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BAKIRTAŞ M, UNCU ULU B, BAŞCI S, DARÇIN T, ŞAHİN D, YILDIZ J, MERDİN A, BATGİ H, OZCAN N, YİĞENOĞLU TN, SEÇİLMİŞ S, İSKENDER D, BAYSAL NA, KIZIL ÇAKIR M, DAL S, ALTUNTAŞ F. Evaluation of seasonality in the diagnosis of diffuse large B cell lymphoma in Turkey. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.828027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Afungchwi GM, Hesseling PB, Achu P, Bardin R, Kouya F. Burkitt lymphoma: Trends in children below 15 years reveal priority areas for early diagnosis activities in north-west Cameroon. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2019. [DOI: 10.4102/sajo.v3i0.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Burkitt lymphoma is one of the most common childhood cancers in Cameroon. Incidence rates of 5.9/100 000 and 2.58 per 100 000 have been reported in two studies in 2005 and 2012 amongst children below 15 years in the North-West Region.Aim: This study seeks to examine how Burkitt lymphoma incidence has varied between the various health districts of north-west Cameroon from 2003 to 2015.Setting: North-West region of Cameroon.Method: Ethics approval was obtained from the relevant university and Health Services Institutional Review Board. Population data was obtained from the regional delegation of public health. The Paediatric Oncology Networked Database registry from two hospitals and two pathology-based registries were reviewed for cases per year from the various districts. Age-standardised incidence rates were computed for all districts by year using the World Health Organizaion world standard populations.Results: A total of 317 cases were registered. Overall age-standardised incidence rate was 3.07 per 100 000. Annual incidence ranged from 0.09 in 2003 to 6.12 in 2010. The districts with the highest incidence rates for the entire study period include Nwa with 10.54; Ndop with 5.63; Benakuma with 5.48; Ako with 4.97; and Nkambe with 4.73.Conclusion: Clustering of Burkitt lymphoma is seen in the region, with the highest incidence in Nwa, Ndop, Benakuma, Ako and Nkambe. These districts should be prioritised for awareness creation campaigns. There is need for a population-based childhood cancer registry in the region, which will use both active and passive surveillance methods to record all childhood cancer cases.
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Offor UT, Akyea RK, Neequaye JE, Renner LA, Segbefia CI. The changing clinical pattern of endemic Burkitt lymphoma in Western Africa: Experience from a tertiary center in Ghana. Pediatr Blood Cancer 2018; 65:e27275. [PMID: 29873879 DOI: 10.1002/pbc.27275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Burkitt lymphoma (BL) is the most common childhood cancer in Ghana, where the endemic variant is the predominant subtype and historically presents as a highly chemo-sensitive jaw tumor. This study aimed to update the current epidemiological characteristics of childhood BL in our institution. PROCEDURE Patient data for all children diagnosed with BL and seen at Korle Bu Teaching Hospital between January 2007 and December 2012 were retrospectively analyzed. RESULTS BL was diagnosed in 173 children (<13 years) during the study period, with the abdomen as the most common tumor site (46%) followed by the jaw (31%). Abdominal tumors were associated with advanced/disseminated disease (P = 0.002), and were more likely to occur in females irrespective of tumor stage (relative risk = 1.56 [95% CI; 1.1-12.3]). Twenty-five percent (43/173) of the study cohort died and mortality was influenced by increasing age (P = 0.02) and advanced disease (P = 0.03). Treatment delay was experienced by nine in ten patients primarily due to familial financial constraint (75%). Treatment abandonment was observed as a first event in 94% of patients and two thirds of children in the study were eventually lost to follow-up. CONCLUSION The predominance of primary abdominal tumors in our study cohort may indicate a changing epidemiological pattern of BL in Ghana. High rates of treatment delay and abandonment were evident and are likely to be contributing factors to the poor childhood cancer survival outcomes seen in resource-limited countries in Africa.
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Affiliation(s)
- Ugonna T Offor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, United Kingdom.,Pediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Ralph K Akyea
- Pediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana.,Faculty of Medicine and Health Sciences, University of Nottingham School of Medicine, Nottingham, United Kingdom
| | - Janet E Neequaye
- Pediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lorna A Renner
- Pediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Catherine I Segbefia
- Pediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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Williams CKO, Foroni L, Luzzatto L, Saliu I, Levine A, Greaves MF. Childhood leukaemia and lymphoma: African experience supports a role for environmental factors in leukaemogenesis. Ecancermedicalscience 2014; 8:478. [PMID: 25435906 PMCID: PMC4239129 DOI: 10.3332/ecancer.2014.478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 11/06/2022] Open
Abstract
Major differences exist in the nature of leukaemia and lymphoma in low-income African children compared to those in the high-income countries. These include the absence of the peak incidence of acute lymphoblastic leukaemia (ALL) in under-five-year olds that characterizes the disease in high-income countries. Conversely, chloroma association with acute myelogenous leukaemia (CA-AML/AMML) and Burkitt's lymphoma (BL) are rare in the high-income countries. This report describes clinical and laboratory as well as epidemiological features of childhood leukaemia and lymphoma reported betwen 1982 and 1984 in the city of Ibadan, Nigeria. The observed pattern of distribution of childhood haematological malignancies in the city is more consistent with the observations of Ludwik Gross's experiments on environmental influences, such as malnutrition and infections, animal leukaemogenesis, and mirroring the consequences of the primordial pressures that have shaped human genetics and pathophysiology.
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Affiliation(s)
- Christopher KO Williams
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Hematology Oncology Consultancy, Port Angeles, WA 98362, USA
- FHCRC/UW Centre for AIDS Research (CFAR), Seattle, WA 98104, USA
| | - Letizia Foroni
- Department of Haematology, Royal Postgraduate Medicine School, London W12 ONN, England
| | - Lucio Luzzatto
- Department of Haematology, Royal Postgraduate Medicine School, London W12 ONN, England
| | - Idris Saliu
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Arthur Levine
- Department of Haematology, Royal Postgraduate Medicine School, London W12 ONN, England
- Viral Epidemiology Branch, Landow Building 3C19, National Cancer Institute, Bethesda, MD 20205, USA
| | - Mel F Greaves
- Chester Beatty Laboratories, London SW3 6JB, England
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Muwazi L, Rwenyonyi CM, Kutesa A, Kasangaki A, Kamulegeya A. Seasonality of Burkitt's lymphoma in Uganda. J Oral Maxillofac Pathol 2014; 18:S6-S10. [PMID: 25364181 PMCID: PMC4211240 DOI: 10.4103/0973-029x.141323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/20/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/AIMS Burkitt's lymphoma is the most common childhood oral maxillofacial tumor in Africa and some studies have reported seasonal variation. MATERIALS AND METHODS All Burkitt's cases diagnosed from 1969 to 2006, from all over Uganda, at the Makerere University's Department of Pathology, were analyzed, to determine seasonal variation. This was done by evaluation of monthly and rainy versus dry season prevalence. STATISTICAL ANALYSIS The Wilcoxon test was used in both cases, to assess the statistical significance of differences in the diagnostic rates of Burkitt's lymphoma, in comparison to nonspecific chronic inflammation, using the total as the denominator. Yearly variation in prevalence was examined by a Chi-square test for linear trend. Mann-Whitney tests were done to compare the climatic regions. Multivariate analysis of variance (MANOVA) was used to test for differences when gender, seasons and climatic regions were factored in. RESULTS Although monthly frequencies varied considerably over the period, none of the differences were statistically significant (Pearson's 15.199, degrees of freedom df = 11, P = 0.174). Likewise, there was no statistically significant difference in the total number of Burkitt's and nonspecific chronic inflammation biopsies handled at the Department during the rainy and dry seasons. CONCLUSION Although the 38-year period gave us sufficient numbers to use the Edward's method for seasonality, it also meant that a lot of seasonal changes that occurred during the period were not taken into consideration. We hence feel that a review of this data with weather experts, so as to group the biopsies into accurate rainfall and dry patterns, would yield a more authoritative publication.
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Affiliation(s)
- L Muwazi
- Department of Dentistry, Makerere University College of Health Sciences, Mulago Hospital Complex, Dentistry, Second floor, Clinical Research Bldg, Makerere University College of Health Sciences, Kampala, Uganda
| | - CM Rwenyonyi
- Department of Dentistry, Makerere University College of Health Sciences, Mulago Hospital Complex, Dentistry, Second floor, Clinical Research Bldg, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Kutesa
- Department of Dentistry, Makerere University College of Health Sciences, Mulago Hospital Complex, Dentistry, Second floor, Clinical Research Bldg, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Kasangaki
- Department of Dentistry, Makerere University College of Health Sciences, Mulago Hospital Complex, Dentistry, Second floor, Clinical Research Bldg, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Kamulegeya
- Department of Dentistry, Oral Maxillofacial Surgery Unit, Mulago Hospital, Mulago Hospital Complex, Dentistry, Second floor, Clinical Research Bldg, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Dentistry, Makerere University College of Health Sciences, Mulago Hospital Complex, Dentistry, Second floor, Clinical Research Bldg, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Dentistry, Oral Maxillofacial Surgery Unit, Hutchinson Cancer Research Institute, Upper Mulago Hill, Kampala, Uganda
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Clinical characteristics, treatment and outcome of childhood Burkitt's lymphoma at the Uganda Cancer Institute. Trans R Soc Trop Med Hyg 2011; 105:717-26. [PMID: 22047912 DOI: 10.1016/j.trstmh.2011.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 08/02/2011] [Accepted: 08/16/2011] [Indexed: 11/21/2022] Open
Abstract
Burkitt's lymphoma (BL) is a major cause of death among Ugandan children. We studied clinical characteristics and outcomes of childhood BL over time at the Uganda Cancer Institute (UCI). A total of 1217 children (766 boys, 451 girls, mean age 6.69 years) diagnosed with BL between 1985 and 2005 were included. There were no significant changes in the proportion of boys and girls diagnosed, or in mean age at diagnosis. Facial tumor (n=945, 77.65%) and abdominal disease (n=842, 69.19%) were the most common presentations. The proportion of children presenting with hepatic mass, malignant pleocytosis, and advanced-stage (stage C and D) BL increased during the study period (P<0.01). A total of 1085 children out of 1206 (89.97%) received at least one cycle of chemotherapy, and 832 of 1099 (75.71%) demonstrated objective response (i.e. complete or partial remission). The most common symptoms at BL diagnosis were fever (n=621, 51.03%), anemia (n=593, 48.73%), and weight loss (n=588, 48.32%). Significant increases in the proportion of children with fever, and significant changes in the proportion of children with anemia, night sweats and severe infection were observed. HIV positivity was 3.87%, but no substantial differences in the proportion of HIV-positive children were observed. Mortality was not significantly different over time: it was similar in boys and girls, higher in older children (compared with younger ones), in those with advanced-stage BL, and HIV-positive children, but lower in children with facial tumors compared with other tumor presentations, and among those who received chemotherapy.
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Okebe JU, Skoetz N, Meremikwu MM, Richards S. Therapeutic interventions for Burkitt lymphoma in children. Cochrane Database Syst Rev 2011; 2011:CD005198. [PMID: 21735399 PMCID: PMC7390501 DOI: 10.1002/14651858.cd005198.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Burkitt lymphoma (BL) is an important cancer found mostly in children but uncertainty remains as to the most effective form of management. In endemic areas, late-stage presentation as a result of delayed access to treatment compounds the situation. OBJECTIVES To assess the evidence for chemotherapy, surgery, radiotherapy and immunotherapy in the treatment of children with endemic BL. SEARCH STRATEGY We updated and re-ran the searches in the following electronic databases from the time of the first publication; the Cochrane Controlled Trials Register (CENTRAL) (Issue 1, 2011); MEDLINE (January 2011); EMBASE (January 2011); and the clinical trials registry (up to January 2011) to identify relevant trials. In addition, we also updated the search of the US clinical trials register for on-going and completed trials up to January 2011. We also updated the search terms and used the Cochrane filter for identifying randomised trials in MEDLINE. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any duration. We included studies conducted in children with a confirmed diagnosis of BL. We did not restrict studies by geographical location or by language of publication. We considered any therapeutic intervention. The primary outcome was overall survival. DATA COLLECTION AND ANALYSIS Two review authors assessed studies for relevance. We assessed studies that met the entry criteria for study quality. We independently extracted data and entered the data into Review Manager (RevMan). In this update, two review authors independently assessed citations from the updated search and reviewed abstracts for relevance. MAIN RESULTS We included one new study in this update. In total, 13 trials involving 1824 participants met the inclusion criteria for this review however, data in usable format were only available in 10 trials (732 participants). Inadequate reporting of study methodology was a common feature of the trials preventing thorough assessment of study quality. We were unable to pool data for any of the outcomes due to the differences between the interventions assessed in the studies. Eight studies aimed to induce remission; overall survival did not differ significantly between treatment groups. Five studies aimed to maintain remission. In two out of three studies reporting survival, this was substantial but the difference was not statistically significant between treatment groups. Less aggressive treatment schedules appear to produce similar effects with less adverse event profiles. AUTHORS' CONCLUSIONS This review notes a preference in more recent studies for less aggressive care options for treatment of BL. However, the evidence for the relative effectiveness of interventions to treat BL is not strong as studies were small, underpowered and prone to both systematic and random error. We included one additional trial without change of conclusions.
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Affiliation(s)
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Martin M Meremikwu
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria
| | - Sue Richards
- Oxford UniversityClinical Trials Services UnitWoodstock RoadOxfordUKOX2 6HE
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Béogo R, Nacro B, Ouédraogo D, Ouoba K. Endemic Burkitt lymphoma of maxillofacial region: results of induction treatment with cyclophosphamide plus methotrexate in West Africa. Pediatr Blood Cancer 2011; 56:1068-70. [PMID: 21344617 DOI: 10.1002/pbc.23058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 01/05/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Burkitt lymphoma is frequent a cancer in the developing countries where its treatment is based on non-intensive chemotherapy protocols. The purpose of this study was to assess the effectiveness and the toxicity of a non-intensive chemotherapy protocol combining cyclophosphamide and methotrexate in children with Burkitt lymphoma of the maxillofacial region. PROCEDURE A retrospective descriptive study was carried out in patients with Burkitt lymphoma of maxillofacial region who received at least one weekly treatment with intravenous cyclophosphamide and methotrexate between 1999 and 2006 in a university teaching hospital in Burkina Faso. The demographic characteristics of the patients, the effectiveness and the toxicity of the treatment were recorded. RESULTS A total of 58 patients were included. The mean age was 7.2 years. According to Murphy's staging, 28 patients (48%) were at stage I, 18 (31%) at stage II, 11 (19%) at stage III and 1 (2%) at stage IV. Among 28 patients who received all the cycles of the protocol, 21 (75%) achieved complete remission, 6 (21%) had partial remission and 1 (4%) had progressive disease. The major complications during the treatment were febrile leucopenia and anemia. The mortality rate was 19% (11/58). CONCLUSION Non-intensive chemotherapy protocol with cyclophosphamide and methotrexate could be an alternative to intensive chemotherapy protocols for the management of the stage I-III endemic Burkitt lymphoma in developing countries.
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Affiliation(s)
- Rasmané Béogo
- Department of Stomatology and Maxillofacial Surgery, CHU Sanou Souro, Burkina Faso.
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Abstract
This review considers recent studies regarding the role of environmental factors in the etiology of childhood leukemia and lymphoma. Potential environmental risk factors identified for childhood leukemia include exposure to magnetic fields of more than 0.4 micro Tessla, exposure to pesticides, solvents, benzene and other hydrocarbons, maternal alcohol consumption (but only for certain genotypes), contaminated drinking water, infections, and high birth weight. The finding of space-time clustering and seasonal variation also supports a role for infections. There is little evidence linking childhood leukemia with lifetime exposure to ionizing radiation although fetal exposures to X-rays are associated with increased risk. Breast-feeding, consumption of fresh fruit and vegetables and having allergies all appear to be protective. Burkitt lymphoma (BL) is confined to areas of the world where malaria is endemic, with the additional involvement of the Epstein-Barr virus (EBV) as a co-factor. Environmental risk factors suggested for other types of non-Hodgkin lymphoma (NHL) include exposure to ionizing radiation (both lifetime and antenatal), pesticides, and, in utero exposure to cigarette smoke, benzene and nitrogen dioxide (via the mother). Hodgkin lymphoma (HL) is especially associated with higher levels of socioeconomic deprivation, but breast-feeding seems to confer lower risk. This is consistent with an infection or immune-response mediated etiology for HL.
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Affiliation(s)
- Richard J Q McNally
- School of Clinical Medical Sciences, Child Health, University of Newcastle Upon Tyne, UK.
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Okebe JU, Lasserson TJ, Meremikwu MM, Richards S. Therapeutic interventions for Burkitt's lymphoma in children. Cochrane Database Syst Rev 2006:CD005198. [PMID: 17054245 DOI: 10.1002/14651858.cd005198.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Burkitt's lymphoma (BL) is a small non-cleaved cell lymphoma which commonly presents as jaw swellings. Uncertainty remains as to the most effective form of management. OBJECTIVES To assess the evidence of any therapeutic strategy in the treatment of BL. SEARCH STRATEGY We searched MEDLINE (1966-March 2006), LILACS (1982-March 2006), EMBASE (1974-March 2006) and the Cochrane Controlled Trials Register (all years, latest Issue 01/2006) to identify relevant trials. All of these references were accessed in order to identify additional trials in BL. SELECTION CRITERIA Randomised controlled trials (RCTs) of any duration were included. We included studies conducted in children with a confirmed diagnosis of BL. Studies were not restricted by geographical location or by language of publication. Any therapeutic intervention was considered. The primary outcome was overall survival. DATA COLLECTION AND ANALYSIS Two reviewers assessed studies for relevance. Studies that met the entry criteria were assessed for study quality. Data were extracted independently and were entered into RevMan 4.2. MAIN RESULTS Twelve studies met the entry criteria of the review but data could only be retrieved from ten. Inadequate reporting of study methodology was a common feature of the trials preventing thorough assessment of study quality. We were unable to pool data for any of the outcomes due to the differences between the interventions assessed in the studies. Seven studies aimed to induce remission: Overall survival did not differ significantly between treatment groups in three out of four studies reporting this outcome. Five studies aimed to maintain remission: In two out of three studies reporting survival, it was substantially, but not statistically significantly, different between treatment groups. AUTHORS' CONCLUSIONS This review does not currently provide any strong evidence on the relative effectiveness of interventions to treat Burkitt's lymphoma. The studies that have been conducted to date are small, underpowered and prone to both systematic and random error.
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Affiliation(s)
- J U Okebe
- Medical Research Council Laboratories, Malaria Programme, PO Box 273, Fajara, Gambia.
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Abstract
Most oral health surveys in Nigeria have been sporadic and based on convenience samples. Periodontal disease with deep pocketing occurs in Nigerians at an early age, the prevalence being 15-58% in those aged above 15 years. Caries experience has been reported to vary between very low and low in most studies, but is moderate in some urban communities. Although mean DMFT is below 4 in most communities, the restorative index is extremely low, most carious teeth remaining unrestored. The higher caries prevalence in second than first permanent molars that has been reported is most likely due to a change from traditional to Western-type diet. Other oral health problems include malocclusion, truamatised teeth, dental fluorosis, and oral tumours. The scanty oral health services available in the country are mainly in urban areas. There is, therefore, a need to develop sustainable strategies for national preventive and therapeutic oral health services in Nigeria.
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Affiliation(s)
- E S Akpata
- Department of Restorative Sciences, Faculty of Dentistry, Kuwait University, 13110, Kuwait.
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