Khartoum Teaching Dental Hospital Research Articles

Temporomandibular Joint Ankylosis Pattern, Causes and Management among a Sample of Sudanese Children

Background: Temporomandibular joint ankylosis is the fusion of mandibular condyle to the glenoid fossa, which causes distressing conditions. It may be due to trauma or infection. The aim of this study is to determine the frequency of TMJ Ankylosis in Khartoum teaching dental hospital among children. Materials and methods: A retrospective cross sectional study for 48 patients (32 male, 16 female) aged 0-18 years old. Data were collected from patients records registered from January 2009 to April 2015. Results: Males were more affected than females, the most affected age group was 7-12 years old, bilateral ankylosis more common than unilateral, intra capsular ankylosis is the most common type, and micrognathia is the most common deformity. 41 patients received treatment, coronoidectomy with condylectomy and physiotherapy is the most preferable treatment method. Also Condylectomy + Gap arthroplasty + Physiotherapy and Gap arthroplasty + Coronoidectomy + Physiotherapy were used. In some cases physiotherapy overcome the ankylosis, and only 7 patients didn’t receive any type of treatment. Conclusion: The prevalence of TMJ ankylosis among children was high; the most common causes were trauma and infection, whereas most of patients came with intracapsular type ankylosis in children leads to facial deformities. Improvement of awareness regarding condyle fracture is required.

Clinical Profile of Lymphatic Malformation from One Oral and Maxillofacial Center in Sudan

Background: Lymphatic malformations are developmental defects of the lymphatic system. They are frequently present at birth and are most commonly found in the head and neck regions. The aim of the study was to investigate the clinical presentation of head and neck Lymphatic malformations in relation to, age, gender, color and site of distribution. Methods: This is a retrospective descriptive study, where the record of the patient diagnosed as lymphatic malformation at the Department of Oral and Maxillofacial Surgery at Khartoum Teaching Dental Hospital, during the period of 2005 to 2008 where retrieved and analysed. Result: A cervicofacial lymphatic malformation was found more common in females than in males with a ratio of 11:9. The mean age was 14 ± 10 years, with lip and tongue being the most common sites, followed by the buccal mucosa in the intraoral site and neck in the posterior triangle was the most common site for extraoral site (30%). It was found that the bluish color was the commonest presenting color in oral lymphangioma followed by red pink color. Conclusion: Females are more affected than males, while infants and children were more affected than other age groups. The bulks of the patients were presented with soft swelling, blue to normal colour in the lip, neck and in the tongue. Further prospective studies are needed to evaluate the clinic picture and treatment outcome.

Prevalence of Preoperative Anemia in Patients Admitted At Khartoum Teaching Dental Hospital

Objective: The aim of this study was to evaluate preoperative anemia in patients undergoing oral and maxillofacial surgery under general anesthesia. Material and methods: A prospective cross sectional hospital-based study was carried at Khartoum Teaching Dental Hospital. Five hundred and twenty three patients were included in the study, 324were males and 199 were females. Patients’ age was ranging from 6 months to 84 years. Children formed 34.6% of the patients. Cleft lip and palate constituted the largest number of the patients (173). There were 70 oral cancer patients, 126 trauma patients and 154 patients with benign lesions. Anemia was defined according to the WHO criteria as hemoglobin concentration (Hb) less than 13 g/dl for males, less than 12 g/dl for females while Children were diagnosed based on their age. Variables related to hemoglobin level, age, gender and related diseases were analyzed. Test of significance (P< 0.05) was applied using SPSS version 20. Results: Preoperative investigations revealed a high prevalence of anemia in patients constituting 48.2% for men, 45% for females and 47% for children. Severe anemia was found in 4.5% of children and 1.4% of males. The mean hemoglobin level for males was 12.8 ± 2.1 g/dl, for females was 12.1± 4 . 1 and for children was11.4±1.6. One way analysis of variance revealed a significant difference in the mean of hemoglobin between patients with different diseases (P-value=0.001). Conclusion: The findings of this study indicated that anemia is a common finding among patients undergoing oral and maxillofacial surgery and most of the time it was discovered during the preoperative investigation for surgery preparation.

Clinical relevance of the utilization of vital Lugol's iodine staining in detection and diagnosis of oral cancer and dysplasia.

The aim of this study is to assess the clinical relevance of the utilization of vital Lugol's iodine staining in detection of oral cancer and dysplastic lesions as well as demarcation of the extent of these lesions. A prospective, cross-sectional, hospital-based study was performed in Khartoum Teaching Dental Hospital, Sudan. Suspicious oral epithelial lesions indicating incisional biopsy were stained with 10% Lugol's iodine solution and were clinically designated as "negative" for dysplasia or neoplasia when no unstained lesion (USL) area was observed, or as "positive" when a USL area is observed. Incisional biopsies involving both the unstained portion and the stained portion were obtained and histologically evaluated for definitive diagnosis. Forty-five biopsies were obtained from 28 patients. Histopathological examination of the specimens confirmed some degree of dysplasia or neoplasia in all clinically positive specimens with oral squamous cell carcinoma (OSCC) being the most common definitive diagnosis (17 patients, 60.7%). Clinical relevance level of vital Lugol's iodine staining in detecting oral cancer and dysplasia was found to be 90.9% (SE=0.05, P=0.05). The findings of this study showed that Lugol's iodine is an easy, safe, and effective method of visualizing oral epithelial lesions and differentiating epithelial carcinoma and dysplasia from other benign mucosal lesions. Despite certain limitations, its use is of great value in detection and diagnosis of oral cancer and dysplasia. Lugol's iodine staining can effectively be used in detection of the dysplastic and malignant superficial lesions of the oral epithelium.

Maxillofacial fractures among Sudanese children at Khartoum Dental Teaching Hospital

BackgroundMaxillofacial fractures in children are less frequent compared to adults but result in special complications affecting the growth, function and esthetics.AimThe study aimed at assessing the characteristics and the pattern of facial fractures among children seen at Khartoum Teaching Dental Hospital (KTDH).MethodThe study included 390 patients presenting with maxillofacial trauma at KTDH during a year period (2010–2011).ResultsA total of 390 patients, diagnosed with facial fractures, were seen at KTDH; 14.1 % (55) were children below 16 years of age with the mean age of 10 years (SD ± 3.9). The ratio of males to females was 2.2:1. Most fractures were due to road traffic accidents (RTA) 56.4 %, followed by daily living activities 21.8 % and assault 16.4 %. The most prevalent anatomic sites of fractures were mandible 77 %; combination fractures i.e. more than one site 32.7 % and zygomatic-complex (13.5 %). Concomitant injuries were found in 9.1 %. Almost half of the patients were managed conservatively 49.1 %, closed reduction 34.5 % and surgical open reduction 16.4 %.ConclusionsThe findings of this study indicated that pediatric facial fractures constitute 14.1 % of the total number of facial fractures. RTA was the main cause, which should be considered in legislative and preventive strategies.

Determinants of first dental visit in a group of Sudanese children: A dental hospital based study

Objectives: To assess the characteristics of the first dental visit in terms of age, chief complaint(s), treatment needed and anxiety level in a group of Sudanese children attending Pediatric Dental Clinics at Khartoum Teaching Dental Hospital (KTDH) & University of Khartoum (U of K). Methods: The study is a descriptive, cross-sectional, dental-hospital based study which was conducted in order assess the determinants of the first dental visit in terms of age, chief complaint(s), treatment needed and anxiety level in a group of Sudanese children. A representative sample of 215 Children who attended the Pediatric Dental Clinics at Khartoum Teaching Dental Hospital& University of Khartoum was targeted. Data were collected prospectively between February to May 2010. A written questionnaire was completed by direct interview of the parents/or caregivers, followed by clinical examination for the chief complaint(s), during which the child’s behavior was rated using the Frankl Behavior Rating Scale (FBRS). Radiographs; periapical views and DPTs, were taken whenever needed to confirm diagnosis of the chief complaint and to determine the treatment needed accordingly. The various chief complaints were categorized as follows, Orientation and prevention, Dental caries, Deposits / bad breath, Trauma, Pain/ sensitivity, Malocclusion, Missing/extra tooth, Soft tissue lesions, Swelling, Discoloration and Others. When dental caries was the chief complaint, it was further combined with other parameters (pain and/or swelling) to clarify its extent as follows; ‘dental caries (without pain or swelling), ‘dental caries with pain’, ‘dental caries with swelling’ and ‘dental caries with pain and swelling’. Results: the median age for the first visit was found to be 7.08 years. Most common chief complaint for the visit was dental caries (74.42 %), of which dental caries and pain constituted the majority (44.65 %). Most of the children expressed Frankl level 3 (positive) during the clinical examination (57.21%). Extraction was found to be the treatment needed for almost half of the children at their first dental visit (46.98%). Conclusion: Sudanese children are brought very late to the pediatric dental clinics for the first time complaining mainly of caries and pain which necessitates invasive dental procedures (mostly extraction). The behavior rating during examination was found to be mostly Frankl 3. Keywords: Age, first dental visit, Frankl behavior rating scale, treatment needed, chief complaint, dental caries, behavior rating .

Bimaxillary protrusion in a Sudanese sample: A cephalometric study of skeletal, dental and soft-tissue features and treatment considerations

Introduction: Bimaxillary protrusion (BP) is a condition that results in the convexity of the face and lip incompetence. There are two forms of BP, a dentoalveolar type and a skeletal type each requiring a different treatment plan. Aims: The aims of this study were to cephalometrically determine the skeletal, dental and soft-tissue features of a sample of Sudanese adults with BP to establish the origin, growth pattern, and presence of gender dimorphism. Design: Descriptive, retrospective study. Setting: Orthodontic Clinics in University of Khartoum, Khartoum Dental Teaching Hospital and University of Science and Technology. Materials and Methods: Pretreatment lateral cephalometric radiographs of 60 patients (30 males and 30 females) with BP (mean age 25.4 ± 6 years) were collected and manually traced. Twenty-two variables were assessed and compared to Sudanese norms ( n = 73) which included (35 males and 38 females) of similar age (22.5 ± 3 years) using Student t -test and one sample t -test. Results: The sample revealed significantly smaller SNA, SNB angles and increased incisor protrusion and lip thickness than Sudanese norms ( P P Conclusion: It can be concluded that facial convexity in Sudanese patients with class 1 molars is a result of bimaxillary dentoalveolar protrusion and increased lip thickness. The patients also revealed a vertical growth pattern with males and females demonstrating similar cephalometric profiles. Treatment of such patient entails extraction of all first premolars with maximum anchorage.

Assessment of the Knowledge of Dental Surgeon about Halitosis from Two Dental Teaching Hospitals in Khartoum City

The present study is a descriptive cross-sectional study that was conducted to assess the level of knowledge about halitosis among dental surgeons in Khartoum city. One hundred and six dental surgeons were randomly selected from two dental teaching hospitals: Khartoum Dental Teaching Hospital and Ribat Teaching Hospital in Khartoum city. A fully structured, close ended questionnaire was used. Data collected was assembled and analyzed using the SPSS statistical software. Most of the respondents were general practitioners. The knowledge about the causes and diagnosis of halitosis was generally poor (81%). The awareness about the treatment was generally moderate (37%) and good (38%).No association was found between gender and the level of knowledge about halitosis (p>0.05).A significant association was noted between the level of qualification or the years of clinical experience and the knowledge about the causes and diagnosis of halitosis (p<0.05). The study revealed that dentists lack adequate knowledge regarding causes and diagnosis of halitosis especially for those with lesser years of clinical experience. An increase in knowledge levels could be achieved by emphasizing on this subject during professional training.

Knowledge, Attitude and Acceptance of Dental Implants among Patients Attending Khartoum Dental Teaching Hospital

Background: Replacement of lost teeth with dental implants is considered as a positive experience by patients. Dental implants are widely accepted as a prosthetic treatment of completely or partially edentulous patients. The objective of this study was to assess the level of knowledge, attitude and acceptance of Sudanese dental patients regarding dental implant as a treatment modality for replacing missing teeth. ` Subjects and Methods: Descriptive cross sectional hospital based study among 384 adult males and females’ patients attended outpatient dental clinics in Khartoum dental teaching hospital in period from 1 st April to 1 st May 2013. Eligible participants were selected by convenience sampling technique. Questionnaire was used to assess their knowledge, attitude and acceptance of Dental implant as treatment option for replacement of missing teeth. Associated factors; gender, socioeconomic status, level of education, sources of information about implants was assessed using chi square test with P value ˂ 0.05. Results: The important of replacing missing teeth was revealed by 74% of the Participants, 68.5% were aware about dental implant as treatment option regarding replacing missing teeth, Of the total participants; 56.8% didn't know how dental implant lasts, more than half (53.1%) did not know the place where the implant inserted. Majority (79.4%) could accept their dentist advice for replacement of missing teeth by implant, but 29.1% said expensiveness was main barrier against this option. Knowledge about dental implant is significantly associated with level of education (P = 0.00) Conclusion:

HIV/AIDS-related attitudes and oral impacts on daily performances: a cross-sectional study of Sudanese adult dental patients

BackgroundFew studies have investigated the relationships between HIV-related knowledge, fear of contagion in dental environments and Oral Impacts on Daily Performance (OIDP) among dental patients. Our objectives were to investigate the associations between HIV-related knowledge and fear of contagion in dental environments and OIDP among dental patients, and to evaluate whether those associations were modified by the frequency of dental service attendance.MethodsA total of 1262 patients (mean age 30.7 years, 56.5% females) were recruited from the Khartoum Dental Teaching Hospital and the University of Science and Technology during March–July 2008. The participants underwent a full-mouth oral clinical examination and completed an interview in a face-to-face setting.ResultsOf the study participants, 41.4% had visited a dentist at least twice during the last 2 years, 96.2% had caries experience (DT > 0) and 79.1% reported oral impacts (OIDP > 0). The most frequently reported oral impacts were problems eating, sleeping and cleaning teeth. In total, 26.3% of the participants had HIV transmission knowledge, 75.6% knew people with HIV/AIDS and 58.7% perceived a high risk of cross-infection in dental environments. After adjusting for sociodemographic characteristics, frequency of dental service attendance and caries experience, patients who had high HIV-related information exposure, a positive attitude toward people with HIV/AIDS and a high perceived risk of cross-infection were more likely to report oral impacts, whereas patients who knew people with HIV/AIDS were less likely to report oral impacts. The association between OIDP and HIV transmission knowledge was modified by frequency of dental service attendance.ConclusionsDental patients who were informed about HIV and had a high HIV/AIDS risk perception were more likely to report impaired oral health-related quality of life than their less informed counterparts and those who perceived a low risk of contagion. The effect of HIV transmission knowledge on oral impacts was influenced by frequency of dental service attendance.

Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan

BackgroundHIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (socio-demographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors.MethodsDental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview.ResultsA total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8).ConclusionDisparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.

Sudan case of the day: diprosopus‐duplicated oral cavity

AbstractThe presence of an accessory or a duplicated mouth and mandible is extremely rare. The authors reported a case of a 19‐year‐old female patient with a duplicated oral cavity and mandibular dentition, presented to Khartoum Teaching Dental Hospital, Sudan. The clinical and radiological findings were described together with the surgical technique. To the best of our knowledge, this is the second adult case with an isolated duplicated oral cavity and mandible in the medical literature, but the first one fully illustrated with clinical images and radiographs.