Reasons for Delay in Seeking Treatment for Dental Caries in Tanzania

INTRODUCTION

The delay in seeking dental treatment is a universal health problem, with a reported prevalence as high as 98%. It is a critical feature not only in planning management but also in the final treatment outcome.

AIM

This study aimed to determine the reasons for the delay in seeking treatment for dental caries amongst patients attending public dental clinics in Dar es Salaam, Tanzania.

METHODOLOGY

This was a cross-sectional study carried out in 5 public hospitals in Dar es Salaam, Tanzania. It included 315 adult patients who had dental caries. Data were collected using a questionnaire that included questions regarding reasons for the delay in seeking care for dental caries. Data were analysed using the SPSS computer software version 26. A one-way analysis of variance was used to assess the association between variables, and the significance level was set at P < .05.

RESULTS

A majority (n = 244, 77.5%) of the participants delayed seeking dental care upon noting a problem in their teeth. However, the association between the sociodemographic characteristics of the participants and delay in seeking dental care was statistically insignificant (P > .05). The most common reason given by the participants who delayed seeking dental care for their decayed teeth included self-negligence (n = 184, 75.4%), the practice of self-medication (n = 164, 67.2%), and ignorance (n = 110, 45.1%).

CONCLUSIONS

The majority of patients experiencing dental caries seek dental care very late. Delay in seeking dental care is not dependent on sociodemographic characteristics of individuals. Self-negligence, the practice of self‑medication, and ignorance are the major reasons for the delay.

Potential Alternative Therapeutic Modalities for Management Head and Neck Squamous Cell Carcinoma: A Review

Head and neck squamous cell carcinoma (HNSCC) includes malignancies of the lip and oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx. It is among the most common malignancy worldwide, affecting nearly 1 million people annually. The traditional treatment options for HNSCC include surgery, radiotherapy, and conventional chemotherapy. However, these treatment options have their specific sequelae, which produce high rates of recurrence and severe treatment-related disabilities. Recent technological advancements have led to tremendous progress in understanding tumor biology, and hence the emergence of several alternative therapeutic modalities for managing cancers (including HNSCC). These treatment options are stem cell targeted therapy, gene therapy, and immunotherapy. Therefore, this review article aims to provide an overview of these alternative treatments of HNSCC.

Establishment of an intravenous conscious sedation service at a University Dental Clinic in Tanzania

Background

With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania.

Methods

In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic.

Results

The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office.

Conclusion

This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.

Knowledge, attitudes, and practices related to COVID-19 among patients attending public dental clinics in Tanzania: A cross-sectional study

Introduction

The risk of contracting COVID-19 through dental treatment is potentially high, thus several guidelines have been developed to minimize the spread of COVID-19 in the dental office worldwide. These changes have posed some relevant questions among oral health professionals regarding the understanding and attitudes of dental patients toward COVID-19. This study aimed to assess the knowledge, attitude, and practices of dental patients in Dar es Salaam, Tanzania.

Methodology

This cross-sectional study was carried out in 4 public hospitals in Dar es Salaam, Tanzania involving 472 adult patients. Data were collected using a questionnaire that had a set of questions regarding knowledge, attitude, and practices (KAP) related to COVID-19. Data were analyzed using the SPSS computer software version 26. For descriptive analysis means, standard error of the mean, and proportion were used. Multivariate regression analysis was utilized for the response analysis. Alpha of less than 0.05 was considered to indicate statistical significance.

Results

Good levels of knowledge, attitude, and practices related to COVID-19 were found in 76.5%, 74.8%, and 58.1% of participants respectively. On performing multivariate analysis, odds of having good knowledge regarding COVID-19 were almost 2 folds higher in participants who were females, with high education levels, those without partners, and those with stable income. Females were 1.5 folds more likely to have a good attitude toward COVID-19 and odds of good practice against COVID-19 were 3 folds higher in young adults compared to the elderly.

Conclusion

A majority of dental patients have good knowledge and attitude related to COVID-19. Predictors of good knowledge were sex, education level, marital status, and income of the participants. Sex predicted good attitude and age predicted good practice.

A meta-analysis on the presentation of Unicystic Ameloblastoma in the jaws and the consequences for their treatment

INTRODUCTION

This meta-analysis provides reliable data on the prevalence of unicystic ameloblastomas (UA's) among solid/multicystic ameloblastomas (SMA's), as well the ratio of their presence in the maxilla and mandible and in the tooth-bearing area versus the posterior regions of the mandible, including the third molar region and ascending ramus.

MATERIAL AND METHODS

A systematic review and meta-analysis was performed according to PRISMA guideline using the strategy ((unicystic ameloblastoma) OR (((ameloblastoma) OR (solid ameloblastoma)) OR (multicystic ameloblastoma))) NOT ((((systematic review) OR (literature review)) OR (case report)) OR (Immunohistochemical)).

DISCUSSION

The study included 3856 SMA's and 1537 UA's, which amounted to 28.5% UA's. Of the 380 cases of UA from twelve articles that mentioned the involved jaws, 355 were in the mandible and 25 in the maxilla. The preponderance for the mandible is much higher than reports from previous studies of smaller series. Only five articles mentioned the location within the mandible. The vast majority was in the posterior area.

CONCLUSION

The consequences for treatment were discussed, with an emphasis on the approach to unicystic lesions in the posterior part of the mandible for which a protocol is suggested.

Conscious sedation in dentistry: knowledge and practice among dental professionals in Tanzania

Background

Conscious sedation is a useful adjunct in the treatment of patients in dentistry; however, a lack of knowledge among the dental profession regarding sedation is a restricting factor in the practice of dental sedation. Therefore, this study was conducted to assess the knowledge and practice of sedation in dentistry among dental professionals in Tanzania.

Methods

This was a cross-sectional study conducted for five months targeting all practicing dental professionals in Tanzania. A modified questionnaire contained 14 questions regarding knowledge about sedative agents and a section on the practice of sedation. The data obtained from this study were coded and entered into a computer program and analyzed using SPSS software version 23.0. The data are presented as frequencies and percentages in tables and charts. Statistical significance was set at P < 0.05.

Results

The age range of participants was between 24 and 63 years (mean 36.6 ± 7.7 years). There were 107 men (78.1%), and the male-to-female ratio was 3.6:1. The majority (76.6%) of participants only had an undergraduate dental degree. Thirty-one percent of participants only worked in publicly owned health facilities. Slightly more than half (59.9%) of participants had satisfactory knowledge regarding sedation in dentistry. There was no statistically significant association between the level of sedation-related knowledge and the demographic characteristics of the participants. Only 21.9% reported using sedation in their practice, and the most commonly used sedative drug was diazepam. The reasons for not using dental sedation in clinical practice included a perceived lack of knowledge on sedation, lack of equipment, and cost.

Conclusion

Most dental professionals in Tanzania have basic knowledge of sedation in dentistry, although knowledge regarding sedative agents is generally low. The practice of sedation in dentistry in Tanzania is very low compared to that in middle- and high-income countries. Inadequate knowledge, lack of equipment, and the cost of practicing sedation are the main reasons for not practicing sedation.

Pattern and management outcomes of head and neck hemangiomas: a prospective study from Tanzania

Introduction: Hemangiomas arise from the proliferation of endothelial cells surrounding blood-filled cavities. They have a slightly higher female predilection and about 60–70% of them occur in the head and neck region. Various medical and surgical options are available for the treatment of hemangiomas. Aim: To determine the pattern and management outcomes of head and neck hemangiomas in Tanzania. Material and methods: This was a one-year prospective, cross-sectional study that involved all consecutive patients with head and neck hemangiomas treated in Muhimbili National Hospital. A structured questionnaire was used to collect information including age and sex of the patient, chief complaint and, duration, size and site of the lesion. The treatment modalities were surgery and/or intralesional bleomycin injection (IL-Bleo). A standard dose of bleomycin was 0.3 to 0.6 mg/kg per injection not exceeding 15 units per cycle with a maximum of 6 cycles. Frequency distribution and cross-tabulation were performed and association between variables was assessed by the Chi-square test, whereby the p-value was set at p < 0.05. Results: A total of 58 patients were included in the study. The male to female ratio was 1:1.4 and the median age was 6.15 years. Majority (74%) of the patients had infantile hemangioma. The most common presenting complaint of patients/guardians of the patients were facial disfigurement (94.8%), pain (32.8%) and ulceration (22.4%). The most frequently involved sites were the lips (55.2%) followed by the cheeks (37.9%). In patient who were managed surgically, there was a 100% reduction in size of the lesion. Of those who were treated with bleomycin, the percentage reduction in the area of the lesion ranged from 8.33% to 100% with mean of 72.6%. Only 6% of the patient had post IL-Bleo complications. Conclusion: Head and Neck hemangiomas are more common in females and majority are infantile hemangioma. Facial disfigurement is the commonest presenting complication of these lesions, and the lips and the cheeks are mostly affected areas. Intralesional bleomycin is an effective treatment modality which has low complication rates.

Oral and maxillofacial surgical services amid COVID-19 pandemic: perspective from Tanzania

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 is a global pandemic that affects individuals from all walks of life. Considering that the virus can be passed on directly from person to person through respiratory droplets, contact, fomites, and saliva, the oral and maxillofacial surgeons are exposed to COVID-19 in their daily clinical duties. This is because of the nature of their work, which entails working within a short distance from patients' oral cavity and upper airway. As such, there is a need for having locally tailored standard guidelines for managing patients with oral and maxillofacial conditions during the COVID 19 pandemic in Tanzania.

Pattern of mandibular fractures and helmet use among motorcycle crash victims in Tanzania

BACKGROUND

The maxillofacial structures are commonly affected in motorcycle crashes, with the mandible being one of the most frequently fractured bones. Helmets have been shown to have a protective effect in preventing maxillofacial injuries, however, its effect on the occurrence of mandibular fractures is not very well established.

OBJECTIVES

To evaluate the pattern of mandibular fractures among motorcycle crash victims in Tanzania, and determine the role of helmets in occurrence of mandibular fractures among the motorcyclists.

METHODOLOGY

This was a 6-months prospective, cross-sectional study that recruited motorcycle crash victims who reported with mandibular fractures following motorcycle crash at Muhimbili National Hospital. A specially designed questionnaire was used for data collection. For purpose of analysis, the Statistical Package for Social Sciences software version 20 was used.

RESULTS

The study included a total of 132 participants of whom majority were male (120, 90.9%). The peak age incidence was 21-40 years in 76.5% of the victims. More than half (89, 67.4%) of the victims were riders during the crash. Helmet use was reported in 42.3% of the victims, and majority (67.3%) were usinghalf-face helmets. The symphysis region was the frequently fractured anatomical location (50, 37.9%). More than half of the victims had multiple site involvement, with higher odds observed in individuals wearing half-face helmets.

CONCLUSION

Young males were affected ten times more than females. Most of the victims were riders during the crash. The symphysis region was the frequently fractured anatomical site. There was no difference in occurrence of mandibular fractures between those who wore and those who did not wear helmets during the crashes. However, the severity of mandibular fractures was dependent on the type of helmet used.

Benign fibro-osseous lesions of the jaws: a clinicopathologic study of 98 Tanzanian patients

Introduction: The benign fibro-osseous lesions (BFOL) are characterized by replacement of the normal bone by cellular fibrous tissue containing various forms of ossification. They encompass common clinical, radiologic and histopathological features and hence pose considerable diagnostic and therapeutic challenges to clinicians and pathologists. Objective: To analyze the clinico-pathological and radiological features of BFOLs of the jaws in patients treated at Muhimbili National Hospital, Tanzania. Material and methods: A retrospective study of files of patients who were diagnosed with BFOLs from January 2011 to December 2013 was done. The collected information included data on demographic characteristics, the duration of the lesion, location of the lesion, presence of swelling, associated symptoms and reported radiological and histological features. Results: A total of 98 patient's records were retrieved. There was a predominance of females (59, 60.2%), with a male to female ratio of 1:1.5. The patient's age at presentation ranged from 5 years to 75 years with a mean age of 29.81 ± 15.28 years. Four types of BFOLs were encountered. Ossifying fibroma were the most frequent (61.2%), followed by fibrous dysplasia (19.4%). Maxilla was more affected than the mandible. Majority (>70%) of the BFOLs were radio-opaque. The common histological features in all four types of BFOL included presence of: woven bone in fibrous stroma, giant cells, loose collagen and foci of hemorrhage. Conclusion: In this sample, BFOLs, were slightly more prevalent in females than males, affecting individuals below 40 years at large. They showed several overlapping clinical, radiological and histological features; thus a combination of different modalities seems necessary for an accurate diagnosis.

Concurrent manifestation of clinical hypodontia and blindness: a case report

A case is reported of a 26-year-old blind man with hypodontia and multiple apparently underdeveloped impacted teeth. The patient reported that he had progressively developed visual impairment at the age of 11 years whence he became totally blind when he turned 12 years. The aim of this report is to open an academic and professional debate on the challenges of its definitive diagnosis and appropriate intervention.Blindness is not reported in any of the previously described syndromes; therefore, concurrent manifestation of "hypodontia, blindness, failure of eruption and digital lesions" can be proposed as a syndrome. However, in the absence of genetic studies, it is difficult to characterize this case with any one of the specifically documented syndromes; therefore, academic and professional discourse is suggested with regard to appropriate intervention.

Assessment of iodine deficiency disorders using the 30 cluster approach in district Kangra, Himachal Pradesh, India

Iodine deficiency is an important public health problem in Himachal Pradesh. District Kangra is a known iodine deficiency endemic area. A survey conducted in 1956 reported a goitre prevalence of 55 per cent in the district. A more recent pilot study (1994) in four blocks of the district reported the total goitre rate (TGR) as 7 per cent. A continued prevalence of goitre in more than 5 per cent of school-aged children was found in pilot study, in spite of the distribution of iodised salt. The present study was conducted to assess the prevalence of iodine deficiency disorders (IDD) and to estimate the iodine content of salt consumed by the population in district Kangra. The '30 cluster' sampling methodology and indicators for assessment of IDD, as recommended by the joint WHO/UNICEF/ICCIDD consultation, were utilized for the survey. A confidence level of 95 per cent, a relative precision of 10 per cent and a design effect of three were taken into account for calculation of the sample size. A total of 23,348 school children in the age group 6-11 years were included in the study. The total goitre prevalence rate was found to be 12.1 per cent. The median urinary iodine excretion of the children studied was found to the 15.00 mcg/dl. About 12.7 per cent of families consumed salt with an iodine content of less than 15 ppm. The results of the present study indicated that the population of district Kangra is in a transition phase from iodine deficient to iodine sufficient nutrition and that there is a need for further strengthening of the system of monitoring the quality of iodised salt made available to the population to eliminate IDD from the Kangra Valley.