The effect of dental anxiety on surgical time of mandibular third molar disimpaction

Background

Dental treatment of anxious patients induces stress due to the patients' expectation of pain. This may prolong treatment due to such patients' inability to cooperate during treatment.

Aim

The aim of the study was to determine the effect of dental anxiety on surgical time of mandibular third molar (M3) disimpactions at a Nigerian hospital.

Subjects and Methods

A prospective study was conducted at the Oral Surgery clinic of Aminu Kano Teaching Hospital, Kano, between October 2016 and September 2017 to assess the effect of dental anxiety on surgical time of M3 disimpactions using the Modified Dental Anxiety Scale (MDAS). The Patients' biodata, clinical and M3 radiologic data were recorded. Surgical durations were also recorded. Data were analyzed with Statistical Package for Social Sciences for Windows (IBM statistics 23 software).

Results

One hundred and sixteen subjects (64 males, 52 females) were studied. Forty-two subjects (36.2%) were mildly anxious, 67 (57.8%) were moderately anxious, and 7 (6.0%) were highly anxious. The females were more anxious and the overall surgical time (OST) of disimpaction correlated with the anxiety levels of the subjects. The OST increased by approximately 0.8 min with every unit rise in the anxiety score. Other factors that affected OST in the study were M3 depth, type of impaction, and root curvature.

Conclusion

The patients' dental anxiety increased the surgical time of M3 disimpactions. Clinicians should consider the patients' anxiety among the factors that affect the surgical time of M3 disimpactions. Verbally soothing anxious patients and administering anxiolytic when necessary, may help to reduce the patients' anxiety, and hence, prevent surgical time prolongation.

Management of Odontogenic Fibromyxoma in Pediatric Nigerian Patients: A Review of 8 Cases

Odontogenic fibromyxoma (OFM) is a benign, locally invasive and aggressive nonmetastasizing neoplasm of jaw bones. They are considered relatively rare and known to be derived from embryonic mesenchymal elements of dental origin. Treatment of OFM depends on the size of the lesion and on its nature and behavior. Varying treatment modalities ranging from curettage to radical excision have been documented. Aim; This paper is a review of management of 8 pediatric patients with histologically diagnosed OFM at a Nigerian tertiary health care facility. This was a retrospective study of all patients aged 15 years and below who presented to the Oral and Maxillofacial Surgery Clinic of Aminu Kano Teaching Hospital, Kano, over a 5-year period (January 2008 to December 2012), with a histologic diagnosis of OFM. The information obtained included patients' demographics, as well as their clinical characteristics such as the anatomical site and side of lesions. Other information collated included presenting features, the onset of symptoms, type of treatment carried out, as well as treatment outcome. The data were analyzed and the results presented as frequencies and percentages. Among the 8 patients with OFM, more males (n = 5/8; 62.5%) were affected than females (n = 3/8; 37.5%). The mandible (n = 5/8; 62.5%) was the most frequent site of occurrence, and the anterior mandible was the most favored location (n = 4/8; 50%). Seven patients had excision of the lesion with peripheral ostectomy of the underlying bone while only one patient had a bone resection. These patients have been followed up for at least 1 year, and no recurrence was observed throughout the follow-up period. OFM causes gross facial disfigurement and may result in the destruction of the entire jaw bone; the impact of which may be grave for a growing child. Prompt surgical intervention and follow-up have proven to be adequate management protocol.

Cost of illness in patients with mandibular fracture following road traffic crash and its socioeconomic implications in KANO STATE, NIGERIA

BACKGROUND

The Upward trend in facial injuries following road traffic crashes has been attributed to increasing urbanization and industrialization.

AIM

This study was conducted to determine the cost of illness for mandibular fractures and its socioeconomic implications.

METHODOLOGY

All the consecutive patients with mandibular fractures following road traffic crashes that presented to the Aminu Kano Teaching hospital in Kano State were recruited over one year.

RESULTS

A total of 50 patients were managed during the study period with 58% in the age range 21-30 years with mean of 27.9 ± 8.1 years, motorcycle-related road traffic crashes constituted the commonest aetiology. The cost of illness for mandibular fractures was N89, 312.20 ($488) per person. Cost of managing mandibular fractures was equivalent to 8.4% of the health care budget of the state and also equivalent to 15.2 % of the GDP per capita of the year of study surpassing the cost of illness for hypertension and diabetes.

CONCLUSION

These findings highlight the need for policies that would ensure safe driving, enforce the use of safety gadgets, protocols for efficient fracture management and reduced hospital stay.

EXPERIENCE WITH miniplate osteosynthesis in THE MANAGEMENT OF mandibular fractures IN NORTHWEST NIGERIA

BACKGROUND

Fractures of the mandible are the commonest facial fractures and various treatment modalities exist like wire osteosynthesis and the use of miniplates and screw with most of the industrially developed world leaning towards the use of miniplates in the treatment of these fractures. The use has however been limited in developing countries (including Nigeria) mostly due to the cost of the plates and screws.

AIM AND OBJECTIVES

To identify the versatility of miniplates in the treatment of mandibular fractures at a tertiary care centre in a developing country.

METHODS

All Subjects aged 16 years and above in whom mandibular fractures were diagnosed were recruited over a two year period. Patients were treated under general anesthesia using either the miniplates and screws or wire osteosynthesis while some patients had both miniplates and maxillo-maxillary fixation.

RESULTS

A total of 94 patients were recruited for the study of which 89.4% were males while the age group 16 to 25 years constituted the majority. Though 29.8% of the study population was involved in business, only 9.6 % were professional motorcyclists. Motorcycle-related road traffic crashes constituted the commonest aetiologic agent with 41.5%, while combination fractures were the commonest fracture types seen in 54.3% of the study participants. Of the 94 patients, 77.7% had treatment of mandibular fractures by open reduction and immobilization with mini plates, while 7.4% had mini plates with Maxillo-maxillary fixation and 14.9% had wire osteosynthesis only. The site of fracture was significantly associated with the treatment modality (p= 0.02).

CONCLUSION

This study showed that the choice of fixation appliances in mandibular fractures was influenced by the number of fractures and the multiplicity of fracture sites. Miniplates offered functionally stable fixation with minimum complications.

Pediatric maxillofacial injuries at a Nigerian teaching hospital: a three-year review

AIM

To determine the nature of pediatric maxillofacial injuries, according to etiology and characteristics of patients.

MATERIALS AND METHODS

The records of patients aged 15 years and below who presented with maxillofacial trauma to the Maxillofacial Clinic of Aminu Kano Teaching Hospital, Kano, Nigeria over a 3-year period were retrospectively examined. Patients' demographic and etiologic factors were obtained and analyzed. A P value of <0.05 was considered significant.

RESULTS

A total of 160 patients comprising males, 102 (63.8%) and females 58 (36.2%), were seen over the period of study. The age of patients range from 4 months to 15 years, mean 7.07 ± 4.52 years. There was no gender difference in terms of age (P < 0.05). Road traffic accident (RTA) was the most common etiologic factor accounting for 45.0% of cases. This was followed by fall (40.6%). Animal related injury and violence accounted equally for 3.8%. Soft tissue injuries in the form of abrasion, laceration and avulsion accounted for 70.0% of cases. Other anatomical sites included the mandible (16.3%), dento-alveolar fractures(12.5%), and midface (1.3%).

CONCLUSION

Road traffic accident and falls still remains the leading cause of maxillofacial injuries in children in this part of the globe. There is a need to reinforce existing traffic laws that aimed at minimizing the menace of RTA-related accidents.

Spectrum of oral and maxillofacial surgical procedures in Kano, Nigeria

The goal of the maxillofacial surgeon is to correct facial deformity while eradicating surgical diseases, prevent recurrence or complication and restore function. The aim of this paper is to review the surgical procedures carried out in a new tertiary teaching hospital. A retrospective study of patients with maxillofacial surgical diseases seen at the Department of Dental and Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria, between 2001 and 2003, was conducted. A total of 87 patients had various (primary and secondary) surgical procedures during the period under review. There were 51 males and 36 females, a male to female ratio of 1:0.61 with an age range of 3 days to 90 years and a mean age of 34.5 years. The majority of the patients were in the lower socio-economic group. Reduction and immobilization of the jaw fractures (n = 21, 23.3%) was the most common, followed by transosseous wiring (n = 12, 13.3%). The most common complications were malocclusion (n = 14, 29.8%) and facial defects (n = 12, 25.5%). Reduction and immobilization, and tumour surgery of the jaws seem to be the most common surgical procedures while osteotomy was the least. Reduction and immobilization with simple arch bars appeared to be very effective, more so when the patients could not afford more modern methods of treatment. Reconstructive surgeries of ablated jaws are advocated in view of the devastating aesthetic and psychosocial effects that these have on the patients.