Nigerian Journal of Dental Sciences

A Rare Posterior Maxillary Natal Tooth in a Nigerian Child: A Case Report and Review of Literature

Onyebuchi J. ANAGO — 2023-07-03

Background: Natal and neonatal teeth are terms used to describe teeth that erupt before the normal time. Their low prevalence and incidence give credence to its rarity. The presence of natal/neonatal teeth in the mouth is surrounded by certain cultural beliefs/myths, in Nigeria.

Objective: The objective of this article was to report a rare case of a supernumerary maxillary natal tooth in the molar region in a 6 weeks old Nigerian infant.

Case report: A six-weeks old male infant presented to the paediatric dental outpatients’ clinic. History revealed that a small tooth-like structure was first seen in the maxillary right molar region at birth by the mid-wife who then informed the child’s mother. The tooth was grossly mobile with no history of traumatic injury to mother’s breast, nor ulceration on the child’s tongue, or inconvenience during suckling. Patient had received the relevant immunizations; mother cleans baby’s mouth and tooth with a clean handkerchief daily.

Examination showed a healthy-looking infant with a mobile whitish opaque coloured, tooth-like structure with irregular shape in the right maxillary molar region. Radiographic investigation revealed an immature supernumerary toothlike structure with thin radiopaque shell with a radiolucent core. There were no distinct morphological delineation of enamel, dentine and pulp. Based on clinical and radiographic examination a final diagnosis of natal tooth was made. Tooth was extracted on the basis of being a supernumerary, gross mobility of the tooth, child’s good health, parents’ insistence and cultural beliefs. Extraction and healing were satisfactory.

Conclusion: Supernumerary natal teeth in the maxillary molar region is a very rare occurrence. The associated problems include risk of aspiration of the tooth, traumatic ulcers to child’s tongue and mother’s breast. Cultural and societal beliefs play a huge role in its management.

Erosive Lichen Planus-Vulvovaginal Gingival Syndrome: A Case Report

Mercy OKOH — 2023-07-03

Objective: Lichen planus is a chronic mucocutaneous disease characterized by oral ulcerations with or without cutaneous lesions. Erosive lichen planus is a rare form of lichen planus characterized by painful oral ulcers, and often associated with ulcers in the genital area. Erosive lichen planus is considered a pre-malignant condition. The objective of this paper is to report a case of Erosive lichen planus (vulvovaginal gingival syndrome) in a 67-year-old female with oral and genital lesions; to highlight the nature of a severe variant of lichen planus, its clinical presentation and management.

Case report: A 67-year-old female presented with a one- year history of recurrent mouth ulcers. This was associated with itchy cutaneous lesions around the navel and genital region. Patient had been placed on steroid therapy alongside antibiotics by general practitioners. This gave her temporary relief. Intra-oral examination revealed wide spread erosions and erythema, worse on both buccal mucosae and the tongue. Some areas were covered with pseudomembrane which could not be scrapped off. There was also marked desquamative gingivitis. An impression of Erosive lichen planus-vulvovaginal gingival syndrome, was made based on a history and clinical assessment and patient was commenced on prednisolone 50mg daily, dapsone 50mg 12hourly, and dexamethasone oral rinse 12hourly. Subsequent reviews showed healing oral and cutaneous lesions. Patient is currently on maintenance dose of prednisolone 10mg, dapsone 100mg daily, and oral steroid rinse.

Conclusion: This study reports a case of Erosive lichen planus ‘vulvovaginal- gingival syndrome’ in an elderly female, with refractory oral and genital ulcers. Early and accurate diagnosis with appropriate treatment is very important for alleviation of symptoms and improvement of patient’s wellbeing.

The Diagnostic Dilemma and Prognostic Implications of Orofacial Granulomatous Diseases (OGD)

Jovana I. EHIZONAGA — 2023-07-03

Background: Orofacial granulomatous diseases (OGD) are heterogeneous group of disorders characterized by granulomatous type of chronic reaction. Its multifactorial causes and indistinct presentations may pose diagnostic challenge with great implications on the treatment outcome.

Objective: This study aimed to evaluate the prevalence, diagnostic challenges and its implications of the orofacial granulomatous diseases seen in a tertiary hospital.

Methods: A retrospective study of all histopathologically diagnosed granulomatous diseases of the orofacial region over 30 years period (January 1990 – September 2022). The data were retrieved from the archive of the Department of Oral Pathology and Medicine and were analyzed.

Results: A total of 12 cases were diagnosed histopathologically as orofacial granulomatous diseases within the study period. The mean age was 27.3 ± 9.9years with peak age group at 2nd decade of life (n=5, 41.7%). There were 7(58.3%) males and 5(41.7%) females with male to female ratio 1.4:1. The mid-facial region (n=9, 75%) was the commonest site of occurrence. Prior to biopsy, these 12 cases had clinical diagnosis of chronic granulomatous lesions (n=2, 16.7%), carcinoma of the maxillary antrum (n=1, 8.3%), ameloblastoma (n=1, 8.3 %), lymphoma (n=1, 8.3%), necrotizing fasciitis (n=1, 8.3%) and 6 cases (50.0%) had no clinical diagnosis. Only 3 (25%) cases did ancillary investigations and had definitive diagnosis; one case each of actinomycosis (n=1, 8.3%), aspergillosis (n=1, 8.3%) and (n=1, 8.3) deep mycoses. There was a case of Wegener’s granulomatosis (n=1, 8.3%) as the definitive diagnosis based on histopathology only.

Conclusion: The diagnostic challenge associated with OGD is due to arrays of possible aetiological factors and non-specific presentations. Hence, detailed history, prompt histopathological diagnosis with ancillary investigations is necessary for positively impact prognosis.

Prevalence of Self Perceived/Reported Halitosis and Oral Hygiene Practices Among Resident Doctors in Tertiary Hospital in South-South, Nigeria

Jennifer J. ONAGAUMAH — 2023-07-03

Objective: The aims of this study were to assess the prevalence of self-reported halitosis, oral hygiene practices and related diseases among Resident doctors in University of Benin Teaching Hospital.

Methods: Ninety-four self-administered structured questionnaires were used to investigate self-perception of halitosis and oral hygiene practices among a group of Resident doctors in UBTH. Chi square test was used to detect significant differences between frequencies and to test correlation between self-perception of halitosis and measures of oral hygiene.

Results: 60.4% of the participants were males and 39.6% were females. Self-perception of halitosis was reported by 34.6%. Halitosis was reported with the highest frequency (79.1%) during wake-up time. Halitosis was perceived by only 6% during the hand on mouth test.

Conclusion: The prevalence of self-perceived halitosis among the volunteers in this study was within the range of other studies. Knowledge and practices of appropriate methods of oral hygiene care was lower among non-dental medical practitioners.

Patients’ self- use of mobile phone camera to capture extraction socket: a proposal as distant clinical patient follow-up after exodontia in this COVID era

Ifueko Patience OSAGHAE — 2023-07-03

Introduction: Exodontia is one of the most common procedures carried out by the oral surgeon and post- surgical follow-up is important in the management of patients who undergo exodontia. The outbreak of COVID 19 has necessitated preventive measures which include social distancing and reduction in interpersonal contacts, especially when carrying out dental procedures that usually require close proximity to patients.

Objective: To describe the possibility of using self-taken photographs of extraction socket as a means of assessing post extraction outcome

Methods: This involves the patients taking a photograph of the extraction socket with their phone and sending the photos through WhatsApp to the surgeon. The posterior teeth were chosen because of the possible challenge posed by their location in the oral cavity.

Patients were coached on how to seat and position their camera phones. Scores were given to each wall of the extraction socket with 30% allotted to the floor of the socket and 20% for the other walls of the socket; the total value for the 5 walls of the extraction socket came to 110% in the Likert rating.

Outcome: To access the feasibility of such photos replacing the clinical presence of the patients during follow-up for monitoring of extraction sockets.

Results: Twenty (20) photographs were expected but 16 (80%) photos were received. Three (19%) of the photos were not acceptable due to difficulty in socket identification. These three photos were ranked in the VAS as 0 and 1. One of the photos was assigned 0 because it was off target. Thirteen (81%) of them captured the walls of the extraction socket to varying degrees of satisfaction. The result of the scores ranged from 0-110% in the Likert rating. Specifically, one patient scored 110%; 4: 80-90%; and 3 scored 0%. Overall, 62.5% were satisfactory.

Conclusion: Distant clinical examination of patients’ extraction socket can be possible through the use of self-taken patients’ photo of extraction socket. The ability of the patients to adequately capture their extraction sockets can be improved by more coaching on proper position and angulation of their phone camera. Other surgeons can use the laid down guidelines to agree or not as to the extent the intended purpose for the photographs were achieved.

Integration of Preventive Oral Healthcare Services into Immunization Services: A model proposal

Clement C. AZODO — 2023-07-03