Patricia Omowunmi Ayanbadejo

Could Periodontitis Affect Time to Conception

Background: Chronic periodontitis is gaining increasing prominence as a potential influnce on systemic health. Time to conception has been recently investigated in relation to chronic periodontitis among Caucasians. The authors set out to replicate the study among Nigerian pregnant women. Aim: The etiology of many medical conditions have been linked with the state of the oral health and one of such is the time to conception (TTC) among women. This study was aimed to assess the effect of periodontitis on TTC. Subjects and Methods: A cross-sectional study in a hospital setting involving 58 fertility clinic attendees and 70 pregnant controls using the simplified oral hygiene index, community periodontal index (CPI) and matrix metalloproteinase-8 immunoassay. Statistical analysis used included Spearman′s rank order correlation statistic, Z-statistic and logistic regression. Results: Good oral hygiene correlated with shorter TTC (<1 year) than fair oral hygiene, but not statistically significant. The odds of increased conception were higher with CPI (odds ratio [OR]: 0.482, 95% confidence interval [CI]: 0.259-0.895, P = 0.02), periodontitis risk (OR 0.157, 95% CI 0.041-0.600, P < 0.01) and age (OR 0.842, 95% CI 0.756-0.938, P < 0.01). Conclusion: Chronic periodontitis was positively associated with increased TTC in the present study. The authors are recommending that women in child bearing age should be encouraged to have regular preventive dental check-ups in order to maintain good oral and periodontal health.

Severe Presentation of Necrotizing Ulcerative Periodontitis in a Nigerian HIV-Positive Patient: A Case Report

Objective: To report a case of severe necrotizing ulcerative periodontitis (NUP) with a rarely associated sequestrum formation in a Nigerian HIV-positive patient. Clinical Presentation and Intervention: A 47-year-old HIV-positive male patient with no history of previous dental visits presented with a severe toothache in his lower jaw of 4 weeks’ duration, which had affected his ability to chew properly. Clinical examination revealed marked gingival inflammation, moderate gingival recession and mobility of some of his lower anterior teeth: 31, 32, and 33. There was also a sequestrum present associated with the affected teeth. His CD4 cell count was 226 cells/mm3. His viral load was very high (360,082 copies/ml). The intervention included thorough debridement of the necrotic lesion and sequestrectomy. The patient responded well to treatment after 1 week of follow-up. Unfortunately, the CD4 count was not assessed further because the patient was lost to follow-up. Conclusion: This case showed that a high CD4 cell count does not necessarily prevent the occurrence of NUP in HIV-positive patients. Intervention might have enhanced a rapid positive response to the treatment within a short time.

AP-PCR and Antimicrobial Susceptibility Patterns of Fusobacterium nucleatum Associated with Chronic Periodontitis among Patients at Lagos University Teaching Hospital

Aims: To isolate, identify and evaluate the genetic diversity and antimicrobial susceptibility of F. nucleatum recovered from Nigerian patients with chronic periodontitis. Study Design: Cross-sectional design.

Prevalence and Determinants of Chronic periodontitis in HIV positive patients in Nigeria

Abstract Objective To determine the prevalence and determinants of chronic periodontitis in HIV positive patients. Methods A total of 120 HIV positive patients attending the dedicated HIV outpatient clinic of the Lagos University Teaching Hospital, Nigeria were recruited for the study. Their periodontal status was assessed using the community periodontal index of treatment needs. Their CD4+ cell count was determined using the flow-cytometer method. The risk factors for periodontitis including age, gender, education, smoking, CD4+ cell counts, bleeding on probing (BOP) were determined. Results Prevalence of periodontitis was high (63.3%) in the HIV positive patients. In a bivariate analysis, significant associations were observed between severity of periodontitis and age ≥35 years (P=0.021), male gender (P=0.005), smoking (P=0.040) and ≥3 community periodontal index of treatment needs sextants exhibiting BOP (P=0.004). In a binary logistic regression, independent predictors of periodontitis were ≥3 sextants exhibiting BOP (odds ratio 1.738, 95% CI 1.339 to 2.256, P=0.000) and age ≥35 years (odds ratio 1.057, 95% CI 1.005 to 1.111, P=0.030). The CD4+ cell counts were not associated with periodontitis in the HIV positive patients (P=0.988). Conclusions A high prevalence of periodontitis was found among the HIV positive Nigerian patients in this study. Older age ≥35 years and BOP were the determinants of periodontitis. There is therefore a need for close periodontal monitoring of HIV positive Nigerian patients with emphasis on preventive, professional oral prophylaxis.

Detection of FUS-1 (OXA-85), a class D beta-lactamase from Fusobacterium nucleatum subspecies Polymorphum in Nigeria.

Aims: Beta-lactamase production and subsequent resistance to β-lactam drugs has been a global concern in the treatment of Gram negative anaerobes. The aim of this study was to identify F. nucleatum strains producing Class D β-lactamase through the detection of FUS-1 (OXA-85) resistance gene. Place and Duration of Study: Department of Preventive Dentistry, Lagos University Teaching Hospital, Idi-Araba, between February 2010 and November 2010. Methodology: Twenty two oral clinical samples were obtained from patients with chronic periodontitis who admitted to previous use of amoxicillin. Antibacterial susceptibility of the bacterial isolates was determined by E-test on Brucella Blood agar. Amplification of Short Communication British Microbiology Research Journal, 3(4): 492-500, 2013 493 the bacterial DNA was carried out by PCR using F. nucleatum species-specific primer, FUS-1 specific for blaFUS-1 and strain-specific primers for subspecies nucleatum, fusiforme, polymorphum and vincentii. Results: From the 19 samples collected, F. nucleatum was isolated, and the identity of the isolates was confirmed by PCR. Four of the isolates produced similar bands with the control strain, 3 (15.7%) strains were able to produce amplication with FUS-1 primer specific for blaFUS-1 gene found in β-lactamase producing F. nucleatum subsp. polymorphum. Conclusion: This study shows the presence of class D β-lactamase producing F. nucleatum species in Nigeria.

Association of elevated c-reactive protein with severe periodontitis in hypertensive patients in Lagos, Nigeria: A pilot study

Background: Epidemiological studies have shown that individuals with chronic periodontitis have a significantly higher risk of developing cardiovascular complications, which might be attributed to the increased production of inflammatory cytokines initiated by the complex microbiota in dental biofilm. Aim: The study aims to evaluate the association between chronic periodontitis and C-reactive protein (CRP) levels in a group of hypertensive individuals in Nigeria. Materials and Methods: The investigator enrolled 50 hypertensive patients with chronic periodontitis into the study from the medical outpatient clinic of a teaching hospital in Lagos, Nigeria. Full-mouth periodontal examination was done to assess the participants periodontal status, with probing depths and clinical attachment levels of six sites on all teeth. The investigator defined periodontitis as at least one interproximal site with probing depth ≥4 mm. Classification of participants into three groups was done based on their severity of periodontitis; mild (n = 16), moderate (n = 27), and severe (n = 7) periodontitis. Their CRP serum levels were measured, and the association with the severity of periodontitis was determined. P was found to be ≤ 0.05. Results: The median CRP levels were 1.0 (0.6, 2.2), 2.4 (1.1, 4.8), and 4.1 mg/L (3.3, 9.4) for mild, moderate, and severe chronic periodontitis, respectively. The association between the serum CRP levels and severity of periodontitis was statistically significant (P = 0.006). Conclusion: There was an association of elevated serum CRP level with increased severity of chronic periodontitis in hypertensive individuals. This preliminary finding among Nigerians suggests that chronic periodontal inflammation may contribute to systemic inflammatory burden in hypertensive patients.

Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria

Objective To assess internal medicine residents’ knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients’ periodontal health. Methods A cross-sectional survey using a self-administered questionnaire was conducted among internal medicine residents attending the Faculty of Internal Medicine 2014 Update Course organized by the National Postgraduate Medical College of Nigeria. Participants came from all over the country. Data on respondents’ demographic characteristics, periodontal disease knowledge, knowledge of associations between periodontal disease and systemic illnesses, and attitudes toward patients’ periodontal health were collected. Data were analyzed using Epi INFO software. The Pearson chi square test was used to measure significant association between categorical variables such as the knowledge of periodontal disease and gender, age group and designation of the participants (p ⩽ 0.05). Results Of 150 questionnaires distributed, 123 were returned (82% response rate); 109 questionnaires were completed properly and included in the analysis. The most common source of residents’ information on oral health was television (59.4%). Only 11.2% of respondents were aware that gingival bleeding was the earliest sign of periodontal disease. Respondents correctly identified periodontal disease as a risk factor for coronary heart disease (45.9%), stroke (43.5%), hospital-acquired pneumonia (53.2%), diabetes mellitus (13.8%), and preterm birth (11%). Increased age (p = 0.032) and male gender (p = 0.022) were associated significantly with knowledge of periodontal disease as a risk factor for stroke. Higher designation (p = 0.002) and longer duration in residency training (p = 0.004) were associated significantly with knowledge of periodontal disease as risk factor for peripheral arterial disease. The majority (90.9%) of respondents had positive attitudes toward the referral of their patients for regular periodontal care. Conclusions Knowledge of periodontal disease as a risk factor for systemic illnesses among medical residents in Nigeria is inadequate. These relationships should be emphasized in continuing medical education courses.

Prevalence of self-reported halitosis and associated factors among dental patients attending a tertiary hospital in Nigeria

Objectives: To determine the prevalence of self-reported halitosis among dental patients seen in a teaching hospital. Materials and Methods: This was a cross-sectional study that included 135 dental patients enrolled at the Oral Diagnosis/Periodontology Clinics of the Lagos University Teaching Hospital. Self-administered questionnaires were used to assess self-reported halitosis (oral malodor) in the subjects. Association between self-reported halitosis and sociodemography (age, gender, education, marital status, ethnicity, and religion) and intraoral findings (gingivitis, periodontitis, tongue coating, caries, and number of mobile teeth) was determined. Results: The prevalence of self-reported halitosis was 14.8% and was significantly associated with age of 40 years and above (P = 0.025), and male gender (P = 0.032). Subjects with gingivitis were 2 times more likely to have halitosis than those without gingivitis (odds ratio [OR] = 2.19 while subjects with tongue coating were 2 times more likely to have halitosis than those without tongue coating OR = 2.02. About 50% perceived halitosis by themselves, 25% by family and friends, and 20% from presumed actions of people around them. The majority (70%) of the patients perceived the halitosis from their mouths, 30% from their mouth and nose. Most (75%) of the subjects had perceived the halitosis for more than 4 weeks while only 3% had sought professional treatment. Conclusion: Older age of 40 years and above and male gender were the factors associated with self-reported halitosis in this study. The health-seeking behavior of the patients for the treatment of the halitosis was poor.

Comparative periodontal status of human immunodeficiency virus-positive patients and controls in a dedicated human immunodeficiency virus clinic in Nigeria

Background: There are diverse reports on the prevalence and severity of chronic periodontitis in human immunodeficiency virus (HIV) positive persons. Few studies have been carried out in developing countries in Sub-Saharan Africa. This study was aimed at comparing the prevalence and severity of chronic periodontitis of HIV-seropositive patients with that of HIV-seronegative persons using the community periodontal index (CPI). Methodology: This was a comparative study of the periodontal status of 110 HIV-positive subjects and 110 age and gender-matched HIV-negative controls attending a dedicated HIV Clinic in a Teaching Hospital in Lagos, Nigeria. The CPI and simplified oral hygiene index score were used in the periodontal examination. Highest CPI scores and percentages of CPI sextants assessed the prevalence and severity of chronic periodontitis respectively. Logistic regression was used in adjusting demographic differences in the study population. P ≤ 0.05 was considered as significant. Results: A significant proportion of the HIV-positive patients 61 (55.5%) and the HIV-negative controls 53 (48.7%) had shallow pockets (4–5 mm) (CPI code 3). The prevalence of deep pockets (≥ 6mm) (CPI code 4) was higher among HIV-positive patients 9 (8.2%) than the controls 4 (3.5%) (P = 0.079). HIV-positive patients had a greater percentage of CPI codes 3, 4 and fewer CPI code 0 sextants than controls (P = 0.000). Both groups had comparable oral hygiene status (P = 0.209). Using a logistic regression analysis, HIV-positive status and lower education accounted for the greater severity of chronic periodontitis. Conclusion: HIV-seropositive patients had more severe chronic periodontitis than the HIV-seronegative controls, which was independent of lower education.

Periodontal health knowledge of nonmedical professionals and their oral hygiene behavior in a teaching hospital in Nigeria

Background: The awareness of periodontal diseases is generally poor among Nigerians. Working within the hospital environment should give an edge to nonmedical professionals, who could help to promote periodontal health awareness in countries with an inadequate number of dental health professionals. This study aimed to determine the awareness, knowledge of periodontal diseases and oral hygiene behavior of nonmedical professionals within a hospital setting. Materials and Methods: A cross-sectional descriptive study was conducted on 302 nonmedical professionals in a teaching hospital in Nigeria. Pretested, self-administered, semi-structured questionnaires were utilized for data collection on sociodemography, number of years of work experience in the hospital, work cadre, awareness and knowledge of periodontal diseases, oral self-care and dental attendance pattern. Results: The awareness of periodontal disease was relatively high (60.2%) in the nonmedical professionals. However, only 29.8% had adequate knowledge of periodontal diseases. Their knowledge was significantly associated with male gender (P = 0.042), higher education (P = 0.006) and nonYoruba ethnicity (P = 0.015). Their duration of work within the hospital premises did not significantly affect their periodontal health knowledge. Less than half (42.7%) practiced twice or more daily brushing while only 11.9% used interdental floss for interproximal plaque removal. Their dental attendance pattern was mostly (83.5%) problem-oriented rather than preventive. Conclusion: The nonmedical professionals had fairly high awareness but inadequate periodontal health knowledge and oral hygiene practices. These findings may make their role as oral health promoters a questionable one, unless, this is addressed urgently.