| dc.description.abstract | The objectives of this study were: to determine the prevalence of acute necrotizing
gingivitis ( ANG), its characteristic clinical features and whether it varies seasonally;
to assess oral hygiene and nutritional status of ANG patients; to detect potential
cases of psychiatric morbidity among children with ANG; to compare the
effectiveness of treating ANG patients with (a) amoxycillin capsules (250 mg) or
suspension (5 ml), given 8 hourly for 7 days only, with (b) amoxycillin capsules (250
mg) or suspension (5 rnl), given 8 hourly for 7 days and scaling after the acute
symptoms have subsided, and to establish the extent to which failure to do scaling
contributes to the recurrence of ANG.
1,152 children were randomly selected from 15,219 children in Nairobi Primary
Schools. Besides, 650 children from schools which had pre-unit classes were
also examined and investigated thoroughly. They were assessed for the
following:- their oral hygiene status, nutritional status and potential cases of
psychiatric morbidity. Seasonal variation was determined from the records of
53,572 patients who were seen in the Dental Unit of Kenyatta National Hospital
(KNH) from 1992 to 1993. Children with ANG were randomly assigned to either
of the following treatment modalities:- (a) amoxycillin capsules (250 mg) or
suspension (5 ml), given 8 hourly for 7 days, and (b) amoxycillin capsules
(250 mg) or suspension (5 ml), given 8 hourly tor 7,days and scaling on the
second day after the acute symptoms had subsided. They were then reviewed at
intervals. To deteCf'differences in the cure rates between the two treatment
modalities, the proportions cured and their confidence intervals in each of the
groups were calculated.
Of the 1,802 school children, only one (0.06%) had ANG. The commonest signs
and symptoms of ANG in this and the other 34 ANG cases referred from KNH,
were: gingival bleeding (97.1 %), interdental craters (97.1 %), halitosis (94.3%)
and pain (88.6%). 88.6% were below 11 years. 14.3% were preceded by
malaria and 11.4% by common cold. 60.9% of the interdental papillae were not
involved. 0.9% of the papillae had associated sequestration of the alveolar
process and teeth. The mean body temperature was 36.920C. Analysis of
combined mean debris scores and calculus index scores showed that only 34.4%
of the patients had poor oral hygiene. 58.4% had normal weight for height Zscores.
44.1% had normal height for age Z-scores. 69.7% were potential cases
of psychiatric morbidity. Only 14.3% had recurrent histories of ANG. Neither of
the treatment modalities emerged significantly better than the other.
Of the 53,572 patients treated at KNH, 0.15% had ANG. 32.9% were between 21
and 40 years. 72% were seen in March and April and between September and
December. Their commonest complaints were: pain (73.2%), gingival bleeding
(42.7%), swelling of the cheek or gums (25.6%) and bad breath (20.7%). The
commonest clinical features were gingival ulceration (61.9%), poor oral hygiene
(47.6%), interdental craters (39.7%) and submandibular lymphadenitis (34.9%).
It is concluded that ANG affected children and adults; its prevalence was very low;
it was not invariably associated with poor oral hygiene; its main clinical features
were: gingival bleeding, interdental craters, halitosis and pain; there was no
difference between treating ANG with (a) antimicrobials alone and (b) treating it
with antimicrobials and scaling after the acute symptoms had subsided.
It is recommended that treatment of ANG wifh antimicrobials alone be accepted
as a standard treatment. Where possible, scaling or improved oral hygiene are
recommended as additional steps aimed at reducing the oral burden of microorganisms
involved in ANG. | en |
