Researchers in Dentistry

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Academic-service partnerships, research, and the South African Dental Academic
(American Dental Education Association, 2012) Grossman, Elly S.; Naidoo, Sudeshni
In South Africa, academic dentistry is managed through joint agreements between the South African Department of Health (DoH) and each university, in a type of academic-service partnership. For this study, dental faculty members were surveyed to ascertain staff attitudes towards academic research in dental schools and to find out whether the joint arrangement impinges upon research activities. A survey was distributed to 200 members of the South African division of the International Association for Dental Research (SA IADR) and the academic staff of the four South African dental schools. One hundred and five responses were obtained for a response rate of 53 percent; most of the respondents were lecturers (26 percent), specialists (17 percent), heads of department (17 percent), or senior lecturers (13 percent). The majority were employed by the DoH (77 percent) and were members of the SA IADR (51 percent). Most reported feeling that research is an important issue in their school (83 percent) and perceived general research output had declined (59 percent). While 79 percent said they were concerned about the decline, many (71 percent) felt there was little they could do about it. The respondents mentioned the following as reasons for the decline: lackluster approach of DoH structures, weak university support, poor research equipment and facilities, inadequate funding, emphasis on service delivery, undergraduate teaching loads, onerous working conditions, and lack of vision, leadership, and governance by senior management. Faculty members’ twin obligations of service delivery (required by the DoH) and teaching (required by their institutions) have severely impacted South African academic dental research.
Adapting a community of practice model to design an innovative ethics curriculum in healthcare
(Karger, 2013) Naidoo, Sudeshni; Vernillo, Anthony T.
The focus of healthcare ethics within the framework of ethical principles and philosophical foundations has always, in recent times, been the community, namely, the healthcare provider, the patient or, in research, the study participant. An initiative is thus described whereby a community of practice (CoP) model was developed around health ethics in health research, education and clinical care. The ethics curriculum was redesigned to include several components that are integrated and all embracing, namely, health research ethics, healthcare ethics, health personnel education in ethics and global and public health ethics. A CoP is a group who share a common interest and a desire to learn from and contribute to the community with their variety of experiences. The CoP is dynamic and organic, generating knowledge that can be translated into effective healthcare delivery and ethical research. It requires the collaboration and social presence of active participants such as community members, healthcare professionals and educators, ethicists and policy makers to benefit the community by developing approaches that adapt to and resonate with the community and its health - care needs. Philosophical principles constitute the foundation or underpinning of this innovative curriculum. Recommendations are presented that will continue to guide the consolidation and sustainability of the CoP.
The association between area level socio-economic position and oral health-related quality of life in the South African adult population
(South African Dental Association, 2016) Naidoo, Sudeshni; Ayo-Yusuf, Imade J.; Ayo-Yusuf, O.A.
Objective: To investigate the association between arealevel socio-economic position (SEP) and oral health-related quality of life (OHRQoL). Methods: Data collected from a nationally representative sample of the South African population ?16 years old (n=3,003) included demographics, individual-level SEP measures and self-reported oral health status. OHRQoL was measured using the Oral Health Impact Profile-14 (OHIP-14). The General Household Survey (n=25,653 households) and Quarterly Labour Force Surveys (n~30,000 households/ quarter) were used to determine area-level SEP. Data analysis included a random-effect negative binomial regression model and Blinder-Oaxaca decomposition analysis. Results: Area-level deprivation was associated with more negative oral impacts, independent of an individual's SEP. Other significant predictors of oral impacts included having experienced oral pain and reporting previous dental visits. Area differences in dental attendance contributed the most (37.5%) to the observed gap in OHRQoL, explained by differences in area-level SEP, whereas individual-level SEP contributed the least (18.8%). In the more affluent areas, satisfaction with life in general and individuals' SEP were significantly positively associated with OHRQoL.
Avoiding perverse incentives
(South African Dental Association, 2015) Naidoo, Sudeshni
A general dental practitioner was approached by a friend and colleague, a maxillo-facial surgeon, who had recently taken up rooms near her practice. He offered incentives to her for any surgical referrals she could provide. Furthermore, he said that since he was participating in a pharmaceutical research clinical trial, he could increase the incentive if she referred patients who were eligible for inclusion in the trial ... should the specialist's offer raise ethical concerns?
Dental ethics case 13: what do I do when I suspect that my elderly patient is being abused?: dental ethics
(South African Dental Association, 2011) Naidoo, Sudeshni
The problem of elder abuse and neglect in South Africa is widespread. Elder abuse occurs across all economic, ethnic, religious, gender and cultural groups. In South Africa the problem was previously the sole responsibility of the Department of Welfare (Social Development) with the result that abuse was only dealt with in homes for the aged. With older persons encouraged to live in their communities and families as long as possible, it means that the responsibility for dealing with elder abuse has shifted to many more sectors. Elder abuse can be defined as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person”. Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial abuse. It can also be the result of intentional or unintentional neglect.
Dental ethics case 16: Pull out my four front teeth ...
(South African Dental Association, 2011) Naidoo, Sudeshni
The scenario is a 14 year old girl who requests the extraction of her four front teeth, even though she has no problems with her teeth. She said it is because all her friends and some of her family members have had their front teeth extracted and she would like to do the same. Despite counselling against the removal of her teeth, she is adamant that she wants the teeth removed. A commentary is given on this scenario.
Dental ethics case 17: What are my obligations and ethical responsibilities when treating patients with HIV?
(South African Dental Association, 2011) Naidoo, Sudeshni
This ethical case is about a 20 year old female patient who had recurrent ulcers in and around her mouth. The dentist suspected that the recurrent ulcers and candidiasis were oral manifestations of HIV and confronted her with his suspicions of her being HIV-positive.
Dental ethics case 18: Use of amalgam for dental restorations
(South African Dental Association, 2012) Naidoo, Sudeshni
A commentary is given to the scenario of patients who request that the removal of perfectly serviceable amalgam restorations and replace them with composite or tooth-coloured materials.
Dental ethics case 20 suspected malignancy: to tell or not to tell the truth?
(South African Dental Association, 2012) Naidoo, Sudeshni
Dental ethics case 21: extreme makeovers - the ethics of aesthetic dentistry
(South African Dental Association, 2012) Naidoo, Sudeshni
Aesthetic sensibilities need to develop within the limits of physiological, morphological and occlusal parameters in restoring function and improving dentofacial and facial aesthetics.
Dental ethics case 24: Non-therapeutic cosmetic treatments including botox
(South African Dental Association, 2012) Naidoo, Sudeshni
Dental ethics case 25 the drug-abusing patient – what are my ethical obligations to treat?
(South African Dental Association, 2012) Naidoo, Sudeshni
Dental ethics case 26 the incompetent geriatric patient
(South African Dental Association, 2012) Naidoo, Sudeshni
Dental ethics case 27 - the orthodontic dilemma of non-compliance
(South African Dental Association, 2012) Naidoo, Sudeshni
Dental ethics case 2: What are your responsibilities to patients who may have an eating disorder?
(South African Dental Association, 2010) Naidoo, Sudeshni
Eating disorders are a serious concern and can also have significant consequences on oral health. They represent a clinical challenge to dental professionals because of their unique psychological, medical, nutritional and dental patterns as well as their distinctive characteristics.
Dental ethics case 3: informed consent: risks and benefits of treatment
(South African Dental Association, 2010) Naidoo, Sudeshni
Studies have shown that pre-operative patient education, providing coping strategies and/or reasonable expectations regarding the post-operative course can help lessen patient anxiety and decrease pain, complications and recovery time.
Drug-abusing patients - Can I refuse to treat them?
(ALLSA, 2013) Naidoo, Sudeshni
In the past few months, there have been increasing numbers of drug-abusing patients attending my practice. More recently, an anorexic, very agitated and nervous 20-year-old presented at my consulting rooms requesting medication for pain. He reported using methamphetamine (‘tik’) for the better part of 5 years. When he was refused pain medication he became aggressive and violent towards staff members. What are my ethical obligations, and can I refuse to treat patients who abuse drugs?
The effects of an educational intervention on the early management of oral lesions in the uMgungundlovu district in KwaZulu-Natal
(MedPharm Publications, 2013) Muslim, T.; Naidoo, Sudeshni
Oral lesions that are associated with human immunodeficiency virus (HIV) infection are often the first clinical signs of an underlying infection. This study aimed to test primary healthcare (PHC) nurses’ knowledge and practices before and after an educational intervention on the detection and management of oral diseases, and in particular, those associated with HIV infection. A crosssectional study was conducted among PHC nurses who were employed in a range of clinical settings within the public sector (hospitals, clinics and nurse training colleges) in urban and rural areas in the uMgungundlovu Health District of KwaZulu-Natal. The convenience sample comprised 121 nurses who completed a self-administered questionnaire, undertook pre-education testing, were provided with educational material and underwent post-education testing. The obtained results showed that most nurses (90%) had received little or no undergraduate or postgraduate training in the examination, diagnosis or treatment of oral lesions. Analysis of the pre-education test results that pertained to the identification of a number of oral lesions revealed a mean correct response rate of 38.5%. Post-education results revealed a statistically significant (p-value < .0001) (24%) improvement to 62.4%. The provision of a basic education intervention can have significant effects on knowledge, treatment and referral patterns, and can lead to early diagnosis, treatment and improved quality of life for persons who are infected with HIV.
Endodontic treatment - reamers do break
(South African Dental Association, 2013) Naidoo, Sudeshni
During routine root canal treatment (RCT) of a lower molar tooth, a reamer fractured in one of the root canals. Should I inform the patient? What are my ethical obligations to the patient? Is a broken reamer or file a legal or practice management problem? Should I only charge the patient if the RCT is successful? When should I as a general dental practitioner refer the patient to a specialist?
Ethical considerations when treating patients with eating disorders
(South African Dental Association, 2015) Naidoo, Sudeshni
In South Africa, the prevalence of eating disorders remains largely unknown. However with the unique, complex, social and political transformation of the country and increasing urbanization, it is anticipated that there will be an increased local risk of eating disorders. Psychological, social, biological, cultural and familial factors play a role in the development of these ailments. Adolescence is a time of significant self-awareness, identity development and critical self-evaluation and has perhaps been most impacted by socio-cultural changes in contemporary South African society. It is usually during this developmental phase that, among females predominantly, body dissatisfaction and aesthetic concerns are raised and efforts to address these worries often result in dieting. Western culture and the seductive emphasis on consumerism appear to have a powerful impact on the development of eating disorders. Consequent assimilation of the associated Western value system, where physical appearance and self-worth are seemingly synonymous, seems inevitable. The media plays a pivotal role in promoting and reinforcing the development of eating disorders as youngsters are faced with a barrage of media propaganda suggesting what is the ideal body.