Abiola A. Adeniyi

Do maternal factors influence the dental health status of Nigerian pre‐school children?

OBJECTIVE This study was designed to investigate the relationship between maternal related factors and the dental health status of pre-school children in Lagos State, Nigeria. METHODS A cross-sectional study of 404 pairs of mothers and their pre-school children was conducted at two selected primary health centres in Lagos State Nigeria. An interviewer administered questionnaire recorded the mothers socio-demographic characteristics and assessed her perception of her childs dental needs, attitude to oral disease prevention, level of dental health knowledge and attitude to oral health. The childs dental status was assessed using the dft index (caries status) and the simplified oral hygiene index. Data analysis tools included Spearmans correlation coefficient and multivariate logistic regression. RESULTS Maternal age, maternal education, location of residence, maternal knowledge, and attitudes were all positively correlated with the childs caries and oral hygiene status. There were statistically significant correlations between maternal attitude and the oral hygiene index (P = 0.01) and dft score (P = 0.001). Maternal age also had a significant relationship with the childs caries status (P = 0.003). CONCLUSION This study concluded that maternal age and attitude were important determinants of caries experience whereas the mothers attitude was an important determinant of oral cleanliness in pre-school children in Lagos State Nigeria.

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

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

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

BackgroundThe 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.DiscussionThe 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.SummaryExisting 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.

An appraisal of the oral health care system in Nigeria

OBJECTIVES This study aimed to assess the strengths and weaknesses of the oral health care system in Nigeria and to outline broad policy options for strengthening the system. METHODS A critical appraisal of the oral health care system in Nigeria was conducted. The Maxwell criteria were used to assess performance. RESULTS There has been some progress and growth in the oral health care system in Nigeria. However, it is clear that the system falls short on many desirable attributes. The system is neither effective nor efficient and the resources available are grossly inadequate and are overstretched in many areas. The oral health care system is unresponsive to the needs of the populace and there is little stewardship of the system. CONCLUSIONS Urgent action in the Nigerian oral health care system is required on the part of all stakeholders. The first step should involve the provision of adequate resources for the immediate implementation of the national oral health policy. There is also a need for more research on oral health-related issues in the country. Efforts towards improving the system must be properly coordinated by the Federal Ministry of Health and involve all stakeholders in the sector in order to achieve success.

Determinants of preventive dental practice for children among final-year dental students in Nigeria

BACKGROUND This study aims to identify the determinants of caries prevention-oriented practice for children among final-year dental students in Nigeria. METHOD A questionnaire was distributed to 179 final-year dental students in six dental schools in Nigeria. It requested information on age, gender, knowledge of caries prevention measures, self-perceived competency in providing caries-preventive care for children, and caries prevention-oriented practice for two hypothetical cases with high and low risk of caries. Chi-squares tests and logistic regression analysis were done. RESULTS Between 24% and 41% of the respondents indicated their inability to determine the appropriate treatment modality for children with high and low caries risk. Majority of the students failed to differentiate between the caries-preventive practice for children with high and low risk of caries: preventive strategies for children with high caries risk were also used for those with low caries risk. Age, gender, knowledge of caries prevention measures, and self-perceived competency in providing caries-preventive care were not associated with students capacity to provide caries-preventive practice for children. CONCLUSION Caries-preventive practice among dental students in Nigeria could be improved. It may be important to explore the possible role of problem-based learning approach in addressing this challenge.

Integration of oral health into primary health care system: views of primary health care workers in Lagos State, Nigeria

The limited access to oral health care in developing countries can be greatly improved by integrating oral health into the Primary Health Care (PHC) system. This study was designed to assess the views of PHC workers on integrating oral health care into the PHC system. A self-administered questionnaire survey was conducted in two selected local government areas of Lagos State. The instrument contained three sections assessing sociodemographic features, knowledge of common oral diseases and views on integration of oral health into PHC respectively. The mean knowledge score was 7.75 (SD=±1.81), while 60.4% of the respondents had average knowledge scores. Educational status (P=0.018) and designation (P=0.033) were significantly related to the mean knowledge scores. There was no significant difference in the oral health knowledge of the various cadres (P=0.393). Majority (85.4%) of the respondents were willing to include oral health education in their job schedule and 82% believed they needed more training on oral health. The knowledge of the respondents on the causes of the common oral diseases was deficient. Oral health education should be included in the future curriculum of these personnel.

Current pattern of cleft lip and palate deformities in Lagos, Nigeria.

Objective To evaluate the current pattern of cleft lip and/or palate deformities in Lagos, Nigeria. Design Descriptive epidemiology. Setting Statewide survey of patients. Participants/Methods All patients with cleft lip and palate deformities that were seen during a screening program for individuals with orofacial deformities in Lagos, Nigeria, between June 2006 and May 2008 participated in this study. Demographic data were collected and physical examinations carried out. Cleft lip and/or palate deformities were classified using the Kernahan classification for common cases and the Tessier classification for the atypical cleft defects. Results A total of 225 patients were enrolled and completed the study. Cleft lip and palate was the most common presentation and was found in nearly 45% of the patients. Cleft lip was found in 61 (27%) patients. Twenty patients (8.89%) with different types of rare orofacial cleft deformities were seen. Cleft lip with or without cleft alveolus deformities occurred more commonly among males; whereas, cleft palate was more common among females. Cleft lip and/ or palate occurred more frequently among males. Cleft lip with or without cleft alveolus was found predominantly on the left side. Conclusions The pattern of cleft lip and/or palate deformities in Lagos, Nigeria, is different from those of other parts of Nigeria in some aspects. The proportion and varieties of atypical orofacial deformities in the study are striking. The prevalence of cleft lip and/or palate deformities in the study was 2.25 per 100,000. There may be an association between the prevalence of atypical deformities and the high level of environmental pollutants in the Lagos area.

Screening Children for Caries: An Ethical Dilemma in Nigeria

Dental caries is the main oral health challenge for children in Nigeria. Concern about its negative impact makes screening for caries in children an attractive public health strategy. The ability to detect the preclinical phase of caries, the availability of screening tools with high accuracy, and the possibility of treatment before onset of clinical symptoms with significant cost and health benefits, makes it appropriate for screening. However in Nigeria, the poor availability of highly specific and sensitive screening tools, poor access to oral health care and concerns with pre-screening consent, raise the question of the appropriateness of conducting screening programmes for children. We argue that a number of structural challenges associated with poor uptake of oral health care services need to be addressed before screening for caries can be considered ethically appropriate. These include facilitating access of children to quality oral health care and a systematic national approach to oral health implementation. Failure to address challenges associated with dental service utilization by children in Nigeria increases the risk of screening programmes promoting inequitable access to oral health care services.

Integrated oral, mental and sexual health management for adolescents: a call for professional collaboration.

Abstract Background: Globally, young people account for 15.5% of the total global disability-adjusted life-years burden for all age groups. They face mental health, nutritional problems, accidental and intentional injuries, sexual and reproductive health problems, and substance abuse. These health challenges have effects on their oral health. This paper discusses the oral health problems adolescents face and suggests approaches for providing integrated oral and general health care for adolescents. Discussion: Oral health issues linked with adolescent health concerns include: malocclusion and esthetic concerns linked with mental health status; oral and maxillofacial injuries linked with accidental and intentional injuries; oral manifestations of sexually transmitted infections; oral leukoplakia and oral cancers linked with alcohol, tobacco and psychoactive substance abuse; and oral manifestations of anemia resulting from nutritional problems. Training oral health care providers on adolescent health and care could promote prompt diagnosis, management and prevention of complications associated with major health challenges affecting adolescents. Conclusion: Adolescent oral health care needs focused attention: as a possible route for early diagnosis and management of general health problems and for promoting adolescent oral health care. Oral health care should be integrated into adolescent friendly services and oral health care providers should learn how to handle adolescents’ health needs.