIN OUTCOME MEASURES: The examiner's choice of suitable proximal cavities restorable using the ART approach was related to the decision made to either restore or not during the operative stage. The radiographic findings of the selected cavities were also compared to the decision made by the operator. The results obtained were used to determine the examiner's accuracy in selecting suitable proximal cavities for restoration using the ART approach. RESULTS: The majority of the children recruited in the study were excluded due to absenteeism, pulpal-exposure or anxiety during the operative stage. Only 804 children received one restoration in their primary molars. The examiner's accuracy in selecting suitable ART-restorable cavities clinically was 94.9% and based on radiographic analysis was 91.7%. CONCLUSIONS: A trained and diligent examiner has a very good chance of selecting proximal carious lesions restorable with the use of ART approach, without the threat of dental pulpal-involvement during the excavation of caries.

ART class II restoration loss in primary molars: re-restoration or not?

AIM: The purpose of this study was to find an answer as to what to do with Atraumatic Restorations (ART) failures: re-restore or leave the preparation further unfilled? STUDY DESIGN: Cross sectional study. METHODS: In 2006, 804 children in Kenya each had one proximal cavity treated using the ART approach. Out of the original group of 192 children, who had lost their restorations but still had the treated molars in situ, were selected for further study in 2008. The length of time that the restorations had been in situ was known while the colour, hardness and the extent of infected dentine was then evaluated and documented. STATISTICS: Analysis of the data obtained was conducted using SPSS 16.0. Chi Square tests were performed with the variables of hardness, colour and infected dentine, and a 5% confidence interval was used. The Spearman's Rank Correlation Coefficient was also calculated. RESULTS: The results showed that 66% of the molars that had lost restorations had hard dentine, 78% of the preparations showed dark dentine and 50.7% appeared to have no infected dentine. These percentages increased with the increase in the survival time of the restorations. CONCLUSIONS: It is not always necessary to re-restore primary molars after ART restoration loss. Further research is necessary to confirm these findings.

Short communication: Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years.

AIM: This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. METHODS: The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach. During restorations 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were used by the operators. The restorations were then followed for a period of 2 years. STATISTICS: SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used. RESULTS: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. CONCLUSION: Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

Prevalence and pattern of early childhood caries among 3-5 year olds in Kiambaa, Kenya.

OBJECTIVE: To determine the prevalence and pattern of early childhood caries among three to five year olds. DESIGN: This was a descriptive, cross-sectional study. SUBJECTS: A total of 336 children aged 3-5 years. SETTING: Pre-schools in Kiambaa division, Kiambu District, Kenya. RESULTS: Slightly over a half, 201 (59.5%) had dental caries. The mean decayed, missing and filled teeth (dmft) was 2.46 +/- 2:3.2 with the greatest component (95%) being decayed teeth. The mandibular deciduous molars and the maxillary incisors were the most frequently carious teeth. CONCLUSIONS: The prevalence of early childhood tumours in Kiambaa was 59.5%. The mandibular deciduous molars and maxillary incisors had the highest caries frequency.

Two-year survival of glass ionomer sealants placed as part of proximal atraumatic restorative treatment restorations.

OBJECTIVE: To evaluate after two years, the survival rate of glass ionomer cement (GIC) sealants placed in primary molars of six to eight year-olds and as part of proximal atraumatic restorative treatment (ART) restoration. DESIGN: A longitudinal clinical study. SETTING: Matungulu/Kangundo rural divisions, Machakos district, Kenya. SUBJECT: A total of 804 six to eight year-olds from rural Kenya received a sealant as part of a proximal restoration placed in a primary molar using the atraumatic restorative treatment (ART) approach. RESULTS: The two-year cumulative survival of the sealants was 10.9%, and the survival of the sealants was not significantly affected by the GIC material brand and the tooth-isolation method used. However, slightly more sealants survived when Fuji IX and rubber dam tooth- isolation method were used. CONCLUSION: The two-year survival rate of the sealants was poor and was not significantly influenced by the GIC material or the tooth-isolation method used.

Influence of the experience of operator and assistant on the survival rate of proximal ART restorations: two-year results.

AIM: The objective of the study was to determine the influence of the experience of the operator and the assistant on the survival rate of proximal ART- restorations after 2 years when placed using two methods of tooth-isolation and three glass ionomer cement-brands. STUDY DESIGN: A clinical intervention study. METHODS: Each of 804 children aged 6-8 years received one proximal restoration in their primary molars. The restorations were placed by 'experienced/inexperienced' operators randomly paired with 'experienced/ inexperienced' assistants. The atraumatic restorative treatment (ART) approach was used with 3 brands of glass ionomer cements (GIC) and 2 tooth-isolation methods (rubber dam vs cotton rolls). Trained and calibrated evaluators evaluated the restorations, soon after placement and after 2 years. STATISTICS: The data collected were analyzed using SPSS 14.0, to determine and relate the survival rate of the restorations to the operator and assistant with respect to the other factors such as the restorative material used and the isolation method applied. RESULTS: After 2 years, the survival rate of the restorations was 30.8%. In general, there were no statistical significant differences in the survival rate of the restorations made by the 'experienced' vs 'inexperienced' operators, but individually, the operator with more experience was associated with a significantly higher survival rate of the restorations. The experienced assistants were associated with significantly higher survival rates of the restorations. The most 'experienced' operator paired with any 'experienced' assistant and using rubber dam tooth-isolation method, was associated with a significantly higher survival rate of the restorations. CONCLUSION: The combination of the 'experienced' operator and assistant using rubber dam tooth-isolation method had the best chance of survival for proximal ART restorations, irrespective of the material-brand used.

Hereditary gingival fibromatosis: report of family case series.

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic, dense fibrous connective tissue with acanthotic gingival epithelium. A family presented at the School of Dental Sciences, University of Nairobi with a complaint that some of the children developed swollen gums very early in life and that this got worse with eruption of the permanent teeth. The first born, a 23-year-old male, had had the swellings for over ten years. Other siblings aged 5, 9 and 12 years were also affected. The swellings had affected the appearance, speech and the psychosocial wellbeing of the children. The parents were unaffected with apparently negative family histories. Following oral examination and appropriate investigations, conventional gingivectomy was performed of the maxillary and the mandibular gingivae for the siblings: the 23- 12- and the nine-year olds. The fourth affected child, a five-year-old, was still in primary dentition and had just started showing mild signs of gingival hyperplasia. The histopathological examination of the specimens from the present cases confirmed features consistent with those of HGF. This article highlights a familial presentation of HGF.

Prevalence of molar incisor hypomineralisation in six to eight year-olds in two rural divisions in Kenya.

OBJECTIVE: To determine the prevalence of molar incisor hypomineralization (MIH) and any associated causes of MIH in children from two rural divisions in Kenya. DESIGN: Prospective cross-sectional study. SETTING: Seventeen primary schools in Matungulu and Kangundo divisions of Machakos district in Kenya. SUBJECTS: All six to eight year-olds in the seventeen primary schools. RESULTS: A total of 3,591 children (55.6% males and 44.4% females) were examined for MIH. All the children were from a low socio-economic community with little access to proper medical/dental health care. The prevalence of MIH was 13.73%, with a female to male ratio of 3:1. CONCLUSION: The prevalence of MIH of 13.73% was high in the study population and was probably associated with the poor health conditions that the children went through during the most venerable period of between birth and age three years.

Orthodontic treatment needs among 12-15 year-olds in Moshi, Tanzania.

OBJECTIVE: To assess malocclusion and orthodontic treatment needs among 12-15-year-olds in Moshi municipality, Tanzania. DESIGN: A cross-sectional study. SETTING: Moshi municipality, Tanzania. SUBJECTS: Two hundred and eighty nine randomly selected primary school children in Moshi municipality in the year 2003. RESULTS: Maxillary median diastema occurred in 20.1% of the children. Crowding and spacing in the incisor segments occurred in 41.2% and 28.4% respectively with significantly more crowding in males than in females (p = 0.009). Anterior irregularities occurred in 46% of the sample in the maxilla and 51.6% in the mandible. These irregularities were significantly more common in the females than in males in the maxilla and mandible (p = 0.014, p = 0.037 respectively). Reverse overjet was extremely rare (0.3%). Anterior openbite and antero-posterior molar relation discrepancies occurred in 6.2% and 32.5% of the sample, respectively. Crowding, irregularities in the incisor segments and antero-posterior molar relation discrepancies were dominant malocclusion traits in this population. The sample mean DAI score was 24.6 points (CI 95% 23.86-25.36). There was no statistically significant gender difference of DAI scores (p = 0.473). About 65% of the subjects had either no need or had slight need for treatment whereas 35.3% were found with orthodontic treatment needs ranging from elective (21.5%), highly desirable (6.9%) to mandatory (6.9%). There was no significant gender difference in the categories of treatment need (p = 0.942). Unmet orthodontic treatment needs were present in this population with a very small proportion of subjects exhibiting handicapping malocclusion. CONCLUSION: The information from this study forms part of the basis not only for further research, but also for planning orthodontic care in this community where unmet orthodontic treatment needs are present.

Prevalence of malocclusion among 12-15-year-olds in Moshi, Tanzania, using Bjork's criteria.

OBJECTIVE: To assess the prevalence of malocclusion in 12-15 -year-olds in Moshi, Tanzania. DESIGN: Cross-sectional study. SETTING: Moshi Municipality, Kilimanjaro region, Tanzania. SUBJECTS: Two hundred and eighty nine randomly selected primary school children (153 males and 136 females) had a clinical examination for malocclusion traits done. RESULTS: The overall prevalence of malocclusion was 97.6%. Angle's Class II and III malocclusion occurred in 6.9% and 11% of the sample respectively. Crowding was encountered very frequently in both jaws, especially in the lower anterior segments. Anterior open bite occurred in 6.2% and the deep bite in 10.7% of the sample. There was no significant gender difference in either the overall prevalence of malocclusion or in the occurrence of the different occlusal traits. CONCLUSION: It was noteworthy that some of the malocclusion traits recorded were relatively minor deviations from the normal occlusion. Hence the high prevalence of malocclusion did not necessarily imply a heavy burden of need and demand for orthodontic treatment.

Awareness and concern about malocclusion among 12-15 year-old children in Moshi, Tanzania.

OBJECTIVE: To assess awareness and concern about malocclusion in 12-15 year-olds in Moshi, Tanzania. DESIGN: A cross-sectional study. SETTING: Moshi Municipality in Kilimanjaro region, Tanzania. SUBJECTS: Two hundred and ninety eight randomly selected Public primary school children aged 12-15 years (158 males and 140 females). RESULTS: About 56% of the respondents thought their teeth were properly aligned. However only 29.1% of the respondents reported being dissatisfied with the way their teeth appeared in their mouth. About 25% of the respondents found their teeth to have been worse than most of their age-mates. Children who reported to have been teased due to their malocclusion comprised 25.8%. Those who thought it was unpleasant to stay with malaligned teeth constituted 55.7% of the respondents. Subjective orthodontic treatment need was reported by 69.1% of the sample. Majority of the children (75%) were ready to accept orthodontic treatment. There were significant correlations between factors of awareness and those of concern about malocclusion among the subjects. CONCLUSIONS: In spite of very little orthodontic treatment exposure in this population, awareness and concern about malocclusion was reported by a significant proportion of the children. These findings form a baseline line for future studies on the trends of awareness and concern towards malocclusion in this population. They will also be useful in the planning of orthodontic services in Tanzania.

Antimicrobial and buffer capacity of crude extracts of chewing sticks (Miswaki) from Kenya.

The use of Chewing sticks (Miswaki) in the third world for control of dental plaque is very popular. Some of the studies that have been conducted on this subject have reported marked decrease in the incidences of dental caries and periodontal diseases in the users of Miswaki, when compared to the users of the conventional toothbrush living under similar conditions. Various mechanisms by which the Miswaki contributes to this phenomenon have been suggested. The purpose of the present study was to investigate in vitro, the anti-microbial action, the potential acid buffer capacity and fluoride content of crude aqueous extracts of eight commonly used chewing sticks from three regions in Kenya. The results obtained in the study, showed that one of the Miswaki had remarkable antibiotic activity against three stains of oral bacteria. Three of the Miswaki had significant acid buffer capacity. None of the eight Miswaki showed any significant fluoride release.