Age-specific associations with dental caries in HIV-infected, exposed but uninfected and HIV-unexposed uninfected children in Nigeria

Background

HIV infection and its management confer a substantial health burden to affected individuals and have been associated with increased risk of oral and dental diseases. In this study, we sought to quantify HIV-associated differences in the prevalence and severity of dental caries in the primary and permanent dentition of 4–11-year-old Nigerian Children.

Methods

We used clinical, laboratory, demographic, and behavioral data obtained from an ongoing cohort study of age-matched HIV-infected (HI, n = 181), HIV-exposed-but-uninfected (HEU, n = 177), and HIV-unexposed-and-uninfected (HUU, n = 186) children. Measures of dental caries experience (i.e., prevalence and severity) were based on dmft/DMFT indices recorded by trained and calibrated clinical examiners. Differences in primary and permanent dentition caries experience between HI, HEU, and HUU were estimated using multivariable logistic and negative binomial regression modeling.

Results

HI children had significantly higher caries experience (33%) compared to HEU (15%) and HUU (22%) children. This difference persisted in fully adjusted analyses [odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.0–2.6], was most pronounced in the permanent dentition (OR = 3.4; 95% CI = 1.2–9.5), and mirrored differences in caries severity. While molars were predominantly affected in both primary and permanent dentitions, caries lesion patterns differed between dentitions. Caries severity was significantly associated with hypoplastic primary teeth, gingival inflammation, and lower CD4 counts.

Conclusions

We found that the higher prevalence and severity of dental caries among HI children was driven by increased burden of permanent dentition caries compared to their uninfected counterparts. The dentition-specific associations identified in this study highlight the need to design and implement age-specific caries prevention strategies. These may include intensified oral hygiene regimens aimed at mitigating the cariogenic impact of hyposalivation among HI children. Similarly, the long-lasting impacts of developmental defects of the enamel in the primary and permanent dentitions must not be ignored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02421-w.

Perception and Concerns about the Use of Gloves, Facemask, and HIV Discriminatory Attitude of Children attending Dental Clinics in Southern Nigeria

INTRODUCTION

The use of face masks and gloves can prevent possible cross infection between dental patients and health care practitioners.

AIM

The study identified the perception of paediatric dental patients on the need for dentists to use face masks and gloves; and their attitude towards using the same clinic with paediatric dental patients living with HIV.

METHODS

This was a cross sectional study that recruited 438 children aged 8-15 years attending three paediatric dental clinics located in Southern Nigeria.

STATISTICAL ANALYSIS

The dependent variables were perception of cross infection control and attitude towards children living with HIV. The independent variables were age, sex, socioeconomic status and location of clinic. Chi-square analysis was conducted to determine the associations between the dependent and independent variables. Logistic regression analysis was also conducted to assess the effect size of the associations between the dependent and independent variables. The level of statistical significance was inferred at P < 0.05.

RESULTS

Majority of the respondents agreed that it was necessary to wear gloves (98.6%) and facemasks (88.1%) during patients' management. More females 62(28.2%) than males 38(17.4%) assumed gloves were used by dentists to protect themselves from patients' bad breath (p=0.007). More children from Benin 97(64.2%) were aware that face masks protect the dentists and the patients (p=0.004), and a few believed that it is embarrassing to patients for dentists to wear facemasks (p=0.001). More children 102(70.8%) from Ile-Ife perceived that face masks protects from bad breath (p=0.004).Children less than 10 years (AOR: 0.85; 95% CI: 0.42-1.70; p=0.64), with high socioeconomic status (AOR: 0.90; 95% CI:0.53-1.52; p=0.70) and children aged 10 to 14 years (AOR: 0.85; 95% CI: 0.44-1.63; p=0.62), in the middle socioeconomic status (AOR: 0.72; 95% CI: 0.39-1.33; p=0.30) were less willing to use the dental clinic alongside children living with HIV.

CONCLUSION

There were sex, and clinic location disparity in the perception and attitude of children towards the use of Personal Protective Equipment and the use of the dental clinic alongside children living with HIV.

Association between mental health, caries experience and gingival health of adolescents in sub-urban Nigeria

Background

This study assessed the association of mental health problems and risk indicators of mental health problems with caries experience and moderate/severe gingivitis in adolescents.

Methods

A cross-sectional household survey was conducted in Osun State, Nigeria. Data collected from 10 to 19-years-old adolescents between December 2018 and January 2019 were sociodemographic variables (age, sex, socioeconomic status); oral health indicators (tooth brushing, use of fluoridated toothpaste, consumption of refined carbohydrates in-between-meals, dental services utilization, dental anxiety and plaque); mental health indicators (smoking habits, intake of alcohol and use of psychoactive drugs) and mental health problems (low and high). Gingival health (healthy gingiva/mild gingivitis versus moderate/severe gingivitis) and caries experience (present or absent) were also assessed. A series of five logistic regression models were constructed to determine the association between presence of caries experience and presence of moderate/severe gingivitis) with blocks of independent variables. The blocks were: model 1—sociodemographic factors; model 2—oral health indicators; model 3—mental health indicators and model 4—mental health problems. Model 5 included all factors from models 1 to 4.

Results

There were 1234 adolescents with a mean (SD) age of 14.6 (2.7) years. Also, 21.1% of participants had high risk of mental health problems, 3.7% had caries experience, and 8.1% had moderate/severe gingivitis. Model 5 had the best fit for the two dependent variables. The use of psychoactive substances (AOR 2.67; 95% CI 1.14, 6.26) was associated with significantly higher odds of caries experience. The frequent consumption of refined carbohydrates in-between-meals (AOR: 0.41; 95% CI 0.25, 0.66) and severe dental anxiety (AOR0.48; 95% CI 0.23, 0.99) were associated with significantly lower odds of moderate/severe gingivitis. Plaque was associated with significant higher odds of moderate/severe gingivitis (AOR 13.50; 95% CI 8.66, 21.04). High risk of mental health problems was not significantly associated with caries experience (AOR 1.84; 95% CI 0.97, 3.49) or moderate/severe gingivitis (AOR 0.80; 95% CI 0.45, 1.44).

Conclusion

The association between mental problems and risk indicators with oral diseases in Nigerian adolescents indicates a need for integrated mental and oral health care to improve the wellbeing of adolescents.

Mesiodistal Crown Dimensions of the Permanent Dentition in a Nigerian Population

Mesiodistal crown dimensions of the permanent dentition were assessed in a Nigerian population. The study sample consisted of 54 dental casts of Nigerian subjects (33 males; 21 females) with a mean age of 26.6 (sd = 2.1) years. The subjects had their permanent teeth present and fully erupted from first molar to first molar, no interproximal caries or restorations and no abnormal tooth sizes or shapes. Descriptive statistics are provided. Sex differences in the means and comparisons with the means from other population were evaluated using t-tests. Results revealed no statistically significant difference in mesiodistal crown dimensions between the sexes and no left to right side tooth size discrepancy in the sample. The study provides normative data on the mesiodistal crown dimensions of Nigerian subjects. Compared to African Americans, crown dimensions tended to be smaller in these Nigerians, especially in males.

General anxiety, dental anxiety, digit sucking, caries and oral hygiene status of children resident in a semi-urban population in Nigeria

BACKGROUND

Digit sucking can represent untreated anxiety or other emotional problems. The aim of this study was to determine if digit sucking is a predictor of general anxiety and dental anxiety; and if general and dental anxiety are associated with caries and oral hygiene status of children resident in sub-urban Nigeria.

METHODS

This was a secondary data analysis of a household survey conducted in Ile-Ife, Nigeria. The level of general anxiety and dental anxiety of 450 6 to12 year old children were measured using the Revised Child Manifest Anxiety Scale and Dental Subscale of the Child Fear Survey Schedule respectively. Presence of digit sucking habit, caries and oral hygiene status were determined. General anxiety and dental anxiety scores were dichotomized into low and high levels respectively. Logistic regression was conducted to determine if digit sucking was a predictor of general anxiety and dental anxiety; and if general anxiety and dental anxiety were predictors caries and good oral hygiene status. Adjustments were made for age and sex.

RESULTS

Digit sucking is not a significant predictor of dental anxiety (p = 0.99) and general anxiety (p = 0.79). Children with high general anxiety (AOR: 5.02; 95% CI: 2.9-9.74; p <  0.001) and high dental anxiety (AOR: 1.74; 95% CI: 1.15-2.65; p = 0.009) had higher odds of having caries and good oral hygiene respectively.

CONCLUSION

Digit sucking was not a significant predictor of general anxiety and dental anxiety. General and dental anxiety however, had effects on the likelihood of having caries and good oral hygiene.

Digit Sucking, Age, Sex, and Socioeconomic Status as Determinants of Oral Hygiene Status and Gingival Health of Children in Suburban Nigeria

BACKGROUND

This study determines prevalence of digit sucking and gingivitis, and association among age, sex, socioeconomic status, presence of digit-sucking habits, oral hygiene status (OHS), and gingivitis among a group of Nigerian children.

METHODS

Data of 992 children aged 1 to 12 years recruited through a household survey conducted in Osun State, Nigeria were analyzed. Information on age, sex, socioeconomic status, and history of digit-sucking habits were collected. Children were assessed for OHS and severity of gingivitis using the simplified oral hygiene index and the gingival index, respectively. Predictors of presence of gingivitis and poor oral hygiene were determined using multivariate logistic regression.

RESULTS

One (0.2%) and 454 (93.0%) children aged 1 to 5 years had poor oral hygiene and mild gingivitis, respectively. Twenty-two (4.4%) and 361 (72.9%) children aged 6 to 12 years had poor oral hygiene and mild gingivitis, respectively. The odds of having poor oral hygiene (adjusted odds ratio [AOR]: 0.26; 95% confidence interval [CI]: 0.20 to 0.35; P <0.001) and gingivitis (AOR: 0.21; 95% CI: 0.14 to 0.31; P <0.001) was significantly reduced for children aged 1 to 5 years. The odds of having gingivitis was increased in children with low socioeconomic status (AOR: 2.09; 95% CI: 1.32 to 3.31; P = 0.002). There was no significant relationship among sex, digit sucking, OHS, and presence of gingivitis.

CONCLUSIONS

A digit-sucking habit did not increase chances of having poor oral hygiene and gingivitis. Increasing age and low socioeconomic status were factors that significantly increased chances of having poor oral hygiene and gingivitis.

Use of caries prevention tools and associated caries risk in a suburban population of children in Nigeria

AIMS

To determine the association between use of recommended oral self-care (ROSC) caries prevention tools and presence of dental caries in children resident in suburban Nigeria.

METHODOLOGY

Secondary analysis was conducted for a dataset generated for 1-12 years old children recruited through a household survey. Information on use of ROSC caries prevention tools (brushing more than once a day, use of fluoridated toothpaste always, and eating sugary snacks between main meals less than once a day), use of oral health adjuncts (dental floss, mouth rinses, other tooth cleansing agents) and presence of caries were extracted. The odds of having caries when ROSC caries prevention tools were used singly or in combination, were determined using multivariate logistic regression adjusted for age and sex.

RESULTS

The single or combined use of ROSC caries prevention tools had no statistically significant association with presence of caries. Brushing more than once a day reduced the odds of having caries while consumption of sugar between meals once a day or more increased the odds of having caries after adjusting for age and gender. The use of two ROSC caries prevention tools reduced the risk for caries (AOR 0.28; 95 % CI 0.05-1.53) when adjusted for age. The converse was observed when adjusted for gender (AOR 1.15; 95 % CI 0.38-3.45). The largest effect size was observed when sugary snacks were taken once a day or more between meals after adjusting for age (AOR 5.74; 95 % CI 0.34-96.11).

CONCLUSION

The use of a combination of fluoridated toothpaste and twice-daily tooth brushing had the largest effect on reducing the chance for caries in children resident in Ile-Ife, Nigeria.

Impact of dental caries and its treatment on the quality of life of 12- to 15-year-old adolescents in Benin, Nigeria

AIM

To assess the impact of caries and its treatment on quality of life (QoL) in 12- to 15-year-old children in Benin, Nigeria.

DESIGN

This was a cross-sectional study involving 1790 children. Clinical examinations were conducted using the WHO criteria for diagnosis and coding of caries. The Decayed Missing Filled Teeth score of each child was calculated. The child Oral Impact on Daily Performance questionnaire was used to assess the QoL of children with caries pre- and post-treatment. Associations between age, sex, and socio-economic status and caries were analysed using bivariate and multivariate logistic regression analysis.

RESULTS

The prevalence of caries in the study population was 21.9%. Approximately 57% of children with caries reported negative impact on their QoL pre-treatment. Eating (47.6%) was the most affected domain. The mean pre-treatment QoL score was 8.40 ± 10.34. Four weeks post-treatment, only 1.12% of participants reported negative impact of caries treatment on their QoL. The mean post-treatment QoL score was 0.22 ± 0.91 There was a significant difference between pre- and post-treatment QoL scores (P = 0.0001) with significant changes in all the eight domains studied. Age, sex, and socio-economic status had no significant impact on QoL pre- and post-treatment.

CONCLUSIONS

Caries had a significant impact on the QoL of adolescents. Its treatment resulted in marked improvement in QoL.

Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria

BACKGROUND

Early Childhood Caries (ECC) is defined as the presence of caries lesion in an primary tooth in children below the age of 71 months. It is a significant public health problem with consequences for the growth and development of affected children. The objective of this study was to determine the prevalence and ECC risk indicators in a suburban population in Nigeria.

METHODS

The data of 497 children aged 6 months to 71 months who were recruited through a household survey conducted in Ile-Ife, Nigeria was analysed for prevalence of ECC and risk indicators. Information on children's ages, sex, socioeconomic status, tooth brushing habits, sugary snacks consumption, use of fluoridated toothpaste, birth rank, infant-feeding practices, breastfeeding practices, maternal age at childbirth, and maternal knowledge of oral health was obtained. Children's oral hygiene and caries status was also determined. Risk factors associated with ECC were determined using logistic regression analysis.

RESULTS

Thirty-three (6.6%) children had ECC. Four (0.8%) had severe ECC. The four risk indicators for ECC were the child's gender, mothers' knowledge of oral health, consumption of sugary snacks in between meals more than three times a day, and the child's oral hygiene status. Females (PR: -0.06; 95% CI: -0.01- -0.01; p = 0.02), and children with mothers who had good knowledge of oral health (PR: -0.06; 95% CI: -0.11--0.008; p = 0.02) were less likely to have ECC. Children who consumed sugary snacks in between meals three times a day or more (PR: 0.05; CI: 0.003 - 0.01; P = 0.04) and children with fair oral hygiene (PR: 0.05; 95% CI: 0.005-0.10; p = 0.03) were more likely to have ECC.

CONCLUSIONS

The prevalence of ECC in the study population was low. Promoting good oral hygiene practices and enhancing mothers' knowledge of oral health may help reduce further, the risk for ECC in the study population.

Programme guidelines for promoting good oral health for children in Nigeria: a position paper

BACKGROUND

The objective of this paper is to draw attention to the oral health needs of children in Nigeria, and promote the use of appropriate interventions for disease prevention in the population. It also evaluates the value of the ongoing twice-daily tooth brushing campaign, which focuses on promoting good periodontal health and its relevance for children in Nigeria.

DISCUSSION

The main oral health burden for children in Nigeria is untreated dental caries, attributable to low utilization of oral health facilities. While there is a strong association between oral hygiene status and caries occurrence, no research had established an association between frequency of tooth brushing and caries in children in Nigeria. Prevalence of caries and gingivitis is low, despite the fact that a majority of children brush once a day and most of them have fair oral hygiene. Campaigns that promote twice daily brushing to prevent chronic periodontitis in children are not driven by evidences supporting the local epidemic, and therefore cannot be considered as efficient use of the limited resources available.

SUMMARY

Existing evidences show that the main oral health need of children in Nigeria is the management of untreated caries. Promoting the treatment of caries should be the primary focus of oral health programmes for children in Nigeria, as this would reduce further risks of developing new carious lesions. Public health campaigns should focus efforts at creating demand for oral health care services, for both preventive and curative purposes.

Appraisal of the national response to the caries epidemic in children in Nigeria

BACKGROUND

This article reviews the caries profile for children in Nigeria and proposes an appropriate framework for addressing the silent caries epidemic.

DISCUSSION

We reviewed the caries prevalence among children in Nigeria, assessed the existing responses to the caries epidemic including the national oral healthcare delivery situation in the country and discussed the current caries management in children. We then proposed a response framework for Nigeria. We argue that successful interventions will require the adoption of a socio-ecological model. This would ensure that the micro-, meso-, exo- and macrosystems required to support the behavioural, structural and biological interventions for promoting caries prevention are addressed. National oral health surveys are required to help understand the epidemiology, social determinants of and factors that undermine the ability of children to access oral health care. A global caries prevention agenda for children would help get the government's support for a national response agenda. Currently, there is no global call for action on the caries epidemic in children. This lack of an agenda needs to be urgently addressed.

SUMMARY

A combination of approaches for the prevention of caries in children in Nigeria is needed. A national survey is needed to generate the needed evidence for the planning of community relevant responses to the national caries epidemic in children. The design of a global health agenda for children is an important first step that can facilitate the development of a national oral health programme for children in Nigeria.

Non-third molar related pericoronitis in a sub-urban Nigeria population of children

BACKGROUND

The study will report on the prevalence, clinical presentation, diagnosis, and management of non-third molar related pericoronitis seen in children below the age of 15 years who report at the Pediatric Dental Clinic, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 4½ year period.

MATERIALS AND METHODS

This is a prospective study of cases of pericoronitis affecting any tooth exclusive of the third molar diagnosed in the pediatric dentistry out-patient clinic in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and June 2012. Pericoronitis was diagnosed using the criteria described by Howe. Information on age, sex, history malaria fever, upper respiratory diseases, tonsillitis, and evidence of immunosuppression were taken. Radiographs were taken in all cases to rule out tooth impaction and information on treatment regimen was also collected.

RESULTS

The prevalence of non-third molar related pericoronitis was 0.63%. More females (63.6%) were affected. Chronic pericoronitis was the most common presentation (73.3%). No case was reported in the primary dentition and the premolar. No case was associated with tooth impaction and the tooth most affected was the lower right second permanent molar (35.7%). Bilateral presentation was seen in 36.4% patients. Herpetic gingivostomatitis was reported in association with one case. Chronic pericoronitis resolved within 3 days of management with warm saline mouth bath (WSMB) and analgesics, while acute/subacute resolved within 10 days of management with antibiotics, analgesics, and WSMB.

CONCLUSIONS

The prevalence of non-third molar related pericoronitis is the low. The most prevalence type is chronic pericoronitis affecting the lower right second permanent molar.

Dentoalveolar abscess among children attending a dental clinic in Nigeria

OBJECTIVE

To determine the incidence and causes of dentoalveolar abscess among children attending an outpatient dental clinic in Nigeria.

MATERIAL AND METHODS

This is a retrospective study of paediatric dental patients treated in University of Benin Teaching Hospital, Benin City from October 2010 to September 2011.

RESULTS

The incidence of dentoalveolar abscess was 6.4% (53/824). However only 42 cases had their case notes retrieved for final research analysis. It occurred mostly in the lower right quadrant of the mouth. The affected children were majorly males and first or second child of monogamous family. A total 17 (40.5%) of the affected children were in the 6-11 years age group. This was the first dentist consultation among 35 (83.3%) of the children. The presenting complaint was toothache among two-thirds of the children. History of asthma, tonsillitis, peptic ulcer disease and previous surgery were medical history elicited from 6 (14.3) of the patients. The most implicated tooth was deciduous first molar. The causes of abscess include untreated dental caries 35 (83.3%), trauma 5 (11.9%), failed restoration 1 (2.4%) and periodontal diseases 1 (2.4%). Periapical radioluscency was predominant radiological finding among affected children. Tooth extraction was commonest treatment done.

CONCLUSION

The incidence of dentoalveolar abscess among children was significant. The high frequency of untreated dental caries as the cause of dentoalveolar abscess indicates the need for school and community-based preventive strategies like encouraging infant oral health and preventive dentistry programs and early treatment intervention and dental health education.