Awareness and knowledge of risk factors associated with oral cancer among military personnel in Nigeria.

Background: The military lifestyle has been reported to increase the risk of this population group to the development of oral cancer. Aim: This study aimed to determine the awareness and knowledge of oral cancer in a population of soldiers to acquire data for establishing an educational program for units of the Nigerian Army in oral cancer prevention and monitoring. The study was conducted in the dental center of 82 Division Military Hospital, Nigerian Army, Enugu, Nigeria. A cross-sectional survey was performed using a pre-tested self-administered questionnaire. Materials and Methods: Questions relating to oral cancer awareness, knowledge of causes, and relationship to certain habits, treatment options, and desirability of screening opportunities for oral cancer were asked. Soldiers attending the military hospital, dental center, were chosen randomly for the study. Results: Three hundred soldiers were surveyed. The mean age of those surveyed was 37.5 and had spent an average of 11-15 years in the Army. The majority of the soldiers (80.7%) have heard of cancer; the types most known were breast (75%), skin (30%), and lung cancer (28.3%). Of the 300 soldiers surveyed, 15.3% knew about oral cancer, with 41.3% of these able to identify cigarette smoking and (26%) alcohol consumption as possible risk factors associated with oral cancer. The majority believed that cancer was caused by some form of supernatural phenomenon. Conclusion: Oral cancer awareness is low among soldiers in the Nigerian Armed Forces, and strategies to increase awareness should be developed.

Clinical evaluation of postoperative fever in patients that had oral and maxillofacial surgery in university of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

BACKGROUND: Postoperative fever (POF) is often encountered after major oral and maxillofacial surgical procedures. This could become an unwanted complication, requiring detailed clinical evaluation and investigations to determine the cause. AIM: The aim is to determine the major causes of POF in patients that had oral and maxillofacial surgery under general anesthesia at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu. MATERIALS AND METHODS: The selected patients were admitted and prepared for surgery. Eight hourly axillary temperature readings were taken from the day of admission till discharge. Necessary samples were collected for laboratory analysis from patients that developed fever after their surgery. RESULTS: The patients consisted of 70 males (64.8%) and 38 females (35.2%) giving a ratio of 1.8:1. The mean age of the patients was 27.15 years (SD 13.1). Of the 108 patients studied, 23 (21.7%) developed fever after their surgery. In majority of the patients, the POF lasted within the first 4 days of surgery. There was a significant relationship between duration of surgery and POF. CONCLUSION: This study suggests that most cases of POF are of early onset and of short duration. The longer the surgery time, the more likely POF will occur.

A comparative analysis of the level of cortisol and the number of teeth extracted among patients undergoing routine dental extraction.

BACKGROUND AND OBJECTIVE: A postextraction comparative (cohort) study was carried out to determine whether the number of teeth extracted has an effect on salivary cortisol and by extension on stress. SUBJECTS AND METHODS: Sixty-three consecutive patients comprising 27 males (42.9%) and 36 females (57.1%) with a male: female ratio of 1:1.3, divided into two groups of A and B with a mean age of 25.8 ± 4.9 years, and age range of 18-37 years took part in the study. Fifty (79.4%) of them in group A (22 males and 28 females) each had a tooth extracted while 13 (20.6%) in group B (5 males and 8 females) had two teeth removed. One ml of resting saliva was collected from each patient 10 minutes after the procedure and analyzed for cortisol. All extractions and sample collections were done between 10 am and 2 pm to standardize the study and control for the diurnal variation of cortisol. Statistical analysis of the generated data was performed by using Student's t-test on SPSS version 17.0. The level of significance was set at 0.05 with P< 0.05 regarded significant. RESULT: The result showed mean salivary cortisol level of 12.914 ± 2.4684 ng/ml for group A and 12.108 ± 1.7192 ng/ml for group B though not statistically significant (P > 0.05). Females had more extractions in the two groups when compared with males. Male gender had a statistical significance difference (P < 0.05). CONCLUSION: This study shows that the number of teeth extracted did not have effect on mean salivary cortisol, as a result two teeth extraction does not impart more stress to the patient when compared with one, and as such no additional adjuvant stress relieving measures are needed in two teeth extractions.

Correlation of vermilion symmetry to alveolar cleft defect in unilateral cleft lip repair.

Asymmetry is a major problem in repaired unilateral cleft lip (UCL). One of the important manifestations of this is the asymmetry of the vermilion. The aim of this study was to correlate the severity of the asymmetry in the vermilion to the size of the alveolar defect. Twenty patients aged between 6 and 18 months with complete unilateral cleft lip, alveolus, and palate were included. An impression of each patient's alveolus at the time of cheiloplasty was taken using silicon rubber base material, and a study cast was prepared. The width of the cleft alveolus was measured on these casts using a transparent grid. Frontal photographs were taken at 6 months postoperative and vermilion symmetry was measured as the ratio between the cleft and non-cleft sides. The results obtained in this study showed a direct correlation between the size of the alveolar defect and the vermilion symmetry in repaired UCL. The wider the cleft alveolus and greater the antero-posterior discrepancy, the greater is the vermilion asymmetry. The asymmetry of the vermilion in UCL after repair is directly dependent on the size of the alveolar defect. The alveolar discrepancy causes 'in-rolling' of the vermilion on the cleft side and affects the vermilion symmetry.

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.

Evaluation of cortisol concentrations in saliva as a measure of stress in patients having routine dental extractions.

We measured changes in the salivary concentrations of cortisol as an index of stress, and to find out if patients were stressed during routine intra-alveolar dental extractions. A total of 126 patients (63 experimental and 63 controls) matched for age and sex with a mean (SD) age of 26 (5) years (range 18-40) were recruited. Samples of saliva from patients whose glands had not been stimulated were collected twice from the study group (30minutes before, and 10minutes after, the procedure) and once from the control subjects. All samples were collected between 10.00 and 14.00hours to standardise the method and control for the diurnal variation of cortisol. There was a slight but not significant increase in the mean salivary concentration of cortisol between the preoperative samples (mean (SD) 12.3 (1.5)ng/ml and the postoperative samples 12.8 (2.3)ng/ml in the study group) and the control 8.7 (1.0)ng/ml. However, there was no difference between the sexes. The study highlights a simple but effective way of evaluating stress in patients having intra-alveolar dental extraction, and emphasises the invaluable role of salivary cortisol in the evaluation of stress (particularly in our environment).

Assessing health workers knowledge on the determinants of health: a study in Enugu Nigeria.

BACKGROUND: Different social economic and personal factors have been touted as determining a person's health. This encompasses a person's living environment, economic status, genetic makeup, physical attributes and not just access to health services. It is important that health workers recognize that a person's socio-economic environment can have an adverse effect on the health status ofthe individual so as to capture this aspect in their choice of intervention. METHODS: The study was carried out in two tertiary institutions in Enugu state selected purposively because they housed a dental clinic. It was a descriptive cross sectional study consisting of 87 participants which represented all the dental taff available during the study period. The participants were interviewed with a structured questionnaire used to elicit the knowledge of health workers on health determinants. RESULTS: When individual factors were considered, a greater percentage of health workers, believed that safe drinking water (98.9%), where a person lives (96.6%) and a balanced diet, affect health more than availability of health services (59.8%) or the ability of the health care system to meet the needs of the people (55.2%). However when ranking the magnitude of the contribution of the various determinants of health the majority (37.9%) considered a good health care system the most important contributory factor to determining health of a community while social environment (14.9%) was the least. CONCLUSION: The ranking of good healthcare system over social environment points to the emphasis being laid on curative instead of preventive management of diseases, which have been entrenched in our health workers. Considerations should therefore be made for public health institutions to dwell more on health promotion and education activites on the importance of the social determinatants on health.

The delusion of halitosis: experience at an eastern Nigerian tertiary hospital.

BACKGROUND: Halitosis is a recognized problem in dental practice. Some individuals have the belief that they have offensive mouth odour which neither the dental clinician nor any other person can perceive. This condition is known as delusional halitosis. Delusional halitosis can be classified as either Pseudo halitosis or Halitophobia depending on the response to initial treatment. Halitophobia is an olfactory reference syndrome and is a psychological condition that the dental surgeon is ill equipped to treat alone. This study aimed to analyse patients diagnosed with delusional halitosis, highlight our experiences and make suggestions for improved management of such patients. METHODOLOGY: All patients who presented at the dental clinics of University of Nigeria Teaching Hospital between January 2005 and December 2009 with a primary complaint of oral malodour were examined organoleptically. Those with obvious halitosis and known psychological conditions were excluded from the study Once a diagnosis of delusional halitosis was made, each patient was educated on the nature of halitosis, its causes and prevention. They then received oral prophylaxis and oral hygiene instructions. They were then recalled at one week, four week and six week intervals to establish a definitive classification. RESULT: 18 out of the 25 patients who presented were diagnosed with delusional halitosis. 61% of them male and 39% of them female with an average age of 30yrs. Pseudo halitosis comprised a majority of the cases seen (13). Halitophobia was seen in the minority (5). Reasons sited for believing that they had mouth odour by the patients studied included, peoples reaction when they were in close proximity and how people tended to avoid them (94.4%), ability to self perceive the foul odour from their mouths (55%) and 27.8 % said they had been told by another person that they had bad breath. All the patients had very good oral hygiene, with a tendency to over indulge on oral care products and tended to use mouthwash, breath mints and sweets in an attempt to mask the perceived odour with a few having excessive tooth brushing habits. Most had visited 2 or more other physicians within the year of presentation at the clinic with the same complaint. The patients were embarrassed (55.6%) frustrated (27.6%), self conscious (11.1%) or felt helpless (5.6%) by their perceived foul mouth odour, but none claimed to have suicidal thoughts. CONCLUSION: In all cases of delusional halitosis, there is usually an underlying psychosomatic problem, which can range from an over valued belief to a frank delusional disorder where the individual can hardly be dissuaded from their belief of mouth odour. A multidisciplinary approach to treatment between the dental surgeons and the psychological specialists may present the best approach for the patients.

Patterns of oral and jaw tumours seen in eastern Nigeria: a review of sixty cases seen over a 5-year period--1 January 2000 to 31 December 2004.

Morbid anatomy, University of Nigeria Teaching Hospital (UNTH) caters for over 30 million people, mainly Black Africans. Sixty oral and jaw specimens were received and analyzed. In UNTH, Nigeria record of incidence and pattern of salivary lesions is scanty and, there had been no prior published report on this subject. This is a retrospective study to establish the pattern of oral and jaw tumours seen in Eastern Nigeria and show their sex and age variations. 2. Compare with results published elsewhere. Departmental records for oral and jaw lesions from biopsies were analysed. Sixty oral and jaw tumours were received out of a total of 4500 specimens constituting 1.3% of all biopsies. Twenty-four (40%) were males, 36 (60%) were females. The categories were calcifying odontogenic cysts and fibromas 11 (18.3%). Ameloblastomas affecting the mandible eight (13.3%). Fibrous dysplasia seven (11.7%). Invasive squamous cell carcinomas seven (11.7%). Infections with cellulites and sinusitis six (10%). Post inflammatory polyps and pseudocysts four (7%). Burkitt's Lymphomas four (7%), Haemangiomas and lymphangiomas four (7%), Soft tissue swellings from osteomyelitis three (5%). Butyroid rhabdomyosarcoma, adenoid cystic carcinoma angiofibroma, fibrous histiocytoma and fibrosarcoma were each one (1.7%). Oral and jaw tumours therefore constitute a mere 1.3% of biopsies. The most common subtype seen were the dentigerous cysts/fibromas, followed by ameloblastomas.

A technique of tongue fixation after total mandibulectomy: the Oji spatula.

When ameloblastoma presents late, as is often the case in Nigeria, it can affect the whole mandible. The treatment of choice is total mandibulectomy. The procedure may necessitate the resection of the musculature of the floor of the mouth to which a large portion of the tongue is attached. In our hospitals, immediate reconstruction is not undertaken for various reasons. Consequently, the musculature of the floor of the mouth cannot be reattached to a graft. The purpose of this paper is to illustrate a simple and patient-friendly method for fixation of the tongue after total mandibulectomy to achieve a secure airway. The tongue is tied to a wooden spatula, which stretches horizontally across the mouth. It is in contrast to the conventional technique of rigid fixation of the tongue to the pectoral muscle. This technique was used for 11 patients with large ameloblastomas. For the purpose of comparison, the conventional technique was used in 4 patients. The method of using a wooden spatula as a means of tongue fixation is known in the maxillofacial unit of the University of Nigeria Teaching Hospital, Enugu as the Oji spatula after the surgeon who developed it. All 11 patients tolerated this method well, but the 4 patients who had their tongues tied to the pectoral muscle complained of pain and discomfort. All the patients survived the procedure without postoperative blockage of the airway by the tongue. Follow-up for up to 6 months established that the patients had no respiratory problems.