The prevalence of early childhood caries and its associated risk factors among preschool children referred to a tertiary care institution.

OBJECTIVE: The aim was to determine the prevalence of early childhood caries (ECC) and its association with infant feeding and oral health-related behavior among preschool children aged 6-71 months in Lagos. MATERIALS AND METHODS: This was a descriptive cross-sectional study in which 302 children aged 6-71 months were selected from four pediatric outpatient clinics in Lagos, Nigeria. A structured questionnaire was used to obtain information regarding oral hygiene practices, dietary habits, breast and bottle feeding, birth weight of child and socioeconomic status of the family, from mothers of the children. The status of dental caries was recorded according to the World Health Organization criteria. RESULTS: The prevalence of ECC among 302 children aged 6-71 months was 21.2% while the mean deft was 0.735. Multivariate logistic regression analysis showed the correlation of ECC with the associated risk factors. ECC was significantly higher in children who were bottle-fed at night. Method of tooth cleaning other than using fluoridated toothpaste significantly increased the prevalence of ECC. Breastfeeding for duration of 3-6 months showed significantly lesser caries prevalence. Caries significantly increased with age. CONCLUSION: Early childhood caries is a multifactorial disease in which prolonged duration of breastfeeding, nocturnal bottle feeding, and use of cleaning methods other than fluoridated toothpaste are risk factors for ECC. Oral health promotion programs should be targeted at mothers, pediatricians, nurses, caretakers at day care centers and primary care health workers.

Utilization of Oral Health Care Services by University Undergraduates in Lagos, Nigeria.

BACKGROUND: Data on the utilization of the available oral health facilities by university undergraduates is scarce in Nigeria. OBJECTIVES: To determine the level of utilization of oral health care services and to identify the barriers to seeking treatment among University of Lagos students. METHODS: A cross-sectional survey was carried out among University of Lagos undergraduates. Systematic sampling was used to select participants after randomly selecting a male and female hostel. Self-administered questionnaires were distributed to participants and collected immediately. The data was analyzed using Epi info version 6.04 software. Statistical significance was evaluated with chi square test and p-value <0.05 was regarded as significant. RESULTS: About half (50.9%) of the respondents had visited the dentist previously while only 42.7% respondents had utilized dental services in the past 12 months. There was no significant association between the age, gender, year of undergraduate education, and the faculty of these students and their level of utilization of oral health care services. A high proportion of respondents that had attended the dental clinic went for dental checkup (33.6%) and extractions (30.9%).The major barriers to receiving dental treatment was a lack of perceived need for dental treatment (53.1%) followed by lack of time (27.1%), fear/anxiety (18.2%) and cost of treatment (18.2%). CONCLUSION: The low level of utilization among the undergraduates in Lagos, Nigeria shows that there is need for greater oral health awareness among the students, thereby increasing the use of oral health care facilities.

Changes in the prevalence of dental caries in primary school children in Lagos State, Nigeria.

OBJECTIVES: To evaluate the changes in the prevalence of dental caries in Lagos State over a 3 years period and the role of age, sex, and playing in the changes observed. MATERIALS AND METHODS: Three primary schools in Lagos State, Nigeria were randomly selected for the study. Six hundred and thirty-three children age 2-12 years, were examined for caries in 2000 while 513 children were examined in 2003. The prevalence of tooth decay and the prevalence of untreated tooth decay were calculated for the two years, that is, 2000 and 2003. Also the degree of unmet treatment need among the population with caries experience was measured. Differences in the prevalence and severity of dental caries in the primary and permanent dentition were assessed. RESULTS: Approximately 18% of children had untreated tooth decay in their primary dentition in 2003: A 26.1% increase from 2000. About 12.0% of the decay, extracted, and filled teeth (deft) index was seen with decayed teeth in 2000 and 16.6% in 2003. Extracted primary teeth decreased from 2.5% in 2000 to 1.5% in 2003. The change in mean deft between 2000 (0.42) and 2003 (0.47) was 11.9%. Over the study period, the overall reduction in the prevalence of dental caries was 34.8% in the permanent dentition. The decline was larger among children aged 5-9 years (62.1%) and among females (75%). CONCLUSION: The study showed no overall changes in caries severity but a decrease in caries prevalence in the permanent dentition over the study period. The largest decline in caries prevalence in the permanent dentition was observed in children aged 5-9 years and females. On the contrary, there was an increase in the caries prevalence in the primary dentition.

ORAL HEALTH QUALITY OF LIFE IN A NIGERIAN UNIVERSITY UNDERGRADUATE POPULATION.

INTRODUCTION: Oral health related quality of life is utilized in health services research to examine trends in oral health and population-based needs assessment. OBJECTIVE: To assess both the generic and orthodontic specific aspects of the Oral health-related quality of life of a University undergraduate population. METHODOLOGY: This was a cross-sectional descriptive study carried out among 420 undergraduate students, aged 18-30years old, attending the University of Lagos, Nigeria. The data collection was carried out through oral interviews and self-administered questionnaires. Two Oral health related quality of life instruments were used (1) A generic scale: the Shortened version of the Oral Health Impact Profile (OHIP-14) and (2) A condition specific scale: the Psychosocial impact of dental aesthetics questionnaire (PIDAQ). Data analysis was carried out using the Statistical Package for Social Sciences (SPSS). RESULTS: With respect to the Oral Health Impact Profile (OHIP-14) scale, the overall mean score recorded by the students was 10.43+7.85. The physical pain subscale recorded the highest impact with 93.3%, while the least impact was recorded in the handicap subscale, with 29.9%. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) scales revealed significant gender differences, with the subscales of 'social impact', 'psychological impact' and 'aesthetic concern' recording low mean subscale values. CONCLUSION: . The mean Oral Health Impact Profile (OHIP-14) score of the students (10.43 + 7.85) in this study reflects that the oral health status of most of the students did not significantly affect their Oral health-related quality of life. However, the physical pain domain was the most severely affected aspect of their Oral health-related quality of life. The Psychosocial Impact of Dental Aesthetics (PIDAQ) scale scores recorded significant gender differences.

Caries incidence in a cohort of primary school students in Lagos State, Nigeria followed up over a 3 years period.

AIM: To describe the progression of dental caries in pupils who had access to an education intervention programme over a three years period. STUDY DESIGN: This was a prospective cohort study. METHODS: A school-based study consisting of 251 children aged 2-10 years old attending three primary schools in Lagos State, Nigeria. Baseline and exit dental examinations were conducted. Study exit examination was conducted 3 years after the baseline. The deft and DMFT index was used to assess caries severity. The key outcome measure recorded in the study was the development of new cavities in any of the previously caries-free teeth. The presence or absence of caries was represented by the change in deft and or DMFT status. STATISTICS: In the analyses, the incidence of new cavities was recorded at both the subject and tooth levels. Incidence rates for the development of new caries were calculated for all children who: were caries-free at recruitment had caries at recruitment were caries-free at recruitment but developed caries during follow up. Relative risk (RR) analysis was also computed for caries-risk estimation. RESULTS: The caries incidence for the study cohort was 9.9%. About 11.0% of children who were caries free at inception of the study developed caries three years later. The cumulative incidence of caries for the cohort of children who were caries-free at the commencement of the study was 105 new cases per 1,000 persons. Of the 40 children who had caries at the inception of the study, 21 (52.5%) developed new caries lesions. The cumulative incidence of caries for the cohort of children who had caries at the commencement of the study was 525 new cases per 1,000 persons. The relative risk of developing caries over a three year period was significantly higher (RR=4.99; 95% CI = 2.88 - 8.64; p< 0.001) in those who had caries at baseline than those who were caries-free at baseline. Caries severity remained stable over the 3 years period. CONCLUSIONS: Caries incidence and severity was low for the study cohort. The relative risk of developing new caries lesion was significantly higher in those with caries when compared with those without caries.

Patient satisfaction: a survey of dental outpatients at the Lagos University Teaching Hospital, Nigeria.

BACKGROUND: Patient satisfaction with dental services has received minimal attention in Nigeria. Quality of service is however, an integral part of any business. The study assessed dental outpatients' satisfaction with oral health care delivery a tertiary institution in Nigeria. The perceptions of the oral health care provider and suggestions that will improve service delivery were also obtained from these consumers. METHODS: A modified Dental Satisfaction Questionnaire (DSQ) was used to assess the patients. An aggregate score was also calculated for each respondent for all variables tested under the five items on dental patient satisfaction. The highest possible score was 76, based on the number of items assessed. The cut off point for satisfaction was set at 38. RESULTS: Three hundred patients participated in the study. The items with the top three scores were dentist-patient relationship (respect/listen), rapport and infection control with mean scores of 3.5, 3.4, and 3.3 respectively. The range for the aggregate score for level of satisfaction was 16-68. High level of satisfaction reported in 159 (53%) of the respondents and low level in 141 (47%). Dissatisfaction was expressed with regards to the infrastructure, electricity/regular supply of water and being treated by unsupervised students in 85.7%, 59.5% and 89% respectively. CONCLUSIONS: The overall high level of satisfaction was related to the communication skills and rapport of staff with the patients. There is an urgent need for improvement on infrastructure and provision of a steady supply of water and electricity.

Patient Satisfaction: a Survey of Dental Outpatients at the Lagos University Teaching Hospital; Nigeria

Background:Patient satisfaction with dental services has received minimal attention in Nigeria. Quality of service is however; an integral part of any business. The study assessed dental outpatients' satisfaction with oral health care delivery a tertiary institution in Nigeria. The perceptions of the oral health care provider and suggestions that will improve service delivery were also obtained from these consumers. Methods: A modified Dental Satisfaction Questionnaire (DSQ) was used to assess the patients. An aggregate score was also calculated for each respondent for all variables tested under the five items on dental patient satisfaction.The highest possible score was 76; based on the number of items assessed. The cut off point for satisfaction was set at 38. Results: Three hundred patients participated in the study. The items with the top three scores were dentist-patient relationship (respect/listen); rapport and infection control with mean scores of 3.5; 3.4; and 3.3 respectively.The range for the aggregate score for level of satisfaction was 16-68. High level of satisfaction reported in 159 (53) of the respondents and low level in 141 (47). Dissatisfaction was expressed with regards to the infrastructure; electricity/regular supply of water and being treated by unsupervised students in 85.7; 59.5and 89respectively.Conclusions:The overall high level of satisfaction was related to the communication skills and rapport of staff with the patients.There is an urgent need for improvement on infrastructure and provision of a steady supply of water and electricity

Coping with Oral Pain: Lay Management Strategies Adopted by Patients Prior to Presentation

Objectives:To identify lay measures taken by patients in response to oral pain before seeking professional care and to determine factors leading to demand for professional oral health care.Methods: A cross-sectional survey of patients aged 16 years and above who presented with oral pain at the oral diagnosis clinics of the Lagos University Teaching Hospital and the Lagos State University Teaching Hospital was carried out. Data was collected by means of questionnaires which sought information on onset and duration of pain; character; aggravating and relieving factors and actions taken by the patients before presentation at the dental clinic. Results: A total of 215 patients participated. More than half of them described their pain as severe to very severe with 106(49.3) and 21(9.8) reporting sleep disruptions and severe agony respectively. Delay in presentation range from over a month in 56(26) patients to years in 85(39.5). Responses to pain symptoms included; communication with different persons for advice in 192(89.3) and application of at least one lay measure in 183(85.1) patients. Duration and persistence of pain was associated significantly with the use of more than one measure. There was no association between gender or age and the use of lay measures. Use of measures with possible adverse effects like petrol and acid was reported in 5(2.7) of the respondents. Conclusion: Lay strategies in response to oral pain are common in this Nigerian population and appear to be used as an alternative to professional oral health care

Hepatitis B virus infection and prevention in the dental clinic: knowledge and factors determining vaccine uptake in a Nigerian dental teaching hospital.

BACKGROUND: hepatitis B virus (HBV) is a well recognised occupational risk for dental health care workers in an endemic area like Nigeria. It is however effectively vaccine preventable. There had been a suboptimal uptake of this vaccination. OBJECTIVES: This study assesed the knowledge of respondents on pre-exposure prevention and post exposure management of HBV infection. It also investigated level of compliance with the vaccination and factors associated with non-compliance. METHODS: The study was conducted by self-administered questionnaires distributed to clinical students and all cadres of staff working at the dental clinic of the Lagos University Teaching Hospital. RESULTS: 159 persons participated. Knowledge of the infection was inadequate. There was an overall vaccination rate of 40.3%. However, dentists were significantly more likely to be vaccinated than either the other cadres of staff or the students (p = 0.014). Students had the poorest compliance. 54% of respondents gave reasons suggestive of complacency for non-uptake. CONCLUSIONS: Students and staff of the Dental School of the Lagos University Teaching Hospital are not adequately protected against HBV. We recommend mandatory immunisation of both students and-staffs before exposure to clinical practice

Does exposure to dental education change the perceptions of Nigerian students to dentistry as a profession?

AIM: To assess any effect of exposure to dental education and training on the perception and acceptance of dentistry by dental students at a Nigerian dental school. PARTICIPANTS AND METHODS: The study was conducted by means of an anonymous self-administered questionnaire distributed to second-, fifth- and sixth-year dental students at the College of Medicine, University of Lagos. Participation was voluntary and 67 students agreed to participate in the study. Majority (51%) were aged between 24 and 27 years. The questionnaire contained questions on demography, preferred choice of course on admission, attempts at change of course, their present perception to dentistry and future dental practice. RESULT: Over 90% of them were admitted through the Joint admission and matriculation board and 40 (60%) chose Medicine as their first course choice. Of the 40, 18 had attempted a change of course and eight were still interested in a career change (four were in the fifth year). Most of the change in attitude occurred in fourth year. Sixty (90%) intend to practice dentistry but 38 (63%) of these would like to practice outside Nigeria. CONCLUSION: Exposure to dental training appears to improve students' perception about dental practice but uncertainty about future prospects in Nigeria may lead to brain drain in the dental profession.

Gender Differences related to HIV/AIDS in South West Nigeria

The aim of this study was to determine some underlying gender differences in the pattern of infection in a group of HIV positive patients in Nigeria. It involved 328 consecutive HIV positive patients attending dedicated clinics at four teaching hospitals in the South western part of Nigeria. Information on patients' socio-demographic characteristics and their attitude towards disclosure of their HIV status were collected with an interviewer administered questionnaire. There was a significant difference in the age distribution between the genders with a higher proportion of those younger than 35 years being females and higher proportion of males in the older age groups (p 0.05). A higher proportion of the female respondents were unemployed (73.2); students (88.9) and small scale traders (62.5) compared to the males. There was also a significant difference between the genders concerning disclosure of HIV status with the males more willing to disclose their status compared to the females (p 0.05). Fear of breach of confidentiality and discrimination were the most common reasons given. Conclusion: There is a need for economic empowerment of women as poverty increases the vulnerability of women to the infection

Assessment of knowledge and practice of cross--Infection control among Nigerian dental technologists.

OBJECTIVE: to determine the knowledge and current infection control practices among dental laboratory technologists in Nigeria. METHOD: a cross-sectional descriptive study using self-administered questionnaires distributed through the Dental Technologist Board. RESULT: 86 questionnaires were returned out of the 200 distributed (response rate=43%). Knowledge of risk of transmission of infections was poor with a remarkable percentage of non-responders. More than half (61.9%) considered HIV infection as the greatest infectious occupational hazard for them while only 25.5% correctly responded that Hepatitis B(HBV) was the greatest risk. Infection control practices were inadequate with 53.5% of them never sterilising their hand instruments and 74.4% treat impressions by rinsing in water while as high as 39.5% never wear gloves while working in the laboratory. Only 21(24.4%) had received HBV vaccination and 38.4% were not aware of the need to be vaccinated. CONCLUSION: the knowledge and practice of infection control was poor and below acceptable standards. The paper recommended ways by which improvements can be made.

Perceived sources of stress in Nigerian dental students.

The objective of this study was to identify sources of stress among dental students at the University of Lagos, Lagos, Nigeria. A modified Dental Environment Stress (DES) questionnaire was used to study the 137 students in years 3-6, of which 105 (76.6%) responded. Results show that the year 5 students indicated the highest level of stress overall on items relating to pre-clinical training with 21 (70%) recording aggregate DES score over the cut-off point for high stress. For clinical items, nearly all the students - 27(90%) of year 5 and 24 (100%) of year 6 recorded aggregates over the cut-off point. The most important stressors were those related to the lack of provision of a well-supported system of dental education in Nigeria in terms of availability of materials for clinical training and study materials. There were no significant differences in stress perception between genders. However, students who chose Medicine as their first choice for admission with Dentistry as an alternative experienced significantly higher overall mean and higher mean scores for most items. In conclusion, it appears there is a need to improve support for dental education in Nigeria.

Gum bleeding as a symptom of disease : are Nigerian mother aware ?

Aim: to assess the perception of Nigerian mothers on causes of gum bleeding in children.Method: A cross-sectional survey of all willing mothers attending the maternal and child health clinics of the Lagos University Teaching Hospital and two randomly selected primary health care clinics in a local Government area of Lagos state.Result: 464 mothers were involved in the study. Of these; 259(55.8) had received some form of oral health education. 187(39.7) did not know the probable causes of gum bleeding and of the remaining 277; only 61(13.1) and 42 (9.1) ascribed the cause to poor oral hygiene and bacteria respectively. Majority of them had wrong perceptions about gum bleeding. Their perception was significantly associated with their level of education and a history of previous dental visit. In conclusion; oral health education in Nigeria should be structured so it addresses diseases of priority. There should be integration of primary oral health care in other health care programmes for a wider reach of the population

Gum Bleeding as a Symptom of Disease : are Nigerian Mothers Aware

Aim: to assess the perception of Nigerian mothers on causes of gum bleeding in children. Method: A cross-sectional survey of all willing mothers attending the maternal and child health clinics of the Lagos University Teaching Hospital and two randomly selected primary health care clinics in a local Government area of Lagos state. Result: 464 mothers were involved in the study. Of these; 259(55.8) had received some form of oral health education. 187(39.7) did not know the probable causes of gum bleeding and of the remaining 277; only 61(13.1) and 42 (9.1) ascribed the cause to poor oral hygiene and bacteria respectively. Majority of them had wrong perceptions about gum bleeding. Their perception was significantly associated with their level of education and a history of previous dental visit. In conclusion; oral health education in Nigeria should be structured so it addresses diseases of priority. There should be integration of primary oral health care in other health care programmes for a wider reach of the population

Public perception of cross-infection control in dentistry in Nigeria.

OBJECTIVES: To assess the perception of patients on the use of gloves and facemasks in dental practice, methods of sterilisation and the risk of cross-infection. METHODS: Questionnaire survey of patients attending two teaching hospitals and a private dental clinic in Lagos, Nigeria. RESULTS: 228 respondents returned the questionnaires. Nearly all (98.6%) regarded the use of gloves as necessary and 189 (82.9%) did not mind the use of gloves, only 129 (56.6%) felt the facemask was necessary although 132 (57.9%) did not mind its use. More than half of the respondents (54%) felt they could contract an infection in the dental clinic and 43% of them identified HIV as a risk. This response was significantly affected by educational status (p<0.05). 140 patients (61.4%) would not attend a clinic if they knew that HIV patients were treated there. Females were significantly more unwilling to attend (p<0.05). CONCLUSION: While this survey shows a high level of acceptance of the use of gloves, there is a glaring lack of knowledge and acceptance of the use of the facemask indicating a need for more effective public enlightenment on the use of barrier methods. It also reveals a great deal of fear for HIV among Nigerians.

A survey of the knowledge, attitude and practices of antenatal mothers in Lagos, Nigeria about the primary teeth.

To assess the knowledge, attitude and practices of antenatal mothers about the primary dentition. This cross-sectional study was carried out in Lagos. It assessed the knowledge, attitude and practices of 464 Nigerian mothers about the primary teeth. All the mothers were seen at the antenatal clinics of the Lagos University Teaching Hospital and primary health centres in the local government area of the teaching hospital. The mothers' knowledge of the 2 most commonly presenting oral conditions: bleeding gums and dental caries were evaluated. Results of the study showed that approximately 36.7% of the mothers had received information on oral health care from a dentist. About seventy percent (71.33%) reported that primary teeth were important and 79.31% agreed with the statement that tooth decay was preventable. However, only 8% of the mothers used toothbrush and toothpaste for cleaning their children's teeth. Only 37(7.97%) of the mothers had taken their children to a dentist before. The visits were for symptoms of pain and tooth decay. There was a statistically significant association between educational status and knowledge of primary teeth, (p=0.003308). Over half (51.3%) of the study sample associated caries with consumption of sugars. There was a statistically significant association between perceived aetiology of caries and educational status, p=0.00000. There was a statistically significant association between mother's past dental visit and child's past dental visit, p=0.000000005. The findings of the study show that oral health knowledge of the primary teeth by this group of Nigerian mothers is rather diffuse. It is recommended that medical professionals; obstetricians, gynaecologists and paediatricians encourage mothers to seek professional oral health counselling as soon as possible especially as soon as or before the primary teeth start to erupt. In addition, regular dental visits will ensure that the child benefits from age-specific information that is readily available to the mother.

Primary Oral Preventive Practices: Knowledge and Practice among College of Medicine University of Lagos Students

This was a prospective study to assess the primary oral preventive practices of 200 students attending the College of Medicine of the University of Lagos. This was assessed using a structure self-administered questionnaire. The questionnaire was designed to elicit information on knowledge of oral health preventive practices; their beliefs and oral hygiene practice. Two hundred students submitted properly filled questionnaire. Only 35

Minimum practicable and acceptable infection control recommendations for dental practice in Nigeria.

The advent of HIV/aids has led to a renewed interest in infection control and occupational safety in dentistry. The full implementation of "Universal Precautions" to prevent cross-infection of HIV, hepatitis B, and other blood borne pathogens would have a heavy financial implication on developing countries like Nigeria which are faced with the arduous problem of coping with scarce resources. Dentistry is bound to cost more when effective infection control is practised. This paper therefore proposes recommendations for minimum, practicable and acceptable infection control standards which are not only cost effective but also attainable.

Dental caries status of primary school children aged 4-16 years in southwest Nigeria.

OBJECTIVE: To assess the dental caries status of primary schoolchildren aged 4-16 in both urban and rural areas of Lagos State, Southwest Nigeria. DESIGN: Cross sectional and descriptive. METHOD: Sample comprised of primary school children (n = 1,829) selected from five urban non-fee paying schools and three fee-paying schools as well as five rural fee-paying schools. Caries was diagnosed based on the WHO caries diagnostic criteria (1997). RESULTS: Caries prevalence was 14.4% in the urban area and 5.7% in the rural area (p < 0.01). Children from the fee-paying schools had a caries prevalence of 21% while those from the non-fee paying schools had a caries prevalence of 8.1% (p < 0.01). There was no significant difference in dft score among 4-6 year-olds, which was 0.33 and 0.32 in both the urban and the rural areas respectively but there was a significant difference in dft and DMFT score in the older age groups. Most of the caries were unrestored, only 3 (0.16%) had filled teeth. 9.1% required restorative treatment, 2.4% had teeth for extraction. CONCLUSION: The prevalence of caries is low in the Nigerian population studied. Treatment rate is very low.