The Role and Place of Medicinal Plants in the Strategies for Disease Prevention

Medicinal plants have been used in healthcare since time immemorial. Studies have been carried out globally to verify their efficacy and some of the findings have led to the production of plant-based medicines. The global market value of medicinal plant products exceeds $100 billion per annum. This paper discusses the role, contributions and usefulness of medicinal plants in tackling the diseases of public health importance, with particular emphasis on the current strategic approaches to disease prevention. A comparison is drawn between the ‘whole population’ and ‘high-risk’ strategies. The usefulness of the common-factor approach as a method of engaging other health promoters in propagating the ideals of medicinal plants is highlighted. The place of medicinal plants in preventing common diseases is further examined under the five core principles of the Primary Health Care (PHC) approach. Medicinal plants play vital roles in disease prevention and their promotion and use fit into all existing prevention strategies. However, conscious efforts need to be made to properly identify, recognise and position medicinal plants in the design and implementation of these strategies. These approaches present interesting and emerging perspectives in the field of medicinal plants. Recommendations are proposed for strategising the future role and place for medicinal plants in disease prevention.     

Microbiological understandings and mysteries of noma (cancrum oris)

The microbiologic history of noma was reviewed. Studies have associated the disease process with large numbers of fusiform bacilli and spirochetal organisms. In order to study the microbiology of the staging and infection periods of noma 62 Nigerian children, aged 3-14 years, 22 children had acute necrotizing ulcerative gingivitis (ANUG) and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished and 20 were free of acute necrotizing ulcerative gingivitis and in good nutritional state) were evaluated for the presence of viruses and oral microorganisms. The ANUG cases in the malnourished children had a higher incidence of Herpesviridae, the main virus being detected was cytomegalovirus. There were more anaerobic microorganisms recovered, with Prevotella intermedia as the predominant isolate, in the malnourished children as compared to the healthy children. A study of the predominant microflora in active sites of noma lesions was carried out in eight noma patients, 3-15 years of age, in Sokoto State, northwestern Nigeria. Fusobacterium necrophorum was recovered from 87.5% of the noma lesions. Oral microorganisms isolated included Prevotella intermedia, alpha-hemolytic streptococci and Actinomyces spp. which were isolated from 75.0, 50.0 and 37.5% of the patients, respectively. Peptostreptococcus micros, Veillonella parvula, Staphylococcus aureus and Pseudomonas spp. were each recovered from one lesion. All strains were observed to be sensitive to all of the antibiotics tested with the exception of one strain of P. intermedia which showed resistance to penicillin. The pathogenic mechanisms of F. necrophorum as a trigger organism were discussed. The isolation from human noma lesions of F. necrophorum, a pathogen primarily associated with animal diseases, may have important etiologic and animal transmission implications.     

Traditional oral health practices among Kanuri women of Borno State, Nigeria.

A structured questionnaire was administered on 495 women (urban 339, rural 156) from two LGAs of Borno State, Nigeria, using the interviewer method. The age range of the subjects was 12 to 80 years with a mean age (+/- SD) of 35.7 +/- 13.44 years. Majority (83.5%) did not have any formal education. Oral hygiene tools used by the respondents included toothbrush/paste 36 (7.9%), chewing stick 250 (54.9%), charcoal 159 (34.9%) and ordinary water 10 (2.2%). Of those using chewing sticks; 168 (67.2%) use Salvadora persica, 36 (14.4%) use Azadirachta indica and 46 (18.4%) use Eucalyptus camaldulensis. Forty (8.1%) of the respondents do not clean their teeth at all. Strong association was found between choice of teeth cleaning material and educational level (P=0.000). Three hundred and one (60.8%) of the respondents stain their teeth with flowers of Solanum incanum or Nicotania tabacum while, 218 (44.0%) perform tattooing of lip or gingivae and of this number 213 (97.7%) performed tattooing before marriage. Tattooing is usually performed without local anaesthesia with thorns of Balanites aegyptiaca and a mixture of charcoal & seeds of Acacia nilotica var. tomentosa as pigments. It is concluded that traditional oral health practices still constitute important part of the lifestyle in the study population.     

Sugar consumption and dental caries experience in Kenya

Introduction: There have been claims that dental caries experience and prevalence in Kenya has been increasing as a result of increased sugar consumption. A review of the literature in 1986 failed to link dental caries experience with an increase in gross national sugar consumption. Subsequently, a number of studies were conducted, necessitating further review to examine trends in dental caries experience and to relate this to changes in per capita sugar consumption. Methods: Studies conducted since 1980 for children 3–15 years of age were examined. Dental caries prevalence and experience for 3–5 years’ (deciduous teeth) and 12 years’ (permanent teeth) age groups were analysed. Calculation of per capita sugar consumption was performed using gross national annual sugar consumption for 1969–2009 national population census years. Results: There was a gradual increase in per capita sugar consumption, from 35.5 g/day in 1969 to 60.8 g/day in 2009. Dental caries experience in deciduous teeth for children 3–5 years of age increased from a decayed, missing and filled teeth/decayed and filled teeth (dmft/dft) index of 1.5 in the 1980s to 2.95 in the 2000s. At 12 years of age, caries experience for permanent teeth increased from a DMFT of 0.2 to a DMFT of 0.92 over the same period. Dental caries prevalence for both deciduous and permanent teeth also increased with time. Conclusion: These observations suggest that dental caries prevalence and experience increased with time, in parallel to an increase in per capita sugar consumption. However, a clearer understanding can be derived from longitudinal studies, based on actual household age-specific sugar consumption and dental caries incidence.Key words: Sugar, caries experience, socio-economic development     

Patterns of oral manifestation of HIV/AIDS among 225 Nigerian patients

Objective:  The purpose of this study was to determine the prevalence of the oral manifestations of HIV/AIDS and to correlate the prevalence of these lesions with the stages of the disease in the Ife-Ijesa zone, Nigeria. No comprehensive data were available for correlating it with the staging of HIV/AIDS in this region.
Subjects:  The pattern of oral HIV lesions as classified by the EC-Clearinghouse was studied in 225 confirmed consecutive HIV-infected patients in this zone.
Methods:  Clinical dental examinations were conducted under natural daylight on all consenting HIV patients, sitting in an upright chair, using dental mirrors and probes.
Results:  The prevalence of oral HIV lesions was 84.0%, with lesions ranging in number from one to six. The commonest HIV lesion was pseudo-membranous candidiasis (43.1%) followed by erythematous candidiasis (28.9%), angular cheilitis (28.9%), linear gingival erythema (24.0%) and ulcerations (8.9%). Lesions less commonly found were oral hairy leukoplakia (1.3%) and salivary gland swellings (1.3%). Heterosexual intercourse was the most common mode of transmission (94.7%) and HIV-1 (96.9%) the most prevalent pathogen among the study population. The majority of the patients were in the WHO clinical stage III (59.1%) and presented late.
Conclusions:  The prevalence of oral HIV lesions in the present study was high.     

HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital

The objective of the study was to determine the effects of the HIV/AIDS pandemic on surgical practice in a Nigerian teaching hospital. It involved a questionnaire survey of all the doctors practising in the surgical specialties at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, in order to obtain their attitudes and practices toward HIV-positive surgical patients. Sixty-five doctors were interviewed, their ages ranged from 26 years to 62 years with a mean age of 35.1 years. The majority (35.4%) were in general surgery or obstetrics and gynaecology (24.6%). Almost half (47.7%) had operated on known HIV-positive patients and the majority were in support of preoperative HIV screening. Almost all (95.4%) were worried about occupational HIV infection--a significant number of consultants would refuse to be screened if their patient were allowed to know the results (P = 0.014). The cross infection control commonly employed included adequate instrument sterilization, presurgical hand washing and the use of gloves and facemasks. The wearing of eye goggles, double gloving, indirect instrument passing and wearing of water impervious gowns were used less frequently. As HIV/AIDS infected individuals are presenting for surgical procedures in the hospital, there is a need to improve the use of universal infection control measures and to educate all categories of healthcare personnel in order to allay the fears and to prevent discrimination that could militate against effective management of HIV/AIDS patients.     

Oral Health and Dental Treatment Needs in Nigerian Patients with Epilepsy

Summary: Purpose: We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy.
Methods: A questionnaire was administered to 56 consecutive patients (35 males, 21 females) presenting to an outpatient clinic. All patients underwent dental examinations. The clinical and diagnostic features of each patient's epilepsy were also obtained.
Results: The mean age (±SD) of the patients was 25.1 ± 12.1 years (range, 12–56 years). Of 9 patients receiving phenytoin (PHT) monotherapy, 3 (33.3%) had gingival hypertrophy; 15 of 18 (83.3%) patients receiving PHT in combination with phenobarbital (PB) manifested the disorder. Traumatized anterior teeth were found in 26 (46.4%) patients with the males significantly more affected than females (p = 0.02). When the dental treatment needs were considered, 24 (42.9%) patients required dental prophylaxis with oral hygiene instruction, and an equal number required various types of restorative treatments. Only 13 patients (23.2%) had previously visited a dental clinic; the 43 (76.8%) who had never sought dental treatment claimed they did not see any need for it.
Conclusions: Our study showed an increased predilection to anterior dental injuries in patients with epilepsy as compared with the prevalence earlier reported for those without epilepsy in Nigeria (p = 0.00). There is a clear need for effective interaction between medical and dental practitioners in the management of epilepsy.     

Gender differences among oral health care workers in caring for HIV/AIDS patients in Osun State, Nigeria

The study investigated the relationship between gender and knowledge, attitude and practice of infection control among oral health care workers in the management of patients with HIV/AIDS in Osun State of Nigeria. It was a cross-sectional survey using 85 oral Health care workers (OHCWs) enlisted in the public dental health clinics. A self-administered questionnaire was designed and used for data collection. A total of 85 questionnaires were distributed. The response rate was 93%; 42 (53%) were males and 37 (47%) females. The majority of the respondents were in the 25-40 year old age group and the mean age was 37.3 years. This study found significant differences in gender and ability to identify HIV/AIDS oral manifestations (p<0.001) and recognition of HIV/AIDS risk factors (p<0.001). There was statistically significant gender difference and infection control practices (p=0.02) among the OHCWs. Males were more compliant to the universal cross-infection control principle than the female respondents. A significant association (p< 0.001) was found between OHCW gender and their attitude to the management of HIV/AIDS patients with males showing a better attitude towards the care of HIV/AIDS patients. This study shows that there are significant gender difference in attitudes, behaviour and practices of OHCW with males faring better than the females. National AIDS Control Programme, Health Control bodies, Health educators and other organizations should make efforts to improve the attitude and practice of oral health care workers regarding the management of patients with HIV/AIDS.     

Oral health status in a population of Nigerian diabetics

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.