Dental focus on facial deformities

Starting with his home nation of Nigeria, Azeez Butali is on a mission to make facial deformities, such as cleft lip and cleft palate, a health priority in Africa.

Cleft lip describes a condition where the lip has not completely formed and can result in a large opening from the lip up through the nose.

In cleft palate, the roof of the mouth has not completely closed, leaving an opening from the mouth into the nasal cavity. In severe cases it can extend from the front of the mouth right back to the throat.

Cleft lip and cleft palate are among the most common birth defects, affecting about one out of every 700 babies. The severity of the deformity can vary from child to child - some are mild, but many are severe, requiring surgery.

In the developing world, where the cost of rehabilitation and problems of access puts treatment beyond the reach of vast numbers of affected individuals, these facial abnormalities are a serious health and social burden to children and families. The cause and prevention of the conditions is unclear but of major importance.

Azeez graduated with a Bachelor of Dental Surgery from the University of Lagos before taking up a Masters degree in the School of Dentistry at Dundee where he is conducting research into the cause and prevention of orofacial (affecting the mouth and face) clefts in Nigeria.

"I am investigating the genetic and environmental causes of orofacial clefts in Nigeria with the ultimate aim of prevention. First, we need to determine exactly how many children in the country are being affected," Azeez said.

A systematic review of the incidence and prevalence of the condition carried out last year revealed that the number of children born with orofacial clefts was being underestimated in Africa.

"The available studies were hospital based. All of the information was obtained from hospital records and it is likely that this figure represents only a small proportion of the total population", Azeez said.

Azeez is working on "Nigeriacran" - a major project to develop a hospital birth defects registry in Nigeria and a gene-environment interaction study to establish the genetic and environmental triggers that predispose babies to the condition.

"By setting up a registry that records birth defects, we can significantly improve our understanding of the size of the problem. Presently only one birth defects registry exists in the whole of Africa - the South African Birth Defects Surveillance System," he said.

The project will also involve collecting information on any illness experienced by the mother, medication, lifestyle and any pollutants she may be exposed to through her work or the environment. DNA samples will be collected from the affected child prior to surgery and, when possible, both parents.

The study is involving a significant collaborative effort, coordinated by the University of Dundee. Thirteen hospitals across Nigeria are participating. The charity Smile Train will fund cleft repairs and the Nigerian Institute for Medical Research will conduct DNA extraction and storage.

The School of Dentistry is one of only two WHO collaborating centres for craniofacial anomalies in the world. The research at Dundee is led by Professor Peter Mossey, who was selected by the WHO to be one of four experts to drive their international craniofacial anomalies research project.

"The ultimate scientific and humanitarian aim of WHO collaboration on Cleft Lip and Palate (CLP) is primary prevention; and in order to advance this, objective consistency of association with respect to genetic and environmental risk factors will be necessary for proof of causality," Professor Mossey said.

"It is therefore important that research in the developing world is part of the WHO research portfolio and projects in India, Nepal, Latin America and Nigeria are underway. Dr Azeez Butali, being from Nigeria provides the research liaison between the WHO Collaborating Centre in Dundee and the 13 Nigerian Centres participating in this project."

Now in the second year of his PhD, Azeez plans to continue work on orofacial clefts when he graduates.

"I plan to work closely with cleft teams across Africa, including government and non-governmental organisations, to set up craniofacial birth defects registries in Africa, investigate the causes of orofacial clefts in different groups, and plan strategies for prevention," he said.

Azeez also hopes to maintain his links with Dundee.

"Africa will benefit a great deal from the WHO collaborating centre at the University of Dundee in the quest to improve the care of children with craniofacial birth defects, especially cleft lip and palate."

"My future plan is to influence government policies in order to make craniofacial abnormalities a health priority in Africa."