An Evaluation of Knowledge, Attitude, and Practice of Accelerated Orthodontics amongst Orthodontists.

BACKGROUND: Accelerated orthodontic teeth movement are procedures carried out to increase the rate of tooth movement thereby reducing treatment time. There are numerous techniques currently available to accelerate orthodontic treatment time, but evidence is still needed to determine the degree to which orthodontists accept and practice accelerated orthodontics. The present study is aimed at assessing the knowledge of Orthodontists on the practice of accelerated orthodontics; as well as their willingness to adopt it as a treatment option for their patients. METHODOLOGY: Ethical approval was obtained before the commencement of the study. The study population comprised all orthodontists practicing in Nigeria. Questionnaires were administered physically to the orthodontists at their annual general meeting. E-mails were further used to distribute the questionnaire to the orthodontists who were absent from the annual meeting. The questionnaire obtained information on respondents' biodata, knowledge, attitude, and practice of accelerated orthodontic treatment procedures.Statistical analysis was performed using IBM SPSS software version 27. The level of significance was 0.05 for all statistical analysis. RESULTS: The study participants comprised 60 respondents, with a mean age of 34.18 years and a male-to-female ratio of 1.3:1. A Majority of them were satisfied with treatment time/duration (61.7%), they had a good knowledge of accelerated orthodontics (83.3%) with piezocision (75%) and micro-osteoperforation (63.3%) being the most popular. All orthodontists were interested in accelerated orthodontics, if it offered up to 30% reduction in treatment time. Major limitations to the practice included unavailability of technique materials (50%), insufficient knowledge (41.7%) and cost (35%). CONCLUSION: Most orthodontists did not routinely practice accelerated orthodontics despite adequate knowledge. They were willing to offer accelerated orthodontic treatment (AOT) if patients were willing to pay an additional fee. The less invasive methods were more accepted.

CONTEXTE: Les mouvements dentaires orthodontiques accélérés sont des procédures réalisées pour augmenter la vitesse de déplacement des dents, réduisant ainsi le temps de traitement. Il existe de nombreuses techniques actuellement disponibles pour accélérer le temps de traitement orthodontique, mais des preuves sont encore nécessaires pour déterminer dans quelle mesure les orthodontistes acceptent et pratiquent l'orthodontie accélérée. La présente étude vise à évaluer les connaissances des orthodontistes sur la pratique de l'orthodontie accélérée, ainsi que leur volonté de l'adopter comme option de traitement pour leurs patients. MÉTHODOLOGIE: L'approbation éthique a été obtenue avant le début de l'étude. La population étudiée comprenait tous les orthodontistes exerçant au Nigeria. Des questionnaires ont été administrés physiquement aux orthodontistes lors de leur assemblée générale annuelle. Des courriels ont ensuite été utilisés pour distribuer le questionnaire aux orthodontistes absents de l'assemblée annuelle. Le questionnaire a recueilli des informations sur les données biographiques des répondants, ainsi que sur leurs connaissances, attitudes et pratiques en matière de traitement orthodontique accéléré. L'analyse statistique a été réalisée à l'aide du logiciel IBM SPSS version 27. Le niveau de signification était de 0,05 pour toutes les analyses statistiques. RÉSULTATS: Les participants à l'étude étaient au nombre de 60, avec un âge moyen de 34,18 ans et un ratio hommes-femmes de 1,3:1. La majorité d'entre eux étaient satisfaits du temps/durée du traitement (61,7 %), ils avaient de bonnes connaissances en orthodontie accélérée (83,3 %) avec la piezocision (75 %) et la micro-ostéoperforation (63,3 %) étant les plus populaires. Tous les orthodontistes étaient intéressés par l'orthodontie accélérée, si elle offrait une réduction allant jusqu'à 30 % du temps de traitement. Les principales limitations à la pratique comprenaient l'indisponibilité des matériaux de technique (50 %), le manque de connaissances (41,7 %) et le coût (35 %). CONCLUSION: La plupart des orthodontistes ne pratiquaient pas systématiquement l'orthodontie accélérée malgré des connaissances adéquates. Ils étaient prêts à proposer un traitement orthodontique accéléré (TOA) si les patients étaient prêts à payer des frais supplémentaires. Les méthodes moins invasives étaient plus acceptées. MOTS-CLÉS: Orthodontie accélérée, orthodontiste, temps de traitement, piezocision.

Management of pediatric mandibular fracture using orthodontic vacuum-formed thermoplastic splint: A case report and review of literature.

Fractures of the mandible are relatively less frequent in children when compared to adults. The anatomic features of children are protected. Children have a higher adaptation to maxillofacial fractures compared to adults. Treatment principles of mandibular fractures in children differ from that of adults due to concerns regarding mandibular growth and the developing dentition. A case of a 6-year-old boy with fractured mandibular symphysis managed by closed reduction using a vacuum formed thermoplastic splint and circummandibular wiring is presented. This article also provides a review of the literature regarding the management of mandibular fracture in young children.

FACTORS ASSOCIATED WITH ODONTOGENIC BACTERAEMIA IN ORTHODONTIC PATIENTS.

BACKGROUND: Various researches have investigated factors associated with the prevalence and intensity of bacteraemia following oral procedures including orthodontic procedures. AIM: The aim of this study was to determine the effect of age, gender, plaque and gingival indices on the occurrence of odontogenic bacteraemia following orthodontic treatment procedures. SETTING: Orthodontic Clinic, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. METHODOLOGY: Using the consecutive, convenience sampling method, a total of 100 subjects who met the inclusion criteria were recruited for the study and peripheral blood was collected before and again within 2 minutes of completion of orthodontic procedures for microbiologic analysis using the BACTEC automated blood culture system and the lysis filtration methods of blood culturing. The subjects were randomly placed in one of four orthodontic procedures investigated: alginate impression making (Group I), separator placement (Group II), band cementation (Group III) and arch wire change (Group IV). Plaque and gingival indices were assessed using the plaque component of the Simplified Oral Hygiene Index (OHI-S) (Greene & Vermillion) and Modified gingival index (Lobene) respectively before blood collection. Spearman Point bi-serial correlations and logistic regression statistics were used for statistical evaluations at p < 0.05 level. RESULTS: An overall baseline prevalence of bacteraemia of 3% and 17% were observed using the BACCTEC and lysis filtration methods respectively. Similarly, overall prevalence of bacteraemia following orthodontic treatment procedures of 16% and 28% were observed respectively using the BACTEC and lysis filtration methods. A statistically significant increase in the prevalence of bateraemia was observed following separator placement (p=0.016). An increase in age, plaque index scores and modified gingival index scores of the subjects were found to be associated with an increase in the prevalence of bacteraemia following orthodontic treatment procedures, with plaque index score showing the strongest correlation. CONCLUSION: Separator placement was found to induce significantly highest level of bacteraemia. Meticulous oral hygiene practice and the use of 0.2% chlorhexidine mouth rinse prior to separator placement may be considered an effective measure in reducing oral bacteria load and consequent reduction of the occurrence of bacteraemia following orthodontic treatment procedures.

Holdaway's analysis of the nose prominence of an adult Nigerian population.

BACKGROUND: Facial beauty is a function of harmonious balance among all parts of the face, and the nose plays a dominant role in this because of its location exactly in the middle of the face. Therefore, an evaluation of the nasal form and its position relative to other facial structures should play an important part in the assessment of patients before orthognathic surgery, rhinoplasty or orthodontics. AIM: The aim was to establish normative values for the nose prominence of an adult Nigerian population using Holdaway's soft tissue cephalometric analysis. METHODOLOGY: Lateral cephalometric radiographs of 100 adults aged 18-25 years, with normal occlusion and a harmonious facial appearance were analyzed. The nose prominence was assessed using Holdaway's analysis. Twenty radiographs randomly selected, were retraced to assess for errors. Data analysis included descriptive statistics, Student's t-tests and analysis of variance using the Statistical Package for Social Sciences. RESULTS: The mean value recorded for the nose prominence of the study population was 3.49 mm (standard deviation [SD], 3.26 mm), with a range of -5.0 mm to 15.0 mm. Mean values obtained for females were 3.73 mm (SD, 2.88 mm) and males 3.19 mm (SD, 3.70 mm). No statistically significant gender difference was observed (P>0.05). In addition, no significant difference was observed between the nose prominence values recorded for different age-groups (P>0.05). CONCLUSION: Normative values were established for the nose prominence of an adult Nigerian population. The values obtained for Nigerians in this study are comparatively lower than that reported for other populations. These values would aid in treatment planning for orthognathic surgery, rhinoplasty and orthodontics in Nigerians.

Metric analysis of the hard palate in children with digit sucking habits.

BACKGROUND: The effects of digit sucking on dentofacial structures has been widely studied, but its relationship with the function and/or shape of the palate has been negleted. A clinical observation of high palatal vault has been reportedly associated with digit sucking. However, the description has been made on the basis of subjective clinical observation rather than actual measurements. The aim of this study is to assess the effects of digit sucking habits on palatal dimensions of children with digit sucking habit; and compare the findings obtained to a control population. METHOD: Cross-sectional sucking behaviour data was collected on 250 school children aged 3 to 5 years using questionnaires completed by parents. Parameters including palatal widths, depth and heights were measured directly from the maxillary casts obtained from the children and palatal index was calculated. All values were compared using t-test. RESULTS: Significant differences were seen in palatal depth, palatal width, palatal height and palatal index at the level of the maxillary primary first and second molars. No significant difference was observed for palatal index at the level of the maxillary primary canine. CONCLUSIONS: It was concluded that digit sucking may cause changes in palatal dimensions.

Effects of digit sucking on dental arch dimensions in the primary dentition.

The purpose of this study was to assess the effects of the duration and type of digit sucking habits (thumb or finger) on the dental arch dimensions of children with digit sucking habit; and compare the findings with children without the habit. A cross-sectional sucking behaviour data was collected on 250 school children aged 3 to 5 years using questionnaires completed by parents. Dental arch parameters including arch widths and arch depths were measured directly from the models obtained from the children and compared using t-test and ANOVA. The results indicated reduced maxillary arch widths (P < 0.001), increased maxillary arch depths (P = 0.009), reduced mandibular canine arch depth (P = 0.004) in those with digit sucking habits compared with the controls. Thumb sucking showed a significant reduction in intercanine widths and mandibular molar arch depth when compared with finger sucking. There was no statistically significant association between duration of digit habits and changes in dental arch depths. In addition, some changes in the dental arch parameters persisted well beyond the cessation of the digit habit. The results suggest a need for recommendations for discontinuing these habits that will be optimal in preventing digit sucking related malocclusion.

Malocclusion and its impact on quality of life of school children in Nigeria.

BACKGROUND: Malocclusion, though not life-threatening, is an important public health issue, which has a large impact on the individual, causing discomfort, social and functional limitations. OBJECTIVE: To evaluate objectively orthodontic treatment needs in Nigerian schoolchildren and the impact of malocclusion on their quality of life. METHODS: This cross-sectional study involved schoolchildren aged 12 to 16 years from four randomly selected secondary schools in Lagos, Nigeria. A prestructured questionnaire was administered and a clinical examination was conducted. Occlusal status was assessed for each subject using the Dental Aesthetic Index (DAI). Oral Health Impact Profile-14 (OHIP- 14) was also evaluated. RESULTS: There were 410 (50.9%) females and 395 (49.1%) males aged 12 to 16 years. Mean age was 14.5±1.3 years. Irregularity of teeth was the most prevalent malocclusion. Generalised spacing and midline diastema were seen in 59% and 31% respectively; crowding in 43% of the schoolchildren. Other occlusal anomalies were recorded. There was no statistically significant difference between the sexes. Over one third of the study population did not need treatment, treatment was mandatory in 24.3%, elective in 21% and highly desirable in 17%. More females than males did not need orthodontic treatment. Oral conditions had no effect on the quality of life of 85.3% of the study sample. CONCLUSION: Most Nigerian schoolchildren were found to have a dental appearance that needed orthodontic treatment. However, components of the oral conditions impacted on the quality of life of a few subjects. Psycho-social need is very important in orthodontic diagnosis.

Malocclusion and its impact on quality of life of school children in Nigeria

BACKGROUND: Malocclusion, though not life-threatening,is an important public health issue, which has a large impacton the individual, causing discomfort, social and functionallimitations.OBJECTIVE: To evaluate objectively orthodontic treatment needsin Nigerian schoolchildren and the impact of malocclusion ontheir quality of life.METHODS: This cross-sectional study involved schoolchildrenaged 12 to 16 years from four randomly selected secondaryschools in Lagos, Nigeria. A prestructured questionnaire wasadministered and a clinical examination was conducted.Occlusal status was assessed for each subject using the DentalAesthetic Index (DAI). Oral Health Impact Profile-14 (OHIP-14) was also evaluated.RESULTS: There were 410 (50.9%) females and 395 (49.1%)males aged 12 to 16 years. Mean age was 14.5 ± 1.3 years.Irregularity of teeth was the most prevalent malocclusion.Generalised spacing and midline diastema were seen in 59%and 31% respectively; crowding in 43% of the schoolchildren.Other occlusal anomalies were recorded. There was nostatistically significant difference between the sexes. Over onethird of the study population did not need treatment, treatmentwas mandatory in 24.3%, elective in 21% and highly desirablein 17%. More females than males did not need orthodontictreatment. Oral conditions had no effect on the quality of life of85.3% of the study sample.CONCLUSION: Most Nigerian schoolchildren were found tohave a dental appearance that needed orthodontic treatment.However, components of the oral conditions impacted on thequality of life of a few subjects. Psycho-social need is veryimportant in orthodontic diagnosis. WAJM 2010; 29(6): 417­424

Dental Spacing in Primary Dentition of Nigerian Children and its Relationship to Arch and Crown Dimensions

Objectives: The aims of this study were to compare mesiodistal and buccolingual crown widths; as well as dental arch dimensions between children with spaced and normal dental arches; and to determine which of the parameters mostly influence dental spacing. Methods: Crown and dental arch dimensions of dental casts of 125 children; grouped into spaced and normal primary dental arches; based on the tooth size-arch length discrepancy; were measured using electronic digital caliper. The data were statistically analyzed using t-test and stepwise multiple regression analysis. Results: Maxillary and mandibular spaced arches had statistically significant larger intercanine widths than the normal arches. The total mesiodistal tooth size in both arches; and mean buccolingual width of the mandibular first and second primary molars of the spaced arches were significantly smaller than those of the normal arches. However; there were no significant differences between spaced and normal arches in arch length; arch depth and intermolar arch width. The most important predictor of spacing in both arches is the intercanine width; followed by total mesiodistal tooth size. Conclusions: The parameter that mostly influences dental spacing is the intercanine width

Behavior management techniques employed by nigerian dentists for their child patients / Técnicas de manejo do comportamento utilizadas por dentistas nigerianos em pacientes infantis

Objective: To determine the different behavior management techniques employed by dentists in Nigeria for their child patients. Method: One hundred and fifty questi onnaires were hand delivered to dentists in different locations in Nigeria. Information required include respondent's bio data, years post graduation, behavior management techniques employed, and reasons for choice of technique. Results: A total of 128 (85.3%) were returned completed, comprising 53.2% females and 46.8% males, in age groups, < 30 years (25%), 30-39 years (48.4%), 40-49 years (19.5%) and 50 years and above (7.1%). Thirty five (27.3%) practiced in health centers, 88 (68.8%) in teaching hospitals and 5 (3.9%) in private hospitals. Majority (98.4%) attended to child patients and 29.6% rated their patients as uncooperative. The most frequently used behavior management technique was 'tell-show-do'. (73.4%) followed by positive reinforcements (35.9%), modeling (31.2%), desensitization (18.7%), restraints (13.2%), sedation (11.7%) and 'hand over mouth' (4.6%). Only 3.2% used general anesthesia. The major factors influencing choice of behavior management technique was age of child (78%), convenience to dentists (28%), availability of facilities (25.8%), and acceptability by parents/child (18.8%). Only 25.8% rated their facilities as adequate. Conclusion: The 'tell-show-do' technique was practiced by majority of respondents in this study. Improvements of facilities may increase the number of dentists employing pharmacological methods of management.

Objetivo: Determinar as diferentes técnicas de manejo do comportamento utilizadas por cirurgiões-dentistas nigerianos em seus pacientes infantis. Método: Cento e cinquenta questionários foram enviados a cirurgiões-dentistas em diferentes regiões da Nigéria. As informações requisitadas incluíam dados do respondente, pós-graduação, técnicas de manejo do comportamento utilizadas e motivos para a escolha da técnica. Resultados: Um total de 128 (85,3%) questionários foram devolvidos preenchidos, dos quais 53,2% eram de mulheres e 46,8% de homens, em relação à faixa etária, < 30 anos (25%), 30-39 anos (48,4%), 40-49 anos (19,5%) and 50 anos ou mais (7,1%). Trinta e cinco profissionais (27,3%) exercia a profissão em centros de saúde, 88 (68,8%) em hospitais escola e 5 (3,9%) em hospitais privados. A maioria (98,4%) atendia crianças e 29,6% classificaram seus pacientes como não cooperadores. A técnica mais utilizada foi a do 'falar-mostrar-fazer' (73,4%) seguida pelo regorço positivo (35,9%), modelagem (31,2%), desensibilização (18,7%), contenção (13,2%), sedação (11,7%) e ?mão sobre a boca? (4,6%). Somente 3,2% utilizam anestesia geral. Os principais fatores influenciadores quando da escolha da técnica foram a idade da criança (78%), a conveniência do profissional (28%), disponibilidade de instalações (25,8%), e aceitação pelos pais/criança (18,8%). Apenas 25,8% avaliaram suas instalações como adequadas. Conclusão: A técnica 'falar-mostrar-fazer' é utilizada pela maioria dos profissionais. A melhoria das instalações poderia aumentar o número de cirurgiões-dentistas que utilizam técnicas farmacológicas de manejo comportamental.

Unusual allergic reaction to orthodontic wire: report of a case in a Nigerian patient and implications for clinical management.

Material reactions of both an irritant and hypersensitivity nature are not uncommon in contemporary orthodontic practices. The most common hypersensitivity reactions in orthodontic patients are due to alloy components of metal-based orthodontic appliances. This article reports a case of an unusual reaction to the component of an orthodontic appliance in a 6-year-old girl. There was associated trauma with local irritation. The implications and suggestions for management in the orthodontic clinic are reviewed.

Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria.

The main purpose of this study was to analyze the current psychosocial implications of malocclusion in Ibadan, Nigeria. The study sample comprised 614 secondary school children (327 males and 287 females) aged 12-18 years (mean age, 14.9 +/- 2.9 SD) who filled in a questionnaire containing general questions about body image and specific inquires concerning self-perception and social implications of dental appearance. The children's occlusions were also assessed using the Dental Aesthetic Index (DAI) and the malocclusion traits related to body image, self-perception, and social implications of dental appearance. Subjects with malocclusion rated only the teeth significantly least satisfactory among other twelve items of body image. The lowest rating was observed in subjects with crowding of the maxillary and mandibular incisor segments. Highly significant differences (P < 0.001) were found between subjects with normal or minor malocclusion and those with marked malocclusion in indicating awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavourable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred significantly more often in the presence of malocclusion (P < 0.001). Unfavourable perceptions of the teeth were expressed significantly more often by subjects with anterior maxillary irregularities of up to 1 mm and more, spacing of both maxillary and mandibular incisor segments, midline diastema, crowding (especially of the mandibular incisor segment), anterior open bite and molar relation deviations. It was concluded that certain malocclusions, especially occlusal and space anomalies, may adversely affect body image and self-concept of Nigerian adolescents.

Parental awareness of emergency management of avulsion of permanent teeth of children in Lagos, Nigeria.

BACKGROUND/OBJECTIVES: Traumatic injuries in children and adolescents affecting both the primary and permanent dentitions and their supporting structures are a common problem seen in children. Avulsion of permanent teeth in children resulting from trauma is an emergency in children. The prognosis of avulsed teeth depends on prompt and appropriate treatment, which often relies on lay people such as the children's parents and their schoolteachers who are present at the site of the accident, prior to the initial professional dental contact. Knowledge of parents on the emergency management is thus surveyed. METHOD: A 13- stemmed questionnaire comprising questions on demographic data, attitude and knowledge was distributed to parents who have accompanied their children (patients) to the Orthodontic/Paedodontic Clinics of Lagos University Teaching Hospital (LUTH) for treatment over a 12-week period from October- December 2002. RESULT: A total of ninety parents were studied. Over 90% of the parents felt they should seek professional help urgently following an avulsion injury, but their knowledge of transport medium for the tooth was poor. Only 1.1 per cent and 3.3 per cent knew that milk was the medium of choice for washing and transporting an avulsed tooth respectively. 91.1% of parents surveyed had never received advice on what to do in the event of an accident where a permanent tooth was avulsed. CONCLUSION: There is a need for educational campaigns aimed at parents to increase their knowledge of the emergency procedures required when the tooth is avulsed.

Transmigration of mandibular permanent canine in a Nigerian patient: presentation and management.

A rare dental anomaly--transmigration is presented in a 12-year-old female Nigerian who was referred for orthodontic assessment. A right mandibular canine was found completely located in the left side of the body of the mandible having moved ectopically and progressively from its normal developmental site through the symphysis of the mandible. The importance of the radiological diagnosis with the use of panoramic radiograph is highlighted and the management briefly discussed.