Comparative analgesic efficacy and tolerability of celecoxib and tramadol on postoperative pain after mandibular third molar extraction: A double blind randomized controlled trial

Background

The choice of an efficacious and well-tolerated analgesic for the control of postoperative pain after third molar surgical extraction remains a challenge.

Aim

The aim of this study was to compare analgesic efficacy and tolerability of celecoxib and tramadol following mandibular third molar extraction.

Materials and Methods

This was a prospective randomized, double blind controlled trial. Ninety patients were randomly assigned equally to either celecoxib or tramadol. Appropriate doses of the assigned drugs were administered orally immediately after the surgical extraction and patients recorded the pain intensity felt before the extraction, immediately after extraction, at 4 h, 8 h, 16 h, 24 h, and 48 h after the extraction using the visual analogue scale (VAS). Adverse effects of the medications were also recorded.

Results

Four of the patients dropped out of the study. Fifty five percent of patients in tramadol group experienced adverse effects but none in celecoxib group. The median VAS score of the celecoxib group was lower than tramadol group throughout the postoperative period and there was statistically significant difference in the median VAS score between the two groups 4 hours after drug administration (P = 0.001).

Conclusion

In our study, celecoxib was more efficacious and better tolerated than tramadol for the management of pain after surgical extraction of mandibular third molar.

Impact of oral antibiotics on health-related quality of life after mandibular third molar surgery: An observational study

AIM

To compare the impact of antibiotics on health-related quality of life (QoL) outcomes following third molar surgery.

MATERIALS AND METHODS

The study population consisted of 135 subjects that required surgical extraction of mandibular third molar under local anesthesia and met the inclusion criteria. The subjects were randomized into three study groups of 45 subjects each: Group A - extended amoxicillin/clavulanic acid (GlaxoSmithKline Beecham England), 1 gram pre-operatively and then 625 mg BD for 5 days Group B - prophylactic amoxicillin/clavulanic acid (GlaxoSmithKline Beecham England) 1 gram pre-operatively only, and Group C - prophylactic levofloxacin 1 gram pre-operatively only. Patients were assessed pre- and post-operatively on days 1, 3, 5, 7, and 14 using the United Kingdom oral health-related QoL (OHRQoL) questionnaire.

RESULTS

This study showed that surgical removal of impacted teeth exerted a negative influence on patient's QoL across various physical, social, and psychological aspects of life. Comparing the three groups, Group A showed a slightly better QoL score; although, there was no statistically significant difference among them. Studies have shown better clinical recovery following administration of antibiotics after third molar surgery.

CONCLUSION

There was a significant deterioration in OHRQoL in the immediate postoperative period, particularly postoperative days 1 and 3 following third molar surgery. QoL was also observed to be slightly better in Group A than Groups B and C, although this was not statistically significant.

Comparative study of anxiety and depression following maxillofacial and orthopedic injuries. Study from a Nigerian University Teaching Hospital

This study hopes to compare levels of anxiety and depression in the maxillofacial and orthopedic injured patients over a period of 12 weeks. This was a prospective, repeated measure design. A total of 160 participants (80 with maxillofacial and 80 with long bone fractures) had repeated review follow-ups within 1 week of arrival in the hospital (Time 1), 4-8 weeks after initial contact (Time 2) and 10-12 weeks thereafter (Time 3), using hospital anxiety and depression scale questionnaire. Road traffic accident remained the main cause of injury in both groups of subjects. The Hospital anxiety and Depression scale detected 42 (52.5%) cases of depression at baseline, 36 (47.4%) cases at Time 2, and 14 (18.4%) cases at Time 3 in the maxillofacial injured group. In the long bone fracture subjects, 47 (58.8%) cases were depressed at baseline, 23(33.3%) cases at Time 2, and only 5 (7.2%) cases at Time 3. Both groups showed reduction in depression levels with time. Fifty-six (70.0%) had anxiety at baseline, 32 (42.1%) at Time 2, and only 9 (11.8%) had anxiety at Time 3 in the maxillofacial fracture group, whereas in the long bone fracture group, 69 (86.3%) subjects were anxious at baseline, 32 (46.4%) at Time 2, and 22 (31.9%) at Time 3. There were significant differences in depression and anxiety level in both the maxillofacial and the long bone fracture subjects at baseline (Time 1), Time 2(4-8 weeks) and Time 3(10-12 weeks).

Oral health related quality of life (OHRQoL) following third molar surgery in Sub-Saharan Africans: an observational study

Introduction

Surgical extraction of the impacted third molar is one of the commonest minor oral surgical procedures carried out in oral surgery. Problems created by the disturbances in post-extraction wound healing and physiologic sequelae of third molar surgery can significantly affect the patient's quality of life.

Methods

The study population consisted of 135 subjects that required surgical extraction of mandibular third molar under local anesthesia and met the inclusion criteria. Patients were assessed pre-operatively and post-operatively on days 1,3,5,7, and 14 using the United Kingdom Oral Health related Quality of Life questionnaire (UK-OHRQoL).

Results

This study also showed that surgical removal of impacted teeth exerted a negative influence on patient's Quality of life (QoL) across various physical, social, psychological aspects of life. UK-OHRQoL-16 mean scores showed that severe difficulty in eating was experienced by 106 (78%) patients on postoperative day (POD) 1. The symptom however improved within the first week with only 16 (11.9%) experiencing this symptom by POD 7 and none by POD 14.

Conclusion

There was a deterioration in oral health related quality of life in the immediate postoperative period particularly POD 1 and 3 following third molar surgery, which slowly returned to preoperative level by 7th day. Routines such as eating, laughing and smiling, work and speech were also affected. Patients need to be informed of these symptoms after third molar removal so as to enable them prepare very well for the procedure and its sequelae.

Comparative Efficacy of Amoxicillin/Clavulanic Acid and Levofloxacin in the Reduction of Postsurgical Sequelae After Third Molar Surgery: A Randomized, Double-Blind, Clinical Trial in a Nigerian University Teaching Hospital

Background:

The most common sequelae after surgical removal of mandibular third molar are pain, trismus, swelling, and dysphagia. However, these symptoms can also signal the onset of surgical site infection and alveoli osteitis. The aim of this study was to evaluate the efficacy of prophylactic amoxicillin/clavulanic acid and levofloxacin and preemptive therapy of amoxicillin/clavulanic acid in the reduction of postinflammatory complications, surgical site infection, and alveolar osteitis following the third molar surgery.

Patients and Methods:

A total of 135 patients were randomized into three equal groups: Group A (preemptive therapy of amoxicillin/clavulanic acid) with preoperative dose of 875/125 mg amoxicillin/clavulanic acid followed by 500/125 mg amoxicillin/clavulanic acid 12 hourly for 5 days, Group B (amoxicillin/clavulanic acid prophylaxis) with a single preoperative dose of amoxicillin/clavulanic acid 875/125 mg tablets, and Group C (levofloxacin prophylaxis) with a single preoperative dose of levofloxacin 1000 mg tablets. All patients had ostectomy using surgical handpiece and burs and received same analgesics (tabs ibuprofen 400 mg 8 hourly for 3 days).

Results:

No case of surgical site infection or alveoli osteitis was recorded in the study groups. There were no statistically significant differences between the treatment groups with regard to pain, mouth opening, postoperative facial dimension, and body temperature.

Conclusion:

Amoxicillin/clavulanic acid as a single preoperative bolus should be adequate for the prevention of postoperative wound infection and alveoli osteitis following the third molar extraction as there is no need for an extension of the antibiotic. Moreover, levofloxacin can be utilized as prophylaxis in patients undergoing mandibular third molar extraction if such patients are allergic to penicillins.

Reconstruction of mandibular defects using nonvascularized autogenous bone graft in nigerians

Objectives:

The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria.

Patients and Methods:

A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients’ records. This information include patients’ demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications.

Result:

There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded.

Conclusion:

The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.

Odontogenic and oral soft tissue myxomas: clinicopathologic analysis of 16 cases from Ile-Ife, Nigeria

OBJECTIVES

Odontogenic myxomas (OMs) are considered slow-growing tumours with the potential for extensive bone destruction, cortical expansion, and a relatively high recurrence rate. We analysed the cases histologically diagnosed as OM in our centre and compared these to the data found in the literature.

METHOD

A record-based study of OMs histologically diagnosed at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Southwest Nigeria between 1990 and 2009 was conducted. The tumours were classified as myxomas, fibromyxomas or myxofibromas depending on the histologic picture. Gingival masses with similar histologic features but not showing bone involvement were included in the series as soft tissue myxomas.

RESULTS

A total of 16 histologically diagnosed cases were recorded, 11(68.8%) in females and 5 (31.2%) in males giving a male:female ratio of 1:2.2. The most common tumour site was the maxilla (7 cases, 43.8%) and the mean age of the patients at the time of diagnosis was 31.1+/-18.0 years. Myxomas, exhibiting complete myxomatous tissue (8 cases, 50%) with no appreciable fibrous component were the most common histological type.

CONCLUSION

The peak incidence was in the 2nd decade of life and there was a predilection for females (M:F = 1:2.2) and the maxilla. The recommended treatment of choice is radical surgery or conservative excision depending on tumour size.

A classification system for recurrent ameloblastoma of the jaws--review of 30 cases in Nigerians

This paper reviewed the clinicopathologic presentation of recurrent ameloblastoma in 30 Nigerian patients at three tertiary referral centers with the sole objective of developing a classification system. Most recurrences occurred in patients in their 3rd decade of life (20-29years) and males were more frequently affected than females (1.5 to 1). Though enucleation resulted in the highest rate of recurrences (30%), hemi-mandibulectomy also resulted in a 20% recurrence rate. Majority of the recurrences occurred within 5 to 9 years after primary surgery. Most primary jaw sites of the lesion corresponded with the primary jaw sites of the recurrent tumor which in itself may be a reflection of inadequate primary treatment. The most frequent anatomic site of primary tumors that recurred was c4 (highest level of ramus involvement). The most frequent anatomic classification of the recurrent tumors was recurrence at one bone margin (Bla) and recurrence at intervening /adjacent soft tissues between the resected bone edges (Blc). Mandible to maxilla recurrence increases the likelihood of extension to the skull and brain.

A survey of facial nerve dissection techniques in benign parotid surgery among maxillofacial and ear, nose, and throat surgeons in Nigeria

OBJECTIVE

The aim of the present study is to identify the facial nerve dissection technique routinely used during parotidectomy for benign parotid tumors by Nigerian Oral and Maxillofacial (OMF) and Ear, Nose, and Throat (ENT) Surgeons.

MATERIALS AND METHODS

A questionnaire-based study was conducted among Oral and Maxillofacial and Ear, Nose, and Throat Surgeons in Nigeria, on their experience with antegrade and retrograde facial nerve dissection techniques in parotid surgery. The respondents were asked to indicate their choice of dissection techniques in revision parotidectomy, limited superficial parotidectomy, and in obese patients with large tumors. They were also asked to indicate if they routinely used perioperative facial nerve monitoring devices in parotid surgery for benign tumors.

RESULT

About half (47.5%) of them routinely used the antegrade technique, while only a few (12.5%) used the retrograde technique. A large number of them (40%), however, used a combination of antegrade and retrograde routinely. Technical ease was the main reason for the choice of technique. The antegrade technique was the technique of choice by most respondents for revision parotidectomy (60%) and limited superficial parotidectomy (62%). However, the retrograde approach was the technique of choice by most of them (47%) in case of parotidectomy in obese patients with large tumors. The routine use of perioperative facial nerve monitoring devices is an uncommon practice among OMF and ENT surgeons in Nigeria.

CONCLUSIONS

The antegrade approach for facial nerve dissection is the most common technique used in parotid surgery by Nigerian OMF and ENT surgeons. Nigerian surgeons need to consider the retrograde approach in selected cases of parotid surgery especially for localized tumors that are amenable to limited superficial parotidectomy. Inclusion of perioperative facial nerve monitoring devices is also advocated.

A rare case of orofacial blast injuries caused by explosion of dry cell batteries in a 12-year-old Nigerian

BACKGROUND

Severe isolated facial injuries arising from the explosion of dry cell battery in children is extremely rare. The management of the resultant tissue devastation in a scarce resource economy can be quite challenging.

METHOD

We report a case of 12 year old boy who sustained extensive oral and facial blast injuries caused by shattering of a locally assembled fan as result of an explosion of four 1.5 Volts dry cell batteries. He had multiple lacerations and avulsion of facial soft tissues as well avulsion and fractures of the mandible and maxilla. There was associated oronasal communication and avulsion of the anterior teeth in the upper and lowerj aws.

RESULTS

Serial debridement and minimal repair of soft tissue injuries as well as splinting of the mandible was done under local anaeasthesia. Fourteen months after the injuries there was complete healing of mandibular fracture and closure of the oronasal communication. However patient had perioral hypertrophic scar, microstomia and edentulism.

CONCLUSION

Extensive life threatening injuries can be caused by a simple device such as a 1.5v dry cell battery. Early surgical intervention offers the best hope for full recovery.

Health-related quality of life in Nigerian patients with facial trauma and controls: a preliminary survey

We examined the health-related quality of life (HR QoL) of patients with facial trauma and compared it with that of healthy controls; temporal changes in HR QoL of patients over 12 weeks compared with baseline values; and whether the risk of depression could be identified by baseline HR QoL. For 26 months we recruited 126 consecutive patients with facial injuries and 126 age and sex-matched healthy controls for the study. Enrollment criteria included age 18 years and over, Glasgow coma scale score on admission of 12 and over, and duration of stay of more than 24 hours. HR QoL was measured using the 26-item World Health Organization Quality of Life Questionnaire (WHO QoL-Bref), and depression was measured with the Hospital Anxiety and Depression Scale (HADS). Scores in all domains of the WHO QoL-Bref (physical, psychological, social relations, and environment) were considerably reduced in injured patients compared with controls. During follow up there were improvements only in the domains of physical health and environment, but not in psychological health. There was a significant reduction in the HR QoL domain of social relationships with time. The regression equation for all four QoL domains as predictors was significantly related to depression scores throughout the study period. Patients with facial injuries are at risk of poor QoL after trauma. There was a high incidence of depression throughout the follow-up period, and poor QoL at baseline predicted depression during follow-up.

Psychological Complications of Maxillofacial Trauma: Preliminary Findings From a Nigerian University Teaching Hospital

PURPOSE

This study sought to determine 1) the prevalence of psychological distress in a series of subjects who sustained maxillofacial injuries and 2) temporal changes in psychological functioning over 12 weeks compared with baseline values.

PATIENTS AND METHODS

This was a prospective, repeated-measures design study of consecutively recruited subjects at a Nigerian university teaching hospital. A total of 51 subjects with facial injuries had repeated follow-up assessments (10 days, 6 to 8 weeks, and 10 to 12 weeks) after the trauma, using standard instruments.

RESULTS

The General Health Questionnaire identified a high prevalence of psychological morbidity in the subjects (90%), with 41.2% and 11.8% scoring above threshold values on the hospital anxiety and depression scales, respectively. Five subjects satisfied the criteria on the Trauma Screening Questionnaire for a diagnosis of post-traumatic stress disorder during the follow-up period. Psychological distress (General Health Questionnaire caseness) remained at high levels during the 2 follow-up assessments.

CONCLUSIONS

The management of facial injuries should integrate a multidisciplinary approach that addresses the psychological needs of the patients in both the short term and the long term.

Bacterial infections of the head and neck fascial spaces in Nigerians

BACKGROUND

Bacterial infections of the head and neck region remain a major public health concern in Nigeria despite the availability and widespread use of antibiotics in the country.

OBJECTIVE

This study was conducted to determine the pattern, aetiology, management and outcome of head and neck fascial space infections at Ife.

METHODS

All consecutive patients who presented with fascial space infections between January 1995 and July 2004 at the Maxillofacial Unit of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria were admitted into the study. A structured questionnaire was completed for each patient and analyzed in respect of patients' demographics, source of infection, predisposing factors, location of infection; treatment and outcome.

RESULTS

One hundred and three patients were managed during the study period. There were 55(53.4%) males and 48(46.6%) females with age ranging from 1-85 years. Submandibular space was the most common single space involved followed by the buccal space. The fascial spaces around the mandible were more involved those around the maxillae and scalp for all age groups. Four patients presented with Ludwigs' angina. Odontogenic infections arising from pulpitis, periodontitis and pericoronitis caused over 70% of the space infections. Microbial cultures showed mixed aerobic and anaerobic bacteriology. Management was by incision and drainage/decompression, removal of the source, use of antibiotics and supportive care. Two deaths were recorded in the course of this study.

CONCLUSION

Bacterial infections of the head and neck region remain a major health hazard among Nigerians with spread of infection commonly involving the submandibular and the buccal spaces.

Antibacterial activity of aqueous extracts of selected chewing sticks

This aim of this study was to determine the antibacterial activity in extracts obtained from various Nigerian chewing sticks. Aqueous extracts from seventeen chewing sticks and the fruit of C. ferruginea, one fruit used in oral hygiene in Nigeria, were screened for antibacterial activity against type cultures of Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa. Eleven of the test extracts showed activity against at least two of these referenced organisms. Minimum inhibitory concentrations (MIC) of these eleven extracts against clinical isolates from orofacial infection were determined. All the extracts demonstrated activity against Staphylococcal and Streptococcal isolates. Over half of the extracts were active against Enterobacteriaceae and obligate anaerobic isolates, including Prevotella melaninogenica, Porphyromonas gigivalis, Fusobacterium nucleatum, and Peptostreptococcus prevotii. Extracts of the Vitellaria paradoxa root, Bridellia ferruginea stem and twigs, Garcinia cola stem, Terminalia glaucescens root, Morinda lucida root, and Cnestis ferruginea fruit showed appreciable activity against all classes of bacterial isolates. The extracts of these plants may serve as sources for chemotherapeutic agents for the management of orofacial infections.

Orofacial injuries in eclamptic Nigerians

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative.

A study of orofacial bacterial infections in elderly Nigerians

This retrospective study was designed to determine the pattern of occurrence, and principles of management of orofacial bacterial infections in elderly Nigerians. Ninety-two patients aged 55-90 years (mean +/- SD 62.4 +/- 7.5 years), were admitted into the study (male:female ratio 1.1:1). The origin of orofacial infection was predominantly odontogenic and the lower face was three times more commonly involved. The percentage of patients with underlying systemic disease was 16.2%. Patients with underlying disease had a 3.5 times greater risk of developing orofacial infections. Similarly, a significant correlation was demonstrated between both sexes of patients with orofacial infections and underlying illness (P < 0.05). There was a general delay before presenting for treatment (average 19.5 weeks) and the mortality rate was 3.3%. The study findings demonstrate that a significant relationship exists between elderly Nigerians with orofacial infections and systemic disease.

Craniocervical necrotizing fasciitis in Ile-Ife, Nigeria

Sixteen cases of necrotizing fasciitis were seen at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1990 to 2000. Primary craniocervical involvement was recorded in seven patients (five men and two women). The clinical records of five patients were sufficiently detailed to allow us to report their age, aetiology, predisposing illness, clinical features, complications, management regimen and outcome. The patients were aged 30-75 years and in four of them odontogenic infections were the cause of the condition. Hypertension, diabetes mellitus and obesity were the underlying systemic diseases in three cases and the body/angle region of the mandible was the predominant site of the infection on the face. All five cases had involvement of the neck. Mediastinal extension was recorded in three cases. Two patients had complications: one had septicaemia and renal failure and the other developed bone necrosis. Pre-existing ill health, old age, late surgical intervention, and mediastinal and thoracic extension of infection were responsible for the only death. Treatment involved frequent and multiple surgical debridement, aggressive antimicrobial treatment and control of systemic disease. Early recognition, prompt surgical intervention, and aggressive antimicrobial treatment are essential to minimize morbidity and mortality. Rapid progression of infection, financial constraints, delayed referrals from rural clinics and distance to the tertiary hospital caused problems.

Prevalence of signs and symptoms of temporomandibular disorders in young Nigerian adults

The objective of this study was to determine the prevalence of signs and symptoms of TMD in young Nigerian adults and to establish a baseline for comparison with other studies. It consisted of a cross-sectional study at Obafemi Awolowo University, Ile-Ife, Nigeria in 1997. The subjects consisted of 308 medical and dental students (207 males and 101 females) randomly selected from a Nigerian University. Their ages ranged from 17 to 32 years with a mean age of 23 +/- 3.0 years. They were assessed according to the criteria of Helkimo (1974). Whilst 26.3 per cent of the subjects reported mild symptoms (Ai I) of TMD, only 2.9 per cent reported severe symptoms (Ai II). Similarly, 46 per cent showed mild dysfunction signs (Di I), whilst 16.5 and 0.3 per cent exhibited moderate (Di II) and severe (Di III) signs of TMD, respectively. No significant relationships were found between sex, anamnestic index, and the clinical dysfunction index scores. However, there were low but significant correlations between ananmestic index scores (Ai) and the recorded signs (Di), as well as the clinical dysfunction scores (CDS). There is some evidence to show that signs and symptoms of TMD occur amongst Nigerians, although restricted lateral and protrusive mandibular movements contributed significantly to clinical dysfunction scores. This report contrasts with what is found in western societies regarding the low prevalence of TMJ pain. Refereed Scientific Paper

Burkitt's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report

An unusual case of stage D Burkitt's lymphoma in a 24 year old Nigerian female undergraduate is reported. There was a four month history of left lower lip paraesthesia followed three months later by a slowly progressive 'pimple-sized' nodular mandibular swelling arising from the mental foramen region. A full-blown, rapidly developing abdominal mass manifested only three weeks after a biopsy of the mandibular swelling. Aspiration of the latter and a histologic report of the mandibular mass confirmed Burkitt's lymphoma. The patient responded very well to appropriate chemotherapy. Clinicians should not overlook insidious jaw swellings in any adult residing in the endemic zone of Burkitt's lymphoma, in view of the fact that successful therapy is dependent on early diagnosis. Mental nerve paraesthesia is very rarely seen in Burkitt's lymphoma.

Unmet orthodontic treatment need in rural Nigerian adolescents

A survey of orthodontic treatment need was carried out among randomly selected rural Nigerian adolescents using the index of orthodontic treatment need. Altogether, 704 subjects (381 boys and 323 girls) aged 12-18 years (mean 14.8, SD 1.79) were recruited in the study. The results indicated that 12.6% of the population were in objective need of orthodontic treatment. Whilst there was a discrepancy in the proportions of Nigerian adolescents needing orthodontic treatment on aesthetic and dental health grounds, girls were found to have a more attractive dental appearance and less orthodontic treatment need than boys. However, the differences were not statistically significant (P>0.05). The correlation between the orthodontist's and the subject's rating of dental appearance was found to be low (r=0.35). The study also provided reliable baseline data for planning orthodontic services in Nigeria especially in areas where there are no dental services.

Eruption times of third molars in young rural Nigerians

The eruption pattern of third molar amongst 1071 rural Nigerians (523 males and 548 females) aged 11-21 years was assessed. The earliest age at which the third molar erupted for males and females was 14 and 13 years respectively with females significantly ahead of males (P < 0.01). A full compliment of erupted third molars was recorded at age 14 years in 1.1 per cent of the population. However, the mean age for the eruption of 1, 2, or 3 and all third molars were 16.58 and 17.50 years respectively. Whilst third molar-eruption was significantly earlier in the mandible, no right-left side differences were found. Problems often associated with the erupting third molars are likely to be seen earlier in young rural Nigerians than in the western countries.