UWCScholar :: Browsing by Author "Naidoo, Sudeshni"

Browsing by Author "Naidoo, Sudeshni"

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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.
Advertising your additional qualifications
(SADA, 2016) Naidoo, Sudeshni
Advertising of a health professional’s credentials is strictly regulated with the aim of protecting both the patient’s and the health professional’s rights. The same ethical principles govern all forms of advertising, whether published in print, electronic or other media. Health professionals must refrain from self-promotion. Unethical behaviour such as the canvassing and touting for patients is strictly forbidden by the HPCSA.1 Nowadays, however, advertising on the Internet has become a norm and every dental practitioner is ethically and legally responsible for his or her online websites. This is made clear by the HPCSA who state “if a health care professional chooses to make known that he or she practices in a specific field, the health care professional assumes a legal and ethical responsibility for having acquired a level of professional competence within the field of expertise which must be demonstrable and acceptable to his or her peers”. By advertising services that one is not trained to provide, the principle of nonmaleficence (do no harm) becomes significant.
Assessment of a framework for the allocation of primary dental services
(University of the Western Cape, 2017) Antunes, Denise Silveira; Naidoo, Sudeshni; Myburgh, Neil G.; Hilgert, Juliana B.; Hugo, Fernando N.; Fisher, Paul D.
Background: Standardized and evidence-based resource allocation frameworks for timely provision of primary dental services may support equitable distribution of comprehensive dental care. However, such frameworks, which can be applicable to primary care settings in Brazil, are not available. The purpose of this study was to explore the complex issue of equity allocation of dental staff for primary dental care services, by estimating time to dental disease progression in order to analyze costs when survival targets are set for patients waiting for primary dental care. The inclusion of wait time benchmarks for dental services in the design of the framework was an attempt to increase knowledge on the quality of access experienced by people living within catchment areas of the Family Health Strategy in Brazil. In view of ever scarce resources for public health services, ethical dilemmas arise in resource allocation when allocation choices require priority setting among individuals who face similar health needs. Since equity of access must be assured for all Brazilian citizens, the present study proposed a rational resource allocation model to help decision-makers in reconciling equity access and budgets. Aim: This study aimed to compare equity of access to dental services and costs of dental staff of two models for primary care settings. Additionally, staffing requirements and staff costs were projected over a three-year time period. Both models comprised three inter-related components: (i) universal access to oral health care, (ii) comprehensiveness of primary dental care and (iii) equity of access to primary dental services. Method: The present study was part empirical and part modeling in design. In the empirical phase, a set of maximum wait times for dental care determined by experts (Model 1) vs. wait times derived from survival analysis (Model 2) was compared. A one-year follow-up of a cohort of dental patients assigned to five primary health care clinics was conducted. The event of interest was clinical deterioration in the waiting time for dental visits. At each consultation with a dentist either for routine or emergency reasons, the oral quadrants of the patient were assessed and classified according to their urgency for dental care (from 1, less urgent to 5, more urgent). In the modeling phase, costs of dental staff were estimated on the basis of survival probabilities found in Model 1 and on survival targets simulated in Model 2. The amount of staff required as calculated by combining data on: dental service needs, activity standards for dental services, workload components in dental care, cost per working hour of dental staff, and probabilities of clinical deterioration in the wait for dental visits. Main Findings: In Model 1 (wait times determined by experts), survival probabilities were found to be unevenly distributed between diagnostic categories: category 4= 0.939 (SE 0.019); category 3= 0.829 (SE 0.035); category 2= 0.351 (SE 0.061) and category 1= 0.120 (SE 0.044). The cost of dental staff in Model 1 was estimated to be R$104 110.88 (BRL). In cost simulations of Model 2, where wait times were derived from the survival analysis study, a similar 0.900 survival probability target for all sampled quadrants (n=7 376) was found regardless of their final classification in the study year. The resulting cost of Model 2 was R$99 305.89 (BRL). Conclusions: From an equity-access perspective, the survival analysis concluded that wait times for dental visits determined by the experts may engender inequitable survival probabilities for oral quadrants classified in different diagnostic categories. From a dental-staff costs perspective, one concluded that less resources were required by setting an equitable 90% survival target for all oral quadrants studied.
Assessment of infection control in public dental clinics in Khartoum State, Sudan
(University of the Western Cape, 2012) Idris, Modather Mohamed Ahmed Sheikh; Naidoo, Sudeshni
The unique nature of dental procedures, instrumentation and patient care settings require specific strategies directed at the prevention of transmission of diseases among oral health care workers and their patients. Aim: The aim of the present study was to assess the knowledge, attitude and practice of infection control among dentists and dental auxiliaries in public dental clinics in Khartoum State, Sudan. Materials and Methods: A cross-sectional survey using a structured administered questionnaire was carried out. The questionnaire consisted of 38 closed-ended questions that included the key areas of infection control including hand hygiene, personal protection, sterilization and disinfection and environmental infection control. There were also questions to elicit perceptions regarding the treatment of HBV and HIV/AIDS patients. Results: All except one (n=125) of the oral health personnel in Khartoum State participated in the study. 68 dentists and 57 dental assistants were interviewed. The majority were female (60.8%) and 31-40 year olds the predominant age group (44%) for both genders. Hand washing before and after treating each patient was reported by 89.6%. Among dentists, 84.8% reported that they take the medical history of every patient. A quarter of the dentists and 36.8% of dental assistants reported using both hands to recap the used needles. 84%were vaccinated against hepatitis B. With regard to personal protection, the highest adherence was reported for glove use (99.2%), and the least for eye protection (45.6%). None of the study participants used plastic barriers to cover the clinical contact surfaces, 61.6% did not high vacuum suction and 97.6% did not use the rubber dam. All respondents used autoclaves for sterilization, but only 7.2%sterilized hand pieces. 72.8%reported that they did not mind treating HIV/AIDS and hepatitis B patients; however, dental assistants were more willing to treat them than the dentists.
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?
Barriers to oral health care among people living with HIV in Kwazulu Natal and the Western Cape
(University of the Western Cape, 2008) Turton, Mervyn Sydney; Naidoo, Sudeshni; Faculty of Dentistry
HIV/AIDS is a major problem in South Africa with more than 25 percent of the adult population infected with HIV. Oral lesions and various opportunistic infections characterize the progression of HIV making it imperative for people living with HIV to have access to good quality oral care. There is a need to examine accessibility and use of dental services in South Africans living with HIV as very little research in this regard, has been undertaken. Aim: To investigate the barriers to oral health care for people living with HIV in the KZN and the WC. Research Design and Methodology: A cross-sectional study utilising a self-administered questionnaire and semi-structured interviews has been employed. Participants were people living with HIV older than 18 years attending HIV clinics located throughout Kwa-Zulu Natal and WC. Binary logistic regression was performed to determine the variables associated with not obtaining care.
Betel nut & tobacco chewing habits in Durban, Kwazulu-Natal
(University of the Western Cape, 2009) Bissessur, Sabeshni; Naidoo, Sudeshni
Betel nuVquid chewing is a habit that is commonly practiced in the Indian subcontinent. This age-old social habit is still practiced by Indians in Durban, Kwazulu Natal (South Africa). The betel nut/quid is prepared in a variety of ways. The quid may be prepared with or without tobacco. This habit is said to be associated with the development of premalignant lesions, namely, Oral Submucous Fibrosis (OSF) which increases the susceptibility for malignancy of the oral mucosa and the foregut. The aim of this study was to investigate the prevalence of betel nut/quid chewing (with or without tobacco), the associated habits (smoking and alcohol consumption) and awareness of the harmful effects of the chewing habit among Indians in Durban, KwaZulu-Natal. A cross-sectional study design was chosen utilising a self-administered questionnaire and semi-structured interviews to collect data. Consenting participants were requested to complete a self-administered, structured questionnaire. The study population included any person in the Durban area who chewed betel nut/quid/tobacco. Only persons willingly and who consented to be part of the study, were included. The sample size was based on convenience. People were approached at the pan shops, leisure markets, traditional functions and at the dental practice the researcher operated at. A total of 101 respondents were interviewed A significantly higher proportion of females chewed betel nut/quid from the total of the respondents. The results showed that the habit is increasingly practiced in the younger age group (20-39 years). There was evidence to show that the chewing habit is used more by the employed than the unemployed (f0.055). Of the sample population, 'l8o/o wera born in South Africa and the rest were immigrants from Pakistan, lndia and Dubai. All respondents from the migrant community were males. The most important reasons for chewing betel nut were for enjoyment and at special functions. More than two third indicated family members (aunts, uncles and cousins) influence iN a reason for chewing in comparison to influences by parents or grandparents. The study also indicated that parents were far more likely to influence betel nut chewing if grandparents did so (p-value: 0.000). ln addition, the study revealed that family members (aunts, uncles and cousins) were far more likely to influence betel nut chewing if parents did so (f0.000). The most popular ingredients chewed were betel nut, betel leaf, lime and pan masala and the most popular combinations were betel nut/lime/betel leaf quid preparation betel nut alone, betel nut/betel leaf/lime/tobacco/pan masala and betel nut/betel leaf/lime/pan masala. Two thirds of the respondents do not know that betel nut chewing is harmful to their health, thus indicating a lack of awareness on the risks associated with the chewing habit, and the majority have not attempted to give up the habit. Most of the respondents retained their chewing habits after being informed about the risks. A little more than half the study population reported neither smoking nor drinking. The present study found that betel nut/quid chewing habits continue to be enjoyed by many people and most are unawire of the hazardous effects of the habit. More younger people are using the habit as compared to previous studies. This is probably because it is an affordable and easily accessible habit. It is recommended that aggressive awareness programmes on the harmful effects of betel nut/quid chewing be developed, similar to that for smoking cessation. Government health warnings need to be instituted, for example, by having written warnings on packaging. Takes need to be imposed on the betel nut and condiments thereby reducing access to most people. Age reflections need to be imposed on purchasing of the betel nut/quid thus making access difficult for the children.
Commercial baby food: Consumption, sugar content and labelling practices in Uganda
(University of the Western Cape, 2022) Mwesigwa, Catherine Lutalo; Naidoo, Sudeshni
There has been a worldwide increase in the consumption of processed foods in low- and middle-income countries. Processed foods are now easily available and accessible with the increased presence of transnational corporations, urbanisation and improving economies—all essential drivers of the nutritional transition. Ultra-processed foods and beverages (UPFB) have been identified as a significant contributor to total dietary energy and, in specific settings, the biggest source of sugar for infants and young children. High consumption of free sugars in early childhood is associated with poor health outcomes, including early childhood caries, overweight/obesity and an increased risk of developing other non-communicable diseases (NCDs).
A comparative analysis of traditional dental screening versus tele dentistry screening
(University of the Western Cape., 2016) Bissessur, Sabeshni; Naidoo, Sudeshni
Background: Teledentistry is the use of information and communications technology (ICT) to provide oral health care services and enhance oral health care delivery to communities in geographically challenged areas. The public health services in South Africa needs to be overhauled to address the inadequacies in the current system. As an attempt to minimise or repair the inadequacies in the public health sector, South Africa has identified the use of ICT’s as a potential tool in improving the delivery of health care. However, although SA has recognised telemedicine as a potential solution to improve access to health care, teledentistry does not feature at all in the dental public health sector. Teledentistry and mobile health has the potential to eliminate or minimise the oral health disparities that exist in South Africa with the use of health information systems. Teledentistry can be initiated in an incremental approach by 'piggy-backing' on existing telemedicine sites, thus reducing ICT costs for the public health sector. Stake holders and government officials need to embrace technology to address some of the challenges that exist in the South African public health sector. This study could aid in providing evidence-based information to assist in the introduction of teledentistry in South Africa as an innovative dental screening and management tool. The most recent SA National Oral Health Survey showed that at least 80% of dental caries in children is untreated (Department of Health, 2003) and this poses a significant public health problem. To reduce the double burden of dental caries in children and human resource shortages in the public sector, the use of teledentistry as a school screening tool has been recommended. Teledentistry screening has the potential to improve access and delivery of oral health care to children in underserved and the rural areas. The aim of the study is to compare traditional dental screening versus teledentistry screening for dental caries in children. Methodology: This study consists of two parts: the first part a concordance study and the second part the determination of user satisfaction with regards to the technology used. The concordance study assessed the diagnostic agreement between traditional and teledentistry screening of dental caries in school children aged between 6-8 years old. The methodology included traditional face-to-face dental screening by two trained and calibrated evaluators, and the teledentistry screening method included the same two evaluators together with two trained and calibrated teledentistry assistants (who were of non-dental background). For the traditional face-to-face dental screenings the two evaluators examined 233 children at selected rural primary schools and scored them for DMFT. For the teledentistry screening method the teledentistry assistants captured intraoral images of the same children and web-based stored the images in corresponding eFiles. After a two week wash out period these intraoral images were then examined by the same two evaluators and scored for DMFT. To determine concordance across methods, Kappa Statistics was applied to the data and this revealed intra-examiner reliability. To determine user satisfaction levels, close-ended questionnaires were designed based on the role of the evaluators and TAs in the teledentistry screening process. Results: The intra-rater agreement and reliability across methods for evaluator one was 98.30%, and for evaluator two it revealed a result of 95.09%. Kappa statistics thus revealed that both evaluators were in agreement between a range of 95%-98.30% of the classifications, or 92.79% of the way between random agreement and perfect agreement (p=0.000). The high concordance level indicated that there was no statistical difference between the traditional dental screening method and the teledentistry screening method (intra-rater reliability), thus suggesting that the teledentistry screening method is a reliable alternative to the traditional dental screening method. For the user satisfaction part, both of the evaluators agreed with 8 of the 13 statements (62%). The statements that were agreed upon related mainly to user satisfaction on the technology which included accessing the intraoral images for screening and the ease of scoring decayed and missing teeth off the images; time and technology suggested the screening process of the images saved time; and indicated teledentistry as being an innovative and easy system to use that will save clinical time for dental professionals. The statements they disagreed with related to the clarity of the images, scoring interproximal caries off the images, and the dental screening method of choice. Both of the TAs agreed with 7 of the 11 statements (64%). They agreed upon statements related mainly to perception of children’s attitudes & behaviour which suggested the children were comfortable during the imaging process and in addition they were excited to see pictures of their teeth; they found teledentistry to be an innovative and easy system to use; they found teledentistry to be a sterile process and hence they were happy with infection control. Both TAs disagreed with the statement that suggested clear images could be captured irrespective of poor lighting. Discordant statements related mainly to user satisfaction on technology which related to ease of using the intraoral camera, ease of storing the captured images into the eFiles and ease of deleting unwanted images. Conclusion: The key findings of this study highlights the reliability of utilising teledentistry as a dental screening and diagnostic tool which can be valuable in the delivery of oral health care in South Africa. This research study further revealed valuable data on user satisfaction levels of the evaluators and TAs, and has an impact on the utilisation of the teledentistry screening system. To ensure adoption and adaptation of the screening process all users must be satisfied with the ICTs used in the teledentistry system. User friendliness can impact negatively on the adoption of teledentistry.
Compliance of public dental clinics in the Umgungundlovu district with norms and standards in the Primary Health Care Package for South Africa
(University of the Western Cape, 2016) Rajcoomar, Nuerisha; Naidoo, Sudeshni
BACKGROUND: The majority of South African citizens are dependent on the State Health Care system for their wellbeing. Dental services are part of this system. The first line of intervention for oral disease is the primary oral health services. The National Norms and Standards for Primary Health Care sets out in detail the services to be offered by state dental clinics. This document also lists the equipment and materials that public dental clinics should be furnished with in order to deliver prescribed services. Despite this, most public dental clinics do not deliver the full spectrum of services due to the lack of materials and equipment. The end result is that patients do not receive the ideal treatment and treatment choices are based on the availability of equipment and material instead of clinical appropriateness. There was a need to determine to what extent the primary oral health clinics comply with the National Norms and Standards for Primary Health Care. The launch of the green paper of the National Health Insurance in 2011 stated that the NHI is a tool to ensure that healthcare to the entire South African population is of an equal standard. The Umgungundlovu District is one of the sites identified as a pilot district for the NHI. Prior to 1994 there was a two tiered health system in South Africa, the private health system and the public health system. It is this historical model that has shaped the current system. It was the socio-economic status of an individual that dictated within which of the two tiers treatment was sought. AIM: To determine whether public dental clinics in the Umgungundlovu District are equipped to deliver the oral health services prescribed by the Primary Health Care Package for South Africa protocol. METHODOLOGY: A cross sectional study was conducted in the Umgungundlovu district which is in KwaZulu Natal to establish which of the prescribed dental services are offered at the clinic. There are 11 dental clinics in the Umgungundlovu District and one mobile dental clinic. All clinics and the mobile clinic were included in the study. Physical inspection and a checklist were used to determine which equipment and materials were available at dental clinics of the Umgungundlovu district and to determine compliance with the National Norms and Standards for Primary Health Care. RESULTS: Dental services were provided at all the 12 dental facilities in the Umgungundlovu district. None of the clinics had 100% of required instruments, materials and equipment. Half of the clinics had more than 50% of required instruments, materials and equipment. Tooth-brushing programs and fluoride mouth rinsing programs were offered by 41.67% of the clinics, fissure sealant applications by 66.67% and topical fluoride application by 25% of the clinics. In addition, while all offered oral examination and emergency pain and sepsis care (including extractions) only half were able to take bitewing radiographs, 58.33% to carry out simple fillings of 1-3 tooth surfaces, 66.67% to provide atraumatic restorative treatment (ART). CONCLUSION: Lack of materials, instruments and equipment, the irregular supply of materials, instruments and equipment and the late supply of materials, instruments and equipment was found to limit the dental treatment offered by the clinics. None of the 12 clinics in the Umgungundlovu district were found to be compliant with the Primary Health Care Package for South Africa – a set of norms and standards document. Availability of dental services was limited in the dental clinics, except at the Edendale Dental Hospital Department
Dealing with non-compliant, abusive or aggressive patients in dental practice
(South African Dental Association, 2016) Naidoo, Sudeshni
There is increasing concern as to how health professionals respond to patients who are considered non-compliant, abusive or difficult. What are their responsibilities to the patient? What are their responsibilities to other patients and staff? Can the patient be refused treatment? What are the responsibilities that providers, as employers, have in relation to staff who might be treating violent or non-compliant patients? What are the competing rights and responsibilities of patients and of the dental provider? Are the above questions influenced by the threat posed by the patient to the safety of staff and other patients? There are many instances in daily practice where patient behaviour, while being difficult and emotive, is not necessarily wrong or inappropriate in the context of the service being provided and the circumstances relating to their particular dental condition. This paper discusses issues relating to circumstances where serious issues arise regarding the behaviour of persons receiving dental treatment in the context where such behaviour is clearly inappropriate, aggressive or violent.
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

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