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Aesthetic outcome following prosthetic rehabilitation after ablative maxillary surgery. A Preliminary Study
No full textObjective: Psychological impact of poor dento-facial aesthetics constitutes a major part of the low quality of life in maxillectomy patients. The purpose of this study was to present the aesthetic outcome following prosthetic rehabilitation after ablative maxillary surgery.Method: All consecutive patients that had surgery for tumours affecting the upper jaw and gave their consent were included in the study. Classification of maxillectomy was based on the Brown\u27s classification. Facial attractiveness after final prosthetic rehabilitation was graded by two independent observers with a modified Liekert scale into four grades. For the purpose of comparison of facial attractiveness, the patients were divided into 2 groups: those below 2A and those above 2A.Result: Seventeen patients with tumours affecting the upper jaw were operated. Ten (58.8%) were females and 7 (41.2%) were males. The age range was 6-65 years, mean (SD), 37.6 (18.5) years. Two (11.8%) cases were children. There were 3 (17.6%) cases in the level 1, one case was 1A, two cases were 1B; 11 (64.7%) cases in level 2, 8 (47.1%) cases were 2A, 3 (17.6%) cases were 2B and 3 (17.6%) cases in level 3. Two (11.8%) patients, both in the level 2B had moderately attractive appearances and also, 2(11.8%) patients in the levels 2B and 3B respectively had least attractive appearances.Conclusion: Majority of our patients had resections at levels 2A and below and there was no obvious difference between the two groups, immediate prosthetic obturation may have minimized collapse of midface in those above 2A.
 
Influence of Socio-demographic Factors on Perception of Midline Diastema
No full textObjective: Socio-demographic factors have been said to affect the perception of midline diastema. Aesthetic importance of maxillary midline diastema varies in individuals and there is no common consensus on the registration of diameter of maxillary midline diastema. The aim of the study was therefore to determine the acceptable width of diastema among a group of Nigerian subjects and the effect of their socio-demographic factors on the perception of midline diastema.
Method: Subjects aged 19-45 yrs were recruited from the 6 geopolitical zone of Nigeria. A structured questionnaire was administered to participants. The questionnaire sought for information such as age, gender, profession, presence of midline diastema and created diastema. The questionnaire included a coloured smile photograph with digitally altered varying sizes of diastema (2mm - 6mm). Subject rated the different coloured photographs using the rating scale (very attractive =1, attractive =2, accepted =3, unattractive =4, and very unattractive =5). Data were analyzed with the Statistical Package for Social Sciences (SPSS) version 16.0 (SPPS Inc, Chicago IL).
Result: A total of 374 participants aged 19 – 45 years was involved in this study. Majority (52.1%) were females and mean age was 37.07+/-0.63 years. Only 30.2% had midline diastema out of which 12% was artificially created. Majority (86.7%) of the created diastema was done by the dentist. Age (p=0.024) and level of education (p=0.017) had a significant relationship with perception of midline diastema. Older subjects and those with lower educational level considered midline diastema a sign of beauty. Majority of the participants perceived the 2-4mm midline diastema attractive and 5-7mm midline diastema unattractive.
Conclusion: It can be concluded from this study that a relationship exists between age and perception of midline diastema. The acceptable width of the midline diastema in this study is 2mm-4mm.
 
Smoker\u27s melanosis or early melanoma- misdiagnosis trap?
No full textObjective: First used by Hedin in 1977, “smokers\u27 melanosis” is currently recognized as a clinical diagnosis without recourse to biopsy. Current research findings however suggest the disturbing possibility of mistaking a “silent” oral malignant melanoma for a benign smokers\u27 melanosis. The objective of the current review is to stimulate an evidence-based rethink.Method: This manuscript is based on a Pubmed search phrase “smokers\u27 melanosis".Result: A total of 24 studies resulted of which 16 were analyzed and 8 non-oral melanomas were excluded. Reports ranged from claims of a “protective” role of melanosis to cases of melanoma from pre-existing melanosis. Alcohol synergistic potentiation of intra-oral melanosis and a categorization of smokers\u27 melanoma as a differential for intra-oral smokers\u27 melanosis were also found.Conclusion: Since many cases of confirmed intra-oral malignant melanomas were preceded with a history of pre-existing “innocent” oral pigmented lesions, adopting a principle of universal biopsy is strongly suggested. This would change this age-long paradigm but would definitely save a few lives.
 
COVID – 19 Pandemic: The Implications for the Practice of Restorative Dentistry
No full textObjective: To assess the implication of COVID-19 pandemic on the practice of restorative dentistry in Nigeria.Materials and Methods: A cross-sectional study regarding the impact of COVID-19 on restorative dental practice was carried out among dentists across different cadres working in either private or public practice. Data was obtained using an online survey questionnaire regarding the infection control practice, availability and use of personal protective equipment, practice modifications to combat COVID-19 outbreak and the impact of COVID-19. Data was analysed using the chi-square test and p-value <0.05 was considered statistically significant.Results: Amongst 137 dentists that participated in the study, majority of respondents were males (58.4%), a greater proportion (49.6%) were in the age range 35-44 years and 78.1% worked in public hospitals. A significantly higher number of male respondents (p=0.019) and public dental workers (p=0.036) immediately changed their mode of dental service delivery following the COVID-19 outbreak. Majority of respondents (60.6%) carried out restorative dental procedures despite the pandemic; most of these procedures being emergency dental treatment and non-aerosol generating dental procedures. About half of respondents had respiratory masks (51.8%) and isolation gowns (54.0%) available. Majority reported that the pandemic had decreased patient flow (88.3%), increased treatment fee (53.3%) and had an impact on the income generated (92%). Only 20.4% of respondents hadproblems with their staff; the problems being emotional problems, work abandonment and demand of salary increase. The pandemic has had a negative impact on most respondents (74.5%) and only 31.4% respondents were optimally prepared to render dental services.Conclusion: COVID-19 pandemic has changed the mode of restorative dental practice in Nigeria; resulting in a psychological impact on dentists and a financial burden on dental practice.
 
Study of Histopathological Variants of Orofacial Lipoma in a Nigerian Population
No full textBackground: The rarity of lipoma in the orofacial region has made it difficult to ascertain the clinicopathological pattern of orofacial lipoma in our environment. This study aims to determine the age, gender, sites and histopathological variants of orofacial lipoma in a Nigerian population.Materials and Methods: A 21-year retrospective review was performed on patients\u27 clinical notes, histopathology slides and reports of all histopathologically diagnosed orofacial lesions in the Department of Oral Pathology and Medicine, University of Benin Teaching Hospital, Benin City, Nigeria.Results: Of the 1116 diagnosed lesions within the study period, there were 15 (1.3%) cases of lipoma. There was a female to male ratio of 2:1, with a mean th age of 31 + 1.2 years and the peak age group was the 4 decade of life (n=6, 40.0%). The buccal mucosa (n=8, 53.3%) and the forehead (n=4, 26.7%) were the commonest orofacial sites of the lesion. The conventional lipoma (n=8, 53.3%) was the predominant lesion, followed by angiolipoma (n=3, 20.0%), fibrolipoma (n=2, 13.3%), spindle cell lipoma (n=1, 6.7%) and intramuscular lipoma (n=1, 6.7%).Conclusion: This study observed a low prevalence of orofacial lipoma comparable to previous reports. The lesion occurred predominantly in adult females and the buccal mucosa was the commonest orofacial site. Apart from the conventional lipoma, angiolipoma was the second most frequent histopathological variant of the lesion. Early surgical intervention and histopathological evaluation of clinically suspicious cases of orofacial lipoma is recommended to avoid facial disfigurement and to rule out a malignant lesion mimicking the benign type.
 
An Audit of Written Instructions Sent to the Laboratory for Fabrication of Fixed Prosthodontic Appliances in a Tertiary Health Institution in Nigeria
No full textObjective: To audit the prescriptions sent by dental practitioners to the dental technicians for fixed dental prostheses.Methods: This was an audit of all written instructions for fixed dental prostheses sent to the advanced conservative dentistry laboratory of the University of Benin Teaching Hospital, Benin City, Nigeria. Data of interest were status of requesting dental surgeon, type of prosthesis, age of the patient, gender of the patient, next appointment date, disinfection status of the impression, metal alloy requested, design of the margin, number of pontics and design, surfaces to be covered by metal only, occlusal scheme, shade, diagram for illustration and the type of porcelain glaze.Results: Various types of fixed prostheses were requested with porcelain fused to metal single crowns accounting for more than half. The quality ofwritten instructions was clear only in 2.0% of the prescriptions while 56.8% had no instructions at all. There was no statistically significant relationship between the cadre of the dental practitioner making the request and the quality of written instructions. There was statistically significant association between types of prosthesis requested and provision of diagrammatic illustration on the written instruction.Discussion: Fixed prostheses are usually fabricated in the dental laboratory by dental laboratory technicians using impressions of the mouth made by dental practitioners. The quality of prosthetic restorations has been shown to be a reflection of the skills of the dentist and dental technicians as well as communication between them.Conclusion: There is need for improved quality of written communication between the dentists and the laboratory personnel.
 
COVID-19 Pandemic and Oral and Maxillofacial Surgery
No full textObjective: To present a brief overview of global adjustments to COVID-19 by oral and maxillofacial surgeons and to characterise the reactions and adaptations of the oral and maxillofacial surgery specialty in Nigeria.Materials and Methods: A review of the global literature was done to highlight available guidelines for oral and maxillofacial surgery under COVID-19 pandemic. Questionnaires were electronically sent to maxillofacial surgeons in Nigeria and, a telephone survey of the Nigerian oral and maxillofacial surgery centres was done to characterise the reactions and adaptations of local practitioners to the pandemic situation.Results: Out of the 822 questionnaires electronically delivered to maxillofacial surgeons across 156 centres worldwide, the response rate was only 20.2%. Twenty-eight (17.9%) centres were completely shut down while only 6 (3.8%) centres were functioning normally. Other centres scaled down services and/or number of personnel. Surgeons older than 60 years were made to stay away in some centres while some personnel were drafted to support the medical team at the frontline COVID-19 treatment centres.Conclusion: It concluded that the variability of practices is remarkable and this is largely due to unequitable resources and lack of uniform policies even among federal tertiary health institutions and the authors therefore proposed an algorithm to guide oral and maxillofacial patients\u27 classification and management in the face of COVID-19 pandemic.
 
Coronavirus Disease 2019: Implications to the Field and Practice of Oral Pathology
No full textObjective: To highlight the implications of COVID -19 disease to the field and practice of Oral Pathology.Materials and Methods: Extensive PubMed and Google Scholar search using relevant mesh terms for articles on the effects of COVID-19 on the practice of Oral Pathology. The relevant articles were thereafter reviewed, and the implications drawn.Results: The virus which is usually transmitted via droplet can survive for days on some materials which are commonly used in the laboratory; thereby constituting a potential source of infection to laboratory workers. In addition, the presence of the viral receptors in the oral mucosa has been established and so presenting the mouth as a possible route of entry. Viral particles are also shed heavily in the saliva. These observations have dual implications. First, it poses increased risk to the oral pathologists in handling oral tissue biopsy and secondly, it potentially makes the saliva an alternative medium of diagnosis. Furthermore, oral exfoliative cytology can be developed for viral detection especially in asymptomatic patients.Conclusion: Maintenance of social distance while attending to patients in the laboratory, regular disinfectant of the working surfaces and careful handling of tissue specimens are essential for preventing the spread of COVID-19 in the laboratory. Research works in the use of saliva and oral exfoliative cytology for screening and diagnosis of COVID-19 patients should be a new area of interest to the oral pathologists.
Assessment of Maximum Mouth Opening of Public Primary and Secondary School Children in Ibadan, Nigeria
No full textBackground: Excessive opening of the mouth has been reported to cause clinical problems such as luxations and traumatic injury to the temporomandibular joint (TMJ). The knowledge of the normal range of mouth opening will help to avoid excessive opening of the mouth which can cause injury to the TMJ of patients during procedures that involve mandibular manipulations. Maximum mouth opening (MMO) has age, race, gender and ethnic variations. Previous studies have looked at normal range of mouth opening among adults, but to the best of our knowledge, no study has looked at this among the paediatric/children population in Nigeria. Thus, this study aimed to determine the normal maximum mouth opening (MMO) among the paediatric population in Ibadan (South Western part of Nigeria) and the effect of gender, age, height and weight of these children on their MMO.
Materials and methods: Six hundred and nine primary and secondary school pupils aged 6 – 15 years were included in this study. Patients with any condition affecting the temporomandibular joint (TMJ) function were not included. Measurements of height, weight and two readings of maximum interincisal distance were performed for each participant. Student\u27s t-test, one-way analysis of variance (ANOVA) and Pearson bivariate correlation were used to assess the sample.
Results: The mean MMO was 44.0 ± 5.3 mm and 42.6 ± 5.6 mm for males and females respectively. There was no significant difference in the MMO of males and females (t= 0.335, p = 0.563). MMO increases gradually with age irrespective of the gender and this was statistically significant (F= 17.1, p =0.001).
Conclusion: The maximum mouth opening established for the paediatric population in this study will help practitioners whose care involves the stomathognathic system to have information about the normal range of mouth opening in this group of patients. The result will also be useful asbaseline for future research.