CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
AFRICA
337
The distribution of valvular lesions is shown in Table 2. The
distribution of scores obtained after calculation of the plaque and
gingival index scores are shown in Tables 3 and 4.
Seven (15.9%) patients had normal panoramic radiographs.
No patients were edentulous. The nature of radiographic
abnormalities and their relative frequency are shown in Table 5.
The panoramic radiographs, shown in Figs 1 to 4, illustrate some
of the abnormalities that were detected.
Discussion
The plaque and gingival index scores were classified as good
in only 13.6 and 15.9%, respectively of patients with severe
rheumatic heart disease who were scheduled to have cardiac
surgery. None of the patients had a score that would have placed
their indices in the excellent category, while 31.8 and 54.6% of
TABLE 1. DEFINITIONS USED FOR
RADIOGRAPHIC LESIONS
19-21
Missing teeth
All permanent teeth not on the radiograph
Unerupted teeth
Teeth that had not reached the occlusal plane and
which were not impeded from doing so
Impacted teeth
Teeth with fully or incompletely formed roots,
impeded by hard tissue from reaching their correct
relationship to the occlusal plane and surrounding
bone
Hypercementosis
Formation of excessive cementum on tooth roots
Peri-apical
radiolucency
Radiolucency associated with the apex of a tooth
root
Caries
Radiolucent areas in a tooth
Attrition
Wearing away of a tooth where teeth rub together
Tooth fracture
Fracture of the crown and/or root of the tooth
Retained roots
Roots which cannot be restored because of insuf-
ficient remaining healthy tooth tissue and/or
supporting tissue
Interdental bone loss Lack of continuity of lamina dura
TABLE 2. DISTRIBUTION OFVALVULAR LESIONS (
n
=
44)
Valvular lesions
No. of
patients
Isolated mitral stenosis
Isolated mitral regurgitation
Mitral stenosis plus regurgitation (mixed mitral valve disease)
Aortic regurgitation
Aortic regurgitation plus aortic stenosis (mixed aortic valve
disease)
Mixed mitral valve disease plus mixed aortic valve disease
8
3
16
3
3
11
TABLE 3. PLAQUE INDEX: DISTRIBUTION OF SCORES
Patients
Rating
Score
Number
Percent
Excellent
Good
Fair
Poor
0
0.1–0.9
1.0–1.9
2.0–3.0
0
6
24
14
0
13.6
54.6
31.8
TABLE 4. GINGIVAL INDEX: DISTRIBUTION OF SCORES
Patients
Rating
Score
Number
Percent
Excellent*
Good
Fair
Poor
0
0.1–0.9
1.0–1.9
2.0–3.0
0
7
13
24
0
15.9
29.5
54.6
*Healthy tissue
TABLE 5. TYPESAND FREQUENCIES OF
RADIOGRAPHICABNORMALITIES
Patients
Abnormality
Number
Percent
Caries
Missing teeth
Peri-apical radiolucencies
Impacted teeth
Unerupted teeth
Hypercementosis
Tooth fracture
Attrition
Retained roots
Interdental bone loss
25
24
8
11
9
5
1
8
10
6
56.8
54.5
18.1
25.0
20.5
11.4
2.3
18.2
22.7
13.6
Fig. 1. Panoramic radiograph showing few abnormali-
ties. This radiograph shows complete dentition, with no
unerupted or impacted teeth. Interdental bone loss is
minimal. A large carious lesion (a) is present in the right
second mandibular molar tooth. A peri-apical radiolu-
cency (c) is also present at the apex of the same tooth.
This is indicative of a peri-apical abscess or granuloma.
21
The overall condition of the teeth of this patient is good.
Fig. 2. Panoramic radiograph showing more abnormali-
ties than Fig. 1. This radiograph shows three impacted
third molar teeth (g). The right first maxillary molar tooth
is missing (b). The crown of the left second mandibular
molar tooth is missing and retained roots are present
(f). The same tooth also shows a peri-apical radiolu-
cency (c) with a well-defined calcified margin indicating
possible peri-apical cyst formation.
21
The retained root of
the right second maxillary incisor tooth is also seen (f).
The occlusal surfaces of the right mandibular first and
second molar teeth show attrition (d).
