an evaluation of the possible relationship between chronic periodontitis and hypertension.

BACKGROUND: Periodontal diseases have been reported to have a form of reciprocal relationship with the general systemic health, in which case those with some systemic diseases such as hypertension have poorer periodontal health and vice versa. The issue of causal or casual relationship is however yet to be finally resolved. AIM: The aim of this study was to determine any possible relationship between chronic periodontitis and cardiovascular risk factors. METHODOLOGY: A cross-sectional assessment of cardiovascular risk factors such as blood pressure, body mass index, waist circumference and the carotid artery intima media thickness (CIMT) was done among 100 consecutive subjects in the echocardiogram unit of the University College Hospital, Ibadan, Nigeria over a period of six months. These cardiovascular risk factors were compared with periodontal parameters such as Simplified Oral Hygiene index (OHI-S), Gingival index (GI) and Community Periodontal Index (CPI). RESULTS: The systolic blood pressure (SBP) of the respondents ranged from 98 - 210 mm Hg with a mean of 133.1 ± 15 mm Hg, diastolic blood pressure (DBP) 60 - 136 mm Hg with a mean of 84.6 ± 6.4 mm Hg. There was a statistically significant relationship between the systolic blood pressure and oral hygiene index (P< 0.000), diastolic blood pressure and oral hygiene index (P < 0.010) and mean carotid artery intima media thickness and oral hygiene index (P< 0.012) among the respondents. CONCLUSION: In view of the significant relationship between the blood pressure and the mean carotid artery intima media thickness, when compared with the oral hygiene status of respondents in this study, more emphasis should be laid on regular preventive dental visit as a way of decreasing cardiovascular health risk.

Periodontal Condition and Treatment Needs of Some Pregnant Women in Ibadan, Nigeria.

BACKGROUND: Periodontal diseases had been reported to be worse in the presence of hormonal imbalance as seen during pregnancy, which if that is the case, should resolve following childbirth when the hormonal level of the women should have reverted to normal. SUBJECTS AND METHODS: Periodontal health of 345 pregnant women was assessed once during pregnancy and at 14(th) week following their childbirth. The clinical variant of community periodontal index of treatment needs probe was used in the assessment. RESULTS: During pregnancy, 167/345 (48.4%) of the women had deep pockets, 178/345 (51.6%) had shallow pockets. After childbirth, 5/345 (1.5%) had healthy periodontium, 25/345 (7.2%) had calculus and 7/345 (2.0%) had deep pockets. All of the respondents required oral hygiene instructions (OHI) and prophylaxis and 167/345 (48.4%) required complex treatment during pregnancy. After childbirth, 340/345 (98.5%) of the women required OHI and prophylaxis. Despite the great need for dental treatment among the respondents, majority never sought any treatment as 308/345 (89.3%) of the respondents had never visited a dentist before the study. CONCLUSION: The fact that the deep pocket reduced drastically following childbirth shows that it was not a true pocket. The high unmet treatment needs among the respondents require a concerted effort from dentists and policy makers in order to enlighten the women, especially those of child bearing age concerning the need for preventive dental visitation.

Clinical correlates of a lateral-flow immunoassay oral risk indicator.

BACKGROUND: The aim of the present study is to investigate the clinical correlates of a novel lateral-flow immunoassay with bleeding on probing (BOP), oral hygiene, and periodontal probing depth. This report offers a simple, rapid, and highly sensitive tool that addresses two issues important to periodontists: 1) detecting active periodontitis, and 2) predicting chronic periodontitis. METHODS: Seventy-six of 86 males requiring seminal fluid analysis as part of a separate study were serially recruited into the study. After basic dental and periodontal examination under natural light and with the use of the community periodontal index of treatment needs (CPITN) probe, debris and calculus indices were recorded per participant. Participants were subsequently grouped into "good," "fair," and "poor" oral hygiene categories based on a simplified oral hygiene index. BOP was assessed with the ball-ended tip of the probe, and periodontitis was assessed with pocket probing as well as a lateral flow of neutrophil collagenase-2 immunoassay, which measures levels of matrix metalloproteinase-8. RESULTS: Neutrophil collagenase-2 immunoassay was 96% sensitive for poor oral hygiene, 95% sensitive for chronic periodontitis (defined as at least two sites with periodontal pockets), and 82.6% sensitive for at least two sites with BOP. CONCLUSION: Neutrophil collagenase-2 immunoassay had a high sensitivity for at least two sites with BOP and two sites with periodontal pockets but a lower relationship for single-site pockets and BOP.

Validation of the oral impact on daily performance frequency scale in Ibadan, Nigeria.

BACKGROUND: Oral health related quality of life measures provide alternative ways to evaluate oral health status in a way that prioritises impact on lifestyle. These measures are, however, hardly used in our setting. Before the measures can be used effectively, validity of the tool needs to be evaluated. The aim of the study was to validate the Oral Impact on Daily Performance (OIDP) frequency scale in an adult Nigerian patient population. METHODOLOGY: This was a descriptive cross sectional study in which consecutive patients attending the Primary Oral Health Care Centre, Idikan and the Oral Diagnosis Clinic of the University College Hospital, Ibadan were recruited. Data was collected with OIDP structured interviewer administered questionnaires, global self-rating and perceived treatment need questions and by oral examination. The frequency scale of the OIDP index was used to compute the impact scores. Data collected was subjected to statistical analysis using SPSS version 19. RESULTS: A total of 204 patients participated in the study. The OIDP score ranged from 0 to 40; 78.9% of the participants reported an impact on daily performance with eating and enjoying food being the most reported activity impacted upon. The Cronbach's alpha coefficient was 0.811; the OIDP index was significantly associated with global self-ratings of oral health, perceived need for dental treatment and was able to discriminate between patients with or without dental caries. CONCLUSION: The OIDP frequency scale exhibited satisfactory psychometric properties amongst adult dental patients in Ibadan, Nigeria.

Dental health service utilisation by resident doctors/medical officers in the University College Hospital, Ibadan, Oyo State, Nigeria.

BACKGROUND: Dental disease is still a serious health problem universally possibly because dental health awareness and dental service utilization is still very low. The reported prevalence of dental diseases, especially periodontal disease, is higher among the black race while their rate of dental service utilization is lower in comparison to Caucasians. AIM: The aim of this study was to assess the rate of dental service utilization and identify the factors influencing such utilization by medical doctors and dentists in the University College Hospital, Ibadan. METHODOLOGY: Two hundred 26-item questionnaires were distributed among the resident doctors/medical officers in the University College Hospital, Ibadan, Oyo state. The questionnaire sought to know if there is any previous dental visits, the reason for such visits and any other follow-up visits afterward. One hundred and ninety of the doctors returned the filled questionnaires giving a response rate of 95%. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 14.0. Level of statistical significance was set at p < 0.05. RESULTS: Majority of the respondents (65.3%) had a previous dental visit but only 25.3% was within the last one year of the study. Among those that had visited a dentist before, 59.7% did so for the symptomatic treatment of one ailment or the other and only 13.7% of them went back for the follow-up appointment after the resolution of their symptoms. There was a statistically significant difference between the rate of dental service utilization and the gender of the respondents (p < 0.001). There was no statistical significant relationship between the rate of dental service utilization and age of the respondents. CONCLUSION: The study showed that the rate of dental service utilization is low when compared with that of developed countries. Some factors identified as contributing to the lack of dental service utilization among the participants include prolonged and repeated dental appointments and the demand of their work.

Effect of academic stress on periodontal health in Nigerians.

The aim of the study was to assess the effect of academic stress on periodontal health. The experimental group consisted of 22 final year dental students preparing for a major final BDS examination. The control group was made of 29 first year dental clinical students who were not preparing for any examination. Informed consents were obtained from all the students who participated in the study. The study was double blind as the examiners and the students were not aware of the aim of the study at the examination stage. The baseline measurements of Oral Hygiene Index (OHI) and Gingival Index (GI) were done 6 weeks prior to the commencement of the final BDS examination for both the experimental and the control groups. Statistical significant differences were observed in the two indices at final reading, between experimental and control groups while the baseline scores for the indices revealed no statistical significant differences. The results indicate that non-demonstrable factors like psychosocial stress represent a risk indicator for periodontal disease and these should be addressed in periodontal patients before and during treatment.

Oral manifestation of HIV/AIDS.

The Human Immunodeficiency Virus (HIV) infection and Acquired Deficiency Syndrome (AIDS) have become a pandemic with about 40 million infected people world-wide. The virus attacks the immune cells resulting in a defective cell-mediated immune response thus exposing the host to opportunistic infections. Oral and peri-oral lesions are often seen in HIV infections and sometimes, appear as the first indicators of the disease. The appearance of these lesions in a known HIV infected person could also be a signal of the deterioration of the infection into a full-blown AIDS. It is therefore necessary that Health care givers should have a good working knowledge of the possible oral manifestations of the disease. This write-up highlights the clinical features and treatment of oral lesions associated with HIV infections.

Nigerian dentists' knowledge and attitudes towards mouthguard protection.

The objective of this study was to assess the knowledge and attitudes of Nigerian dentists towards mouthguard protection. A pre-tested 15-item, one-page questionnaire was distributed to 185 dentists practising in different parts of the country with government hospitals or private establishments, by 'hand-delivery' system. Filled and returned forms were 170 (response rate of 92%). The period of the survey was between April and August 2003. Dental graduates from the different dental schools in the country responded to this survey. About 49% of the respondents indicated having only classroom lectures on mouthguards during their undergraduate trainings, 11% said they had some laboratory sessions in addition while no form of education on mouthguards was received by 40%. About 82% had never recommended mouthguard protection for athletic patients, and the major reason was no formal training in the subject. Only 58.5% were familiar with the different types of mouthguards, 75.9% would not be able to supervise or fabricate mouthguards and 50.6% would prefer custom-made mouthguard for their athletic patients. About 84% felt the current training on mouthguards in Nigerian dental schools is inadequate. Over 98% agreed that mouthguard usage in contact sports should be encouraged with the involvement of the dentists. The knowledge and attitudes of the respondents towards mouthguard protection did not vary significantly across years of postqualification from dental schools as well as the professional status of the dentists (P > 0.05). Although Nigerian dentists support mouthguard protection in contact sports and want to be involved in the provision of mouthguards for athletes, their knowledge of the protective device is inadequate. There is need for attention to be given to this subject in the undergraduate curricula of our dental schools.

Periodontal status of orthodontic patients and the relationship between dental aesthetic index and community periodontal index of treatment need.

This prospective clinic-based study evaluated the pretreatment periodontal status of the orthodontic patients seen at the University College Hospital, Ibadan, Nigeria, and assessed the relationship between dental aesthetic index (DAI) scores and periodontal status according to community periodontal index of treatment needs (CPITN) scores. One hundred forty five patients-70 (48.3%) males and 75 (51.7%) females from 6 to 45 years (mean 15.8 +/- 7.5)-were seen. World Health Organization (WHO) guidelines were followed in the examination and reporting of the periodontal status, and DAI scores were assessed based on WHO guidelines. The chi-square test was used to determine the association between the DAI and the CPITN scores. Most patients were in the 6-15 (55.9%) or 16-25 (35.9%) age groups. Based on the WHO preferred cumulative calculations of treatment need (TN), 35.2% of the patients had TN 0, 64.9% had TN 1, 24.9% had TN 2, and only 0.7% had TN 3. The relationship between DAI scores and periodontal treatment needs was not statistically significant (P >.05). Although many patients were yet to attain the WHO goal of no more than 1 sextant affected by bleeding or calculus at the age of 15, over one third had satisfactory periodontal health.

Juvenile periodontitis--a review of literature.

Juvenile Periodontitis (JP), a condition that was previously regarded as a rare disease has of recent come into the fore as a model for the study of inflammatory periodontal disease. It has also been found to be considerably more common in occurrence than previously thought. This article reviews the literature on the epidemiology, aetiology, pathogenesis, clinical features, histopathological and immunological findings, differential diagnosis, treatment and prognosis of JP. The objective of this article is to give the clinician the current opinions of researchers in all aspects of the disease as compared to previous age long views. It is observed that there are contradictory reports on the epidemiology, etiology and treatment of the disease and hence the need for further studies in these areas.

Pattern of tooth loss in Nigerian juvenile and plaque-induced chronic periodontitis patients.

The aim of this study was to determine the pattern of tooth loss in chronic periodontitis patients and hence help the clinician to plan preventive treatment against the loss of these teeth. Dental record notes of all the subjects, the periapical radiographs and actual intra-oral examinations of the juvenile periodontitis patients were done to determine the number and types of tooth loss. It was observed that the pattern of tooth loss in both groups of chronic periodontitis (plaque Induced periodontitis (PIP) and juvenile periodontitis (JP) was different as the most frequently lost teeth in PIP was incisors and lower incisor in JP while the least lost in PIP was the upper canines and the lower premolars in JP.

Prevalence of pregnancy related oral granuloma in a Nigerian population group and the possible role of contraceptives.

A clinicopathological survey on pregnancy related tumours was carried out on 400 randomly selected pregnant Nigerian women. Fifteen (15) cases of pregnancy granuloma or 'epulis gravidanum' were found. Of these subjects, 287 representing 71.8 percent were on birth control before conception, while 113 or 28.2 percent were not. Nine (9) cases of pregnancy tumour were found in the group on birth control pills and six (6) in the group not on birth control representing an incidence of 3.1 and 5.3 percent respectively. Literature review indicate a general incidence of between 0-2.5 percent. Five of the granuloma regressed post partum, while ten were excised. Patients were followed 1-2 years post partum and no recurrence was recorded, even in patients who have re-commenced on contraceptives.

Oral hygiene status and occlusal characteristics of orthodontic patients at University College Hospital, Ibadan, Nigeria.

Patients seeking orthodontic care are expected to maintain good oral hygiene status and there is still a debate as to whether occlusal characteristics are associated with oral hygiene status and invariably periodontal health. The aims of this study were to assess the pattern of oral hygiene status (OHS) of orthodontic patients at University College Hospital (UCH), Ibadan, Nigeria and to ascertain possible relationship between their OHS and occlusal characteristics. A prospective study of 178 consecutive orthodontic patients (44.4% males and 55.6% females) with mean age of 16.21 +/- 7.81 years seen in the hospital between January 2000 and September 2002 was done. Oral hygiene status was assessed using Greene and Vermillion simplified oral hygiene index while occlusal characteristics were assessed using Angle's classification of malocclusion and Jackson's method for overjet and overbite relationships. In all, 59.6%, 38.2% and 2.2% had good, fair and poor oral hygiene status respectively. Generally, no significant relationship was found between oral hygiene status and various occlusal features (P > 0.05). It was concluded that the patients had satisfactory oral hygiene status and the various occlusal features did not affect their oral hygiene status significantly.

Effects of some risk factors and immunodeficiencies on the periodontium--a review.

The possible role systemic factors might play in initiating or modifying the progress of periodontal disease has been a controversial issue for some time. Gingivitis is initiated by microbial plaque deposits on the dento-gingival interface but progression to periodontitis is modified by several environmental, behavioural, biological and health care variables. The importance of the immune system in modifying the host response to plaque is well established and as such, the immune system is a risk factor for human and animal periodontal disease. This paper reviews the modifying risk factors for periodontal disease and examines the periodontal manifestations of subjects with primary and acquired immuno-deficiencies.

The pattern of malocclusion among orthodontic patients seen in Dental Centre, University College Hospital, Ibadan, Nigeria.

The aim of this study was to analyse the malocclusion pattern among patients who presented for treatment in the Orthodontic Unit of the Dental Centre, University College Hospital, Ibadan, as baseline data for proper treatment planning, teaching and further research. A total of 289 subjects aged 5-34 years with mean age of 10.6 +/- 1.5 (S.D.) years were seen. Angle's classification of molar relationships among those seen is as follows: class I - 76.5%, Class II - 15.5% and Class III - 8.0%. There was increased overjet in 16.2% of the patients, reduced overjet in 0.7% while 2.1% had reversed overjet. Other occlusal abnormalities included: increased overbite (3.8%), reduced overbite (1.4%); anterior open bite (5.2%; crossbite (8.4%) and scissorsbite (0.6%). Crowding, spacing and retained primary incisors constituted 29.7%, 1.4% and 40.1%, respectively. Delayed eruption of canine (1.0%), Bimaxillary protrusion (0.7%), incompetent lips (0.7%), supernumerary teeth (0.7%) malformed tooth (0.3%), mandibular deviation on closure (1.0%) and oral habits (4.5%) were other forms of malocclusion diagnosed. Males were found to have significantly more of classes II and III molar relationships than females (P < 0.05). Occurrence of retained primary teeth as well as overjet deviations from normal were significantly higher in females (P < 0.05). No significant sex differences were found in the other occlusal disorders (P > 0.05): The findings were comparable with previous epidemiological surveys in other parts of the country.

The relationship between juvenile and non-juvenile periodontitis, ABO blood groups and haemoglobin types.

This study was carried out to investigate the relationship between juvenile and non-juvenile peridontitis (JP, non-JP), ABO blood groups and haemoglobin type. The heamoglobin electrophoresis was determined by routine technique using cellulose acetate paper and tris buffer at pH 8.5. Tile blood grouping was carried out on all specimens. Forty Nigerian adolescent individuals were investigated, twenty of which were diagnosed as having JP while the remaining 20 were diagnosed a having plaque-induced chronic periodontitis (non JP). This latter group was used as the control group. All the JP patients were either of blood group B/AB, rhesus positive while the non-JP subjects had B rhesus positive/negative, O rhesus positive/negative or AB rhesus positive. The differences between the results of the test and the control groups were statistically significant P < 0.05. All the forty subjects (JP and non-JP) had the haemoglobin type A and none of them exhibited the S and C haemoglobin types. There is a need to further investigate the relationship between juvenile periodontitis, ABO blood group and the common haemoglobin types (A, AS, S, C, and SS) at molecular level.

Alveolar bone regeneration pattern following surgical and non-surgical treatment in juvenile periodontitis.

One hundred and fifty six interproximal sites, with periodontal pockets deeper than 5mm and showing loss of bone on standard dental periapical radiographs, were treated by subgingival instrumentation and open periodontal flap debridement in 12 patients properly motivated and given thorough oral hygiene instructions. The indices of gingival condition, plaque, calculus, oral hygiene and degree of mobility with loss of attachment were measured at baseline, 1,3 and 6 months after treatment. Standardized reproducible radiographs of the interproximal sites were taken before and 6 months after treatment. Alveolar bone levels pre and post treatment were measured with a grid in square millimetres using a view box (Watson and sons, London) and the Dunning and Leach gingival bone count index for both treatment procedures. Radiographic analysis showed statistically and clinically significant increases in bone fill of both the superficial and deep bone defects for the surgical technique (p < 0.05). This study has shown that surgical procedure resulted in a better bone regeneration than subgingival instrumentation.

Need for preventive and interceptive orthodontic treatment in 3-5 year-old Nigerian children in two major cities.

There is a growing emphasis world-wide for early orthodontic treatment but in Nigeria there is very little information regarding the occlusal development in pre-school children reported. The need for preventive and interceptive intervention for malocclusion was studied in a sample of 563 Nigerian children (289 boys and 274 girls) aged 3-5 years. Orthodontic intervention was estimated to be needed in 12.8% of the children due to cross bite of the anterior or lateral segments. Education was needed in 12.5% of the children in cases of digit sucking, lip sucking and tongue thrusting. Extraction was indicated in 0.4% of children in cases of retained primary incisors causing displacement of the erupting successors. The need for further follow-up of occlusal development was noted in 1.4% of the children due to double primary teeth (0.4%), numerical variation of primary teeth (0.4%), crown dilaceration of a tooth (0.2%) and true class III skeletal malocclusion (0.4%).

Prevalence of periodontal pocketing and tooth mobility according to tooth types in Nigerians--a pilot study.

The aim of the present study was to evaluate the occurrence of periodontal pocketing and tooth mobility according to the tooth types in the mouth. There is a paucity of knowledge concerning which tooth types are more prone to periodontal disease from the review of literature. The study sample comprised 255 subjects, age ranged 16 years to 74 years. These subjects were those referred to the Periodontology Clinic of the University College Hospital, Ibadan, Nigeria, for one form of periodontal disease or the other. All the teeth were tested for periodontal pocketing using William's periodontal probe (Astir Intermedica, Kensington, London) and for tooth mobility using the Miller's Mobility Index method. The study showed that prevalence of tooth mobility is in this descending order--lower incisors, upper incisors, upper first molars, upper second molars, lower first and second molar, the premolars and lastly, the canines with the least occurrence on the upper left canines. This order is slightly different for prevalence of periodontal pocketing. The teeth most affected by pocketing were the upper second molars, followed by upper first molars, lower second molars with the least being the canines. It is suggested that exceptional care be given to these most susceptible teeth for periodontal disease in the mouth in order to prevent the development of irreversible damage of the periodontium.

Dentofacial findings in Down's syndrome: report of case.

Provision of dental services to the mentally subnormal in our society is relatively neglected. A patient with Down's syndrome who sought dental treatment is reported. Following the assessment of the patient, he needed orthodontic-surgical treatment and scaling and polishing. The former was not given due to the cost, complications and stress of such an involving procedure vis-a-vis the benefit to such a patient. However, patient received thorough scaling and polishing with emphasis on routine 6-monthly dental check-ups given. Handicapped individuals are beginning to seek dental services and the percentage of them doing so is likely to increase as more of such individuals are now staying in the normal home setting. Early preventive treatments for such patients are encouraged. Therefore, the dentists and the rest of the therapy team should be sensitized to face the challenge of providing services to them.