Epidemiological And Clinical Studies Of Acute Necrotizing Gingivitis In Nairobi, Kenya
Thuranira, Jacob Kaimenyi
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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.