Ghana Dental JOURNAL

President - Ghana Dental Association

Paapa Puplampu — 2022-07-28

Dear Colleagues,
Warmest greetings and felicitations on the 31st Annual General Congress of our Association. God has been faithful, and I am particularly thankful to Him for preserving our lives during the COVID-19 era. Colleagues, we have come this far because of your commitment to the cause of the Association in delivering good oral health care to the Ghanaian populace, Congratulations!

Awareness of medical emergencies and preparedness of undergraduate clinical dental students in a tertiary institution in Nigeria

Okoh M — 2022-07-28

Background: Medical emergency can be described as an unwanted, unexpected reaction or complication which usually requires
immediate attention or intervention. Aim: This study aims to assess awareness and preparedness for medical emergencies amongst
undergraduate clinical dental students at the University of Benin, Nigeria.
Materials and Methods: A descriptive cross-sectional study involving all clinical dental students in the School of Dentistry,
University of Benin. The questionnaire was divided into three main sections: Socio-demographic characteristics of the respondents; Selfassessed medical emergency preparedness among the respondents; Self-evaluation of knowledge of specific medical procedures about medical emergencies.
Results: The age of the respondents ranged from 19 to 31 years, with a mean age of 24.49 ± 3.1 years. A higher proportion of the
respondents were male (47; 72.3%). Seventy-two percent of students adequately assessed the patient’s medical history, but only 40.0%
regularly used medical Pro-forma to obtain the patients' health history. About 41.5% of the students had poor knowledge about medical emergencies, while 43.1% had adequate knowledge. Only 15.4% of the students had good knowledge.
Conclusion : The study showed that only 15.4% of the students had good knowledge of handling medical emergencies, although
69.2% of the dental students specified good emergency preparedness. The findings point to a deficiency in the dental students’ curriculum regarding medical emergencies, which makes them inadequately prepared to handle them. This emphasizes the need for a review of clinical dental students’ curricula to introduce the management of medical emergencies.

A retrospective study on ameloblastoma presentations to Komfo Anokye Teaching Hospital

Karim D. A — 2022-07-28

Introduction: Ameloblastoma is the second most common benign odontogenic tumor, and only odontoma outnumbers it in reported frequency of occurrence.
Aim: This study reviewed all ameloblastoma cases reported to the Oral and Maxillofacial Surgery Department of Komfo Anokye Teaching Hospital from 2016 to 2018.
Methodology : This was a retrospective descriptive study involving reviewing medical records of all Ameloblastoma cases diagnosed
within the study period at the Oral and Maxillofacial Surgery Department of KATH. A data collection sheet was used for data collection that covered patients’ demographics, location of the lesion, radiographic presentation, histological report, and treatment.
Results : Thirty-four (34) diagnosed cases of ameloblastoma were recorded within the study period, giving an average of eleven cases
(11.3) annually. The mean age of patients was 32.0 years with a male: female ratio of 1:1. All the cases reviewed were located within the
mandible, with none in the maxilla. Twenty-four (70.6%) of them were found in the body of the mandible. Multilocular radiolucency is the joint radiographic presentation (24, 71%). Plexiform was the common histological variant (12, 35.3%). Thirty-two (32, 91.2%) patients were treated by resection with wide margins. There was no incidence of recurrence recorded.
Conclusions: The results of this study indicate that Ameloblastoma cases in Ghana have similar clinicopathological presentations as
commonly reported in the literature.

Clinicopathologic study of 30 fibrous dysplasia of the jaws in Enugu, Nigeria

Okwuosa C. U — 2022-07-28

BACKGROUND: Fibrous dysplasia (FD) is a genetic-based benign fibro-osseous lesion known to affect the jaws and craniofacial bones. Reports of this entity in Eastern Nigeria are scarce.
OBJECTIVE: To determine the prevalence and clinicopathologic features of fibrous dysplasia.
MATERIALS AND METHODS: A total of 643 clinicopathological records (radiographs, clinical records, and histopathological records)
collected between January 2012 and December 2019 were available. The demographic and clinicopathologic records of bone and
maxillofacial pathologies were examined and correlated with histological findings to determine the prevalence of FD.
RESULTS: A total of 643 orofacial lesions of bone lesions were reviewed. In these, 86 benign fibro-osseous lesions (BFOLs) were
identified, of which 30 (34.9%) were FDs. The majority of the BFOLs was ossifying fibromas (OFs). The patients with FD were in the 2nd to 3rd decades of life with a mean age of 19.4 ± 7.9 years.
The male to female ratio was 1: 2.8, while the mandible to maxilla ratio was 1: 4.3. There was a statistically significant prevalence of FD on the right-sided jaw, P = 0.000.
CONCLUSION: This study observed a low prevalence of FD of the jaws, mostly observed in young patients, affecting the right side.

Root canal filling removal during endodontic retreatment - A survey of Ghanaian dentists

Ampofo P.C — 2022-07-28

Background: Endodontic treatment aims to thoroughly clean and shape the root canal system to rid it of any infected pulpal tissue or
bacteria and to provide a three-dimensional hermetic seal to the root canal system to prevent re-infection. Despite the high rates of success of endodontic treatment, failures do occur, and these may be attributed to the persistence of bacteria in the root canal system, lack of a hermetic seal during obturation, inadequate condensation of gutta-percha, inadequate cleaning and shaping of the canal, coronal leakage or the presence of unidentified accessory canals.
For successful endodontic retreatment to occur, all traces of the root filling material (gutta-percha and the sealant) must be removed from the canal walls to enable access to the apical third of the root canal system to be regained. Removal of gutta-percha can be carried out by thermal, laser, chemical, and mechanical techniques or a combination of the above.
General Aim: To determine which instruments and solvents Ghanaian dentists use to remove gutta-percha during endodontic
retreatment.
Metholodology : A cross-sectional study was done by giving out a structured questionnaire at a Continuous Professional Development
(CPD) event held for dentists. Simple descriptive statistics were used together with Chi-square (χ2) and one-way Analysis of Variance (ANOVA) tests. The chosen level of significance was set at p < 0.05. Unanswered questions were treated as missing values.
Results: A total of 64 dental practitioners were surveyed in this study. 32 out of 63(50.8%) respondents performed 2-4 root canal
treatments (RCTs) per week, and 49 out of 62(79.0%) performed 0-1% of re-RCTs per week. 59 out of 62(95.2%) practitioners used hand
files during root canal treatment. 44 out of 57(77.2 %) practitioners used hand files in combination with solvents, Gates Glidden burs, and barbed broaches during endodontic retreatment. Eucalyptol was the most used solvent during endodontic retreatment, accounting for 31 out of 39(79.5%) positive responses by practitioners.
Conclusion : Most Ghanaian dentists use hand files (K-files-54.3%) with solvents (Eucalyptol-79.5%) in the removal of gutta-percha
during endodontic retreatment.

Use of telephone reminder system to improve review attendance of patients with cleft lip and palate

Ogunmuyiwa S. A — 2022-07-28

Background: This study aimed to evaluate the effectiveness of telephone reminders in reducing non-attendance at early review visits following cleft repair surgery.
Materials and Methods: Comparative interventional study that included 58 adult parents/caregivers who presented their children for cleft repair surgery. Subjects were randomized into two groups; (phone call group or control group). The outcome was whether the patient attended the review clinic or not. A semi-structured questionnaire was used to collect the necessary information.
Results: There was a progressive decline in attendance between the 1st and 3rd review visits, similar for the two groups. At the 4th review visit, the trend of decline was sustained for the control group but reversed for the phone call group, although not statistically significant p=0.292. The overall attendance rate for the control and phone reminder groups were 48.5% and 51.5%, respectively (p=0.469). All the respondents who received phone calls considered phone call reminders helpful.
Conclusion: There was some improvement in clinic attendance with phone reminders at early review appointments after cleft repair surgery. The effect of a phone reminder system for patients attending a cleft review in this study area may be more important for the late review visit periods.

Assessment of the effects of digit sucking habit on the masticatory musculature using motion mode Ultrasonography

Otaren N. J — 2022-07-28

Objective: This study assessed the effect of active digit sucking on muscle thickness and fractional shortening of the masseter, lateral
pterygoid, and temporalis in a population of Nigerian children using motion mode ultrasonography.
Methods: The sample consisted of 100 selected children aged 7-12 years, divided into two equal groups of digit sucking and nonsucking. Participants were matched for age groups and gender. Ultrasonography evaluation (2 D and motion mode) of the masticatory muscles was performed using a linear probe of 7.5 MHz. The muscle thickness at contraction/relaxation and fractional shortening was determined. Independent t-test, Pearson correlation coefficient, and Two-way ANOVA were used for data analysis.
Results : Whilst temporalis and lateral pterygoid muscles demonstrated a significant increase in thickness during relaxation (p<0.0001), a significant reduction in fractional shortening was observed (p<0.0001) in the sucking when compared to the non-sucking group.
Similarly, only the temporalis muscle was significantly reduced during the contraction phase (p<0.01). For masseter mid-belly, both right and left sides in digit sucking subjects showed a significant increase in the thickness at contraction. At the same time, a reduction was observed in fractional shortening (p<0.05). Males and females with digit habit showed significantly greater muscle thickness in temporalis and lateral pterygoid during contraction and relaxation phases, whereas a reduction was observed in fractional shortening. Significant associations were observed between the frequency of sucking and muscle thickness in masseter and temporalis in fractional shortening (p<0.05).
Conclusion : Our findings corroborate the assumption that persistent digit sucking in children can affect the morphology and function of the masticatory muscles.

Clinical evaluation of the functional performance of organically modified ceramics (ormocers), nanohybrid, and microhybrid composite in permanent posterior teeth restorations.

Omokhua H. A — 2022-07-28

Background : In recent times, resin-based direct composite restorations have become a routine and well-established dental practice,
meeting the demands for aesthetics and minimally invasive restorative care. The use of resin-based composite resin for defects in
posterior teeth is on the rise. A good knowledge of adhesives, composite resins, and polymerization kinetics is required to effectively use composite in patient care.
Objective : To compare the functional clinical performance of an ormocer and a nanohybrid to that of a traditional microhybrid composite in posterior teeth restorations.
Material and Methods : Patients with at least three carious lesions which required replacement (Class Ι and/or Class ΙΙ), each with an
opposing tooth, were enrolled in this study. A total of 105 restorations were placed, 35 for each. The materials used for this study included an ormocer-based composite, a nanohybrid resin composite, and a micro-hybrid resin composite. One operator placed all the restorations according to the manufacturers’ instructions. Each restoration is finished and polished immediately after placement. The patient returned for follow-up evaluation at one(1 )month, three (3 )months,six6 months, and 12 months. Two independent examiners calibrated with the web-based training called e-calib performed the evaluation using the FDI Criteria.
Results : A total of 105 resin composite restorations, 35 restorations for each of the study materials, were placed in 35 subjects, with a
female to male ratio of 4.8:1. The subject recall rate was 100%. All ormocer, nanohybrid, and micro-hybrid resin composites restorations recorded 100% clinically excellent scores from baseline to 3 months for all parameters. Most of the study materials showed a decrease from 100% clinically excellent scores, with a few recordings clinically good at 12 months. At least one restoration of each material experienced a deterioration of the parameters, fracture, retention of materials, and proximal anatomic form.
The functional clinical performance of ormocer admira (voco), Tetric EvoCeram (Ivoclar Vivadent), a Nanohybrid, and tetric Ceram
(Excite), a micro-hybrid were satisfactory in the restorations of carious posterior permanent teeth. The majority of the restorations maintained clinically excellent scores from 1 month to 12 months. There was, however, no record of scores 3, 4, or 5 by any of the test materials throughout the study.
Conclusion : The functional clinical performance of ormocer admira (voco), Tetric EvoCeram (Ivoclar Vivadent), a Nanohybrid, and
tetric Ceram (Excite) micro-hybrid were satisfactory in the restorations of posterior permanent teeth restorations.

The pattern of mandibular resections in a Nigerian tertiary hospital: a 10-year experience

Ekaniyere B. E — 2022-07-28

Background : Previous reports have shown that conservative resection is mostly performed in developed countries, where patients
report early for treatment, unlike in developing countries.
Aim: To describe the pattern of surgical resections of the mandible at a tertiary health facility in Southern Nigeria.
Materials and Method : A retrospective study was designed to study the pattern and document the patients that had surgical
resections of the mandible from January 2005 to July 2020 at the Department of Oral and Maxillofacial Surgery of a tertiary hospital in
Nigeria. Collected data were age, gender, level of education, place of residence, occupation, tobacco use, and alcohol consumption. Other data collected were the type of lesions, type of resections performed, type of reconstruction, and treatment complications. Crosstabulations were performed with Pearson's chi-square test. All statistics were performed with SPSS version 21(IBM corps, Armonk, New York, US). A P-value of less than 0.05 was considered significant.
Results : The data of 189 patients were collected. The age range was 15-70 years, with a mean age and standard deviation of 44.7±14.9
years. More males (63.5%) than females (36.5%). Disarticulation prevalence, segmental and marginal resections were 64.0%, 27.5%,
and 8.50%, respectively. One hundred and seventy-six cases (79.4%) had no complications, 8(4.20%) had wound dehiscence, 2(1.00%)
with surgical site infection, and plate exposure in 3(1.60%) cases.
Conclusion : The prevalence of mandibular resection was high, with the vast majority being disarticulation resection. Disarticulation
resection was significantly common among alcoholics and patients that had odontogenic keratocyst.Prevalence, mandible, resection, surgery, Nigeria

Case report: The oral health status of siblings with suspected ichthyosis in a peri-urban community of the Central Region of Ghana.

Dsane M — 2022-07-28

Ichthyosis is a dermatological condition characterized by the presence of dry, scaly skin that sometimes resembles fish scales. The
condition may be present at birth, in childhood, or later. Diagnosis is based on clinical features and sometimes on histological features.
Management involves a multidisciplinary approach. No cure is currently available. It has an adverse effect on health-related quality of life with a positive correlation with the severity of the disease.
There is a need for awareness and the establishment of treatment protocols to manage individuals with this condition. This is a case report of two adult siblings with the condition but at different phases.

case report: A rare case of herpes zoster with trigeminal and vestibulocochlear nerves involvement

OSAGHAE I. P — 2022-07-28

Background :The distinguishing characteristic of Herpes Zoster (shingles) is its limitation to a single dermatome. The involvement of
more than one dermatome is unusual, while the involvement of more than one spinal nerve is a rare find. The case presented is a 70 year old woman with herpes zoster of two cranial nerves: the trigeminal and the vestibulocochlear; the three divisions of the trigeminal nerve were also involved.
Methods: A 70-year-old woman who complained of a week old history of blisters on the face and mouth and three (3) weeks history of toothache on the left side is presented. The patient also complained of ringing, pain in the left ear, and rotational dizziness. She admitted that she was treated for malaria fever a week before the onset of these symptoms. On examination, there were ulcers involving the skin of the left side of the face up to the left auricle and the scalp. The left maxillary and mandibular mucous membrane and left side of the tongue also had ulcers. There was no facial muscle weakness.
Laboratory investigation included Full Blood Count, fasting blood sugar (FBS), and retroviral screening (RVS). The FBS was within normal limits, while RVS was non-reactive. Treatment was with oral prednisone -dosage tapered-; antibiotics, and diazepam.
Results: Healed erosions were observed on the 3rd week of treatment.
Conclusion: Multiple dermatome distribution of vesicular rash due to more than one spinal nerve involvement is an uncommon finding
in herpes zoster. Early diagnosis and prompt treatment can result in complete resolution.

Recognition

PETER DONKOR — 2022-07-28

RECOGNITION

Editorial 2022

Patrick Caldicock Ampofo — 2022-07-28

INCLUSION OF MEDICAL EMERGENCIES SYLLABUS IN OUR DENTAL SCHOOL CURRICULUM

The prevention, diagnosis, and management of medical emergencies are of utmost importance in the practice of dentistry. Dental students and dental surgeons must be well trained and prepared to manage all possible medical emergencies in their daily professional practices. The team must be competent and confident in handling the initial basic emergency treatment with quality.
Proper management of life-threatening medical emergencies may lead to the prevention of possible death and complications. This may also avert the psychological trauma that the healthcare professional may go through and the stigma attached to the hospital or clinic. Besides that, the ethical and legal implications of medical emergencies related to the obligations of the healthcare practitioner cannot be overlooked.

The teaching of medical emergencies in our dental schools starts at the pre-clinical undergraduate level. However, the program is not well structured. Despite the consensus on the importance of training in medical emergencies, several international studies show unsatisfactory results by demonstrating low knowledge and confidence of professionals in managing medical emergencies and first aid. As a result of these international research findings, there has been a paradigm shift in teaching undergraduate students in most developed countries. The fundamental change in the approach now is emphasizing on a more competency-based curriculum and more hands-on teaching. Hence the need for a revision and inclusion of medical emergencies in our curricula in Ghana. We need a comprehensive simulation-based training program for our clinical year dental students. There is a tendency for some dental schools to concentrate on theoretical training while not paying attention to the practical aspect.
Creating an emergency medicine department or unit solely responsible for teaching both the theoretical and practical aspects of the program can help us achieve a more structured curriculum. The governing body responsible for accrediting tertiary institutions in Ghana (GTEC) should make it mandatory to have a well-structured medical emergency course included in our curriculum. Besides that, all stakeholders should agree on a minimum number of credit hours.