ABSTRACT Background: Epithelial-myoepithelial carcinoma (EMC) is a rare biphasic salivary gland malignancy that can pose diagnostic challenges. We describe a 52-year-old man whose recurrent right parotid and upper-neck mass was initially considered rhabdomyosarcoma and subsequently non-Hodgkin lymphoma (NHL), before reassessment favoured EMC. Case Report: After an initial biopsy suggesting rhabdomyosarcoma, the patient underwent excision at a private facility. Postoperative histopathology suggested NHL, and lymphoma-directed chemotherapy was unsuccessful. Initial immunohistochemistry (IHC) showed CD45, CD10 and pancytokeratin reactivity, producing an inconclusive interpretation. He was referred for reassessment with a recurrent right parotid, submandibular and upper-neck mass and cervical and axillary lymphadenopathy. Ultrasound demonstrated a heterogeneous mass, while magnetic resonance imaging demonstrated an extensive multinodular, multilobulated neck lesion. Cytology identified malignancy, possibly salivary adenocarcinoma. Repeat biopsy showed clear-cell myoepithelial-appearing tumour cells in nests and sheets with prominent basement-membrane material and hyalinization. IHC demonstrated pancytokeratin and vimentin positivity. The integrated morphologic and immunophenotypic findings supported a diagnosis of EMC, although the limited panel restricts definitive exclusion of mimics. The lesion was considered unresectable; six cycles of chemotherapy were administered at three-week intervals. Clinical reduction of the mass was reported, with no recurrence reported more than one year after treatment. Conclusion: Reassessment of a recurrent salivary-region tumour after discordant diagnoses can clarify management. Morphology should be interpreted alongside a sufficiently discriminating IHC panel; limited marker positivity alone does notestablish EMC. This case illustrates the importance of diagnostic review when treatment response is unexpected. Keywords: epithelial-myoepithelial carcinoma, rhabdomyosarcoma, non-Hodgkin lymphoma, case report, histopathology, immunohistochemistry
ABSTRACTBackground: Mandibular third molar surgery is often associated with pain that can cause considerable discomfort. Pre-emptive analgesia for the control of postoperative pain is targeted at preventing central sensitization before initiating surgical trauma. Some studies have reported promising outcomes with pre-emptive analgesia, whereas others have questioned its benefits, leading Group A received pre-emptive celecoxib, while group B received a placebo. Postoperative pain intensity, the frequency of rescue analgesic use and the time to the first request were the parameters evaluated. Data were analysed using IBM SPSS Statistics version 22.0 with the level of statistical significance set at p<0.05. Results: Postoperative pain intensity, analysed using an independent t-test, showed a statistically significant difference between the two groups at 4 hours (p = 0.02), 8 hours (p = 0.01), 16 hours (p < 0.001) and 24 hours (p <0.001). The mean time to the first request for rescue analgesia was significantly prolonged in the study group (p = 0.003). Conclusion: Pre-emptive celecoxib exhibited significant post-operative pain control. It reduced the need for rescue analgesics in patients within the first 24 hours of mandibular third molar surgery. Keywords: Pre-emptive celecoxib; postoperative pain; third molar surgery.
ABSTRACT Background: Caffeinated beverage consumption has been documented among Nigerian adolescents (5). Recent evidence suggests that opening metal bottle caps with the teeth is becoming an increasingly common oral habit among adolescents. This practice can have significant consequences for dental health, as it may cause trauma to the teeth and surrounding oral tissues. Objective: This study aimed to determine the prevalence of opening bottle caps with the teeth and to assess its impact on the oral health-related quality of life (OHRQoL) of adolescents in Ibadan, Nigeria. Methods: A total of 697 randomly selected adolescents aged 12–19 years from 12 secondary schools in Ibadan participated in this study. Data were collected using structured, pretested questionnaires. Oral health-related quality of life was assessed using the Oral Health Impact Profile-5 (OHIP-5). Data were analysed using SPSS, and the Mann–Whitney U test was used to determine the association between OHIP-5 scores and opening bottle caps with the teeth. Results: The mean age of the participants was 14.6 ± 1.3 years. Overall, 420 (60.3%, 95%CI = 56.6% - 63.8%) adolescents between those who engaged in the practice and those who did not (p > 0.05). The mean OHIP-5 score was 5.2 ± 5.2, and 563(80.8%, 95%CI = 77.9% - 83.7%) participants reported at least one impact on their OHRQoL. Adolescents who opened bottle caps with their teeth reported significantly greater impairment in taste and flavour of food than those who did not (mean ranks: 365 vs. 324; Mann–Whitney U = 51,232.0; p = 0.003). Conclusion: The prevalence of removing metal bottle caps with the teeth was high. Those who removed metal bottle caps with their teeth reported greater impairment in the taste and flavour of food. Keywords: Well-being, Taste, Oral habit, Teeth as bottle opener, Youth
ABSTRACTBackground: Antibiotic prescribing in endodontic practice is central to dental antimicrobial stewardship because systemic antibiotics are often unnecessary when definitive local treatment and source control are achievable. Evidence on prescribing practices among Nigerian dentists remains limited. This study assessed reported antibiotic prescribing and factors associated with potentially guideline-discordant prescribing among dentists in Nigeria. Methods: A cross-sectional survey of 212 Nigerian dentists was conducted between 27 August and 13 December 2025. The primary outcome was potentially guideline-discordant antibiotic prescribing, defined for this study as selecting at least one of irreversible pulpitis, symptomatic apical periodontitis, or interappointment pain as an indication for systemic antibiotics. Descriptive and bivariate analyses were performed with Holm adjustment for six primary comparisons. Multivariable logistic regression examined associations with private versus public practice, a study-defined junior professional group, fewer than 10 versus at least 10 years of practice, and North East versus other regions. Crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Sensitivity analyses examined alternative outcome definitions and one alternative predictor coding. Results: Overall, 199/212 respondents (93.9%; 95% CI 89.8–96.4%) reported prescribing antibiotics following endodontictreatment. Using the primary definition, 156/212 (73.6%; 95% CI 67.3–79.1%) met the criterion for study-defined potentially guideline-discordant prescribing. Among the 199 prescribers, the most frequently selected indications were acute periapical abscess with diffuse swelling (181/199, 91.0%), acute periapical abscess with localized swelling (170/199, 85.4%), and prescribing following endodontic surgical procedures (165/199, 82.9%). However, symptomatic apical periodontitis (137/199, 68.8%), irreversible pulpitis (92/199, 46.2%), and interappointment pain (73/199, 36.7%) were also selected. In the adjusted model, no statistically significant association was observed for private practice (aOR 1.35, 95% CI 0.41–4.44), junior professional group (aOR 1.02, 95% CI 0.39–2.67), fewer than 10 years of practice (aOR 0.83, 95% CI 0.32–2.15), or North East region (aOR 1.38, 95% CI 0.69–2.77). The model showed weak discrimination (AUC 0.542). The primary findings were unchanged across all sensitivity specifications, except that the junior professional group estimate shifted from 1.02 to 1.59 when interappointment pain was excluded from the outcome. Conclusions: Reported antibiotic prescribing was common among the surveyed sample of Nigerian dentists, and study-defined potentially guideline-discordant prescribing was frequent under the study's predefined clinical-scenario definition. The measured professional, practice-setting, experience and regional characteristics showed no statistically significant adjusted associations with the primary outcome. These findings highlight the need for antimicrobial-stewardship interventions appropriate to the local context in endodontic practice, while recognising the limitations of self-reported behaviour, non-probability sampling, and the cross-sectional design. Keywords: Antimicrobial Stewardship; Endodontics; Dentists; Practice Patterns; Nigeria.
ABSTRACTBackground: Children with orofacial clefts (OFCs) experience significant psychosocial morbidity, yet the integration of mental health services into cleft care remains limited in low-resource settings. This study evaluated the impact of integrating structured mental health assessment and intervention into routine cleft care. Methods: This single-arm prospective interventional study enrolled 484 children with OFCs (aged 6–17 years) attending a tertiary cleft clinic in Kano, Northwest Nigeria (January 2024–March 2025). Participants underwent a standardised mental health assessment using validated tools. A stepped-care intervention model was implemented, comprising universal psychoeducation (delivered to all participants), group art therapy (added for those with mild-to-moderate difficulties), and targeted psychiatric referral (added for those with severe difficulties). Outcomes were assessed at baseline, 3 months, and 6 months, and analysed using mixed-effects regression models with Bonferroni correction for multiple comparisons. All hypothesis tests were two-sided. Results: Of 484 enrolled participants, 456 (94.2%) completed 6-month follow-up. Mean Pediatric Quality of Life Inventory (PedsQL) total scores improved from 54.3±11.2 to 79.8±9.4 (mean difference 25.5, 95% CI 23.8–27.2, p<0.001; Cohen's d=2.28). Rosenberg Self-Esteem Scale (RSES) scores increased from 16.9±4.3 to 25.7±3.1 (d=2.05). Revised Children's Anxiety and Depression Scale-25 (RCADS-25) scores decreased from 38.6±8.9 to 21.4±6.2 (d=1.93). Strengths and Difficulties Questionnaire (SDQ) scores reduced from 19.4±4.7 to 12.3±3.8 (d=1.51). Integrated services were associated with higher surgical adherence than the historical control period (92.3% vs 78.6%), although this comparison is subject to secular trend and unmeasured confounding. Speech therapy uptake within the study period was 189/484 (39.0%), compared with 42/484 (8.7%) who had ever received speech therapy at baseline. Conclusions: Integration of mental health assessment and stepped-care intervention into routine cleft care was associated with sustained improvements in quality of life, self-esteem, anxiety/depression, behavioural difficulties, surgical adherence, and speech therapy uptake. This model warrants evaluation in a randomised controlled trial to determine whether the observed improvements are attributable to the intervention. It offers a potentially scalable, culturally adaptable approach for low-resource settings. Keywords: Art Therapy, Cleft Lip, Cleft Palate, Integrated Care, Low-Resource Settings, Mental Health, PsychosocialIntervention
