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Biomedical subjects

S W Guthua

Publications and source records attributed to S W Guthua.

At least 19 recordsLinked to original sources
PubMed2006

Oral hygiene practices and risk of oral leukoplakia.

OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. RECOMMENDATIONS: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Adolescent↗
PubMed2005

Post-operative re-construction of dentoalveolar tissue and the mandible and maxillae using prosthetic therapy.

OBJECTIVE: To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.

Adolescent↗
PubMed2002

Maxillofacial injuries caused by terrorist bomb attack in Nairobi, Kenya.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Adolescent↗
PubMed2002

Extra-abdominal fibromatosis invading the mandible: case report.

Extra-abdominal fibromatosis (desmoid tumour) is a rare aggressive neoplasm with a tendency to infiltrate local structures but rarely metastasises or undergoes spontaneous malignant transformation. The treatment of choice is surgery, however, recurrences have been reported even after wide-field resection. This article presents a case of extra-abdominal fibromatosis that had extensively invaded the mandible.

Adult↗
PubMed2002

Multiple supernumerary teeth in association with malocclusion: report of two cases.

Although multiple supernumerary teeth without any associated syndromes are rare, their occurrence can create a variety of clinical problems such as derangement of the occlusion, prevention of eruption of permanent teeth, damage to adjacent teeth, cystic degeneration and root resorption. Hence, clinical and radiographic evaluation of patients should always be thorough in order to detect their presence. Furthermore, because the clinical management of multiple supernumerary teeth poses a great challenge to clinicians, timely, appropriate consultation and interdisciplinary approach to treatment is extremely important. We report two cases, a 14 year-old boy with eight and a 13-year-old girl with seven supernumerary teeth not associated with syndromes. In the boy, the teeth were bilaterally distributed in all quadrants in the premolar regions, and in the girl they were distributed bilaterally in the premolar regions in the mandible and bilaterally distal to the upper third molars. The clinical implications and management are discussed.

Adolescent↗
PubMed2001

Symptoms in health personnel exposed to disinfectants.

BACKGROUND: While the biocidal efficacy of disinfectants available for use in health facilities has been widely investigated, little attention has been paid to their potential side effects to users. OBJECTIVE: To describe the occurrence of symptoms attributable to occupational exposure to disinfectants with emphasis on gluteraldehyde. DESIGN: Exploratory cross-sectional study. SETTING: Kenyan health facilities. SUBJECTS: One hundred and fifteen members of various health cadres. RESULTS: All the respondents reported using disinfectants. Glutaraldehyde-based preparations, either alone or alongside other agents (excluding hypochlorite), were used by 52.2% of the respondents. Hypochlorite-based preparations, either alone or alongside other agents, were used by 18.3%, while cetrimide preparations and ethanol alongside other agents were used by 13% of the respondents. More than sixty two per cent of the respondents had suffered one or more symptoms during the use of these disinfectants. Among the users of glutaraldehyde preparations, the most common symptoms reported were sneezing (38.3%), headache (31.7%), watering of eyes (25%), skin rash (10%) and chronic cough (8.3%). Among users of hypochlorite and cetrimide preparations, the most commonly reported symptoms were sneezing, headaches and watering of eyes. CONCLUSIONS: Our findings suggest possible occupation-related adverse reactions that may be attributed to the use of disinfectants. Awareness of these potential hazards needs to be increased among users and efforts made to introduce techniques to minimise exposure to liquid and vapourised disinfectants. Further studies involving larger sample sizes, are necessary to unequivocally apportion the various symptoms to specific disinfecting agents.

Cross-Sectional Studies↗
PubMed2001

Influence of cigarette filters on the risk of developing oral leukoplakia in a Kenyan population.

OBJECTIVE: To determine the influence of cigarette filters and the effect of smoking Kiraiku (home processed, hand rolled tobacco) on the risk of developing oral leukoplakia among cigarette smokers. DESIGN: Case control using population-based study groups in a Kenyan rural community. MATERIALS AND METHODS: 85 cases and 141 controls identified in a cross-section house-to-house screening of subjects aged 15 years and over and matched for sex, age (+/- 3 years) and cluster origin were compared for their use of filter and non-filter cigarettes as well as their history of smoking Kiraiku. RESULTS: The relative risk (RR) of oral leukoplakia was 9.1 (95% confidence intervals (CI) = 4.1-20.2) in smokers of filter cigarettes and 9.8 (95% CI = 2.3-47.0) in smokers of non-filter cigarettes. The RR in the latter compared to the former was 1.1 and was not statistically significant. Regarding the influence of smoking Kiraiku, the RR of this lesion was 29.3 in smokers of both Kiraiku and filter cigarettes and 17.3 in smokers of both Kiraiku and non-filter cigarettes. CONCLUSIONS: There was no statistically significant difference between the influence of filter and non-filter cigarettes on the risk of developing oral leukoplakia. The effect of Kiraiku on the risk of this lesion was stronger in filter than in non-filter cigarettes. However, the confounding effect of tobacco dose response parameters could not be ruled out.

Adolescent↗
PubMed2000

Pierre Robin Syndrome: case report.

A case of a female neonate with Pierre Robin Syndrome with frequent cyanotic episodes and feeding difficulties which could not be adequately managed by positioning and oral airway placement is presented. Tongue-anterior mandible fusion procedure was performed with satisfactory results.

Female↗
PubMed1998

Osteosarcoma of the maxillofacial bones in Kenyans.

Osteosarcoma (OS) is a highly malignant tumour and is the most common primary neoplasm of bone; although rare, especially in the maxillofacial skeleton. This article presents 14 Kenyan cases of OS of the maxillofacial bones seen between January 1991 and July 1997: 11 in the mandible, two in the maxilla and one in the right zygomatic arch. Patients ranged in age from one week to 50 years (Mean = 29.7), with an equal gender distribution. While pain and rapid swelling were the commonest clinical features, the radiographic and histopathological characteristics were as varied as has been described elsewhere. Generally, effective management of most of the cases was poor due to late presentation for treatment.

Adolescent↗
PubMed1996

A human MSX1 homeodomain missense mutation causes selective tooth agenesis.

We demonstrate that a mutation in the homeobox gene, MSX1, causes a common developmental anomaly, familial tooth agenesis. Genetic linkage analyses in a family with autosomal dominant agenesis of second premolars and third molars identified a locus on chromosome 4p, where the MSX1 gene resides. Sequence analyses demonstrated an Arg31Pro missense mutation in the homeodomain of MSX1 in all affected family members. Arg 31 is a highly conserved homeodomain residue that interacts with the ribose phosphate backbone of target DNA. We propose that the Arg31 Pro mutatrion comprises MSX1 interactions, and suggest that MSX1 functions are critical for normal development of specific human teeth.

Alleles↗
PubMed1995

The association between oral leukoplakia and use of tobacco, alcohol and khat based on relative risks assessment in Kenya.

A case-control study was conducted to determine the significance of tobacco, alcohol and khat (Catha edulis) chewing habits in the development of oral leukoplakia among Kenyans aged 15 yr and over. In a house-to-house survey, 85 cases and 141 controls matched for sex, age and cluster origin was identified and compared for these risk factors. Smoking unprocessed tobacco (Kiraiku) with a relative risk (RR) of 10.0 (95% confidence interval (CI) = 2.9-38.4) and smoking cigarettes (RR = 8.4; 95% CI = 4.1-17.4) were the most significant factors. While the RR associated with smoking cigarettes alone was 4.5 (95% CI = 1.9-10.8), smoking of both products (RR = 15.2) suggested probable synergy or additive effects. Oral leukoplakia in 18 cases could not be attributed to smoking tobacco. Commercial beer, wines and spirits were relatively weak, but statistically significant, risk factors. Traditional beer, khat and chilies were not significantly associated with oral leukoplakia.

Adolescent↗
PubMed1995

Management of post-traumatic temporomandibular joint ankylosis in children: case report.

Temporomandibular joint (TMJ) ankylosis is a distressing affliction that denies the victim the benefit of normal diet, careers that require normal speech and causes severe facial disfigurement that aggravates psychological stress. Opinions in current literature portray controversy in its management. Hurried clinicians take shortcuts and partially treat symptoms and often make the condition worse. Others ignore shortcomings and erroneously prescribe their preferred techniques as absolute indication to the peril of the affected children. Gap arthroplasty if applied in a growing maxillofacial skeleton as in children, causes iatrogenic arrest of facial growth. The intended correction of facial disfigurement is therefore not achieved. Early detection and immediate psychological support by excision and reconstruction of ankylosed TMJ with a costochondral graft, improves patient comfort and rehabilitation when used as a planned part of a comprehensive therapy. This paper questions prior varied opinions and discusses scientific baseline considerations in management of long standing TMJ ankylosis in children in relatively affordable circumstances.

Ankylosis↗
PubMed1995

Orofacial lesions as indicators of HIV/AIDS among dental patients in Kenya.

Despite an estimated prevalence of 3-5% of HIV infection in Kenya, little has been reported on the occurrence of oral lesions amongst the afflicted individuals. We report ten cases who presented with orofacial lesions and subsequent serological evaluation confirmed them seropositive. In the light of the numerous problems facing clinical staff in less developed countries, these findings underscore the significance of clinical identification of more probable HIV patients on the basis of orofacial signs. Continuing education with respect to HIV infection through wider dissemination of information on orofacial signs to clinical staff especially in the context of invasive care and containment of infection are recommended.

Adult↗
PubMed1995

Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia.

The prevalence of oral leukoplakia and related lesions in a Kenyan rural population was determined in a systematic house to house survey of individuals aged 15 years and above. Among the 803 individuals examined, the following prevalence of lesions was observed: leukoedema (26%), melanosis (12.7%), leukoplakia (10.6%), palatal keratosis (6.4%), frictional keratosis (5.5%), pre-leukoplakia (4.1%), borderline leukoplakia (2.4%), cheek/lip biting (1.3%), and snuff dippers lesion (0.4%). 48.6% of the subjects had at least one of these lesions. Statistically significant preponderance was demonstrated for oralleukoplakia, palatalkeratosis, leukoedema and frictional keratosis among males and melanosis among females. With regard to clinical classification of oral leukoplakia, the prevalence was 10% for homogeneous and 0.6% for nonhomogeneous lesions. On the basis of aetiological classification; the prevalence was 8.3% for tobacco associated and 2.2% for idiopathic leukoplakia. 22.5% of leukoplakia lesions biopsied had evidence of epithelial dysplasia. In view of the premalignant potential of oral leukoplakia, our findings suggest a need for greater attention towards prevention and control of this lesion in the study community.

Adolescent↗
PubMed1994

Utilization of dental auxiliaries in private dental surgeries in Kenya.

This study was done to determine the nature of utilization of dental auxiliaries and medical emergencies in private dental surgeries in Kenya. A self administering questionnaire with pre-paid postage was mailed to 138 dentists. 27.5% responded. 81.6% used dental auxiliaries and the main reason was to improve efficiency in managing patients. 93.5% of the auxiliaries were on job trained secondary school graduates. 63.2% of the respondents delegated duties which were mainly non-clinical. 26.3% did not delegate any duties. In a descending order, the reasons for non delegation were: that it would be risky to patients, not allowed by law, they did not find it necessary and that auxiliaries were not held responsible if something went wrong. The main duties delegated to the auxiliaries were cleaning of instruments and sterilization, mixing of restorative materials and preparing amalgam. Delegation was done primarily based on auxiliaries capability to perform the procedure and meet the set standards. 57.9% indicated that they rarely encountered medical emergencies. Syncope was the commonest emergency encountered. 72.7% indicated that auxiliaries could not handle medical emergencies because they were not trained. It is concluded that most dentists did not delegate clinical duties to dental auxiliaries and medical emergencies were rare.

Adult↗
PubMed1994

Alternative technique of constructing bilateral cleft palate in late childhood: a case report and literature review.

Although great advances in treatment of oro-facial clefts have been made over the past 50 years; in developing countries, due to social stigmas and unavailability of specialised medical facilities and personnel to the majority of the population, there is an increasing incidence of patients coming late for repair of oro-facial clefts. This presents a challenge to both plastic, oral surgeons and associated specialists. The aim of the present article is to demonstrate, in the form of a case report, an alternative surgical technique that has be successful in 8 cases for the late repair of severe bilateral cleft palate utilizing locally available and affordable materials. The objective of managing patients with cleft palate in developing countries is to provide the best repair and rehabilitation with as few operations and in-patient care as possible due to limited financial resources experienced by the majority of in-patients. A multidisciplinary approach to the management of oro-facial clefts is emphasised.

Alveolar Process↗