International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.     

Effects of insulin detemir on balloon catheter injured carotid artery in Zucker fatty rats

ObjectiveWe compared the effect of the long acting basal insulin analog detemir with neutral protamine Hagedorn (NPH) insulin, and normal saline on recovery from vascular injury (balloon catheter mediated) in an animal model of insulin resistance.MethodsFemale Zucker fatty rats were administered NPH/detemir/saline for 7 days following which, they underwent balloon catheter mediated injury of left carotid artery, and were continued on the respective regimen for an additional 21 days when they were sacrificed. We evaluated the injured carotid artery for intimal hyperplasia (Intima/Media ratio) and also, aortic arch protein for markers of oxidative stress and inflammation, in addition to expression and phosphorylation of eNOS using well established methods.ResultsThere was a significant difference in intimal hyperplasia (Intima/Media ratio) between control and detemir treated rats (1.3 ± 0.09, 0.82 ± 0.08; p < 0.001) whereas the IM ratio in NPH treated rats was not significantly different from saline (1.17 ± 0.1). Expression of p-eNOS (ser-1177) in both NPH and insulin detemir (1.3 ± 0.15, 1.11 ± 0.12) was significantly higher than controls (0.56 ± 0.13; p < 0.05). We did not find significant differences in the expression of MnSOD, eNOS and NFκB-p65.ConclusionWe conclude that in insulin resistant states, treatment with Insulin detemir but not NPH is associated with less intimal hyperplasia, although both insulins increased eNOS phosphorylation.     

Pattern of dental extraction in children in a Nigerian tertiary hospital

Changes that occurred in the pattern of tooth extraction in the last 13 years among a population of children in Nigerian were studied. The result of this study was then compared to that of a past study done in the same institution 13 years earlier. Information on age, gender, and indication of tooth extraction was collected prospectively from 379 consecutive patients who visited the outpatient Pediatric Dental Clinic for the first time during the year 2002. Results showed tooth extraction due to caries decreased, while there was an increase in tooth extraction from an apparent increase in orthodontic treatment needs. Acute necrotizing ulcerative gingivitis (ANUG), a significant cause of tooth loss in the last decade, decreased significantly. The pattern of deciduous tooth loss also changed as more anterior teeth were lost for orthodontic reasons in this present study. The pattern of tooth loss in the permanent dentition remains very similar to that of the past study, though more premolars were lost in the present study. There appears to be an increasing need for tooth extractions in orthodontic treatment for this population of children. The focus of planned dental health care provisions, treatment policies, and training emphasis in child dental care may need to shift to addressing orthodontic needs.     

Failures related to crowns and fixed partial dentures fabricated in a Nigerian dental school

The purpose of this investigation was to document the failure rate and length of service of crowns and fixed partial dentures (FPDs) fabricated in a Nigerian dental school. The reasons for failure of the initial restorations and their length of service were also ascertained. Also, the numbers of retainers, pontics, and the types of restoration were recorded. Poor esthetics was the most frequent cause of failure, 66 units (40.5%); followed by fracture, 58 units (35.6%); and dental caries, 25 units (15.4%). These outcomes were contrary to findings previously reported in studies from western countries where dental caries was principally responsible for failures (22.0% to 38.0% of cases). The resin-retained FPDs had the shortest mean years of service at 2.7 years, while the three-unit metal-ceramic FPDs had the greatest longevity at 8.6 years. The overall mean years of service for replaced restorations were 5.6 years. The study found a decrease in the mean years of service as the number of units in the fixed-fixed partial dentures increased. This is in sharp contrast to previous reports where no relationship existed between length of service and the number of units in a FPD.     

Salivary gland neoplasms in Maiduguri, north-eastern Nigeria

OBJECTIVE: To document the pattern of salivary gland neoplasia in Maiduguri, Nigeria. DESIGN AND SETTING: A retrospective clinical and histopathological review (January 1987-December 2002) of cases diagnosed at a tertiary care hospital. MATERIALS AND METHODS: Information on demographics, diagnosis and cancer management in the hospital were retrieved from biopsy reports and case notes of patients. RESULTS: The palatal (71.9%) and parotid (78.3%) glands were the most common minor and major salivary glands involved, with a benign-malignant ratio of 1:1 and 1.4:1, respectively. Pleomorphic adenoma (44.3%) was the most common salivary gland neoplasm recorded. It was commonly reported in the third decade (mean 30.4 years) and among males (M:F, 1.4:1). Ectopic lesions (17.1%) were reported in the neck, nose and cervical nodes. Mucoepidermoid carcinoma (10.1%) was the most common salivary gland malignancy, occurring in the second and sixth decades; of equal gender distribution and predominantly in the palate (50%). The squamous cell carcinoma (10.9%) and adenoidcystic carcinoma (21.9%) were the most common malignancies in the major and minor glands respectively. There was a higher prevalence of malignancies of the parotid than previously reported for northern Nigeria (P = 0.036). CONCLUSION: Pleomorphic adenoma and mucoepidermoid carcinoma were the most commonly reported benign and malignant neoplasia in this series. The prevalence of mucoepidermoid carcinoma contrasts with reported findings in other African studies.     

Anticlastogenic effects of Hibiscus sabdariffa fruits against sodium arsenite-induced micronuclei formation in erythrocytes in mouse bone marrow

An in vivo micronucleus assay using albino mice was used to examine the anticlastogenic effects of a crude aqueous extract of Hibiscus sabdariffa fruits in bone marrow cells of mice. Various doses of freshly prepared crude extract of Hibiscus sabdariffa (50, 100 and 150 mg/kg b.w.) were given by gavaging to male laboratory bred Swiss albino mice for 7 days as a dietary supplement followed by a single dose of sodium arsenite (2.5 mg/kg b.w.) After 24 h, the animals were killed and bone marrow smears were prepared and stained in Giemsa. The results show that sodium arsenite effectively induced micronuclei in polychromatic erythrocytes (PCEs). Administration of a crude extract of Hibiscus sabdariffa led to a significant reduction of micronuclei in PCEs. The results also show that a combination of Hibiscus sabdariffa and sodium arsenite reduced significantly the frequencies of micronucleated PCEs induced by sodium arsenite.     

Pattern of soft tissue injuries to the oro-facial region in Nigerian children attending a teaching hospital

Summary. Objective. This study was designed to determine the aetiological factors and pattern of oro‐facial soft tissue injuries among children in a suburban Nigerian population. The problems encountered in the management of the patients are also highlighted. Setting. Obafemi Awolowo University Teaching Hospitals’ Complex, Ile‐Ife, Osun State Nigeria. Sample and methods. This prospective study was carried out in children aged ≤ 15 years who presented with oro‐facial soft tissue injuries between July 1996 and December 1997. Data was collected from a clinical examination of the child and a questionnaire completed by the parent or carer. Results. During the study period, 174 children were managed for oro‐facial soft tissue injuries, an incidence of 1·1%, out of a total of 15 582 child admissions. A male preponderance was found (1 : 0·74). The mean age ± SD was 7·3 ± 4·2 years and the range was 9 months–15 years. Falls were the most common aetiology followed by road traffic accident. The forehead was the most frequently injured site. A mortality of 3·4% was found. Although animal bites and burns accounted for only 13·8% of all injuries, all the deaths were a result of these aetiologies. Road traffic accidents and burn victims had the longest hospital stay. Conclusion. Although falls and road traffic accidents are frequent causes of oro‐facial soft tissue injuries, less common causes, like burns and dog bites are more likely to result in death.     

An investigation into the relationship between mandibular third molars and angle fractures in Nigerians

We examined the relationship between the presence or absence of mandibular third molars and angle fractures in Nigerians between January 1976 and July 1997. Information was obtained from patients' case records and radiographs.A total of 490 patients were seen during the study period, 408 of whom (83%) had their third molars present, and 76 of whom had angle fractures. Road traffic accidents (n =304, 62%) were the main cause of the fractures. Of these, 44 (14%) had angle fractures compared with 14/75 (19%) patients in whom the mechanism of injury was a fight or assault.Sixty-five of the 408 patients whose third molars were present (16%) had angle fractures, as did 11/82 (13%) who did not have third molars (p =0.57). Of the 77 patients whose lower third molars were not erupted, 24 (31%) had angle fractures compared with 52/331 (16%) in whom the lower third molars were erupted (p =0.002).These findings suggest that angle fractures are uncommon in this population because of their particular mechanism of injury. In addition, the presence of a lower third molar does not necessarily predispose to fractures of the angle of the mandible. However, angle fractures are more likely to occur in people with unerupted lower third molars than in those in whom they have erupted.     

A survey of cases of cancrum oris seen in Ile-Ife, Nigeria

Summary. Aim . To review the records of child patients with cancrum oris who presented at a teaching hospital in Nigeria.
Setting . Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
Sample and methods . The study was carried out through review of records of child patients diagnosed as having cancrum oris or post-cancrum oris defects between 1982 and 1996. Age, gender, site distribution, treatment and its outcome were recorded.
Results . One hundred and forty-two cases were diagnosed during the study period. Mean age was 4·65 years (range 2–16 years). The maxillary quadrants were affected more often than the mandibular. Seventeen patients completed treatment satisfactorily, but 55 failed to do so. All patients had evidence of malnutrition.
Conclusions . The findings of this and other studies demonstrate the need for major initiatives to address the underlying causes of cancrum oris and to promote the utilization of health care.