Capacity of Non-Tertiary Kenyan Health Facilities Selected for Decentralised Dental Training

Objective: To determine the capacity of six non-tertiary Kenyan hospitals enrolled as sites for decentralised dental education.Design: A descriptive cross-sectional study. Setting: The Dental departments of six non-tertiary Kenyan health facilities.Main outcome measures: Capacity of the hospitals to be used as sites for decentralised dental education.Results: Five out of the six facilities had capacity for final year undergraduate students to gain learning experiences in more than 60% of the clinical disciplines studied. All the selected facilities had challenges of lack of specialists; broken down dental equipment and inadequate materials. Conclusion: Although the six hospitals faced various challenges in maintenance of equipment; availability of dental materials and specialist staff; five out of the six facilities had the capacity for dental student learning in more than 60% of the clinical disciplines studied

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.

Nutritional and oral health status of an elderly population in Nairobi.

OBJECTIVE: To determine the nutrition and oral health status of elderly persons in Nairobi, Kenya. DESIGN: A cross-sectional study. SETTING: Households in Dagoretti Division of Nairobi. SUBJECTS: Two hundred and eighty nine persons (29.8% males and 70.2% females) aged 45 years and above were assessed. RESULTS: The level of malnutrition using the mid upper arm circumference was 18.8% while by body mass index was 11.4%. Of the population assessed, 46.4% had normal nutritional status while 40.9% were overweight, with more females (48.0%) than males (25.9%) being overweight. The study established that many of the elderly persons suffered from dental problems, especially periodontitis with 89.9% having dental plaque, calculus 85.6%, gingival recession 82.5% and bleeding gums 77.4%. The decayed index missing and filled teeth, was 7.173 with 19.7% caries free, 51.9% reported tooth mobility and edentulousness was common. CONCLUSIONS: Under-nutrition, obesity and dental problems are issues of concern among the elderly. There is need to develop policies that will look into the nutrition and dental health of the elderly in order to improve their welfare.

Oral hygiene practices and risk of oral leukoplakia.

OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. RECOMMENDATIONS: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Pattern of bone loss in dry mandibles of individuals who died before 1957.

OBJECTIVE: To map out the pattern of periodontal disease in individuals who died before 1957 and were not exposed to formal dental services. DESIGN: Descriptive cross-sectional study. SETTING: National Museums of Kenya. SUBJECTS: The skeletons of people who died before independence are preserved at the National Museums of Kenya in Nairobi. Sixty four out of the 170 dry mandibles stored at the Museum were assessed for periodontal bone loss using a calibrated ruler. RESULTS: All the 64 mandibles assessed were of individuals who died before 1957. Two thousand two hundred and seventy four sites were examined. Most of the subjects were adults aged 30-45 years and the age range was 18-80 years. Majority of the mandibles examined were of the ethnic group from Central Kenya. Of the teeth examined, premolars and molars were the teeth most frequently preserved intact in the sockets. The total mean bone loss for all teeth was 2.51 (SD 1.15) with a range of 0.85-5.80. When the different sites were examined, values for bone loss were 2.59 for mesial surfaces; 2.55 buccal surfaces; 2.38 for distal surfaces. Three categories were identified as follows:- 70% of the individuals had minimal or no bone loss, 26.5% had 3-4 mm or moderate bone loss and 3.5% had >5 mm bone loss or advanced bone loss. Further analysis showed that when bone loss of >3 mm was examined, only 28.12% of the individuals were in this group, 10.93% had >4 mm bone loss and 3.12% had 5 mm or more bone loss. The first molars were the teeth most commonly affected by bone loss of 3mm or more followed by second molars then the premolars. CONCLUSIONS: In this group of individuals mainly from Central Kenya, the bone loss pattern showed that only a small number had experienced periodontal destruction as recorded by bone loss levels. Three groups were identified; those who had no or minimal destruction, those who had experienced moderate destruction and those where obvious bone destruction was evident. Thus susceptibility to periodontal disease is evident in a small proportion of individuals even in populations not exposed to modern diet and formal dental services. Periodontal destruction seems to affect a fraction of the population even when older populations are examined, thus it would save on resources both human and physical if these susceptible individuals could be identified early and treatment provided.

The relationship between tooth brushing frequency and personal hygiene habits in teenagers.

A survey of 904, 14-17 year old school children from secondary schools around Nairobi was done to find out if there was any relationship between toothbrushing frequency and personal hygiene habits. The students completed a questionnaire anonymously in class. Female students brushed their teeth more often than the male students. 62.2% of the females and 50.1% of the males brushed their teeth more than once a day. Of those students who brushed their teeth more than once a day, 52% bathed daily, 22% used perfumes/deodorants daily and 50.1% always washed their hands after visiting the lavatory. No relationship was found between washing of hair and toothbrushing frequency. 69.7% males and 53.2% females gave toothache and tooth decay as the main reasons for mouth care. Those who brushed their teeth more frequently also visited the medical doctor regularly for routine check-ups. These findings indicated that toothbrushing was closely related to personal hygiene habits.

Concentrations of thiocyanate, hypothiocyanite, 'free' and 'total' lysozyme, lactoferrin and secretory IgA in resting and stimulated whole saliva of children aged 12-14 years and the relationship with plaque accumulation and gingivitis.

Resting and stimulated whole saliva was collected from 94 children aged 12-14 years and analyzed for thiocyanate, hypothiocyanite, 'free' and 'total' lysozyme, lactoferrin and secretory IgA. Clinical assessments of the amounts of plaque and gingival inflammation were made, and plaque was collected for determination of dry weight. An inverse relationship was observed between salivary thiocyanate concentrations in both resting and stimulated saliva and the amounts of plaque and gingival inflammation in these subjects (p < 0.05). Lactoferrin concentration in stimulated saliva was directly related to the amounts of plaque and gingivitis (p < 0.05). 'Total' lysozyme concentration in stimulated saliva was directly related to the amount of plaque (p < 0.05), and the 'free' lysozyme concentration in the same saliva was directly related to the amount of gingivitis (p < 0.05). The direct relationship observed between clinical measurements and both lysozyme and lactoferrin concentrations in saliva may have been due to contributions from gingival crevicular fluid. Cluster analysis identified three groups of subjects with different profiles in resting whole saliva, and in particular with different levels of secretory IgA. A statistically significant difference was observed in the quantity of plaque collected from subjects in two of these groups (p < 0.05). These results from cluster analysis using resting whole saliva from children confirmed the findings of a previous study with young adults.

Behçet's syndrome presenting with chronic periodontitis: a case report.

Behçet's syndrome is a disease of uncertain aetiology characterised by recurrent oral and genital ulcerations, ocular lesions and skin lesions. Although cases of this syndrome have been reported almost worldwide, the literature did not reveal any reports from this region. Management of this disorder is mainly palliative. However several treatment regimens have been tried. Following are some of the treatments considered effective. Azathioprine, corticosteroids, chlorambucil, transfusions of fresh blood or plasma and fibrinolytic therapy with phenformin and ethyloestrenol. The importance of multi-disciplinary management of such patients is emphasized.

Prevalence of juvenile periodontitis in national youth service trainees.

The prevalence of juvenile periodontitis was studied in a group of young adults aged 18 to 26 years from the National Youth Service. The study group consisted of a random sample of 350 trainees, 250 males and 100 females. The subjects were examined for plaque scores, gingivitis and pocket depths. Radiographs were used to show bone loss and confirm diagnosis of juvenile periodontitis. Only one subject was diagnosed as having juvenile periodontitis. This represents a prevalence of 0.28% which falls within the range of published prevalence of 0.1% to 3.4% among young adults.

Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11-14 year-old schoolchildren.

The gingival health of 201 schoolchildren aged 11-14 years was assessed at 6 sites on all the incisor and first molar teeth by recording separately the presence or absence of redness and bleeding on probing. Crowding of the incisor teeth was recorded as labio-lingual displacement and mesio-distal overlap. A 2nd examiner recorded the presence or absence of plaque at these sites and assessed mouthbreathing, lipseal and upper lip coverage of the maxillary incisors. Mouthbreathing, increased lip separation and decreased upper lip coverage at rest were all associated with higher levels of plaque and gingival inflammation. Multivariate analysis indicated that this association was statistically significant for mouthbreathing and lip coverage but increased lip separation was not independently related to plaque and gingivitis. The relationship of mouthbreathing and decreased upper lip coverage with gingivitis was most evident in the upper anterior segment and was still evident after covariate analysis to take account of variations due to gender, overcrowding and amount of plaque. However, allowance for these factors also suggested that the influence of mouthbreathing was restricted to palatal sites, whereas lip coverage influenced gingival inflammation at both palatal and labial sites.

Frequency of alveolar osteitis (dry socket) at Kenyatta National Hospital Dental Outpatient Clinic--a retrospective study.

The objectives of this study were to determine the frequency of alveolar osteitis at Kenyatta National Hospital (KNH), most affected age group and the reasons for underlying extractions. Out of 8,393 extractions 273 (3.3%) developed alveolar osteitis. 98.5% of the teeth that developed alveolar osteitis were molars and premolars. 52% of the patients that developed alveolar osteitis were females and 48% were males. The mandible was more affected than the maxilla. The percentage distribution of alveolar osteitis according to age groups 10-19 year, 30-39 years, 40-49 years, 50-59 years and 60-69 years were 6.2%, 53.1%, 23.8%, 5.5%, 4.8% and 2.9% respectively. On the average, patients reported with alveolar osteitis 5.7 days following extraction. Out of 8,393 extractions, 72.5% were due to dental caries, 18% were due to periodontitis and the rest were due to other causes. It was concluded that the frequency and average, patients reported with alveolar osteitis 5.7 days following extraction. Out of 8,393 extractions, 72.5% were due to dental caries, 18% were due to periodontitis and the rest were due to other causes. It was concluded that the frequency and pattern of development of a alveolar osteitis at KNH was similar to that reported in developed countries.