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In Press
Kemoli AM. "Dilemma of managing multi-surface dental caries in the primary dentition using the atraumatic restorative treatment: renaissance or dimming hope." East Afr Med J . In Press. Abstract

Background: Alot of research work has been carried out to determine the effectiveness of using atraumatic restorative treatment (ART) in the management of dental caries, but there are still unresolved issues surrounding the use of the technique particularly in very large carious lesions.
Objective: To determine the current survival rates of multi-surface ARTrestorations placed in the primary dentition and any consequences to the restored tooth after premature loss of the restoration.
Study selection: Using a set of specific key words, a Pubmed/Medline search was carried out to retrieve all publications on ARTrestorations placed in primary teeth in the period January 2000 to December 2011. Only publications whose studies had multi-surface ARTrestorations as an item of study were retrieved and relevant data extracted.
Data synthesis: Twelve studies contained in 12 publications fulfilled the selection criteria and were included in the study. The selected publications were analysed by the author to establish the study follow-up period and the survival rate of the multi-surface ARTrestorations for the different follow-up periods. Further information was adduced on any other effects of restoration on the tooth after premature loss of the restoration.
Results: The search findings indicated that the survival rate for most of the multi-surface restorations were generally very low. Further, there were indications that even after the premature loss of the ARTrestorations, most of the affected teeth survived for the period of the study with a number of them having shown no signs of secondary caries or associated dental abscessees.
Conclusion: While the survival rates of multi-surface ARTrestorations in the studies documenetd in the review were low, the ART restorations appeared to provide some beneficial effects to the retention-longevity of the restored tooth even after their premature loss.

2014
2013
AM K. "Global disparity in childhood dental caries: is there a remedy? ." East Afr Med J, . 2013;90(1):: 1-6.
2012
Kemoli AM. "ART-an alternative approach to the management of dental caries.". In: KDA Annual Conference. Panafric Hotel, Nairobi; 2012. Abstract

Introduction
Dental caries is a world-wide disease, having its aetiological factors involving cariogenic bacteria, saliva composition and flow-rate, exposure to fluoride, tooth integrity and dietary habits. The treatment of dental caries is two prong. First, through a surgical model, entailing the removal of carious materials from a dental cavity and sealing it with an appropriate dental restorative material. Second, a medical model which comprises the reduction of the risk to dental caries and controlling the carious process through a remineralization process.

Atraumatic restorative treatment (ART)
Atraumatic restorative treatment (ART) utilises only hand instruments for its application. This is one dental caries treatment method that incorporates certain facets of the two caries treatment models described above. ART is a simple clinical method that can be performed by any dental personnel with a reasonable clinical background knowledge on the management of dental caries. Once a tooth has been selected that needs to be treated using the ART approach, the operator isolates the tooth with cotton wool rolls. If necessary, the cavity entrance is widened using a hatchet or hoe, before removing the carious materials with an excavator. The cavity is rinsed and dried using wet or dry cotton pellets respectively. The dentine is conditioned with appropriate conditioner for 15 seconds.

After mixing the glass ionomer following the manufacturer's instructions, the mixture is inserted into the cavity using an applier or carver, overfilling it, so that by use of a gloved finger rubbed with petroleum jelly, the material is pressed into the prepared cavity and fissures (press finger technique). After 5 minutes, the excess material is removed with the carver and the occlusion checked. A thin layer of petroleum jelly is applied over the restoration to protect the restoration from moisture contamination, before discharging the patient with the instructions not to chew any food within the first one hour.

Materials used with ART
The preferred material for use with the ART technique is high viscosity glass ionomer cement (GIC). This glass ionomer cements have been developed specifically for use with the ART technique. Like the other glass ionomer cements, this material is self curing, adheres to the tooth tissues, has good marginal adaptation, fluoride releasing properties, reasonably good aesthetics and biocompatible with the oral tissues.what is of importance here is that the high viscosity GCs, though still possess lower material strength, their strength is much higher than the ordinary GICs. However, That is why they still posses same some pertinent shortcomings that include the poor physical strength, water sensitive, long setting reaction, low wear resistance, low compressive and tensile strength.

Advantages and Shortcoming of ART technique
ART is a simple technique to learn and apply and does not need sophisticated dental equipment. For this reason, ART approach can be applied in the field environment, even where there is no electricity or piped water systems. However, the technique has also got its own shortcomings that include hand fatigue, poor strength of the GIC material used with the technique, poor aesthetics due to discolouration of GIC, poor attitude by some dentists who consider the technique to be of low calibre.

Success rate of ART restorations
For periods ranging up to three years, the ART restorations have been reported to have success rates of 85% or higher for occlusal restorations, but of about 49% and lower for proximal restorations. This success rate is obviously dependent on the operator experience, the caries removal from the cavity, the effectiveness of the isolation method used, the size of the cavity, the post-restoration meal consumed by the patient soon after the placement of the restoration, the cooperation of the patient during the procedure and afterwards and the type of material used for the restoration.

Future of the ART technique
ART is not a compromise treatment but an alternative treatment method that is simple and practical for the prevention of dental caries, particularly, for developing nations with scarce resources. It is a technique that is less costly than the conventional methods. ART should be able to form part of a total oral health care for promotion and prevention of dental caries, potentially in children, fearful adults and the handicapped persons, especially in restoring class I and V cavities or as interim restoration in some other cases.

Damle SG. Text Book of Paediatric Dentistry. New Dehli: Arya (Med) Publishing House; 2012.
SG D. "Text Book of Paediatric Dentistry4th Edition, New Dehli, 2012, (Contribution to of chapter 28).". In: Text Book of Paediatric Dentistry. New Dehli: Arya (Med) Publishing House,; 2012.
2011
Developmental Defects of Enamel  . Nairobi: University of Nairobi; 2011.
A. K. . Developmental Defects of Enamel.. Saarbrucken,: LAP Lambert Academic Publishing GmbH & Co, Saarbrucken,; 2011.
Ober-Oluoch JA, Kemoli A, Masiga, Dimba E. "Dental Caries and Periodontal health of Children with Cerebral Palsy.". 2011;2(1).
Kemoli AM, van Amerongen WE. "The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART) approach." Community Dent Health J. 2011;28(1):12-16. Abstract

Objective: To determine the examiner’s accuracy in selecting proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART)
approach.
Basic research design: Intervention study.
Clinical setting and participants: A total of 804 six to eight year-olds from 30 rural
schools in Kenya participated in the study.
Intervention: Three examiners selected a total of 1,560 suitable proximal carious
lesions in the primary molars after examining 6,002 children from 30 schools randomly
selected out of 142 schools in two divisions. Seven operators randomly paired on a daily
basis to eight assistants restored the lesions. An explanation was provided for any cavity
that was not restored. Pre-and post-operative radiographs of the cavities were also taken
for evaluation.
Main outcome measures: The examiner’s choice of suitable proximal cavities
restorable using the ART approach was related to the decision made to either restore or
not to restore. The radiographic findings of the selected cavities were also compared to
the decision made by the examiner. The results obtained were used to determine the
examiner’s accuracy in selecting suitable proximal cavities for restoration using the ART approach.
Results: The majority of the subjects were excluded due to absenteeism, pulpalexposure or anxiety during the operative stage. Only 804 children received one restoration in their primary molars. The examiner’s accuracy in selecting suitable ART restorable cavities was 79.9% based on clinical parameters. The examiners’ judgment that the cavities had not progressed into the pulp was 94.9% based on preoperative radiographic analysis and based on postoperative radiographic analysis, 91.7% that the pulp would not be involved after treatment.
Conclusions: A trained and diligent examiner has a very good chance of selecting
proximal carious lesions restorable using the ART approach, without the threat of dental
pulpal-involvement during the excavation of caries.

Kemoli AM, van Amerongen WE. "Effects of oral hygiene, residual caries and cervical marginal-gaps on the survival of proximal atraumatic restorative treatment approach restorations." Contemporary Clin Dent. 2011;2(4):318-323. Abstract

Aim: To investigate the effects of oral hygiene, residual caries and cervical marginalgaps on the survival rate of proximal restorations placed in primary molars using the atraumatic restorative treatment (ART) approach.
Materials and methods: A total of 804 children participated in the study. They had
their dental plaque levels assessed at baseline and after two years by trained examiners.
Each of the children also had one proximal carious lesion in a primary molar restored by
trained operators and their assistants using the ART approach, 3 brands of glass ionomer
cements and 2 tooth-isolation methods. The restorations were clinically evaluated soon
after placement and after 2 years. Post-operative bite-wing radiographs were also taken
immediately after restoring the teeth and evaluated. The data collected were analyzed
using SPSS version 14.
Results: The cumulative survival of the restorations decreased from 94.4% soon after
placement to 30.8% after 2 years. The plaque index changed from 2.34 (SD 0.46) at
baseline to 1.92 (SD 2.1) after 2 years. Higher plaque indices were associated with
higher restoration failure. Only 507 bite-wing radiographs out of the possible 804 of the restored teeth were of good quality for the study. A total of 48 (9.5%) restorations had residual caries, 63 (12.4%) cervical marginal gaps and 9 (1.8%) both residual caries and cervical marginal gaps related to them. The survival rate of the restorations with both residual caries and cervical marginal gaps was significantly lower (Chi-square, p= 0.003) when related to the restorations that did not have any.
Conclusions: Low survival rate of proximal restorations in the study was associated with the presence of cervical marginal restoration gaps.

A. K. Survival rate of proximal ART restorations. Germany: LAP Lambert Academic Publishing GmbH & Co, Saarbrucken; 2011.
A. K. Survival rate of proximal ART restorations. Germany: LAP Lambert Academic Publishing GmbH & Co, Saarbrucken; 2011.
Kemoli AM, Opinya GN, van Amerongen WE, Mwalili S. "Two-year survival rates of proximal atraumatic restoration treatment restorations in relation to glass ionomer cement and post restoration meals consumed." J Paediatr Dent. 2011;33(3):546-551. Abstract

Purpose: The purpose of this study was to investigate the influence of 3 glass ionomer cement (GIC) brands and the postrestoration meal consumed on the survival rate of proximal atraumatic restorative treatment (ART) restorations.
Methods: A total of 804 proximal restorations were placed in primary molars by trained operators and assistants using 3 GIC brands. The materials’ mixing/placement times, the room temperature and the postrestoration meal consumed by the subjects were documented. The restorations were evaluated soon after placement and after 2 years by trained and calibrated evaluators.
Results: After 2 years, approximately 31% of the restorations had survived. There were no statistically significant differences in the survival rate of the restorations in relation to the GIC brands. The postrestoration meal consumed, which was of “hard consistency,” was associated with significantly lower survival rate of the restorations.
Conclusions: The survival rate of the proximal restorations was not significantly affected by the glass ionomer cement brands used, but was significantly influenced by the consistency of the next meal consumed by each child.

Key words: cariolo gy, dental material s/biomaterial s, dental education

2010
Boon CJPM, Visser NL, Kemoli AM, van Amerongen WE. "ART class II restoration loss in primary molars: re-restoration or not." Eur Arch Paediatr Dent. 2010;11(5):228-231. Abstract

AIM: The purpose of this study was to find an answer as to what to do with Atraumatic restorations (ART) failures:
re-restore or leave the preparation further unfilled?
STUDY DESIGN: Cross sectional study.
METHODS: In 2006 of 804 children in Kenya each had one proximal cavity treated using the ART approach. Out of the original group 192 children, who had lost their restorations but still had the treated molars in situ, were selected for further study in 2008. The length of time that the restorations had been in situ was known while the colour, hardness and the extent of infected dentine was then evaluated and documented. STATISTICS: Analysis of the data obtained was conducted using SPSS 16.0. Chi Square tests were performed with the variables of hardness, colour and infected dentine, and a 5% confidence interval was used. The Spearman’s Rank Correlation Coefficient was also calculated.
RESULTS: The results showed that 66% of the molars that had lost restorations had hard dentine, 78% of the preparations showed dark dentine and 50.7% appeared to have no infected dentine. These percentages increased with the increase in the survival time of the restorations.
CONCLUSIONS: It is not always necessary to re-restore primary molars after ART restoration loss. Further research is necessary to confirm these findings.

Njoroge N, Kemoli AM. "The prevalence of ECC among 3 to 5 year-olds in Kiambaa division, Kenya." E Afr Med J. 2010;87(3):134-137. Abstract

Objective: To determine the prevalence and pattern of early childhood caries among three to five year-olds.
Design: This was a descriptive, cross-section study.
Subjects: A total of 336 children ages 3-5 years.
Setting: Pre-schoos in Kiambaa division, Kiambu district, Kenya.
Results: Slighjtly over a half, 201 (59.5%9 had dental caries. The mean decayed, missing and filled teeth (dmft) was 2.46±3.3 with the greatest component (95%) being decayed teeth. The mandibular deciduous molars and the maxillary incisors were the most frequently carious teeth.
Conclusions: The prevalence of early childhood caries in Kiambaa was 59.5%. The mandibular deciduous molars and maxillary incisors had the highest caries frequency.

Kemoli AM, van Amerongen WE, Opinya GN. "Short communication: Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years.". 2010. Abstract

This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. METHODS: The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach. During restorations 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were used by the operators. The restorations were then followed for a period of 2 years. STATISTICS: SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used. RESULTS: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. CONCLUSION: Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

Kemoli AM, Opinya GN, van Amerongen WE. "Two-year survival of glassionomer sealants placed as part of proximal ART restorations." E Afr Med J. 2010;87(9):375-381. Abstract

Objectives: To evaluate after 2 years, the survival rate of glass ionomer cement (GIC)
sealants placed in primary molars of 6-8 year-olds and as part of proximal ART
restoration.
Study design: A longitudinal clinical study.
Setting: Matungulu/Kangundo rural divisions, Machakos district.
Participants: A total of 804 six to eight year-olds from rural Kenya received sealants as
part of proximal restorations placed in primary molars using the atraumatic restorative
treatment (ART) approach. Trained operators, using the ART approach, placed the
proximal restorations and the sealants using Fuji IX, Ketac Molar Easymix and Ketac
Molar Aplicap, together with rubber dam and cotton roll tooth-isolation methods.
Evaluation to determine the survival of the sealants was done soon after placement
(within 2 hours of placing them) and after 2 years. The data were analyzed using SPSS
14.0 computer programme, and the survival results related to the materials and the
isolation-methods used.
Results: The 2-year cumulative survival of the sealants was 10.9%, and the survival of
the sealants was not significantly affected by the GIC material brand and the toothisolation method used. However, slightly more sealants survived when Fuji IX and rubber dam tooth-isolation method were used.
Conclusion: The two-year survival rate of the sealants was poor and was not
significantly influenced by the GIC material or the tooth-isolation method used.

2009
Wagaiyu EG, Ng’ang’a RN, Kemoli AM. "Hereditary gingival fibromatosis: report of family case series." E Afr Med J. 2009;66(10):491-493. Abstract

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic, dense fibrous connective tissue with acanthotic gingival epithelium. A family presented at the School of Dental Sciences, University of Nairobi with a complaint that some of the children developed swollen gums very early in life and that this got worse with eruption of the permanent teeth. The first born, a 23- year- old male, had had the swellings for over ten years. Other siblings aged 5,9 and 12 years were also affected. The swellings had affected the appearance, speech and the psychosocial wellbeing of the children. The parents were unaffected with apparently negative family histories. Following oral examination and appropriate investigations, conventional gingivectomy was performed of the maxillary and the mandibular gingivae for the siblings: the 23 -12- and the nine- year olds. The fourth affected child, a five- year- old, was still in primary dentition and had just started showing mild signs of gingival hyperplasia. The histopathological examination of the specimens from the present cases confirmed features consistent with those of HGF. This article highlights a familial presentation of HGF.

Kemoli AM, van Amerongen WE. "Influence of the cavity-size on the survival rate of proximal ART restorations in primary molars." Inter J Paediatr Dent. 2009;19:423-430. Abstract

Aim: The objective of the study was to determine the influence of the experience of the
operator and the assistant on the survival rate of proximal ART-restorations after 2 years
when placed using two methods of tooth-isolation and three glass ionomer cementbrands.
Study design: A clinical intervention study.
Methods: Each of the 804 children aged 6 to 8 years received one proximal restoration
in their primary molars. The restorations were placed by ‘experienced/inexperienced’
operators randomly paired with ‘experienced/inexperienced’ assistants. They used
atraumatic restorative treatment (ART) approach, 3 brands of glass ionomer cements
(GIC) and 2 tooth-isolation methods (rubber dam and cotton rolls) to restore the
cavities. Trained and calibrated evaluators evaluated the restorations, soon after
placement and after two years.
Statistics: The data collected were analyzed using SPSS 14.0, to determine and relate
the survival rate of the restorations to the operator and assistant with respect to the
other factors such as the restorative material used and the isolation method applied.
Results: After 2 years, the survival rate of the restorations was 30.8%. In general, there
were no statistical significant differences in the survival rate of the restorations made by
the ‘experienced’ vs ‘inexperienced’ operators, but individually, the operator with more
experience was associated with significantly higher survival rate of the restorations. The
‘experienced’ assistants were associated with significantly higher survival rates of the
restorations. The most ‘experienced’ operator paired with any ‘experienced’ assistant and using rubber dam tooth-isolation method, was associated with a significantly higher
survival rate of the restorations.
Conclusions: The combination of the ‘experienced’ operator and assistant using rubber
dam tooth-isolation method had the best chance of survival for proximal ART
restorations, irrespective of the material-brand used.

Kemoli, AM; van Amerongen WE; OGN. "Influence of the experience of operator and assistant on the survival rate of proximal ART restorations: two-year results.". 2009. Abstract

AIM: The objective of the study was to determine the influence of the experience of the operator and the assistant on the survival rate of proximal ART-restorations after 2 years when placed using two methods of tooth-isolation and three glass ionomer cement-brands. STUDY DESIGN: A clinical intervention study. METHODS: Each of 804 children aged 6–8 years received one proximal restoration in their primary molars. The restorations were placed by ‘experienced/inexperienced’ operators randomly paired with ‘experienced/ inexperienced’ assistants. The atraumatic restorative treatment (ART) approach was used with 3 brands of glass ionomer cements (GIC) and 2 tooth-isolation methods (rubber dam vs cotton rolls). Trained and calibrated evaluators evaluated the restorations, soon after placement and after 2 years. STSTISTICS: The data collected were analyzed using SPSS 14.0, to determine and relate the survival rate of the restorations to the operator and assistant with respect to the other factors such as the restorative material used and the isolation method applied. RESULTS: After 2 years, the survival rate of the restorations was 30.8%. In general, there were no statistical significant differences in the survival rate of the restorations made by the ‘experienced’ vs ‘inexperienced’ operators, but individually, the operator with more experience was associated with a significantly higher survival rate of the restorations. The experienced assistants were associated with significantly higher survival rates of the restorations. The most ‘experienced’ operator paired with any ‘experienced’ assistant and using rubber dam tooth-isolation method, was associated with a significantly higher survival rate of the restorations. CONCLUSION: The combination of the ‘experienced’ operator and assistant using rubber dam tooth-isolation method had the best chance of survival for proximal ART restorations, irrespective of the material-brand used

2008
Kemoli AM, van Amerongen WE, Opinya GN. ". Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years." Eur Arch Paediatr Dent. 2008;11(3):132-135. Abstract

Aim: This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars.
Methods: The study was conducted in two rural divisions in Kenya, with 7 operators
randomly paired to a group of 8 assistants. A total of 804 children had each one proximal cavity in a primary molar restored using the ART approach. During the restoration 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were randomly used by the operators. The restorations were then followed for a period of 2 years.
Statistics: SPSS 14.0 was used to analyze and relate the data obtained to the method of
isolation used.
Results: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator.
Conclusions: Generally the survival rate of the proximal restorations in the present
study was very low, but the use of rubber dam resulted in a higher survival rate of the
restorations.

Kemoli AM. "Prevalence of Molar Incisor Hypomineralization in six to eight year-olds 11in two rural divisions in Kenya." E. Afr Med J . 2008;85 (10 ):514-519. Abstract

Objective: To determine the prevalence of molar incisor hypomineralization (MIH) and any associated causes of MIH in children from two rural divisions in Kenya.
Design: Prospective cross-sectional study.
Setting: Seventeen primary schools in Matungulu and Kangundo divisions of Machakos district in Kenya.
Subjects: All six to eight year-olds in the seventeen primary schools.
Results: A total of 3,591 children (55.6% males and 44.4% females) were examined for MIH. All the children were from a low socio-economic community with little access to proper medical/dental health care. The prevalence of MIH was 13.73%, with a female to male ratio of 3:1.
Conclusion: The prevalence of MIH of 13.73% was high in the study population and was probably associated with the poor health conditions that the children went through during the most venerable period of between birth and age three years.

Kemoli AM. "Prevalence of Molar Incisor Hypomineralization in six to eight year-olds in two rural divisions in Kenya." E Afr Med J. 2008;85 (10):514-519. Abstract

Objective: To determine the prevalence of molar incisor hypomineralization (MIH) and any associated causes of MIH in children from two rural divisions in Kenya.
Design: Prospective cross-sectional study.
Setting: Seventeen primary schools in Matungulu and Kangundo divisions of Machakos district in Kenya.
Subjects: All six to eight year-olds in the seventeen primary schools.
Results: A total of 3,591 children (55.6% males and 44.4% females) were examined for MIH. All the children were from a low socio-economic community with little access to proper medical/dental health care. The prevalence of MIH was 13.73%, with a female to male ratio of 3:1.
Conclusion: The prevalence of MIH of 13.73% was high in the study population and was probably associated with the poor health conditions that the children went through during the most venerable period of between birth and age three years.

2007
Rwakatema DS, Ng’ang’a P, Kemoli AM. "Orthodontic treatment needs amongst 12-15 year-olds in Moshi, Tanzania." E Afr Med J. 2007;84:226-232. Abstract

Objective: To assess malocclusion and orthodontic treatment needs among 12-15-year-olds in Moshi municipality, Tanzania.
Design: A cross-sectional study.
Setting: Moshi municipality, Tanzania.
Subjects: Two hundred and eighty nine randomly selected primary school children in Moshi municipality in the year 2003.
Results: Maxillary median diastema occurred in 20.1% of the children. Crowding and spacing in the incisor segments occurred in 41.2% and 28.4% respectively with significantly more crowding in males than in females (p = 0.009). Anterior irregularities occurred in 46% of the sample in the maxilla and 51.6% in the mandible. These irregularities were significantly more common in the females than in males in the maxilla and mandible (p=0.014, p=0.037 respectively). Reverse overjet was extremely rare (0.3%). Anterior openbite and antero-posterior molar relation discrepancies
occurred in 6.2% and 32.5% of the sample, respectively. Crowding, irregularities in the incisor segments and antero-posterior molar relation discrepancies were dominant malocclusion traits in this population. The sample mean DAI score was 24.6 points (CI 95% 23.86–25.36). There was no statistically significant gender difference of DAI scores (p = 0.473). About 65% of the subjects had either no need or had slight need for treatment whereas 35.3% were found with orthodontic treatment needs ranging from elective (21.5%), highly desirable (6.9%) to mandatory (6.9%). There was no significant gender difference in the categories of treatment need (p = 0.942). Unmet orthodontic treatment needs were present in this population with a very small proportion of
subjects exhibiting handicapping malocclusion.
Conclusion: The information from this study forms part of the basis not only for further research, but also for planning orthodontic care in this community where unmet orthodontic treatment needs are present.

2006
Rwakatema DS, Ng’ang’a P, Kemoli AM. "Awareness and concerns about malocclusion amongst 12-15 year-old children in Moshi, Tanzania." E Afr Med J. 2006;83:92-97.
Rwakatema DS, Ng’ang’a P, Kemoli A. "Prevalence of malocclusion amongst 12-15 year-olds in Moshi, Tanzania, using Bjök’s criteria." E Afr Med J. 2006;83:372-379. Abstract

Objective: To assess the prevalence of malocclusion in 12-15 - year-olds in Moshi, Tanzania.
Design: Cross-sectional study.
Setting: Moshi Municipality, Kilimanjaro region, Tanzania.
Subjects: Two hundred and eighty nine randomly selected primary school children (153 males and 136 females) had a clinical examination for malocclusion traits done.
Results: The overall prevalence of malocclusion was 97.6%. Angle’s Class II and III malocclusion occurred in 6.9% and 11% of the sample respectively. Crowding was encountered very frequently in both jaws, especially in the lower anterior segments. Anterior open bite occurred in 6.2% and the deep bite in 10.7% of the sample. There was no significant gender difference in either the overall prevalence of malocclusion or in the occurrence of the different occlusal traits.
Conclusion: It was noteworthy that some of the malocclusion traits recorded were relatively minor deviations from the normal occlusion. Hence the high prevalence of malocclusion did not necessarily imply a heavy burden of need and demand for orthodontic treatment.

2001
Kemoli AM, van Amerongen WE, de JJ JJS. "Antimicrobial and buffer capacity of crude extracts of chewing sticks (mswaki) from Kenya." J Dent Child . 2001;68(1):183-188. Abstract

The use of Chewing sticks (Miswaki) in the third world for control of dental plaque is very popular. Some of the studies that have been conducted on this subject have reported marked decrease in the incidences of dental caries and periodontal diseases in the users of Miswaki, when compared to the users of the conventional toothbrush living under similar conditions. Various mechanisms by which the Miswaki contributes to this phenomenon have been suggested. The purpose of the present study was to investigate in vitro, the anti-microbial action, the potential acid buffer capacity and fluoride content of crude aqueous extracts of eight commonly used chewing sticks from three regions in Kenya. The results obtained in the study, showed that one of the Miswaki had remarkable antibiotic activity against three stains of oral bacteria. Three of the Miswaki had significant acid buffer capacity. None of the eight Miswaki showed any significant fluoride release.

1974

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