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Ossifying fibroma (OF) is a benign tumor of the jaws, which belongs to the group of fibro-osseous lesions, and exhibits slowly progressive growth leading to jaw expansion with well-defined borders.To evaluate the clinical and radiological characteristics of OFs and their treatment.A 5-year retrospective study was done. The case notes of subjects were retrieved, analyzed, and evaluated. Relevant information about patients was categorized into bio-data, clinical, and radiological. The diagnosis of lesion was made histopathologically by the oral pathologist.Forty- five patients' case notes were retrieved and analyzed and the patients' age ranged from 2 to 70 years (mean 29.4 ± 16.9). Majority of the patients (55.5%; P = 0.23) were 10-29 years. There were 16 (35.6%) males and 29 (64.4%) females giving a male: female ratio of 1:1.8 (P = 0.01). The cross-sectional dimension of the tumors measured vertically and horizontally ranges from 1 cmThe prevalence of OF among the fibro-osseous lesions was 51.0% while against other benign lesions, it was 16.0%. In conclusion, contrary to most other reports across the globe, this lesion in southeast Nigeria occurred more frequently in the maxilla than mandible.

Locally advanced inoperable orofacial malignancies do present clinically, and constitute a significant public health burden worldwide.To determine the prevalence and clinical characteristics of Stage IV locally advanced inoperable orofacial malignancies for consecutive patients.A 24-year retrospective study was undertaken, and data obtained from hospital register, case files, and histopathological reports of patients were recorded in a proforma. The variables studied were age, sex, type of lesion and site, duration of lesion, tobacco/alcohol use, and socioeconomic status of the patients and clinical features of the lesions.Twenty-six patients presented, giving a prevalence of 11.2%. The most common lesion was adenoid cystic carcinoma, 23.1%. Males accounted for 18 (69.2%) cases and females, 8 (30.8%) giving a male to female ratio of 2.3:1. The ages ranged from 21 to 65 years, mean (SD) 48.6 (7.3) years. The gender distribution was clinically and statistically significant in favor of the males (P = 0.001). The patients were in the low socioeconomic class and 20 (76.9%) indulged in chronic use of tobacco and alcohol. The duration of the lesions ranged from 1.8 to 3.1 years. The maxilla/facial skin was the commonest site (46.2%). Clinically and statistically, the relativity of site distribution of lesions was significant (P = 0. 002). The clinical features occurred in combination resulting in an average of 10 symptoms and signs in each patient.The synopsis of these lesions shows that all have undergone metastasis; salivary gland malignancies were most common with maxilla as the commonest site.

Background: Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results. Aim: The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina. Methods: This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t-test was used to compare the mean outcomes of the two groups. Results: A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study. Conclusion: The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.

Dental implants and orthodontic mini implants or temporary anchorage devices (TAD) have been used for tooth replacement and as adjuncts to orthodontic treatment in anchorage control and retraction of segments of teeth respectively. They are manufactured from various materials with titanium being the currently used material. The patients in our environment have diverse cultural acceptances and constraints with some prohibiting the use of certain materials in their oral cavity.The aim of this study therefore was to determine the existence of cultural constraints in the use of dental or orthodontic min-implants and compare them in the management of patients.Four groups of dental patients were selected to determine if cultural constraints exist. Groups 1 and 2 were patients with either anterior or posterior missing teeth requiring replacement with dental implants (implant group) or partial dentures (denture group), respectively. Group 3 were orthodontic patients requiring TAD (orthodontic group) and group 4 were patients with other dental problems and served as the control (normal group). Associations between frequencies, gender, educational, and cultural differences were evaluated with the Chi-square test. Significant values of P0.05 were applied where applicable.A total number of 192 participants were recruited for the study. Group 1 had the highest number of culturally constrained participants (n = 21, 10.9%). A significantly higher number from the group was seen (n = 11, 52.4%) among the African Traditional worshippers (ATR). Although a total number of 58 (30.2%) patients replaced their missing teeth, 37 (19.3%) utilized partial dentures in group 2 with no cultural constraints. Orthodontic implants were not rejected (n = 0, 0%) by all the four groups. Group 4 demonstrated a low level of constraints (n = 7, 4.2%). Of the four religious groups identified, ATR demonstrated the highest level of constraints with Christians and Muslims showing fewer constraints to the use of implants (n = 7, 33.3%) and (n = 2, 9.5%), respectively. Participants with the highest educational levels and social classes were more culturally constrained in the use of dental implants.Cultural constraints exist in the use of dental implants in our environment among African Traditional religion worshippers. There was, however, no cultural constraint to the use of orthodontic implants by any of the religious groups.

Otitis media with effusion is common in children with cleft palate, and the aim of this study was to find out its incidence and risk factors in Nigerians. We prospectively studied 84 patients (42 with cleft palate and 42 control subjects); 27 were male and 15 female, who were age and sex matched with control subjects. The extent and size of the clefts were measured using a dental cast and Vernier calipers, and the otitis media was diagnosed with otoscopy and tympanometry. The mean (SD) age of the groups was 11 (7) months (range 1-33). Twelve children in the cleft group had otitis media compared with three in the control group. Infants and boys were more likely to be affected. There was a significant association between age (p=0.02), sex (p=0.01), and size of cleft (p=0.00). However, only the size of the cleft was confirmed to be an independent predictor, with children who had extremely wide clefts being more likely to develop otitis media than those with narrow clefts (OR=8.71, 95%CI=1.07 to 70.5).We conclude that the incidence of otitis media with effusion was higher among children with cleft palate than among those who did not have a cleft. Infants had a higher incidence than older children, and boys had a higher incidence than girls. Age, sex, and the size of the palatal cleft were significantly associated with otitis media, but not the extent of clefting.

Short-range shotgun wounds of the craniomaxillofacial region are life-threatening and are as devastating as military rifle wounds.This study aimed to evaluate the pattern of presentation of craniomaxillofacial shotgun injuries, types of shotgun injuries, and the outcome of treatments in our environment.This is a prospective observational study. Materials and Methods: This is a prospective observational study conducted from February 2006 to March 2012. All patients with shotgun wounds to the craniomaxillofacial region were included in the study by convenient sampling method. Glezer's shotgun classification scheme was used to categorize the patients into short-, intermediate-, and long-range shotgun wounds. Data collected were analyzed using SPSS version 16.Descriptive statistics were used to calculate the data. Mean and standard deviation (SD) were calculated for all quantitative variables such as age. Frequency and percentages were presented for qualitative variables.A total number of 28 patients were seen. Ages ranged from 19 to 64 years with a mean (±SD) of 32.7 (±11.4) years. The two most commonly used shotguns were locally made pistol (25, 42.9%) and the cut-size gun (10, 35.7%) and the least commonly used was Dane gun (1, 3.6%). Close-range injury to the face was 17 (60.7%) while that of intermediate- and long-range injuries were 6 (21.1%) and 5 (17.9%), respectively.Wounds sustained from close-range shotguns to the face were the most common in this environment. The outcome of treatment was satisfactory when treated with conservative debridement and early reconstruction.

Background and Objective: A postextraction comparative (cohort) study was carried out to determine whether the number of teeth extracted has an effect on salivary cortisol and by extension on stress.Subjects and Methods: Sixty‑three consecutive patients comprising 27 males (42.9%) and 36 females (57.1%) with a male: female ratio of 1:1.3, divided into two groups of A and B with a mean age of 25.8 ± 4.9 years, and age range of 18–37 years took part in the study. Fifty (79.4%) of them in group A (22 males and 28 females) each had a tooth extracted while 13 (20.6%) in group B (5 males and 8 females) had two teeth removed. One ml of resting saliva was collected from each patient 10 minutes after the procedure and analyzed for cortisol. All extractions and sample collections were done between 10 am and 2 pm to standardize the study and control for the diurnal variation of cortisol. Statistical analysis of the generated data was performed by using Student’s t‑test on SPSS version 17.0. The level of significance was set at 0.05 with P < 0.05 regarded significant.Result: The result showed mean salivary cortisol level of 12.914 ± 2.4684 ng/ml for group A and 12.108 ± 1.7192 ng/ml for group B though not statistically significant (P > 0.05). Females had more extractions in the two groups when compared with males. Male gender had a statistical significance difference (P < 0.05).Conclusion: This study shows that the number of teeth extracted did not have effect on mean salivary cortisol, as a result two teeth extraction does not impart more stress to the patient when compared with one, and as such no additional adjuvant stress relieving measures are needed in two teeth extractions.Keywords: Extraction, number of teeth, salivary cortisol, stress

We aimed to determine the contributory percentage of histopathologic diagnoses of routine biopsies and to ascertain the possible indicators for histopathologic examination to confirm the clinical diagnosis of periradicular lesions of extracted teeth.This was a prospective study carried out over a period of 8 months on patients who had single tooth extraction and routine histopathologic examination of recoverable periradicular tissues from extracted teeth.A total of 136 patients participated in this study. There was a male/female incidence ratio of 3:2 and most of the patients with histopathologically diagnosed lesions were within the first, second, and third decades of life (n = 49, 36.0%). Seventy-five (55.2%) cases had histopathologically diagnosed periradicular lesions, which were mostly periapical abscess (n = 30, 22.8%) and inflammatory (periapical) granuloma (n = 23, 16.9%). Some clinical and radiologic features were associated significantly with histopathologic diagnosis of some periradicular lesions (P.05). There also was a significant correlation of clinical diagnosis with histopathologic diagnosis of inflammatory (periapical) granuloma, periapical abscess, chronic osteomyelitis, and Burkitt's lymphoma (P.05).This study shows a higher contributory percentage of histopathologic diagnoses after routine biopsies, compared to previous reports from selected biopsies of periradicular lesions. We identified clinical indicators for predicting possible histopathologic diagnosis of some periradicular lesions, in particular, those that predict possible histologic diagnosis of neoplastic periradicular lesions.

We measured changes in the salivary concentrations of cortisol as an index of stress, and to find out if patients were stressed during routine intra-alveolar dental extractions. A total of 126 patients (63 experimental and 63 controls) matched for age and sex with a mean (SD) age of 26 (5) years (range 18–40) were recruited. Samples of saliva from patients whose glands had not been stimulated were collected twice from the study group (30 minutes before, and 10 minutes after, the procedure) and once from the control subjects. All samples were collected between 10.00 and 14.00 hours to standardise the method and control for the diurnal variation of cortisol. There was a slight but not significant increase in the mean salivary concentration of cortisol between the preoperative samples (mean (SD) 12.3 (1.5) ng/ml and the postoperative samples 12.8 (2.3) ng/ml in the study group) and the control 8.7 (1.0) ng/ml. However, there was no difference between the sexes. The study highlights a simple but effective way of evaluating stress in patients having intra-alveolar dental extraction, and emphasises the invaluable role of salivary cortisol in the evaluation of stress (particularly in our environment).

To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment.Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm).Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant.Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (P0.001). Post operative pain was significantly reduced in all cases treated with the diode laser (P0.001). There was also a significant difference (P0.05) in post operative bleeding in all cases treated with the diode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (P0.001). There was no statistically significant difference in treatment time in the use of the laser compared with conventional surgery.Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

Background: Studies from Nigeria have documented different reasons for tooth mortality and regular follow-up studies to determine any changes in reasons and pattern among Nigerians appears not to be common. The purpose of this study was to determine the reasons and pattern of tooth mortality among Nigerians and the changes that might have occurred after 38 years of the first report. Materials and Methods: The case records of patients seen at the Oral Surgery clinic of the University of Benin Teaching Hospital between March 2007 and February 2008 were retrieved from the Medical Records Department and analyzed for age, gender, reasons for extraction, tooth extracted, frequency of extraction, and mode of extraction. Results: A total of 990 patients were referred for exodontia and 1050 teeth were extracted from 397 (40.1%) males and 593 (59.9%) females of age 14--89 years. The reasons for extraction include caries and its sequelae (n = 905, 86.2%), periodontal disease (n = 69, 6.6%), trauma (n = 41, 3.9%), orthodontics (n = 24, 2.3%), failed endodontics (n = 5, 0.5%), prosthetics (n = 4, 0.4%), pericoronitis (n = 2, 0.2%). The most frequently extracted teeth were the lower right first molars (n = 109, 10.4%) and the lower left first molars (n = 95, 9.0%), respectively. Molar teeth (n = 830, 79.0%) were more frequently extracted while canines (n = 13, 1.2%) were the least. The lower molars were more commonly extracted (n = 479, 45.6%) followed by upper molars (n = 351, 33.4%). The age range of 21-30 years was more commonly referred for extraction with the most frequently extracted teeth being the lower left first molars (n = 32, 3.0%) in females and (n = 27, 2.7%) in males, respectively. Conclusion: Tooth mortality in Nigerians is significantly associated with dental caries and its sequelae especially in younger patients.

Fractures of the zygomatic complex occur worldwide and are a component part of injuries that can be sustained in the maxillofacial region. The objective was to analyze the clinical presentation and management ofzygomatic complex fractures.This was a prospective study carried out over a period of five years at the University of Calabar Teaching Hospital, Nigeria. Data documented were patients' age, gender, time of presentation, cause and type of fracture, associated head and maxillofacial injuries, clinical features, types of plain radiographs, treatment methods, duration of follow-up and complications.Majority of the patients (n = 81, 63.3%) were in their third and fourth decades of life while the male to female ratio was 20.3:1. Road traffic accident (n = 111, 86.7%) was the most common cause of fracture. Fractures of the zygomatic complex alone (n = 105, 82.0%) were more common than isolated fractures of the arch (n = 13, 10.2%) and combined fractures of the zygomatic complex and arch (n = 10, 7.8%).While multi-disciplinary approach to treatment is important, majority of the fractures were treated by simple elevation and transosseous wire osteosynthesis. Delay in presentation, associated injuries and non-availability of mini-plating technique contributed to the development of complications.

This article reports 3 cases of melanin pigmented lesions among 75 histologically diagnosed periradicular lesions of extracted teeth. Case 1 was a 25-year old male who presented with one week history of toothache involving a tender carious left mandibular second molar tooth (37), with periapical radiolucency and diagnosed clinically as acute apical periodontitis. The lesion was diagnosed histologically (using Haematoxylin and Eosin) as periapical granuloma, while histochemical examination (using Masson-Fontana technique) showed the presence of round/oval shaped melanin pigmented macrophages (melanophage) in the lesion. Case 2 was a 54-year old male with one week history of toothache associated with tender carious right maxillary first molar tooth (16) with periapical radiolucency. A clinical diagnosis of acute apical periodontitis was made, but histological and histochemical examination showed a melanin pigmented periapical granuloma with spindle shaped melanophage. Case 3 was a 28-year old female who presented with 4 days history of toothache, involving the tender left mandibular first molar tooth (36). The lesion had periapical radiolucency and a clinical diagnosis of acute apical periodontitis. On examination histologically and histochemically, the lesion was diagnosed as an intraosseous melanocytic naevi with dark-brown nests of round naevus cells. In conclusion, this article shows the rarity of melanin pigmented periradicular lesions in the jaws. The cases reported suggest that the trigger for formation of melanin-pigmented cells in the periradicular lesions may be related to the acute phase of the lesions. Further study is recommended to determine if the remnants of the migratory neural crest cells are the precursors of melanin-pigmented cells in the periradicular region.

Mandibular fracture is an important surgical condition in our environment and elsewhere in the world.The purpose of this study is to clinically determine the most common sites of the mandible prone to fracture.This two-year prospective study was carried out at the Dental and Maxillofacial clinic, University of Calabar Teaching Hospital, Nigeria, in 2007 and 2008.One hundred and seventy four patients' ages between six to 70 years (mean 28.7 ± 5.3 years) were studied. One hundred and forty two (81.6%) of them were males and 32 (18.4%) females, with a male/female ratio of 4.4:1.Road traffic accident significantly (χ2 = 17.1607, P = 0.0087) accounted for 139 (79.9%) of the fractures. There were 244 fracture sites in the 174 patients, with the body of the mandible being significantly (χ2 = 21, P = 0.0008) affected than other sites in fracture (n = 115, 47.1%). However, 96 (39.3%) and 132 (54.1%) of the fractures occurred on the right and left sides of the mandible respectively. Most patients had single (44.3%) and double (31.6%) fractures and this finding was significant (χ2 = 60.9314, P = 0.0000). The patients encountered were fully (62.6%) and partially dentate (37.4%). The fractures were successfully treated by conservative method, closed reduction and open reduction techniques.This study shows that the tooth-bearing portion, body, left and right sides of the mandible are most commonly prone to fracture when multiple aetiologies are considered.