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J PROFCHINDIAMARK, KAVIN DRWAKOLI. "Koech KJ, Chindia ML, Wakoli KA, Gathece LW. Prevalence of oral lesions in HIV infection and their relationship with CD4 count at a Nairobi centre. African journal of oral health sciences,Vol 5 no2, 4-9.". In: African Journal of Oral Health Sciences,Vol 5 no2, 4-9. Hekima III (1) 27-42; Submitted. Abstract
Savanna ecosystems and origins of modern human behavior Hekima III (1) 27-42: (Journal of the Humanities and Social Sciences, University of Nairobi).
2012
Butt FM, Ogengo J, Bahra J, Dimba EAO, Wagaiyu E. "19-year audit of benign jaw tumours and tumour-like lesions in a teaching hospital in Nairobi, Kenya.". 2012. AbstractWebsite

Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and insti-tution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the Afri-can continent. We present a 19-year audit of benign jaw tumours and tumour-like lesions at a University teaching hospital in Nairobi, Kenya. Methods: Histo-pathological records were retrieved and re-examined from the Department of Oral and Maxillofacial pa-thology, University of Nairobi from 1992 to 2011. The jaw tumours were classified according to the latest WHO classification. Results: During the 19-year audit, 4257 biopsies were processed of which 597 (14.02%) were jaw tumours within an age range of between 4 to 86 years. There was greater number of odontogenic tumours 417 (69.85%) than the bone related lesions 180 (30.15%). Of the odontogenic tumours, the epithet- lial and in the bone related types, the fibro-osseous lesions were frequent. Conclusion: Ameloblastoma and ossifying fibroma were the most frequent tumours reported in this audit. The information regarding the prevalence of these tumours is scarce from the conti-nent and can be useful in early detection and man-agement before they cause facial deformity.

Chindia ML, Wagaiyu EG, ocholla Tom, Opondo F, Kihara E. "5-year audit of the range and volume of diagnostic radiographic services at the University of Nairobi Dental Hospital.". 2012. AbstractWebsite

Background: Dental and cranio-maxillofacial diagnostic imaging constitutes an invaluable tool in the accurate diagnosis and management of a diverse range of conditions and diseases that afflict the oral and cranio-maxillofacial region. In order to improve on any existing facility, periodic audit evaluation is paramount. In this way proper and relevant service delivery can be achieved. Objective: To evaluate the range and volume of dental and cranio-maxillofacial diagnostic radiographic services offered at the University of Nairobi Dental Hospital (UNDH) in Kenya over a 5-year period (2006-2010). Methods: Retrospective survey involving manual examination of patient records at the Division of Dental and cranio-maxillo- facial Radiology registry of the UNDH. Results: Over the study period, the range of diagnostic radiographic services offered comprised of both intra- and extra- oral examinations. The total volume of radiographs taken was 48,874 among which 41,980 (86%) were intraoral and 6894 (14%) extraoral views. Among the intraoral views, 74% were bitewing, 25% periapical and only 1% were occlusal diagnostic views. The majority (95%) of the extraoral projections consisted of panoramic views and only 5% constituted other techniques. The volume of radiographs was high from January to September while November and December had the lowest number of examination requests. Conclusion: Intraoral radiography was the commonest examination with bitewings having been the majority while the panoramic tomography was the com- monest extraoral examination performed.

Micha CS, Chindia ML, Awange DO, Dimba EA. "Pattern of occurrence of jaw cysts and cyst-like lesions at the University of Nairobi Dental Hospital: A 10-year histopathologic audit.". 2012. Abstractpattern_of_occurrence.pdf

Jaw cysts and cyst-like lesions cause facial deformity, destruction of dental tissues and af-fect masticatory and phonation functions. These ad-versely erode patients’ psycho-social status; create low self-esteem and may change one’s facial identity and appearance. Objective: To determine the histo- pathologic characteristics, variants and demographic pattern of jaw cysts and cyst-like lesions at the Uni-versity of Nairobi Dental Hospital. Material and Method: This was an analytical and verification study that involved microscopic re-examination of all available incisional/excisional biopsy samples from January 2000 to December 2009 for histo-patho- logical diagnosis at the University of Nairobi Dental Hospital. Results: 187 jaw cysts and cyst-like lesions were diagnosed at the University of Nairobi Dental Hospital over the ten-year period. Keratocystic odon- togenic tumours constituted 28%, dentigerous cysts 25%, nasopalatine duct cysts 19%, radicular cysts 15%, while calcifying odontogenic cysts comprised 4% of all the lesions. The rest of the lesions were be-tween 1% and 3% of all the lesion entities. Conclu-sion: Keratocystic odontogenic tumours and den-tigerous cysts were the most common developmental odontogenic cysts diagnosed in the ten-year period.

2011
Chindia M, Gathece L, Dimba EAO, Kamau MW, D.awange. "Clinico-histopathologic types of maxillofacial malignancies with emphasis sarcomas-A 10 Year Review.". 2011. AbstractWebsite

Sarcomas are malignant neoplasms that occur anywhere in the human body. Though their occurrence in the head and neck region is rare vis-a-vis other malignancies, their presence is of tremendous concern due to their often grave prognosis. Objective: To determine the pattern of occurrence, histopathologic types of maxillofacial sarcomas and their proportion to other malignant neoplasms of this region based on archival material accumulated over 10 years (2000-2009). Design: A combined retrospective and prospective cross-sectional study. Setting: The University of Nairobi Dental Hospital (UNDH).
Subjects: All caseswithadiagnosisofsarcomaregisteredbetween2000-2009wereevaluated. Results: Of the 528 malignancies recorded over the ten-year period, 427 (80.9%) were of epithelial origin while 101 (19.1 %) were sarcomas. Patients with epithelial malignancies were older (54.16 ± 15.94 years) than patients with sarcomas (31.73 ± 16.78) with the differences having been statistically significant. Osteosarcoma was the most commonly occurring sarcoma (29.7%), followed by Kaposi's sarcoma (KS) (28.7%), fibrosarcoma (FBS) (18.8%), and rhabdomyosarcoma (RMS) (9.9%). Sarcomas peaked in the third decade with 70% occurring below the age of 40 years. The maxilla and the mandible were the most afflicted sites in the maxillofacial region accounting' for 52%. The patients on average presented to medical personel about nine months after noticing the lesion with the most frequent complaint having been swelling.
Conclusion: The present study confirms the relative rarity of maxillofacial sarcomas. It also provides data on the histopathologic types and demographic characteristics of maxillofacial sarcomas in a select Kenyan population. This information is a contribution to the comprehensive documentation of sarcomas that occur globally and is useful in the provision of baseline data upon which future prospective analytical protocols may arise.

Ogeng’o J, Bahra J, Chindia ML, Butt FMA. "Pattern of odontogenic and nonodontogenic cysts.". 2011. Abstract

The jaws are host to a variety of cysts due in large part to the tissues involved in tooth formation. Odontogenic cysts (OCs) are unique in that they affect only the oral and maxillofacial region. There are few studies from sub-Saharan Africa. This study was aimed at describing the pattern of various types of cysts in the oral and maxillofacial region in a Kenyan population. This was done at the Departments of Oral and Maxillofacial Surgery and Oral Medicine and Pathology, University of Nairobi Dental Hospital. This was a retrospective audit. All histopathologic records were retrieved from 1991 to 2010 (19 years) and were counted. The following information was extracted and recorded in a data sheet: age, sex, and the type of cystic lesions. There were 194 cysts (4.56%) diagnosed of 4257 oral and maxillofacial lesions. Of these, 64.4% were from male and 35.6% were from female patients with an age range of 1 to 70 years (mean, 23.76 [SD, 14.05] years; peak and median of 20 years). The most common OCs (57.2%) were dentigerous and radicular, whereas the most common nonodontogenic cyst (42.8%) was nasopalatine duct cyst. Other soft tissue cysts reported were epidermoid, branchial, thyroglossal, dermoid, and cystic hygroma. Oral and maxillofacial cysts are not uncommon in this population, the majority being the OC, dentigerous cyst, followed by the nonodontogenic cyst, nasopalatine cyst. The cysts are male predominant and occur 10 to 15 years earlier compared with those in the white population.

2010
Chindia M, Butt FM, Kenyanya T, Rana F, Gathece LW. "An audit of ranulae occurring with the human immunodeficiency virus infecton.". 2010.
Chindia ML, Odhiambo W, Gathece LW, Dimba EAO, Okumu SB. "Clinical features and types of paediatric orofacial malignant neoplasms at two hospitals in Nairobi, Kenya.". 2010. AbstractWebsite

To evaluate the clinical features and histopathological types of orofacial malignant neoplasms in children. Patients and methods: The study involved patients aged 15years and below diagnosed with malignancy at two main referral hospitals in Kenya during the period from July, 2008 to December, 2008. A questionnaire and clinical examination chart were used to document data. Data analysis was done using SPSS 12.0 programme. Results: 65 children (44 males, 21 females) with ages ranging from 0.25 to 14years were evaluated. The main complaints were swelling 61 (94%) and visual disturbance 29 (45%). The mean duration of symptoms was 0.17-36 months. The commonest signs were leucocoria (white reflection from the retina) 23 (35%),proptosis 19(29%)and loss of vision 15 (23%).The commonest sites were orbit 30 (46%)and maxilla 11(17%).Most neoplasms were retinoblastoma 26 (40%),followed by 14(21%)cases of Burkitt's lymphoma (BL)and occurred in patients under 5 years ofage (40 cases) followed by 19cases in children aged 5-10 years. Conclusions: Overall, malignancies were more common in males than females with most having been diagnosed in children aged less than 10years. Retinoblastoma and BLwere the most common neoplasms. © 2011 European Association for Cranio-Maxillo-Facial Surgery.

Sang LK, Mulupi E, Akama MK, Muriithi JM, Macigo FG, Chindia ML. "Temporomandibular joint dislocation in Nairobi.". 2010. Abstract

Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. OBJECTIVE: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. DESIGN: Descriptive cross-sectional study. SETTING: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. RESULTS: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

Chindia ML, Owibingire S, Moshi JR, Butt FMA. "Xeroderma pigmentosum: a review and case series.". 2010. Abstract

Xeroderma pigmentosa (XP) is a condition inherited as an autosomal recessive trait and is characterized by photosensitivity, pigmentary changes, premature skin ageing and malignant tumour development resulting from the defect in DNA repair. The management of complications of XP, especially orofacial tumours entails an enormous surgical challenge to the clinicians. We present five cases of XP.

2009
Chindia ML;, Wetende AM. "Hereditary Gingival Enlargement.". 2009.
Koech KJ, Chindia ML. "Presentation and management of cervicofacial necrotising fasciitis: report of nine cases.". 2009. Abstract

Cervicofacial necrotising fasciitis (CNF) is an acute soft tissue infection that primarily involves the subcutaneous, adipose and fascial planes of the head and neck region. Secondary ischaemia of the skin results in widespread ulceration and suppuration. It is imperative that early diagnosis is made and judicious medical and surgical intervention instituted. We present a case series of patients with CNF diagnosed and managed at the division of oral and maxillofacial surgery of the Kenyatta National Hospital in Kenya.

Awange DO, Wakoli KA, Onyango JF, Chindia ML, Dimba EA, W GS. "Reactive localised inflammatory hyperplasia of the oral mucosa.". 2009. Abstract

To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period. DESIGN: A retrospective, cross-sectional descriptive study. SETTING: Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi. SUBJECTS: A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005. RESULTS: Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) cases were peripheral giant cell granuloma and three cases (0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years (mean = 30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in 41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years (mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 (72.3%) in females with an age range of 2 to 75 years (mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16 (4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouth and other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean = 1.8 years). Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions. CONCLUSION: The present study has shown that the prevalence of reactive localised inflammatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process

Solomon MM, Onyango JF, Nyabola LO, Opiyo A, Chindia ML. "Treatment interruption among head and neck cancer patients undergoing radical radiotherapy.". 2009. Abstracttreatment_interruption_among_head_and_neck_cancer_patients.pdf

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

2008
J PROFCHINDIAMARK. "Butt FM, Chindia ML, Rana F, Machigo FG.Pattern of head and neck malignant neoplasms in HIV-infected patients in Kenya.Int J Oral Maxillofac Surg. 2008 Sep 8.". In: Int J Oral Maxillofac Surg. 2008 Sep 8. Hekima III (1) 27-42; 2008. Abstract

HIV-infected patients face a greater risk of developing malignant disease. The most commonly reported neoplasms of the head and neck region include Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL). There is also an increased risk of oral squamous cell carcinoma (SCC). A descriptive cross-sectional study including HIV-infected patients with neoplastic and non-neoplastic lesions was conducted. Of the 200 participants, 116 (58%) were male and 84 (42%) female with an age range of 18-61 years (mean 37 years). The females were significantly younger (mean 33 years) than the males (mean 37 years) (t test; 2.57; P<0.05 [0.001]). The prevalence of neoplastic lesions in this study was 27%; 37 (68%) patients had KS, 9 (17%) had SCC, 7 (13%) had NHL and 1 (2%) had Burkitt's lymphoma. More females than males presented with lesions of KS and SCC compared with NHL. The youngest patient presented with SCC at 18 years (mean 35.7 years), followed by KS at 23 years (mean 36.3 years) and NHL at 33 years (mean 43.9 years). Most study participants (97%) were in stage III/IV of the disease and the remaining 3% in stage II. In this study, the most common malignant neoplasms were KS, SCC and NHL, manifesting in a younger age group than in the non-HIV group of patients.

J PROFCHINDIAMARK. "Combined chemical micro-abrasion and bleaching technique in the management of enamel flourotic stains.". In: Journal of The Kenya Dental Association (JKDA) Vol 1. No.1: 23-27. Hekima III (1) 27-42; 2008. Abstract
Objective: To remove or modify fluorotic enamel stains using a combined chemical micro-abrasion and bleaching technique. Design: An in-vivo study was carried out. A sample of 21 participants was randomly selected from patients presenting with brown staining due to flourosis as the chief complaint. Eighty nine teeth were selected based on the Thylstrup-Fejerskov Index [TFI] with a score of 4 as the acceptable maximum. Only upper anterior teeth were included in the study. Setting: The study was undertaken at the University Of Nairobi Dental Hospital, Kenya. Subjects: Patients with an expressed need for treatment of their discoloured teeth who consented to a clearly demonstrated treatment procedure constituted the sample. Results: Enamel discolouration was removed or modified yielding a uniform colour and lustre depending on the initial depth of the stain. All patients appreciated the colour change. Conclusion: A combined chemical micro-abrasion and bleaching technique is a feasible treatment modality in selected cases of enamel fluorosis.
W PROFGUTHUASYMON, J PROFCHINDIAMARK. "Odhiambo WA, Guthua SW, Chindia ML, Macigo FG.Pattern and clinical characteristics of firearm injuries.East Afr Med J. 2008 Mar;85(3):107-12.". In: East Afr Med J. 2008 Mar;85(3):107-12. Hekima III (1) 27-42; 2008. Abstract
OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.
2007
Chindia ML, A. WK, Limo AK, Dimba EAO, Gichana J. "audit of oral diseases at a Nairobi center 2004 - 2005.". 2007.
W GS, Macigo FG, Chindia ML, Akama MK. "Pattern of Maxillofacial and associated injuries in road traffic accidents.". 2007. Abstract

Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by pdssenger service vehicles. Objective: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. Design: A cross-sectional study. Setting: Kenyatta National Hospital (KNH). Subjects: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. Results: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively, Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (5TIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1 %) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37}% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. Conclusion: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. Recommendations: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.

Koech KJ, Chindia ML, Njiru AK. "Primary inter-osseous adenoid cystic carcenoma of the mandible.". 2007.
J PROFCHINDIAMARK, KIRIAGO DRAKAMAMATHEW, W PROFGUTHUASYMON. "Akama MK, Chindia ML, Macigo FG, Guthua SW.Pattern of maxillofacial and associated injuries in road traffic accidents.East Afr Med J. 2007 Jun;84(6):287-95.". In: East Afr Med J. 2007 Jun;84(6):287-95. Hekima III (1) 27-42; 2007. Abstract
BACKGROUND: Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by passenger service vehicles. OBJECTIVE: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital (KNH). SUBJECTS: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. RESULTS: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively. Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (STIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1%) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37.7% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. CONCLUSION: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. RECOMMENDATIONS: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.
J PROFCHINDIAMARK. "Butt FM, Chindia ML, Rana FS, Ashani A.Cheilitis glandularis progressing to squamous cell carcinoma in an hiv-infected patient: case report.East Afr Med J. 2007 Dec;84(12):595-8.". In: East Afr Med J. 2007 Dec;84(12):595-8. Hekima III (1) 27-42; 2007. Abstract
Cheilitis glandularis (CG), is a rare inflammatory minor salivary gland disease affecting the lower lip. The hallmarks of which include progressive enlargement and eversion of the lower labial mucosa resulting in the obliteration of the mucosal-vermillion interface. A case is presented of a 47-year-old HIV-infected woman who initially manifested clinical features of CG with a typical histopathology picture of a non-specific sialadenitis while a second biopsy performed six months later revealed well differentiated squamous cell carcinoma (SCC). She is symptom free one year following excision and radiotherapy treatment.
J PROFCHINDIAMARK. "BUTT FMA, CHINDIA ML, WAKOLI KA. Problems in Diagnosing Odontogenic Myxoma: Case Report. East African Medical Journal 2007; 84: 141-145.". In: Journal of The Kenya Dental Association (JKDA) Vol 1. No.1: 23-27. Hekima III (1) 27-42; 2007. Abstract
Objective: To remove or modify fluorotic enamel stains using a combined chemical micro-abrasion and bleaching technique. Design: An in-vivo study was carried out. A sample of 21 participants was randomly selected from patients presenting with brown staining due to flourosis as the chief complaint. Eighty nine teeth were selected based on the Thylstrup-Fejerskov Index [TFI] with a score of 4 as the acceptable maximum. Only upper anterior teeth were included in the study. Setting: The study was undertaken at the University Of Nairobi Dental Hospital, Kenya. Subjects: Patients with an expressed need for treatment of their discoloured teeth who consented to a clearly demonstrated treatment procedure constituted the sample. Results: Enamel discolouration was removed or modified yielding a uniform colour and lustre depending on the initial depth of the stain. All patients appreciated the colour change. Conclusion: A combined chemical micro-abrasion and bleaching technique is a feasible treatment modality in selected cases of enamel fluorosis.
J PROFCHINDIAMARK. "BUTT FMA, VAGHELA VP, CHINDIA ML. Correlation of CD4 counts and CD4/CD8 ratio with HIV-infection associated oral manifestations. East African Medical Journal 2007; 84: 383-388.". In: Journal of The Kenya Dental Association (JKDA) Vol 1. No.1: 23-27. Hekima III (1) 27-42; 2007. Abstract
Objective: To remove or modify fluorotic enamel stains using a combined chemical micro-abrasion and bleaching technique. Design: An in-vivo study was carried out. A sample of 21 participants was randomly selected from patients presenting with brown staining due to flourosis as the chief complaint. Eighty nine teeth were selected based on the Thylstrup-Fejerskov Index [TFI] with a score of 4 as the acceptable maximum. Only upper anterior teeth were included in the study. Setting: The study was undertaken at the University Of Nairobi Dental Hospital, Kenya. Subjects: Patients with an expressed need for treatment of their discoloured teeth who consented to a clearly demonstrated treatment procedure constituted the sample. Results: Enamel discolouration was removed or modified yielding a uniform colour and lustre depending on the initial depth of the stain. All patients appreciated the colour change. Conclusion: A combined chemical micro-abrasion and bleaching technique is a feasible treatment modality in selected cases of enamel fluorosis.
2006
J PROFCHINDIAMARK, ELIZABETH DRDIMBA. "Aden A, Dimba EA, Ndolo UM, Chindia ML.Socio-economic effects of khat chewing in north eastern Kenya.East Afr Med J. 2006 Mar;83(3):69-73.". In: East Afr Med J. 2006 Mar;83(3):69-73. Hekima III (1) 27-42; 2006. Abstract
BACKGROUND: The khat habit is a widespread phenomenon which has in the past two decades spread to parts of Western Europe and North America from Eastern Africa and the Arabian Peninsula. Although khat has been identified as one of the most commonly abused substances in Kenya, restrictions on cultivation, trade and usage have been non-existent since its legalisation in 1977. OBJECTIVE: To describe the socio-economic effects of khat chewing in Ijara District in the North Eastern Province of Kenya. DESIGN: Cross sectional study. SETTING: Ijara District, North Eastern Kenya. SUBJECTS: Fifty respondents were interviewed. RESULTS: Eighty eight percent of the respondents were khat chewers, and the majority (80%) had family members who engaged in the khat habit. There was a general lack of education on the negative effects of khat chewing. Due to reported mood changes and withdrawal symptoms when not chewing khat, many respondents used more than half of their domestic budgets on khat, but few (28%) perceived this as a waste of resources. Fifty four percent of khat chewers typically started the habit during the day, implying a waste of time for productive work. However, only 40% of the persons interviewed admitted that the drug affected work performance negatively. The khat habit was associated with strain on family relationships, anti-social behaviour and health effects such as insomnia. CONCLUSION: In spite of the negative socio-economic impact of khat in Ijara District, khat consumption remains a widespread habit.
J PROFCHINDIAMARK. "Chindia ML.Facing the burden of malignant orofacial neoplasia.East Afr Med J. 2006 Mar;83(3):61.". In: East Afr Med J. 2006 Mar;83(3):61. Hekima III (1) 27-42; 2006. Abstract
No abstract available. PMID: 16771100 [PubMed - indexed for MEDLINE]
J PROFCHINDIAMARK. "Kassim BA, Noor MA, Chindia ML.Oral health status among Kenyans in a rural arid setting: dental caries experience and knowledge on its causes.East Afr Med J. 2006 Feb;83(2):100-5.". In: East Afr Med J. 2006 Feb;83(2):100-5. Hekima III (1) 27-42; 2006. Abstract
OBJECTIVE: To determine the dental caries experience and knowledge on the causes and preventive measures for dental diseases. DESIGN: A community based cross-sectional descriptive study. SETTING: Elwak sub-district hospital, North Eastern Province, Kenya. SUBJECTS: One hundred and forty one adults who presented themselves during a dental check up at a sub-district hospital and gave written consent. MAIN OUTCOME MEASURES: Dental caries status and knowledge on its causes and preventive measures. The importance of outreach programmes in obtaining information as well as helping to alleviate the pain and suffering caused by dental diseases among communities living in remote areas is also revealed. RESULTS: Of the one hundred and forty one individuals, who were included in the study, 63.1% were women and 36.9% were men. Their ages ranged between 18 and over 65 years. 41.1% were in the 18-24-year age bracket. Regarding the oral health knowledge, 43% did not know any causes of dental diseases while 36%, 17% and 12% knew that diet, "dirt" on teeth and bacteria were possible causes, respectively. Fifty percent did not know any preventive measures for dental diseases while the rest indicated abstention from the consumption of sugary foods; and only 0.8% mentioned use of fluoridated toothpaste as a preventive measure for dental caries. 56.7% of the subjects were caries free. The mean DMFT for all ages was 3.4. Of those with caries 72.1% were women. CONCLUSION: There is a low level of oral health awareness and a moderately high level of dental caries experience in this community with women apparently carrying the biggest burden of dental caries.
J PROFCHINDIAMARK, W PROFGUTHUASYMON. "Mutave R, Chindia ML, Guthua SW.Post-operative re-construction of dentoalveolar tissue and the mandible and maxillae using prosthetic therapy.East Afr Med J. 2005 Jun;82(6):311-3.". In: East Afr Med J. 2005 Jun;82(6):311-3. Hekima III (1) 27-42; 2006. Abstract
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.
2005
J PROFCHINDIAMARK, KIRIAGO DRAKAMAMATHEW. "Chindia ML, Akama MK, Awange DO.Ameloblastic fibroma at the University of Nairobi Dental Hospital.East Afr Med J. 2005 Aug;82(8):418-21.". In: East Afr Med J. 2005 Aug;82(8):418-21. Hekima III (1) 27-42; 2005. Abstract
OBJECTIVE: To document the occurrence of cases of ameloblastic fibroma. DESIGN: A retrospective study. SETTING: The Division of Oral Pathology and Oral Medicine histopathology laboratory at the Faculty of Dental Sciences, University of Nairobi, January 1991 to December 2000. RESULTS: Seven complete records of histopathologically confirmed cases of ameloblastic fibroma were identified. There were four male and three female cases with an age range of 10 to 22 years (mean=14 years). Remarkably, six of the cases had lesions in the molar regions of the mandible with a single case with a maxillary molar area lesion. One of the cases had the neoplasm associated with an unerupted tooth. From the clinical notes all the patients were managed by meticulous enucleation and curettage of the lesions. After follow up periods ranging from several months to eight years no recurrences had been recorded. CONCLUSION: Evidently ameloblastic fibroma is an uncommon neoplasm as noted in the earlier literature. Although the lesions can be quite extensive at the time of diagnosis, the recurrence rate appears to be relatively low if the neoplasms are meticulously extirpated.
J PROFCHINDIAMARK. "Muriithi HM, Masiga MA, Chindia ML.Dental injuries in 0-15 year olds at the Kenyatta National Hospital, Nairobi.East Afr Med J. 2005 Nov;82(11):592-7.". In: East Afr Med J. 2005 Nov;82(11):592-7. Hekima III (1) 27-42; 2005. Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
2004
Osundwa MT, Chindia ML, W GS, Awange DO, Onyango. "Squamous Odontogenic Tumour-like Gingival proliferations Occurring with Dentigerous Cysts and Amelogenesis Imperfecta.". 2004. Abstract

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

2003
J PROFCHINDIAMARK. "AKAMA M.K., MACIGO FG, CHINDIA ML, ODHIAMBO W.A. Occurence of injuries of the maxillofacial skeleton seen at a Teaching and National referral Hospital in Nairobi, Kenya. African Journal of Oral health Sciences 2003.". In: African Journal of Oral health Sciences 2003. Hekima III (1) 27-42; 2003. Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
J PROFCHINDIAMARK. "Moshy J, Chindia ML. Clinical characteristics of Oral Squamous Cell Carcinoma at Muhimbili National Hospital, Tanzania. African Journal of Oral Health Sciences, 2003. 4: 170 - 172.". In: African Journal of Oral Health Sciences, 2003. 4: 170 - 172. Hekima III (1) 27-42; 2003. Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
J PROFCHINDIAMARK. "NDUNG'U PM GATHECE LW, CHINDIA ML. Reasons to study Dentistry: Presentattitudes and Career goals among University of Nairobi Dental students. African Journal of Oral Health Sciences. 2003.". In: African Journal of Oral Health Sciences. 2003. Hekima III (1) 27-42; 2003. Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
2002
J PROFCHINDIAMARK. "Chindia ML.Cleft lip and/or palate: searching for aetiological factors.East Afr Med J. 2002 Oct;79(10):509.". In: East Afr Med J. 2002 Oct;79(10):509. Hekima III (1) 27-42; 2002. Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
J PROFCHINDIAMARK. "Chindia ML.Clinical recognition of odontogenic tumours.East Afr Med J. 2002 Jan;79(1):1-2.". In: East Afr Med J. 2002 Jan;79(1):1-2. Hekima III (1) 27-42; 2002. Abstract
No abstract available. PMID: 12380861 [PubMed - indexed for MEDLINE]
J PROFCHINDIAMARK. "NJIRU ABK, CHINDIA ML. Late presentation of patients with oral Squamous cell Carcinoma. African Journal Oral Health , 3:118-121, 2002.". In: African Journal Oral Health , 3:118-121, 2002. Hekima III (1) 27-42; 2002. Abstract
OBJECTIVE: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Five hundred and five patient records with dental injuries were retrieved and analysed. RESULTS: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%). The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth both in the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered. CONCLUSION: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries.
2001
J PROFCHINDIAMARK. "Butt F.M.A., Vaghela V.P, Chindia M. L.: Oral manifestations of HIV/AIDS in a Kenyan Provincial Hospital.East Afr Med J. 2001 Aug;78(8):398-401.". In: East Afr Med J. 2001 Aug;78(8):398-401. Hekima III (1) 27-42; 2001. Abstract

BACKGROUND: In Kenya many patients exposed to the HIV infection present with orofacial lesions as the primary manifestations of the disease and only a few studies have been performed to document this observation. OBJECTIVE: To clinically evaluate and document the range and pattern of oral lesions in a group of hospitalised patients with HIV-infection. DESIGN: A prospective study. SETTING: Coast Province General Hospital in Mombasa, Kenya, which is the main referral institution serving a population of approximately two million people. METHODS: Examination of all the cases included in the study was performed according to the WHO criteria. Both male and female patients aged 16 years and above were selected. The criterion of recruitment was based on a suspicion of immunosuppression, the presence of oral manifestations and the willingness to participate in the study. Prior to the examination each patient had undergone counselling followed by two consecutive screening tests using the ELISA technique. Where indicated incisional biopsy was performed to confirm the clinical diagnosis of the relevant lesions. In collaboration with the medical team, treatment was administered as per the needs of the patient in terms of anti-fungals, antivirals or topical cortisteroids. RESULTS: Of the 61 cases, 25(41%) were males and 36(59%) females with an age range of 19 to 65 years (mean = 34.7 years). While all the cases had periodontal disease, over 80% had candidiasis of the hyperplastic, erythematous and pseudomembraneous types. Lymphadenopathy and angular cheilitis were each diagnosed in 27.9% of the cases; while oral Kaposi's sarcoma was seen in 13% of the patients. Other conditions seen included persistent oral ulceration (11.5%), oral hairy leukopLakia and herpes zoster each constituting 4.9%; herpes simplex, mucosal hyperpigmentation, parotomegaly and facial palsy each comprised six per cent and oral warts seen in one case. In accordance with the pattern and prevalence of oral manifestations in our study, the results were largely consistent with those documented elsewhere. CONCLUSION: For the alleviation of the morbidity arising from the commonly occurring lesions, early detection is mandatory. Furthermore, documentation of the varied regional patterns of occurrence of these lesions may aid in the rational application of the emerging treatments.

J PROFCHINDIAMARK. "Chindia ML, Riyat MS, Nyong'o A.Multiple myeloma presenting as a painful mandibular swelling: a case report.Dent Update. 2001 Jun;28(5):258-60.". In: Dent Update. 2001 Jun;28(5):258-60.v. Hekima III (1) 27-42; 2001. Abstract
Multiple myeloma is a disease characterized by monoclonal proliferation of plasma cells, the most differentiated stage of B-cells. Primary manifestation of multiple myeloma in the jawbones is rare. In the case reported here, a 29-year-old woman who presented with a right mandibular swelling after extraction of a mobile painful tooth turned out to have multiple myeloma. Current diagnostic criteria and management strategies of the disease are discussed.
J PROFCHINDIAMARK. "Chindia ML.Osteosarcoma of the jaw bones.Oral Oncol. 2001 Oct;37(7):545-7.". In: Oral Oncol. 2001 Oct;37(7):545-7. Hekima III (1) 27-42; 2001. Abstract
Currently, it has been established that osteosarcoma (OS) of bone is not a stereotyped disease, and several varieties have been identified by clinical findings, radiographic and histopathologic appearances. Generally, it is the most common primary malignant bone neoplasm that accounts for at least 30% of all primary tumours of bone. In the jaw bones, OS accounts for about 4% of all the primary malignant neoplasms. In the general skeleton, the highest incidence is observed in the second decade of life; the neoplasm is said to be unusual before the age of 5 years and very rare after age 50 years. The aetiology and precise pathogenesis of this disease remain unknown. A diagnosis of clinically and radiologically suspicious OS requires meticulous histologic examination. However, histologic diagnosis may also be difficult since the different varieties of OS may have different morphological patterns in different sample sites. Currently, the two therapeutic modalities used in the primary treatment of OS include radical surgery and cytotoxic chemotherapy. In the general skeleton, the use of surgery alone results in a 90% rate of recurrence of OS. Notably, the advent of adjuvant and neoadjuvant cytotoxic chemotherapy as an adjunct to radical surgery has greatly improved the prognosis of many cases of OS of the jaw bones.
J PROFCHINDIAMARK, MULAMA DROSUNDWATOM, W PROFGUTHUASYMON. "Osundwa TM, Chindia ML, Guthua SW, Nyong'o A.McCune Albright syndrome: autosomal dominant trait in a family of eight.East Afr Med J. 2001 Jul;78(7 Suppl):S40-2.". In: East Afr Med J. 2001 Jul;78(7 Suppl):S40-2. Hekima III (1) 27-42; 2001. Abstract
No abstract available. PMID: 11957248 [PubMed - indexed for MEDLINE]
2000
Chindia ML, MT O, sw. Devani, Odhiambo WA, S.W. G. "Craniofacial features in amelogenesis imperfecta.". 2000.
Akama MK, W GS, Chindia ML. "Pierre Robin Syndrome: case report.". 2000. Abstract

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

J PROFCHINDIAMARK, ELIZABETH DRDIMBA. "Chindia M. L., Dimba E: Neural Tumours of the Head and Neck. East African Medical Journal; 77:531-533, 2000.". In: East Afr Med J. 2000 Oct;77(10):531-3. Hekima III (1) 27-42; 2000. Abstract
OBJECTIVE: To document the pattern of occurrence of all primary neural tumours arising in the neck and craniofacial region over the period 1982 to 1991. DESIGN: A retrospective study. SETTING: Cancer Registry, Nairobi, Kenya. RESULTS: Out of the 289 cases who were identified to have had whole body neural tumours, 225 (77.8%) had the lesions distributed in the neck and craniofacial area. While 80% of the neoplasms located in this region were retinoblastomas (mainly occurring in the age group 0 to 4 years), other lesion types occurred in small numbers thus: neurofibromas comprised 12.4%, Schwannomas four per cent, neuroblastomas and neuromas each 0.4%; and extracranial gliomas 2.7%. Overall, the male to female ratio was 1:1 and the site distribution revealed that over 90% of the lesions afflicted the upper face. CONCLUSION: Neural tumours of the neck and craniofacial region appear generally rare in this population as has been shown elsewhere.
J PROFCHINDIAMARK. "Chindia M.L., Swaleh S.M., Godiah P.M: Sarcomas of the Head and Neck at Kenyatta National Hospital. East Afr Med J. 2000 May;77(5):256-9.". In: East Afr Med J. 2000 May;77(5):256-9. Hekima III (1) 27-42; 2000. Abstract

OBJECTIVE: To determine the pattern of occurrence of sarcomas afflicting the neck and craniofacial region. DESIGN: A retrospective study (1982-1991). SETTING: Cancer Registry, Kenyatta National Hospital, Nairobi, Kenya. METHOD: Examination was performed of the cancer records in the registry over the period 1982 to 1991 inclusive. Histopathological types of the sarcomas were then analysed to indicate the numbers that occurred per year; and also the pattern of occurrence according to age groups, gender and site. RESULTS: Of the 10,897 whole body neoplasms, 985 were sarcomas. Among these sarcomas, 160 (16%) were located in the neck and craniofacial region. The histopathological types of the neoplasms included Kaposi's sarcoma (39%), osteosarcoma (23%), rhabdomyosarcoma (21%), fibrosarcoma (13%), chondrosarcoma (two per cent), malignant fibrous histiocytoma (one per cent) and dermatofibrosarcoma protuberans (one per cent). CONCLUSION: The results of this investigation, in concordance with those of other series worldwide, indicate that the various sarcomas afflicting the neck and craniofacial area are generally rare.

J PROFCHINDIAMARK. "Chindia ML.Evolution of cancer management. East Afr Med J. 2000 Oct;77(10):521-2.". In: East Afr Med J. 2000 Oct;77(10):521-2. Hekima III (1) 27-42; 2000. Abstract
No abstract available. PMID: 12862116 [PubMed - indexed for MEDLINE]
1999
J PROFCHINDIAMARK. "Alibhai ZA, Matee MI, Chindia ML, Moshy J.Presentation and management of chronic osteomyelitis in an African patient with pycnodysostosis.Oral Dis. 1999 Jan;5(1):87-9.". In: Oral Dis. 1999 Jan;5(1):87-9. Hekima III (1) 27-42; 1999. Abstract
A case is reported of pycnodysostosis (PCD) with chronic osteomyelitis in the mandible. The clinical and radiological features and the problems of management and follow-up are discussed.
J PROFCHINDIAMARK. "Chindia ML.Osteomyelitis of the mandible in HIV infection.Br J Oral Maxillofac Surg. 1999 Apr;37(2):154.". In: Br J Oral Maxillofac Surg. 1999 Apr;37(2):154. Hekima III (1) 27-42; 1999. Abstract
No abstract available. PMID: 10371330 [PubMed - indexed for MEDLINE]
1998
Chindia ML, James RM. "Cancer of the mouth and jaws : Prevailing challenges in its management.". 1998. AbstractWebsite

Throughout the economically developing nations, the morbidity and mortality arising from cancer of the mouth and jaws has remained high despite the current advances in surgical and medical practice. Late presentation worsens the survival rates and makes complete rehabilitation of the sufferers difficult. Factors that lead to the late presentation, delayed diagnosis and often inadequate management are diverse. In addition to highlighting the incidences of oral cancer worldwide, this article presents an overview of the current developments in the identification and management of this dreadful disease. Most importantly, it is intended to sensitise clinicians, health planners and managers to evolve viable strategies that may alleviate the grave suffering endured by those afflicted in our populations.

J PROFCHINDIAMARK, W PROFGUTHUASYMON. "Chindia M.L., Guthua S.W., Awange D.O., Wakoli K.A.: Osteosarcoma of the Maxillofacial bones in Kenyans. J Craniomaxillofac Surg. 1998 Apr;26(2):98-101.". In: J Craniomaxillofac Surg. 1998 Apr;26(2):98-101. Hekima III (1) 27-42; 1998. Abstract
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.
1997
J PROFCHINDIAMARK. "Asseri L, Nguvumali HI, Matee MI, Chindia ML.Chronic osteomyelitis of the mandible following tooth extraction in HIV infection.Oral Dis. 1997 Sep;3(3):193-5.". In: Oral Dis. 1997 Sep;3(3):193-5. Hekima III (1) 27-42; 1997. Abstract
A case is presented of refractory chronic osteomyelitis of the left mandible arising after a tooth extraction in HIV infection. The challenges of prompt diagnosis and the dilemma of satisfactory management are highlighted. It is imperative that dental and oral health providers have a particularly high index of suspicion of conditions that occur in HIV infection so that early identification and appropriate management may be instituted.
J PROFCHINDIAMARK, W PROFGUTHUASYMON. "Chindia M.L., Guthua S.W., Kimaro S.S., Moshy J: Gangrenous Stomatitis (cancrumoris) Clinical features, etiologic factors and complications. Quintessence Int. 1997 Apr;28(4):277-81.". In: Quintessence Int. 1997 Apr;28(4):277-81. Hekima III (1) 27-42; 1997. Abstract
Gangrenous stomatitis (cancrum oris) is a lesion involving the orofacial structures that is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene. The general clinical features, associated etiologic factors, and ensuing complications in eight consecutive cases diagnosed between 1991 and 1995 are presented and discussed.
J PROFCHINDIAMARK. "Chindia ML.HIV-associated fulminating herpes zoster infection with alveolar necrosis and tooth exfoliation: a case report.Dent Update. 1997 Apr;24(3):126-8.". In: Dent Update. 1997 Apr;24(3):126-8. Hekima III (1) 27-42; 1997. Abstract
Department of Oral and Maxillofacial Surgery/Oral Pathology and Oral Medicine, Faculty of Dental Sciences, University of Nairobi, Kenya. This paper presents a case of HIV-associated fulminating herpes zoster infection (HZI) that culminated in right mandibular necrosis and tooth exfoliation. The occurrence of such infection in immunosuppression and the impending clinical features are briefly reviewed and discussed.
1995
J PROFCHINDIAMARK, W PROFGUTHUASYMON. "Chindia M.L., and Guthua S.W.: Orofacial Neoplasms in Children. African Health,17:20-21, 1995.". In: African Health,17:20-21, 1995. Hekima III (1) 27-42; 1995. Abstract
Apicectomy is offered where routine endodontics cannot resolve periapical inflammation. This study compared the influence on periodontal attachment level of two surgical procedures, the trapezoidal (TF) and the semilunar (SF) flaps. Twenty patients aged 16-44 years (mean 23.2 years), were randomly assigned to either flap procedure. Prior to surgery the patients received periodontal prophylaxis and oral hygiene instruction. Records were made of gingival indices, pocket depth and the distance from the cemento-enamel junction to the bottom of the gingival pocket. The measurements involved buccal surfaces of 13 to 23. The TF flap extended from 14 to 24 between the interdental papillae, whereas the SF flap was carried in a semi circle from 14 to 24 about 2mm from the attached gingiva. The surgical wounds were closed with black silk sutures. Antibiotics and analgesics were prescribed. Sutures were removed after one week. On recall after 6, 12 and 24 weeks the same measurements as before surgery were made. No statistically significant change was observed in pocket depth or attachment level between TF and SF flaps (p > 0.05). However, the TF flap produced less noticeable scarification than the SF flap.
J PROFCHINDIAMARK. "Chindia M.L., and Valderhaug, J: Periodontal status following Trapezoidal and Semilunar Flaps in apicectomy. East Afr Med J. 1995 Sep;72(9):564-7.". In: East Afr Med J. 1995 Sep;72(9):564-7. Hekima III (1) 27-42; 1995. Abstract
Apicectomy is offered where routine endodontics cannot resolve periapical inflammation. This study compared the influence on periodontal attachment level of two surgical procedures, the trapezoidal (TF) and the semilunar (SF) flaps. Twenty patients aged 16-44 years (mean 23.2 years), were randomly assigned to either flap procedure. Prior to surgery the patients received periodontal prophylaxis and oral hygiene instruction. Records were made of gingival indices, pocket depth and the distance from the cemento-enamel junction to the bottom of the gingival pocket. The measurements involved buccal surfaces of 13 to 23. The TF flap extended from 14 to 24 between the interdental papillae, whereas the SF flap was carried in a semi circle from 14 to 24 about 2mm from the attached gingiva. The surgical wounds were closed with black silk sutures. Antibiotics and analgesics were prescribed. Sutures were removed after one week. On recall after 6, 12 and 24 weeks the same measurements as before surgery were made. No statistically significant change was observed in pocket depth or attachment level between TF and SF flaps (p > 0.05). However, the TF flap produced less noticeable scarification than the SF flap.
J PROFCHINDIAMARK. "Chindia ML.Traditional dental practices.East Afr Med J. 1995 Apr;72(4):205-6.". In: East Afr Med J. 1995 Apr;72(4):205-6. Hekima III (1) 27-42; 1995. Abstract
No abstract available. PMID: 7621750 [PubMed - indexed for MEDLINE]
J PROFCHINDIAMARK. "Wakiaga J, Kisumbi B, Chindia ML.Discolouration of teeth: an overview of the diagnosis and management.East Afr Med J. 1995 Apr;72(4):213-6.". In: East Afr Med J. 1995 Apr;72(4):213-6. Hekima III (1) 27-42; 1995. Abstract
The dentist is faced with a daunting task in application of clinical skills to achieve maximum cosmetic results when it comes to the management of discoloured and/or hypoplastic dentition. In this paper, an overview is made of the diagnosis and the management of these broadly termed conditions and the cost-effectiveness of the various modalities discussed.
J PROFCHINDIAMARK. "Wakiaga J.M., Kisumbi B, and Chindia ML: Discolouration of teeth an overview of the diagnosis and management. East Afr Med J. 1995 Apr;72(4):213-6.". In: East Afr Med J. 1995 Apr;72(4):213-6. Hekima III (1) 27-42; 1995. Abstract
The dentist is faced with a daunting task in application of clinical skills to achieve maximum cosmetic results when it comes to the management of discoloured and/or hypoplastic dentition. In this paper, an overview is made of the diagnosis and the management of these broadly termed conditions and the cost-effectiveness of the various modalities discussed.
1994
J PROFCHINDIAMARK. "Chindia ML, Awange DO.Congenital epulis of the newborn: a report of two cases.Br Dent J. 1994 Jun 11;176(11):426-8.". In: Br Dent J. 1994 Jun 11;176(11):426-8. Hekima III (1) 27-42; 1994. Abstract
Congenital epulis of the newborn is a rare lesion whose histogenesis and natural clinical history have remained obscure. Even with the advent of modern histopathological techniques, it has not been possible to depict specific cellular features unique to this lesion. However, it is important that new cases are reported from all populations so that their occurrence and frequency may be easily noted. Furthermore, the lesion is important as a differential diagnosis of other aggressive lesions early in life. This report presents two Kenyan cases.
J PROFCHINDIAMARK. "Chindia ML, Kimaro S.Congenital lower lip pits and bilateral clefting of the upper lip.East Afr Med J. 1994 May;71(5):332-3.". In: East Afr Med J. 1994 May;71(5):332-3. Hekima III (1) 27-42; 1994. Abstract
An apparently sporadic case of congenital lower lip pits in association with upper lip bilateral clefts is described in an 11-month-old boy. The presentation, mode of inheritance, aetiology and genetic significance are briefly reviewed.
J PROFCHINDIAMARK. "Chindia ML, Ng'ang'a PM.Alcohol injection in the management of paroxysmal trigeminal neuralgia: a report of six cases.East Afr Med J. 1994 Jan;71(1):49-50.". In: East Afr Med J. 1994 Jan;71(1):49-50. Hekima III (1) 27-42; 1994. Abstract
The report revisits the role of alcohol in the treatment of paroxysmal trigeminal neuralgia (PTN). The study included 6 patients, 3 male and 3 female, average age 50 years. In 3 cases PTN involved both the infraorbital and mental nerves; in 2 cases the infraorbital alone while one case had buccal branch involvement. In each case 2mls standard Lignocaine was infiltrated at each site followed by 2mls 60% sterile alcohol. All patients reported swelling postoperatively. One case with mental and infraorbital nerve involvement complained of oral dysaesthesia. Another patient with similar involvement failed to respond and developed trismus. Responders remained pain-free for 9 months on average. While paroxysmal trigeminal neuralgia (PTN) has been recognised for centuries, the aetiology and definitive treatment remain obscure. Since this is a debilitating condition, management should aim at improving the quality of life. Alcohol is available, affordable and offers useful results where medical resources provide limited PTN treatment modalities.
J PROFCHINDIAMARK, W PROFGUTHUASYMON. "GUTHUA, S.W., MWANIKI D.L., CHINDIA M.L.: Orofacial lesions as indicators of HIV/AIDS among dental patients in Kenya. E. Afri. Med. J. 72(2): 135-138, 1994.". In: E. Afri. Med. J. 72(2): 135-138. Hekima III (1) 27-42; 1994. Abstract
No abstract available. PMID: 7621750 [PubMed - indexed for MEDLINE]
1993
J PROFCHINDIAMARK. "Akama M.K., Chindia M.L., and Ndung'u F.l.: Occurrence and pattern of Mandibular fractures at Kisii District Hospital, Kenya. East African Medical Journal. 70: 732-733, 1993.". In: East Afr Med J. 1994 Jan;71(1):49-50. Hekima III (1) 27-42; 1993. Abstract
The report revisits the role of alcohol in the treatment of paroxysmal trigeminal neuralgia (PTN). The study included 6 patients, 3 male and 3 female, average age 50 years. In 3 cases PTN involved both the infraorbital and mental nerves; in 2 cases the infraorbital alone while one case had buccal branch involvement. In each case 2mls standard Lignocaine was infiltrated at each site followed by 2mls 60% sterile alcohol. All patients reported swelling postoperatively. One case with mental and infraorbital nerve involvement complained of oral dysaesthesia. Another patient with similar involvement failed to respond and developed trismus. Responders remained pain-free for 9 months on average. While paroxysmal trigeminal neuralgia (PTN) has been recognised for centuries, the aetiology and definitive treatment remain obscure. Since this is a debilitating condition, management should aim at improving the quality of life. Alcohol is available, affordable and offers useful results where medical resources provide limited PTN treatment modalities.
J PROFCHINDIAMARK, W PROFGUTHUASYMON. "Chindia ML, Awange DO, Guthua SW, Mwaniki DL. Focal epithelial hyperplasia (Heck's disease) in three Kenyan girls: case reports. East Afr Med J. 1993 Sep;70(9):595-6.". In: East Afr Med J. 1993 Sep;70(9):595-6. Hekima III (1) 27-42; 1993. Abstract

We report the first three patients diagnosed with focal epithelial hyperplasia (Heck's disease) in Kenya. Clinically they presented as focal or diffuse papillomatous lesions in the oral mucosa. Histopathological features rule out other similar lesions inter alia multiple fibro-epithelial and viral warts.

1992
J PROFCHINDIAMARK. "Chindia M.L., Valderhaug J and Ng'ang'a P.M.: Oral Health habits and Periodontal Health among a group of University Students in Kenya. East African Medical Journal, 69: 337 - 340, 1992.". In: East African Medical Journal, 69: 337 - 340, 1992. Hekima III (1) 27-42; 1992. Abstract
The purpose of this study was to determine the oral health habits and periodontal health among a group of university students in Kenya. The study comprised 243 randomly selected first year students, mean age 23 years, at the University of Nairobi. Questionnaire response showed that 39% of the participants had visited a dentist before, mainly for extraction. Sixteen per cent said they visited a dentist at least once a year and 96% said they brushed daily. Clinical examination was done in a room with natural daylight using the WHO criteria. Plaque was visible on 35% of the surfaces. 11% of gingival sites examined bled on probing. Only one participant had pocket depth greater than or equal to 4 mm. Supra- and sub-gingival calculus was recorded at 18% of index tooth surfaces. The study will be considered as a baseline for later studies on oral health trends in similar populations.
J PROFCHINDIAMARK. "Chindia M.L: Fighting Orofacial Cancer. Africa Health 14:41, 1992.". In: Africa Health 14:41, 1992. Hekima III (1) 27-42; 1992. Abstract

We report the first three patients diagnosed with focal epithelial hyperplasia (Heck's disease) in Kenya. Clinically they presented as focal or diffuse papillomatous lesions in the oral mucosa. Histopathological features rule out other similar lesions inter alia multiple fibro-epithelial and viral warts.

J PROFCHINDIAMARK. "Chindia ML. Giant twin sialoliths presenting with acute cellulitis: a case report. East Afr Med J. 1992 Mar;69(3):171-2.". In: East Afr Med J. 1992 Mar;69(3):171-2. Hekima III (1) 27-42; 1992. Abstract

Sialolithiasis is a process of unknown aetiology in which calculus concretions form in the salivary gland ducts and tissue. It may occur at any age but it is most common in middle-aged adults. A case is presented of the occurrence of double giant sialoliths in the left Wharton's duct in a 16-year-old boy. The clinical symptoms and signs were somewhat atypical and included acute suppurative cellulitis in the floor of the mouth plus localized periodontitis involving 36. Under a local anaesthetic the stones were surgically extracted and healing was uneventful. Proper interpretation of symptoms and thoughtful investigation for localization of salivary stones is emphasized.

J PROFCHINDIAMARK. "Kaimenyi J.T., Ndung'u F.L., Maina S.W. and Chindia M.L.: Oral Health awareness of Kenyan children aged 9 - 15 years in a peri-urban and urban school. East African Medical Journal, 69:337-340, 1992.". In: East African Medical Journal, 69:337-340, 1992. Hekima III (1) 27-42; 1992. Abstract

We report the first three patients diagnosed with focal epithelial hyperplasia (Heck's disease) in Kenya. Clinically they presented as focal or diffuse papillomatous lesions in the oral mucosa. Histopathological features rule out other similar lesions inter alia multiple fibro-epithelial and viral warts.

J PROFCHINDIAMARK. "Ng'ang'a P.M., Bjorn O., Cruz R, Chindia M.L., AASRI E.: Tensile strength of orthodontic brankets bonded directly to fluorotic teeth: An invitro comparative study. Am J Orthod Dentofacial Orthop. 1992 Sep;102(3):244-50.". In: Am J Orthod Dentofacial Orthop. 1992 Sep;102(3):244-50. Hekima III (1) 27-42; 1992. Abstract

Information related to bonding of orthodontic brackets to fluorotic teeth is scanty. The purpose of this study was to compare, in vitro, the tensile bond strength and the bond failure site of brackets bonded directly to fluorotic and nonfluorotic teeth. The etching patterns were also evaluated. The study involved 26 teeth classified as score 3 and 4, and 26 as score 0 with the Thylstrup and Fejerskov's (TF) fluorosis index. In addition to the clinical classification, difference in the concentration of fluoride in the teeth was verified by acid etching. Brackets were bonded with a composite resin after etching the enamel surface with 40% phosphoric acid for 60 seconds. Tensile bond strength was determined with an Instron testing machine. The bond failure site was assessed by the percentage of residue cement on the tooth surface after debonding and the etching pattern by SEM. The mean concentration of fluoride was 2888.5 ppm (SD 1081.7) in the fluorotic teeth and 1227.1 ppm (SD 526.3) in the nonfluorotic teeth. The mean bond strength was 7.8 N/mm2 (SD 1.47) for the fluorotic teeth and 8.6 N/mm2 (SD 2.19) for the nonfluorotic teeth. The difference between the means for bond strength was not statistically significant (p greater than 0.05). Bond failure site was primarily at the bracket-adhesive interface. The mean percentage of adhesive on the enamel surface after debonding was 70% (SD 25.90) for the fluorotic teeth and 75% (SD 24.66) for nonfluorotic teeth. The difference in the means was not statistically significant (p greater than 0.05).

J PROFCHINDIAMARK. "Ng'ang'a PM, Ogaard B, Cruz R, Chindia ML, Aasrum E.Tensile strength of orthodontic brackets bonded directly to fluorotic and nonfluorotic teeth: an in vitro comparative study.Am J Orthod Dentofacial Orthop. 1992 Sep;102(3):244-50.". In: Am J Orthod Dentofacial Orthop. 1992 Sep;102(3):244-50. Hekima III (1) 27-42; 1992. Abstract

Information related to bonding of orthodontic brackets to fluorotic teeth is scanty. The purpose of this study was to compare, in vitro, the tensile bond strength and the bond failure site of brackets bonded directly to fluorotic and nonfluorotic teeth. The etching patterns were also evaluated. The study involved 26 teeth classified as score 3 and 4, and 26 as score 0 with the Thylstrup and Fejerskov's (TF) fluorosis index. In addition to the clinical classification, difference in the concentration of fluoride in the teeth was verified by acid etching. Brackets were bonded with a composite resin after etching the enamel surface with 40% phosphoric acid for 60 seconds. Tensile bond strength was determined with an Instron testing machine. The bond failure site was assessed by the percentage of residue cement on the tooth surface after debonding and the etching pattern by SEM. The mean concentration of fluoride was 2888.5 ppm (SD 1081.7) in the fluorotic teeth and 1227.1 ppm (SD 526.3) in the nonfluorotic teeth. The mean bond strength was 7.8 N/mm2 (SD 1.47) for the fluorotic teeth and 8.6 N/mm2 (SD 2.19) for the nonfluorotic teeth. The difference between the means for bond strength was not statistically significant (p greater than 0.05). Bond failure site was primarily at the bracket-adhesive interface. The mean percentage of adhesive on the enamel surface after debonding was 70% (SD 25.90) for the fluorotic teeth and 75% (SD 24.66) for nonfluorotic teeth. The difference in the means was not statistically significant (p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

J PROFCHINDIAMARK. "Wagaiyu EG, Chindia ML.Beh.". In: East Afr Med J. 1992 Oct;69(10):596-8. Hekima III (1) 27-42; 1992.
1991
J PROFCHINDIAMARK. "Chindia M.L.: Pathogenesis of odontogenic cysts: An update. East Afr Med J. 1991 Apr;68(4):276-82.". In: East Afr Med J. 1991 Apr;68(4):276-82. Hekima III (1) 27-42; 1991. Abstract
This article briefly reviews the origin, classification and pathogenesis of the various odontogenic cysts. Keratocysts and follicular cysts are said to be developmental lesions arising from the remnants of the dental lamina and the cell rests of the dental follicle respectively. The radicular cysts are the most commonly occurring lesions associated with the apices of non-vital teeth. They are said to arise from proliferation of the cell rests of Malassez in chronically inflamed granulomata. It is noted that bone resorption is the major requirement for any bony lesion to expand; hence the interest in the role of diverse cellular and chemical mediators of bone resorption in disease. The current concepts of the role, in cyst initiation and growth, of enzymes including cellular metabolites and cytokines are presented. Evidence on the activities of collagenase, arachidonic acid metabolites, leukotrienes, hydroxyeicosatetraenoic acids, interleukin–1 and prostaglandins is cited. It is observed that the understanding of these cellular and molecular biological behaviour patterns may yield more appropriate information necessary for the development of more effective management modalities for such tissue degrading lesions as odontogenic cysts.
J PROFCHINDIAMARK, W PROFGUTHUASYMON. "Chindia ML, Guthua SW, Mwaniki DL.Ameloblastoma after surgical removal of an impacted mandibular molar. A case report.Int J Oral Maxillofac Surg. 1991 Apr;20(2):73-4.". In: Int J Oral Maxillofac Surg. 1991 Apr;20(2):73-4. Hekima III (1) 27-42; 1991. Abstract
A case of an ameloblastoma diagnosed about 3 1/2 years after removal of an impacted mandibular 3rd molar is presented. The pre-operative radiographs, though poor in quality, showed an ill-defined radiolucency in relation to the tooth. This feature was not apparent to the examiners at the time of first presentation. Despite unfavourable working conditions in developing countries, a high level of suspicion should be maintained to avoid serious sequelae at a later stage.
J PROFCHINDIAMARK. "Chindia ML, Ocholla TJ, Imalingat B.Osteopetrosis presenting with paroxysmal trigeminal neuralgia. A case report.Int J Oral Maxillofac Surg. 1991 Aug;20(4):199-200.". In: Int J Oral Maxillofac Surg. 1991 Aug;20(4):199-200. Hekima III (1) 27-42; 1991. Abstract

Osteopetrosis is a rare disease of unknown aetiology. The relentless bone growth may progressively obliterate the various craniofacial skeletal foramina leading to nerve compression and a diversity of neurological disorders. A case is reported of a 37-year-old woman who was seen because of frequent attacks of paroxysmal trigeminal neuralgia (PTN); other orofacial neurologic deficits and generalised craniofacial skeletal thickening. The prompt recognition and management of associated disorders such as PTN is emphasized. Despite the lack of definitive treatment modalities for both osteopetrosis and PTN, the patient's quality of life must be sustained.

J PROFCHINDIAMARK. "Chindia ML. A conservative management of an extensive odontogenic residual cyst: a case report.East Afr Med J. 1991 Feb;68(2):143-8.". In: East Afr Med J. 1991 Feb;68(2):143-8. Hekima III (1) 27-42; 1991. Abstract
This article briefly reviews the clinical presentation and management of odontogenic cysts. A case is reported of an 18-year-old girl who, on 12-3-1986, presented for the first time at the Dental Department, University of Nairobi with a painful bony swelling in the chin area. The extensive swelling apparently arose long after the traditional removal of two mandibular incisors. After periodontal prophylaxis the cystic lesion was enucleated under a local anaesthetic and the cavity lining subjected to histopathological examination which revealed appearances consistent with those of an odontogenic residual cyst. Immediate wound care involved dressing the defect with zinc iodoform paste on ribbon gauze for 4 weeks when complete granulation and epithelialisation occurred. Subsequently the patient was instructed on homecare irrigation of the cavity without packing. Clinical and radiographic assessment showed progressively satisfactory healing of both the soft tissue and bone through a follow-up period of about two years. It is suggested that the cavity filling in process by periosteal and endosteal bone deposition may be faster where the defect is left without a pack or obturator following complete granulation and epithelialisation.
J PROFCHINDIAMARK. "Chindia ML. Fibrous dysplasia of the jaws: a case report. East Afr Med J. 1991 Apr;68(4):312-8.". In: East Afr Med J. 1991 Apr;68(4):312-8. Hekima III (1) 27-42; 1991. Abstract
This article reviews the present clinical, radiographic and histologic features of fibrous dysplastic lesions of the jaws. A case is presented of an apparently reactivated fibrous dysplastic jaw lesion, with evidence of cystic degeneration, in a 33-year-old female school-teacher who was first seen at the Department of Dental Surgery, University of Nairobi in March 1986. The dilemma in the management of fibrous dysplasia is reviewed and discussed. It is noted that while conservative surgical procedures remain the treatment of choice, situations arise where tremendous tissue activity would require early intervention by numerous cosmetic surgical shaving procedures. The present case, however, offers a unique management challenge due to the occurrence of extensive cystic degeneration in the mandible.
1990
J PROFCHINDIAMARK. "Chindia ML. Coping with the management of orofacial cancer with limited resources. Community Dent Oral Epidemiol. 1990 Apr;18(2):109.". In: Community Dent Oral Epidemiol. 1990 Apr;18(2):109. Hekima III (1) 27-42; 1990. Abstract
No abstract available. PMID: 2335062 [PubMed - indexed for MEDLINE]
J PROFCHINDIAMARK. "Epidemiology of maxillofacial cancer: a need for enhanced knowledge among communities. Community Dent Oral Epidemiol. 1990 Jun;18(3):165.". In: Community Dent Oral Epidemiol. 1990 Jun;18(3):165. Hekima III (1) 27-42; 1990. Abstract
No abstract available. PMID: 2350957 [PubMed - indexed for MEDLINE]
J PROFCHINDIAMARK. "Mg'ang'a PM, Chindia ML. Dental and skeletal changes in juvenile hypothyroidism following treatment: case report. Odontostomatol Trop. 1990 Jan;13(1):25-7.". In: Odontostomatol Trop. 1990 Jan;13(1):25-7. Hekima III (1) 27-42; 1990. Abstract
A case of juvenile hypothyroidism is presented showing evidence of delayed shedding of deciduous teeth, root development, eruption of permanent teeth as well as retarded skeletal growth. Changes in dental and skeletal ages were of varying degrees following two years of treatment with L-thyroxine.
J PROFCHINDIAMARK. "Ng'ang'a PM, Chindia ML, Hassanali J. Clinical report on longitudinal post-eruptive changes in fluorotic enamel observed in 10 cases over a 2 1/2 year period. East Afr Med J. 1990 Jan;67(1):17-23.". In: East Afr Med J. 1990 Jan;67(1):17-23. Hekima III (1) 27-42; 1990. Abstract
The present longitudinal study was conducted on ten children from age 5-6 years to determine the post-eruptive enamel changes of fluorosed permanent incisors. The children were born and reared in an area of Kenya with a water fluoride level of 14-45 parts per million. The incisors were examined and photographed periodically from the time of eruption over a period of 2 1/2 years. It was noted that the fluorosed incisor was intact as it erupted and then it underwent a variety of changes. In some there was mechanical breakdown (pitting) of the chalky white enamel which occurred rapidly initially and then the breakdown slowed down by 2 years. In others, there was smoothening of the pitted enamel resulting in a translucent appearance. Alternatively there was some degree of patchy staining of the enamel without surface breakdown. Much of the cervical 1/3 of the enamel remained intact even in teeth with severe breakdown. In most cases, these changes were bilaterally symmetrical. The possible reasons for these changes are discussed.
1989
J PROFCHINDIAMARK. "Chindia ML. Intracranial tumour presenting with facial pain .Br Dent J. 1989 Apr 22;166(8):282-3.". In: Br Dent J. 1989 Apr 22;166(8):282-3. Hekima III (1) 27-42; 1989. Abstract
No abstract available. PMID: 2719885 [PubMed - indexed for MEDLINE]
J PROFCHINDIAMARK. "Chindia ML. Some modalities of initiating and sustaining oral health research. Community Dent Oral Epidemiol. 1989 Oct;17(5):274.". In: Oral Epidemiol. 1989 Oct;17(5):274. Hekima III (1) 27-42; 1989. Abstract
No abstract available. PMID: 2791520 [PubMed - indexed for MEDLINE]
1983
Odhiambo, W. A.;, Chindia ML;, W; GS, Macigo FG;, Akama K. "Injuries Of The Maxillofacial Skeleton In Nairobi, Kenya.". 1983. Abstract

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

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