Immune status, and not HIV infection or exposure, drives the development of the oral microbiota.

Even with antiretroviral therapy, children born to HIV-infected (HI) mothers are at a higher risk of early-life infections and morbidities including dental disease. The increased risk of dental caries in HI children suggest immune-mediated changes in oral bacterial communities, however, the impact of perinatal HIV exposure on the oral microbiota remains unclear. We hypothesized that the oral microbiota of HI and perinatally HIV-exposed-but-uninfected (HEU) children will significantly differ from HIV-unexposed-and-uninfected (HUU) children. Saliva samples from 286 child-participants in Nigeria, aged ≤ 6 years, were analyzed using 16S rRNA gene sequencing. Perinatal HIV infection was significantly associated with community composition (HI vs. HUU-p = 0.04; HEU vs. HUU-p = 0.11) however, immune status had stronger impacts on bacterial profiles (p < 0.001). We observed age-stratified associations of perinatal HIV exposure on community composition, with HEU children differing from HUU children in early life but HEU children becoming more similar to HUU children with age. Our findings suggest that, regardless of age, HIV infection or exposure, low CD4 levels persistently alter the oral microbiota during this critical developmental period. Data also indicates that, while HIV infection clearly shapes the developing infant oral microbiome, the effect of perinatal exposure (without infection) appears transient.

A prospective epidemiological study on odontogenic tumours in a black African population, with emphasis on the relative frequency of ameloblastoma.

The persistent view in the literature is that the relative frequency of ameloblastomas is higher in the black population than in Caucasians. The aim of this study was to determine the relative frequency of all odontogenic tumours (OT) in a 100% black population and to compare our findings with those of previous studies. A prospective study was undertaken of all patients presenting with OT to all 16 Nigerian departments of oral and maxillofacial surgery over a 4-year period. The following data were obtained: patient demographics, delay to presentation, extent of the lesion, and histological diagnosis. Six hundred and twenty-two cases were studied. A slight male preponderance was observed (male to female ratio 1.17:1). Patients ranged in age from 5 to 89 years, with a peak incidence in the third decade. The relative frequency of OT was 0.99 per million and that of ameloblastoma was 0.76 per million. Ameloblastoma was the most prevalent OT (76.5%), followed by adenomatoid odontogenic tumours (5.6%), odontogenic myxoma (4.5%), and keratocystic odontogenic tumours (KCOT) (3.1%). The relative frequency of ameloblastoma among Nigerians was not different from frequencies reported previously among Caucasian and Tanzanian black populations. KCOTs were, however, rarely diagnosed in Nigerians as compared to the white population in the Western world.

Antenatal determinants of oro-facial clefts in Southern Nigeria.

OBJECTIVES: Cleft lip with or without cleft palate, is the most common serious congenital anomaly that affects the orofacial regions. The management and care of the cleft patient constitutes a substantial proportion of the workload of the Nigerian maxillofacial surgeon and allied specialties. Yet, there are no specific programmes targeted at this group. We believe that the findings of this study is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of orofacial cleft in Nigeria. METHODS: It was a transverse cross-sectional study that was undertaken at the Maxillofacial Units of the University of Benin Teaching Hospital and the Central Hospital, Benin City respectively. The prevalence and antenatal determinants of cleft lip and palate were determined. RESULTS: Cleft lip and palate were often encountered in clinical practice in Benin City with a prevalence of 1.35%. The results showed that orofacial clefts were commoner in females and that the combined unilateral cleft lip and palate was the commonest entity encountered amongst the cases. The following risk factors were associated with the risk of development of cleft lip and palate: Paternal age >40 years, maternal age >35 years, genetic/family history, low socio-economic status, alcohol consumption and indulgence in the intake of herbal medications in pregnancy. CONCLUSION: Public health education programmes and advocacy activities geared towards raising awareness of the identified risk factors for the development of cleft lip and or cleft palate would go a long way to obviate the occurrence and reduce the burden.

Reasons for exodontia in rural Nigerian children.

OBJECTIVE: To investigate the reasons for exodontia in children attending a general dental practice in Uselu, Edo State. MATERIAL AND METHODS: All pediatric patients that had extraction between January 2006 and December 2008 in a general dental practice in Uselu were recruited for this prospective survey. The data collected include age, sex, reason for extraction and tooth extracted. RESULTS: A total of 756 extractions were done during the survey period. Female constituted 57.4% of treated patients. Caries was the most frequently reason for childhood exodontia (82%). The deciduous teeth were mostly extracted (66.1%) than permanent teeth (33.9%). Deciduous molar accounted for 42.6% of all exodontia in children. Mandibular teeth were more frequently extracted (60%) than maxillary teeth (40%). Exodontia was also more on the right side of the mouth and lower right quadrant CONCLUSION: This survey highlights the need for extensive prevention programs targeted at rural children with high caries risk.

A prospective multicenter study of injury profile, severity and risk factors in 221 motorcycle-injured Nigerian maxillofacial patients.

OBJECTIVE: This 12-month prospective multi-center study was designed to ascertain the entire injury profile, injury severity, and risk factors in motorcycle injured Nigerian maxillofacial patients. METHODS: With a validated investigator-administered questionnaire, we obtained data from motorcycle-injured in- and out-patients managed in the maxillofacial units of four Nigerian teaching hospitals. Standardized information on host factors, agent, and type of crash as well as location, type, and extent of injury were elicited. Injuries were scored using the Facial Injury Severity and Abbreviated Injury scales (FISS, AIS). RESULTS: A significant male preponderance was observed (p = 0.003) with peak age 21-30 years; 62.7% of the patients were riders. Alcohol/substance abuse was implicated in 31.2% of riders, fatigue in 13.5%, and bad roads in 17.6%. The rate of helmet use was 3%. The predominant type of crash was head-on collision (HOC) 58%). Glasgow Coma Scale (GCS) score ranged from 5 to 15 with mean 13.3 (3.5); Facial Injury Severity Score (FISS) ranged from 1 to 11, mean 3.7 (1.9); and Abbreviated Injury Score was mostly 2. FISS was not significantly different between both genders (p = 0.26) and road types (p > 0.05). The mean FISS was greater with multiple passengers than with single or no passengers (p = 0.12) and lower with crashes involving motorcycles carrying heavier loads (p = 0.022). Six of the patients died (2.7% fatality) in the course of their hospitalization all within a month of injury. CONCLUSION: We advocate prompt legislation of a ban on greater than one passenger on a motorcycle, impaired (substance abuse) operation on a motorcycle, and stronger enforcement of speed limit and adoption of legislation that would make it mandatory to wear a full-face helmet when operating a motorcycle in Nigeria.

Oral Health Profile of Primary and Post -Primary School Children at a Health Facility In Uselu; Benin-City

Objective: To investigate the oral health profile of otherwise healthy primary and post -primary school children in Uselu; Benin-city. Methodology: All consecutive primary and post-primary school children accompanying siblings and/or friends to access dental care at Mount Gilead hospital; Uselu between June 1; 2008 and May 31; 2009 and for who consents were obtained from parents or guardians on their behalf were recruited. Age; sex; and the gingival index were noted for these children. The Gingival Index was used to assess the severity and prevalence of gingivitis by examining the qualitative changes (that is; severity of the lesion) of the gingival soft tissue and scored on a four point scale 0-3; as follows: 0= No inflammation. 1= Mild inflammation 2= Moderate inflammation 3 = Severe inflammation Results: A total of 340 children were assessed; with a male to female ratio of 3:2 (That is 204 males and 136 females). Three (0.9) had no gingivitis; 35(10.29) had mild gingivitis; 110 (32.35) had moderate

Aneurysmal bone cyst: a primary or secondary lesion?

OBJECTIVES: To emphasize the origin of aneurysmal bone cyst as "primary" or "secondary" to other lesions of the jaws and 2. Report two cases of the cyst that illustrate its controversial origin in the hope that it will add to the literature on the subject in Africa. REPORT: Two cases of aneurysmal bone cyst occurring in the mandible and maxilla are reported. One of the cysts that occurred in a 13-year-old was a primary lesion while the other in a 5-year-old was associated with a cementifying fibroma. METHOD: The diagnoses of both lesions were confirmed by biopsy. The lesion that occurred in the 13-year-old was treated by curettage while the other in the 5-year-old was treated by excision under general anaesthesia respectively. RESULT: While the lesion in the 13-year-old was haemorrhagic with 'welling up' of blood, the second lesion though haemorrhagic was not associated with this phenomenon. Both patients were transfused with 2 pints and 1 pint of blood respectively. There has not been recurrence of the lesions after two years post operatively. CONCLUSION: Aneurysmal bone cyst can arise as a primary lesion or associated with a fibro-osseous lesion as demonstrated by these two cases. There is a need to serially section biopsy specimens of the cyst to detect coexisting lesions.

The use of thromboembolic prophylaxis by surgeons: A multicentre Nigerian study.

BACKGROUND: Despite the well known contributions of deep vein thrombosis and pulmonary embolism to perioperative deaths, these major causes of morbidity and mortality appear not to be given adequate attention by surgeons in our environment. OBJECTIVE: To study the practice of thromboembolic prophylaxis among surgeons in some sub-specialties in three Nigerian tertiary institutions. MATERIALS AND METHODS: A structured questionnaire was used to collect information from consultants in the surgical sub-specialties on the use of thromboembolic prophylaxis in their practice. RESULTS: Fifty nine adequately completed questionnaires were returned. Of this, only 28 (47.5%) used prophylaxis routinely in major surgeries. Use was most frequent in orthopaedics and least in ophthalmology and otorhinolaringology. Subcutaneous heparin was the most commonly employed agent and the most important indication for prophylaxis was a previous history of thromboembolism. CONCLUSION: The results obtained suggest low use of prophylaxis. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy with the benefits outweighing risks, burdens and costs. Therefore greater attention should be paid to antithrombotic measures by all the surgical sub-specialties and patients stratified according to risk.

Gender and oral manifestations of HIV infection among adult Nigerians.

Oral manifestations were studied in 305 adult Nigerians with HIV infection. Data collected were demographic (age, sex, marital status, educational status and occupation) and clinical (mode of transmission, general manifestations and oral manifestations of HIV infection). The chi- square test was used in test for significance between variables and p values less than 0.05 were regarded as significant. A total of 47.5% patients had oral manifestations. There were 67.6% females and 32.4% males (p <0.001). The patients ranged in age from 19-70 years. Heterosexual contact with multiple sex partners was the most common mode of transmission of infection (42.9% in females and 74.5% in males, p < 0.05). Candidiasis was the most common oral manifestation (78.6% in females and 78.7% in males p >0.05). The study concluded that similar demographic and clinical characteristics were observed in the occurrence of oral manifestations of HIV infection in both male and female Nigerians.

Malignant tumours presenting after dental extraction: a case series.

OBJECTIVE: To present the clinical spectrum of malignant neoplasms detected after extraction of teeth. DESIGN: Retrospective study. SETTING: Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Nigeria. MAIN OUTCOME MEASURES: Demographic and clinical data of patients diagnosed with malignant neoplasms related to a history of tooth extraction. RESULTS: Twelve patients with histopathologically confirmed tumours detected after extraction of teeth were studied. There were 11 males and one female giving a male to female ratio of 11:1. They ranged in age from 15-85 years with a mean age of 53 years. Pain and swelling were the most common presenting complaints. The mandible was more often involved seven (58.3%) cases while five (41.7%) cases occurred in the maxilla. Squamous cell carcinoma (in 9 cases) was the most common malignant neoplasm among these patients. CONCLUSION: Malignant tumours can mimic periapical infections necessitating a high index of suspicion when faced with toothache of uncertain cause.

Extramedullary presentation of multiple myeloma in the parotid gland as first evidence of the disease -- a review with case report.

Myeloma is a neoplasm of plasma cells that causes painful, bone-destructive lesions. It may present as a solitary lesion (plasmacytoma), or involve multiple sites (multiple myeloma). Myeloma may occur in an extraosseous location as a solitary lesion, or less commonly, in combination with multiple myeloma. Oral manifestations may be the first sign or symptom of the disease. Soft tissue plasmacytomas of the head and neck tend to involve the nasal cavity or nasopharynx, rather than the oral cavity. Its occurrence in the parotid gland is rare. We present an unusual case of multiple myeloma with extramedullary involvement involving the parotid gland as first evidence of the disease. Multiple myeloma should be considered in the differential diagnosis of salivary gland swellings.

Death from ingestion of removable partial denture: a case report.

OBJECTIVE: to illustrate the danger of using acrylic denture as removable partial denture in a developing country. METHOD: post mortem examination was performed on a man who died after ingesting removable partial denture. RESULTS: A removable partial denture was seen seated in the mid portion of the oesophagus with its lateral wings deeply embedded in the wall of the oesophagus causing laceration and severe haemorrhage. CONCLUSION: The radiolucent nature of acrylic denture may prevent early diagnosis and intervention when it is ingested or aspirated. There is need for proper education of patients wearing partial denture in especially the acrylic type.

Normal values of medial and lateral canthal distances in 3 to 18 year-old Nigerians.

BACKGROUND: This study was carried out on male and female Nigerians whose age ranged from 3 to 18 years in order to provide a database of canthal measurements for a predominantly black population and compare them with Caucasians. STUDY DESIGN: All the healthy pupils and students were randomly selected. The ages of the children, adolescents and young adults were approximated to their nearest birthdays. Two different researchers measured each parameter and the mean values were recorded. SETTING: Nursery, primary, secondary schools and the University of Benin, in Benin City, Nigeria. RESULTS: Four hundred and sixty eight males (53.4%) and 408 (46.6%) females making up a total of 876 subjects were studied. The mean values for medial canthal distance for male Nigerians are slightly higher than those established for male Caucasians and these differences are significant (p>0.05). There was no significant difference in the lateral canthal distance between the two groups (p<0.05). Nigerian and Caucasian females have significant difference (p>0.05) in mean values for medial canthal distances but not in lateral canthal distance (p<0.05). The difference in these distances between Nigerian males and females are not significant. Weight and lateral canthal distance showed a covariance of 6.980 while age and lateral canthal distance, age and medial canthal distance showed a covariance of 2.970 and 1.140 respectively. There was no correlation between age, height, weight and the distances measured. CONCLUSION: Medial canthal distances between male and female Nigerians compared to males and female Caucasians show significant variations but not in the lateral canthal distances.

Postgraduate dental education in Nigeria: professional knowledge self assessed in relationship to skills among resident dental surgeons in Nigerian teaching hospitals.

BACKGROUND: Improvement in any professional calling demands periodic assessment. The purpose of this study was to assess the professional knowledge in relation to skills of the resident dental surgeons in Nigeria in an attempt to contribute to their training needs analysis. METHOD: A 33-item, self-evaluation one-page questionnaire focussing on their knowledge and skills in the different aspects of clinical dentistry was distributed to the residents in Nigerian teaching hospitals. Sixty-six residents consisting of 38 (57.6%) males and 28 (42.4%) females with age range of 27-46 years (mean 31.3 +/- 3.4 SD) completed and returned the questionnaires giving a 91.7% response rate. RESULTS: The overall means for knowledge and skills of the residents were 70.1 +/- 13.8 (SD) and 67.3 +/- 12.0 (SD) respectively. Residents whose claims of professional knowledge and skills were found below average were 30 (45.5%) and 29 (43.9%) respectively. No statistically significant sex differences were found in the claimed knowledge and skills of the residents as well as in terms of their professional status (P > 0.05). The lowest grand means for knowledge and skills were found for orthodontics/paedodontics. CONCLUSION: The study has shown that the resident dental surgeons in Nigeria claimed better professional knowledge than skills and needed most attention in orthodontics/paedodontics.

Management of impacted third molars among Nigerian dentists.

Seventy-five Nigerian dentists were interviewed on their approach to the management of impacted third molars. The mean age of the dentists was 34.8 years, with a male/female ratio of 3.4:1. Most of the female dentists were found in the training institutions (p = 0.005). More than half of the dentists (58.7%) practiced in institutions with dental schools (training institutions), majority preferred the buccal approach (92%), and all the dentists (100%) preferred third molar disimpaction under local analgesia. Most dentists (88%) prescribe antibiotics following third molar surgery. Fifty dentists (66.7%) routinely reviewed all patients postoperatively while 12 dentists (16%) were of the opinion that all impacted third molars should be extracted. Only 21 dentists (28%) were aware of any protocol on the management of impacted teeth. More dentists in the training institutions performed third molar surgery less frequently than dentists in other hospitals (p = 0.07) who tend to employ chisels/mallet for bone removal (p = 0.0004). The need for continuing education and the formulation of guidelines in order to assist dentists to make informed decisions is emphasised. This will help conserve scarce resources and enhance the operation of the newly introduced National Health Insurance Scheme.