Department of Restorative Dentistry
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Item Assessment of oral health status in a Ghanaian population: rationale, methods, and population characteristics(BMC Oral Health, 2022) Hewlett, S.A.; Blankson, P-K.; Aheto, J.M.K.; Anto, F.; Danso‑Appiah, T.; Sackeyfo, J.; Koram, K.; Amoah, A.G.B.Background: Oral health surveys aid in estimating the oral health of a population and provide a projection for future oral health care needs. We report the procedures and rationale of a survey carried out to assess the oral health status and risk factors for oral disease among adults in the Greater Accra Region (GAR) of Ghana. The objective was to pro vide prevalence estimates on dental diseases, oral health behaviour and risk factors, and to establish baseline epide miological data on the population’s oral health for further research. Methods: This was a population-based cross-sectional study of adults aged 25 years and above. A random, stratified two-stage sampling method was used to select participants from rural and urban communities in three types of districts (Metropolitan, Municipal, Ordinary). A semi- structured questionnaire was used to collect data on socio-demo graphic characteristics, oral health behaviours and risk factors for oral disease. Anthropometric data and a full-mouth clinical examination was carried out including: soft tissue assessment, tooth count, prosthodontic status, dental caries assessment and periodontal assessment. Results: A total of 729 participants were included in the study with a mean age of 43.9 years (SD 14.6). Majority 425 (61.0%) were females. Though the metropolitan districts had more dental clinics and personnel, along with better health insurance coverage, they had a higher prevalence of missing teeth, retained roots, severe periodontitis and poorer oral health coverage. The findings also show some significant differences in disease prevalence, within the different localities and districts. Conclusions: Availability and access to oral health services is not the most important determinant of good oral health outcomes in this region. We recommend exploring socio-behavioral and cultural factors as well. This study provides district level data to inform policy and guide further research.Item Van Der Woude Syndrome: Report of a Case(Ghana Medical Journal, 2005-06) Newman, M.A.; Nartey, N.O.; Nyako, E.A.A rare case of Van Der Woude Syndrome, which is characterized by pits in the lower lip and bilateral cleft of the lip and cleft palate is presented. A multidisciplinary approach to treatment produced an aesthetically pleasing and functional outcome.Item Understanding the causes of breast cancer treatment delays at a teaching hospital in Ghana(Journal of Health Psychology, 2018-11) Sanuade, O.A.; Ayettey, H.; Hewlett, S.; Dedey, F.; Wu, L.; Akingbola, T.; Ogedegbe, G.; De-Graft Aikins, A.Poor outcomes for breast cancer in Ghana have been attributed to late presentation of symptoms at biomedical facilities. This study explored factors accounting for delays in initiation of breast cancer treatment at the Korle-Bu Teaching Hospital in Accra. Focus group discussions were conducted with 20 women with breast cancer. A theory-driven thematic analysis identified three multilevel factors influencing treatment seeking delays: (1) patient (e.g. misinterpretation of symptoms, fear), (2) healthcare provider (e.g. negative attitudes) and (3) health systems (e.g. shortage of medicines). Addressing treatment delays will require multilevel interventions, including culturally congruent education, psychosocial counselling/support and strengthening health systems.Item Bond strength of luting cements to core foundation materials(Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2010-03) Hewlett, S.; Wadenya, R.O.; Mante, F.K.PURPOSE: The purpose was to compare the shear bond strength of luting cements to foundation materials and to determine the effect of storage in lactate buffer solution. MATERIALS AND METHODS: Disks that were 8 mm in diameter and 2-mm thick were fabricated from foundation substrates: amalgam, composite resin, resin-modified glass ionomer, and glass ionomer (n = 20). Cylinders that were 2 mm in diameter and 4 mm in length of resin luting cement, resin-modified glass ionomer luting cement, and a glass ionomer luting cement were bonded to the foundation substrate materials. Shear bond strength of each foundation substrate material/cement pair was determined with a universal testing machine after 24 hours. A second set of specimens was tested after storage in a 0.01M lactate buffer solution for 24 hours. A three-way analysis of variance followed by pair-wise comparisons was performed to compare bond strengths (P < .05). RESULTS: The resin cement provided the highest (P < .05) bond strengths to amalgam, composite resin, and resin-modified glass ionomer foundation materials while the glass ionomer cement showed the lowest bond strength (P < .05) to composite resin and glass ionomer foundation restoration materials. After immersion in a 0.01M lactate buffer solution, the shear bond strength of all the material combinations was significantly lower (P < .05) than nonimmersed specimens, except the bonds between composite resin foundation and resin luting cement, which significantly increased (P < .05) in strength. CONCLUSION: The resin cement had the highest bond strength to most foundation substrates investigated. The highest bond was observed between the composite resin foundation and resin cement. This bond was also the most durable on immersion in lactic acid.Item Prevalence and geographic distribution of edentulism among older Ghanaians(Journal of Public Health Dentistry, 2014-10) Hewlett, S.A.; Calys-Tagoe, B.N.L.; Yawson, A.E.; Dako-Gyeke, P.; Nakua, E.; Folson, G.; Baddo, A.N.; Mensah, G.; Minicuci, N.; Kowal, P.; Biritwum, R.B.Objectives Edentulism has important health implications for aging individuals and is used as an indicator of the oral health of a population. Its distribution is unequal within populations, with the greatest burden on disadvantaged and socially marginalized populations. With an increasing older adult population in Ghana, its burden may increase; however, there is no nationwide information on edentulism in Ghana. Focusing on adults 50 years and older, this study assessed the prevalence of edentulism among older Ghanaians and its distribution across the country. Methods Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Results The overall prevalence was 2.8%, varying by sex (men had lower rates; OR = 0.67, 95% CI = 0.47-0.97); by location, being more prevalent in urban areas (3.6%) and the Western Region (4.7%); by education levels (rates were higher among those with no formal education; OR = 1.626, 95% CI = 1.111-2.380); and by marital status (those living without a partner had higher rates; OR = 1.980, 95% CI =1.366-2.870). On multivariate logistic regression, the variables positively associated with edentulism were older age (OR = 0.945) and urban residence (OR = 0.582). Living in the Brong Ahafo (OR = 3.138), Central (OR = 2.172), Eastern (OR = 2.257), or Volta regions (OR = 3.333) was negatively associated with edentulism. Conclusion Edentulism is unequally distributed across Ghana. Future aged cohorts are likely to follow the same patterns of geographic and social disadvantage if needed interventions are not carried out. This study provides nationwide data to assist service planning. © 2014 American Association of Public Health Dentistry.Item Prevalence of loss of all teeth (Edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa(International Journal of Environmental Research and Public Health, 2014-10) Peltzer, K.; Hewlett, S.; Yawson, A.E.; Moynihan, P.; Preet, R.; Wu, F.; Guo, G.; Arokiasamy, P.; Snodgrass, J.J.; Chatterji, S.; Engelstad, M.E.; Kowal, P.Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%-21.7%) than China, Ghana, and South Africa (3.0%-9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention. © 2014 by the authors; licensee MDPI, Basel, Switzerland.Item Maxillofacial and concomitant injuries in multiple injured patients at Korle Bu Teaching Hospital, Ghana(West African journal of medicine, 2014-05) Parkins, G.; Boamah, M.O.; Avogo, D.; Ndanu, T.; Nuamah, I.K.BACKGROUND: Patients with maxillofacial injuries may sustain concomitant injuries. The presentation of other injuries may be the initial focus of attention of the primary attending surgeon who may miss the maxillofacial injuries to the detriment of the patient.OBJECTIVE: To determine the incidence of injuries associated with maxillofacial injuries at Korle Bu Teaching Hospital (KBTH) from January 2009 to December 2010.METHODS: A prospective study was carried out on patients who were referred to the Maxillofacial Unit of the University of Ghana Dental School and KBTH over the two years with maxillofacial injuries. Their age, sex, type of injury in the maxillofacial region, its aetiology and concomitant injuries were charted. The data was analysed using SPSS 16.0 software.RESULTS: Two hundred and fifty eight (258) patients were seen of which 67 (26.0%) had concomitant injuries. The average age was 29.1 years. The peak incidence was in the age group 21-30 (N=73, 28.3%). 74% were male and 26.0% female. The commonest cause of injury was road traffic accident (RTA) (N=142;55.0%). 52.7% (N=136) of the patients had injuries of the maxillofacial region. 26.7% (N=69) had mandibular fractures, 19.4% (N=50) had middle third fractures and 8.1% (N=21) had fractures of both. Concomitant injuries were mainly orthopaedic (N=31;12%) and the head and spinal region (N=29;11.2%).CONCLUSION: A significant number of patients who suffer maxillofacial injuries also sustain injuries of other parts of the body at KBTH. Prompt multidisciplinary management may contribute to improved outcomes.Item Edentulism and quality of life among older Ghanaian adults(BMC Oral Health, 2015-04) Hewlett, S.A.; Yawson, A.E.; Calys-Tagoe, B.N.L.; Naidoo, N.; Martey, P.; Chatterji, S.; Kowal, P.; Mensah, G.; Minicuci, N.; Biritwum, R.B.Background: Edentulism affects the quality of life and general health of an individual. But in ageing individuals, it has been observed to have greater impact, manifesting in functional, psychological and social limitations. With an increasing older adult population in Ghana, its burden is likely to increase. This study was thus carried out to explore the association between edentulism and quality of life among older Ghanaian adults. Methods: Secondary analysis of WHO's Study on global AGEing and adult health (SAGE) Wave 1 in Ghana was conducted using self-reported edentulism as the dependent variable. Participants included a nationally representative sample of adult's aged 50 years and older living in Ghana. Quality of life was measured using the 8 item WHOQOL measure and a single item measure which was a question "How would you rate your overall quality of life?". To assess the association between edentulism and the independent variables, a bivariate analysis was carried out. A Poisson regression model was then performed, adjusting for age, sex, income, education and the diagnosis of a chronic disease condition. A Spearman's correlation analysis was also carried out between the single and multi item measure of quality of life to assess how well they correlate. Results: Edentulism was observed to be associated with significantly lower levels of SWB among older adults using both the single-item and multiple-item measure (WHOQOL). It, however, showed no association with happiness. Among edentulous respondents, females and those with no formal education reported significantly lower quality of life. The WHOQOL correlated positively and strongly with the single-item measure. Conclusion: Edentulism may not be life threatening and yet it has been shown to have a negative effect on the quality of life of older adult Ghanaians. More emphasis may thus need to be placed on the oral health of the aging population in Ghana to avoid it. © Hewlett et al.; licensee BioMed Central.Item Interactions of extracts from selected chewing stick sources with Aggregatibacter actinomycetemcomitans(2012-04-26) Kwamin, F.; Gref, R.; Haubek, D.; Johansson, A.AbstractBackgroundAggregatibacter actinomycetemcomitans produces a leukotoxin that activates a pro-inflammatory death of human monocytes/macrophages. A specific clone of this bacterium (JP2) has a 530-base pair deletion in the leukotoxin promoter gene and significantly enhanced expression of leukotoxin. This specific clone of A. actinomycetemcomitans is common in some African populations and has a strong association with periodontal attachment loss in adolescents in these populations. Chewing sticks of plant origin are commonly used as oral hygiene tool in Africa, but their role as a therapeutic agent in periodontal disease is poorly investigated.ResultsEthanol extracts were made from 7 common plants used as chewing sticks in West-Africa. None of the tested extracts inhibited growth of A. actinomycetemcomitans. However, extracts from Psidium guajava (Guava) completely neutralized the cell death and pro-inflammatory response of human leukocytes induced by the leukotoxin. None of the six other tested chewing stick extracts showed this effect.ConclusionsThe discovery that extracts from Guava efficiently neutralizes A. actinomycetemcomitans leukotoxicity might lead to novel therapeutic agents and strategies for prevention and treatment of aggressive forms of periodontitis induced by infections with the highly leukotoxic JP2 clone of this bacterium.Item Focal epithelial hyperplasia: report of six cases from Ghana, West Africa.(Journal of Clinical Pediatric Dentistry, 2002-09-01) Nartey, N.O.; Newman, M.A.; Nyako, E.A.Focal epithelial hyperplasia is a proliferative growth of the oral mucosa with distinct clinical and histopathological features. Although focal epithelial hyperplasia is frequently reported in children of American Indian and Eskimo descent, it is rarely seen in Africans. This report presents six new cases of focal epithelial hyperplasia observed in African children. The age of the patients ranged from 4 to 12 years, and all except one were females. Clinical variants, the papillary and the papular types were noted in the same patient. There was spontaneous regression of focal epithelial hyperplasia in four patients during the study period. However, the lesions still persist in two patients three years after the initial presentation.