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.

The purpose of this study was to determine the Rest Vertical Dimension (RVD), Occlusal Vertical Dimension (OVD), Freeway Space (FWS) and their importance in the fabrication of dental prostheses. These prosthetic parameters were determined in 310 dentate patients attending the Dental Hospital of the Obafemi Awolowo University Teaching Hospitals' Complex Ile-Ife. The MMO was obtained by measuring inter-incisal distance. RVD and OVD were derived using Willis gauge. The FWS was taken as 'RVD minus OVD'. Of the 310 attendees, twenty-seven (8.7%) were denture wearers. There was no statistically significant difference between the genders with regards to the use of dentures (P = 0.17). The mean values (+/- standard deviation) for MMO was found to be 50.5 +/- 7.9 mm (range 18.0 to 70.0 mm). The RVD was 73.0 +/- 8.4 mm (range 50.0 to 94.0 mm) and OVD was 69.8 +/- 8.2 mm (range 47.0 t 92.0 mm). The mean FWS was 3.3 +/- 1.4 mm (range 1 to 9 mm). Following the loss of most of the posterior teeth or in a state of complete edentulism, the face profile appears squashed and the vertical dimensions are altered. To provide an efficient and functional prosthesis, the facial dimensions have to be restored to or near pre-edentulous state. The establishment of values for these facial dimensions in given population will assist in the provision of satisfactory prosthesis.

Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture, the large unstructured sex industry, high prevalence of sexually transmitted infections and lack of funding. All of these have an impact on oral health. Future policy directions identified included 'increasing access to HIV information and postexposure prophylaxis' 'shift towards care and support for those living with HIV/AIDS with emphasis on community and home-based care' and 'improving intersectoral co-ordination and collaboration'. The study demonstrated gaps in availability and access to policies and protocols on HIV/AIDS by managers and health workers. Specific strategic recommendations are made for oral health.

An investigation into the pattern of complaints lodged by patients after impacted mandibular third molar surgery was done in a Nigerian teaching hospital over a period of 3 years. One hundred and twenty seven records were retrieved. Pericoronitis (71.2%), pulpitis (17.6%) and periodontitis (11.2%) were the reasons for surgery. No third molar surgery was done for prophylactic or orthodontic reasons. Sixty-one complaints were lodged by 49 (38.6%) patients on day 1, and 37 complaints by 35 patients on day 7. These complaints were verified by the findings of the examining clinician. Pain, swelling and trismus were the commonest complaints. A significant association (P = 0.042) was found between patients' complaints on the first postoperative day and the drug combination given. Similarly, there was a significant relationship (P = 0.0055) between the type of analgesics prescribed and the presence of postoperative pain. No significant relationship was however found between the complaints and patients' age, indication for extraction, impaction type and method of impacted tooth removal. Although the findings of this retrospective study are limited in their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible.

Presence of helicobacter pylori (H.Pylori) in the dental plaques may be associated with the presence of the same organism in gastric mucosa.To assess and compare the prevalence of H. pylori in dental plaques and gastric mucosa of dyspeptic Nigerians.
Sixty-six consecutive patients undergoing endoscopy for investigation of dyspepsia were included in the study. A predesigned questionnaire was used to collect information on socio-demographic and other factors. Each patient also had clinical dental examination. Dental plaque scrapping was collected before endoscopy for helicobacter pylori culture, and at endoscopy, two gastric biopsy specimens were taken for culture and histology.
The mean age (+/- SD) of the patients was 44.8 (+/- 17.4) years (range 5 to 80 years). The positivity rate of helicobacter pylori in gastric biopsy was 35 of 66 (53.0%) while the same for dental plaque was 46 of 66 (69.7%). The correlation (Spearman's) between gastric mucosa and dental plaque colonization with helicobactor pylori was significant (R = 0.30, P = 0.01). When concordant positivity of gastric biopsy culture and histology was taken as diagnostic, the sensitivity of dental plaque culture was found to be 82.9% and the specificity was 45.2%.
This study revealed that helicobactor pylori has a high prevalence in the dental plaque of the population that we have studied and may therefore be of potential relevance in screening for such infection.

The aim of the study is to obtain the views and opinions of People Living with HIV/AIDS (PLWHAS), community leaders and other stake holders (care providers and AIDS orphans), so as to assess the role of Non-Governmental Organisations in the control of HIV infection with the purpose of making appropriate recommendations for policy formulation on issues related to the health and care of PLWHAs. A qualitative research was carried out using in-depth interview method with a questionnaires as a guide. In all, 12 seropositives, 13 community leaders and 34 AIDS orphans were interviewed. Results indicate that there was a lack of networking between the six Non-Governmental Organisations working in the state in relation to HIV/AID. Also, none of these PLWHAs had concrete plans for the future of their children, though they all expressed some form of anxiety about their children's future. The burden of care of AIDS orphans often fall on the maternal family members. Top on the list of the problem of AIDS orphans was their poor education due to financial difficulties. There is the need for the government to provide, support, encourage and monitor the activities of the Non-Governmental Organisations and network with them so as to maximise the benefits that can be obtained from the role they play in HIV/AIDS management.

To evaluate patient's attitudes to the use of gloves by dentists.This consisted of a four-item questionnaire administered to 445 consecutive patients attending our dental clinic.
. Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria.
Four hundred and forty five patients above the age of fifteen years attending the dental clinic for the first time.
Majority of the patients were in the 20-30 year age group and over 93% had formal education. Most of the respondents (88.8%) stated that glove wearing was essential and over 63% considered that glove wearing protected both the operator and the patient. Whilst about one-third of respondents would attend for treatment when gloves were not worn, 81.3% felt that gloves should be changed after each patient. There were statistically significant differences (p<0.05) in responses in relation to age-groups and educational attainment, however no sex differences (p>0.05) were reported.
This survey showed a high level of awareness by patients on the use of gloves by dentists. It also found that age-groups and levels of educational attainment influenced patients attitude to glove use.

Oral health programmes for refugees should emphasize a Primary Health Care approach focusing on prevention, based on appropriate technology, and promoting involvement of the refugee community in the provision of services. This report describes a unique programme at the Liberian refugee camp Gomoa Buduburam, Central Region, Ghana. The programme resulted in the effective participation of a refugee community in oral health promotion, and empowerment of members of the community to take care of their own oral health. A comprehensive primary oral health care programme is essential for refugee camps, especially when the camp has become stable. This programme represents an approach to oral health promotion in refugee situations characterized by full community participation. It is recommended that UNHCR should accommodate oral health within the major health framework for refugee populations, including provisions for Community Oral Health Worker remuneration as well as equipment and material supply.

In this study, 1,325 school children from 7 farm schools were examined. Their mean age (+/- SD) was 10.5 +/- 3.0 (range 6-11) years. At baseline, the mean DMFT score was 1.1 +/- 1.7 and 36.4% of the children had caries. The prevalence of fluorosis among the children was 12.6%. Curative treatment was offered to all the children. A total of 113 children (8.5%) with one-surface cavities on permanent teeth and without fluorosis were treated using the atraumatic restorative treatment (ART) approach. A total number of 163 cavities were included in the study, of which 82 were treated with Fuji IX glass-ionomer cement and 81 with Ketac-MOLAR (hand mix). One year after treatment, restoration and sealant parts of ART fillings were examined. Caries status was also determined. The placing of the ART fillings and their evaluation were performed by different practitioners. A total number of 108 restorations (58 with Fuji IX, 50 with Ketac-MOLAR) were evaluated. Results of ART fillings showed a survival rate of 93.1% with Fuji and 94.0% with Ketac-MOLAR. Retention of the sealant parts of ART fillings was observed in 81% of restorations with Fuji IX and 76% with Ketac-MOLAR, not connected to the filled cavity. Caries was absent on all teeth restored with Fuji IX and noted in only one tooth restored with Ketac-MOLAR, not connected to the filled cavity. The retention rate after a 12-month period was acceptable and ART approach proved to be an appropriate technique for restoring teeth in this population group. There were no statistically significant differences between the survival rates of the two glass-ionomer restorative materials (P > 0.05).

Managed health care (MHC) has emerged in South Africa as an alternative system to control the cost of health care. Fears, negative perceptions and much uncertainty have surrounded this issue since its introduction in South Africa. The purpose of this study was to assess the understanding, perceptions and opinions of dentists residing in the Gauteng province about the emergence, benefits, impact, and future of MHC in South Africa. Eighty-six dentists (21.5%) out of the sample population of 400 responded to the questionnaire. The majority (66.7%) of the respondents perceived MHC to be a threat to their practices, with most feeling that MHC will interfere with the doctor-patient relationship. Forty-two per cent of the respondents were of the opinion that MHC will not succeed in South Africa. The results suggest that this sample of dentists do not consider MHC to be an alternative to the existing fee-for-service system. The introduction of MHC in South Africa is mostly based on models used in the USA, which might not be appropriate in the unique South African environment.

This study determined the knowledge, attitude and practice of oral health care workers in public clinics in South Africa towards HIV/AIDS and investigated the implementation of infection control measures. A total of 727 questionnaires were distributed to dentists, dental therapists, oral hygienists and chairside assistants in the public dental clinics of 9 provinces, of which 276 were returned from 8 provinces, giving a response rate of 38%. The questionnaire covered demographic factors and assessed issues such as knowledge, infection control practices, continuing education, legal, ethical and psychosocial issues and available support for HIV/AIDS. The common oral manifestations seen by respondents were candidiasis, acute necrotising ulcerative gingivitis (ANUG), hairy leukoplakia and Kaposi's sarcoma. Of the 174 who had a previous HIV test, 48% were for insurance purposes and 21% for post-needle-stick injury. Over 10% of the respondents indicated that gloves were not available at all, that there was an inadequate supply of water, and that there was no autoclave in their clinic. Nearly 50% of the clinicians had not had hepatitis B vaccination in the last 3 years. Fifteen respondents (5.4%) were not willing to treat HIV-positive patients. Only 48% had access to a written post-exposure management protocol and post-exposure medication was available to only 36.6%. The vast majority of the respondents clearly expressed a need for additional education on HIV/AIDS. The study demonstrated a need to add knowledge, enhance personal skills and improve the application of universal precautions

A structured, 40-item, self-administered questionnaire was distributed to 290 nurses attending an international health care conference held in Pretoria, South Africa. The questionnaire focused on; personal and demographic details of the respondents, history of dental disease and dental attendance, exposure to oral health during and after basic nurse training, opinions on oral health and the nursing curriculum, perceptions on the relationship between nurses and oral health personnel, perceived ability to promote oral health and self-reported contributions to oral health. The 153 respondents were predominantly female (140, 93.3%) with a mean age (+/- Standard deviation) of 43.0 +/- 7.5 years. One hundred and twenty one (79.1%) had previously visited a dental clinic for personal care and 105 (68.6%) had suffered from dental disease, dental pain, bleeding gums or bad breadth. Only 71 (46.4%) were exposed to experiences in assessing and caring for clients with oral disease during their training. Significant positive correlation were found between exposure (during training) to experiences in assessing and caring for clients with oral diseases and some factors. One hundred and forty-eight (96.7%) agreed oral health should be integrated into the nursing curriculum. Forty-one (26.8%) indicated they have not been contributing to the oral health of their clients or community while 92 (60.1%) described their personal contributions as fair. One hundred and thirty six respondents (88.9%) wished to be able to do more for their clients in the area of oral health.

The changing profile of oral care rendered through the Mobile Dental System (MDS), after the introduction of the Atraumatic Restorative Treatment (ART) approach is described. During the first year of introduction of ART, the percentages of amalgam restorations and tooth extractions decreased significantly (P < 0.0001). This is partly ascribed to a change in choice of treatment by dental operators in favour of ART and also due to an increase in acceptance by patients because of the reduced fear, and the patient-friendly nature of the ART approach. The reduction in amalgam restorations was 16.0 per cent for permanent and 1.4 per cent for primary posterior teeth. Extraction of posterior teeth was reduced by 17.4 per cent in the permanent and 35.7 per cent in the primary dentitions. The restorative component of oral care increased by 33.4 per cent in the permanent and 37.1 per cent in primary posterior teeth. The one-year survival of one-surface ART restorations using Fuji IX and KetacMolar was 93.6 per cent. Full and partial (more than 90 per cent) retention of the sealant part of the ART restoration was obtained in 75 per cent of the cases after one-year. During the one-year period, infection control was made more simple and this facilitated easier maintenance of mobile dental equipment. The introduction of the ART approach reduced extraction, restored more teeth and made oral care in the MDS more preventive, less threatening and thus more patient-friendly.

To promote community involvement in the provision of oral health services.The project consisted of a four-week training course in oral health for selected refugees, an oral health survey based on WHO guidelines and conducted by the refugees themselves and the provision of oral health care services to the community by the trained refugees.
Liberian refugee camp, Gomoa Buduburam in Ghana.
Liberian refugees of all ages.
Twelve refugees were given short term training in oral health. In the oral health survey, 196 refugees were clinically examined for dental caries, periodontal disease and malocclusion.
DMFT (for dental caries), CPITN (for periodontal disease), and malocclusion scores for selected subjects. Also clinical services rendered.
Oral health survey revealed a mean age (+/- SD) of 25.7 (+/- 9.5) years. Only thirty nine (19.9%) of the subjects were caries-free, and total DMFT was 2.5 +/- 2.2. Based on the CPITN, 107 (54.6%) required oral hygiene instructions (OHI), and 41 (20.9%) required prophylactic scaling with OHI. Forty four (22.5%) of the subjects had normal occlusion and 152 (77.5%) mild to severe malocclusion. Periodontal (75.5%), prosthetic (52.5%) interventions and extractions (34.2%) constituted the bulk of the treatment needs required. Clinical treatment was rendered by the trained refugees to 846 patients over a twelve month period.
Relief programmes for refugees should emphasise a primary health care approach, focusing on prevention, based on appropriate technology, and promoting involvement by the refugee community in the provision of services.

We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy.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.
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.
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.

We determined the prevalence of oral disorders and the dental treatment needs of outpatients with epilepsy.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.
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.
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.

An unusual case of cervicofacial actinomycosis in a 60-year old male Nigerian is reported. The patient had had partial mandibular resection for plexiform ameloblastoma one year earlier with insertion of Kirschner wire to serve as a splint. The authors highlight the possible pathophysiology of this condition. It is suggested that clinicians be aware of the various modes of presentation and natural history of the disease to facilitate prompt diagnosis and appropriate treatment. This will assist in forestalling the numerous complications that may result from actinomycosis.