UWCScholar :: Browsing by Author "Stephen, L.X.G."

Browsing by Author "Stephen, L.X.G."

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The antimicrobial activity of four herbal based toothpastes against specific primary plaque colonizers
(University of the Western Cape, 2007) Peck, M. Thabit; Stephen, L.X.G.; Africa, C.; Faculty of Dentistry
Aim: To determine whether there was any significant difference in the antimicrobial activity of 4 herbal toothpastes against cultures of 3 primary plaque colonizers (Streptococcus mutans, Streptococcus sanguinis and a non-specific alpha;-heamolytic streptococcus).
Assessment of diagnostic imaging modalities utilized in the diagnosis of the odontogenic myxoma
(2010) Kheir, Eman Ahmed; Stephen, L.X.G.
Odontogenic myxoma (OM) is one of the rare odontogenic tumours that affect the maxilo-facial regions. Skeletal myxomas are more common than soft tissue types in the facial regions. Odontogenic myxomas (OM) are non metastasizing tumours and therefore are considered benign. These lesions are known for their distinctive infiltrative nature which makes complete surgical removal a challenging task.Since the tumour occurs inside the bone and can reach a considerable size with little or no clinical manifestation, the radiologic examination remains the main method to determine the size and the extension of the tumour preoperatively.Aim of the study To assess the different imaging techniques which are currently in use for the diagnosis of the odontogenic myxomas.Materials and methods The images were retrieved from the library of the Department of Diagnostics and Radiology at the Tygerberg Oral Health Centre.Initially each of the imaging modalities was assessed independently to describe the imaging features of odontogenic myxoma on conventional radiograph,Computed Tomography (CT) and Magnetic Resonance Image (MRI). Secondly the imaging features of the three techniques were correlated and contrasted to determine the most valuable imaging modality in the diagnosis of the tumour.Results In this study we found that MRI was superior to other modalities in the ability to show and determine the true extension of the tumours. Therefore, MRI distinguished the tumour tissue from the surrounding structures and soft tissues.Myxomas were found to display characteristic patterns of growth on MRI. These patterns include lobulations and/or budding, nodulation and crevices formation.Moreover T2 weighted images deduced the contents of the tumour by emitting different signal intensities from the various components of the tumours.Additionally, characteristic pattern of contrast uptake differentiated the myxomatous, collagenous parts and presumed the nature of the trabeculae whether it is bony or fibrous.CT also showed the tumour and determined the subtle extension of the tumour into the adjacent structures and bone. Expansion and status of the cortical margin were reliably detected on CT. It also determined the pattern of growth in all tumours whether it is lobulation and/or budding, crevices formation or combination of them. In the present study this feature seemed to be a characteristic finding for all the tumours on CT. Moreover CT was able to compare densities of the tumours to surrounding muscles.Conventional radiography (CR) showed great limitations with regard to diagnostic abilities. Although it displayed the existence of the abnormality in all cases,conventional radiograph failed to detect margins and extension in most of the lesions. Therefore conventional radiograph is not reliable for presurgical assessment of the tumour or in differentiation the tumour from other benign and some malignant tumour. Conclusion In spite of the many limitations and shortcomings, conventional radiography remains the preliminary step in the diagnosis process. However digital imaging techniques provide images of great diagnostic value which is especially helpful in the diagnosis of odontogenic myxoma.
Association between CD4+T lymphocyte levels and "red complex" pathogens of chronic inflammatory periodontal disease in HIV-positive patients
(University of the Western Cape, 2012) John, Cathy Nisha; Stephen, L.X.G.
Background: Infection with HIV results in gradual loss of immunologic functions, especially those mediated by CD4+T helper cells with consequent impairment of the immune response leading to severe manifestations of periodontal disease. The lower the CD4+T lymphocyte cell count or the higher the level of immunosuppression, the higher the incidence of periodontal disease in those patients will be. Putative periodontopathic bacteria namely Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia, commonly referred to as "red complex", and many other bacterial species have been implicated in the initiation and progression of periodontal disease. Objective: The present study tests the association between different CD4+T lymphocyte levels and "red complex" pathogens using BANA, in HIV-positive patients with chronic inflammatory periodontal disease (CIPD). Methods: 120 HIV-positive patients from the infectious disease clinic at Tygerberg hospital participated in the study with a mean age of 33.3 years. The CD4+T lymphocyte counts were obtained from patient's medical records. The six Ramjford teeth were used for evaluating periodontal clinical parameters such as plaque index, gingival index, periodontal probing depth and clinical attachment loss. Subgingival plaque samples were collected and analyzed by the enzymatic BANA test for the detection of the "red complex". Results: The CD4+T lymphocyte mean level was 293.43cells/mm3. Statistically significant associations were found between CD4+T cell counts and probing depth (p= 0.0434) and clinical attachment loss (p= 0.0268). Significant associations were found between BANA with all the clinical indices (p= <0.05). However no association was found between CD4+T cell counts and BANA. Conclusion: HIV-positive patients show a high prevalence of "red complex" pathogens subgingivally. Immunosuppression seems to favour the colonization of these species, resulting in periodontal disease manifestations.
The association between periodontitis and end-stage renal disease
(University of the Western Cape, 2006) Nadeem, Muhammad; Stephen, L.X.G.; Dept. of Oral Medicine and Periodontics; Faculty of Dentistry
Patients who are in end-stage renal disease (ESRD) experience a significantly increased rate of atherosclerotic complications. Inflammation plays a central role in the pathogenesis of these complications. The major acute phase protein, C-reactive protein (CRP) has been found to predict all-cause and cardiovascular mortality in ESRD patients. Many patients in ESRD experience elevated CRP levels without an overt infection. Periodontal diseases in the general population have been associated with both an increased prevalence of atherosclerotic complications and an elevation in serum CRP values. The aim of this present study was to investigate whether periodontal disease is associated with increased systemic inflammation reflected by CRP values, in patients with ESRD on maintenance haemodialysis (HD) or perioneal dialysis (PD).
Comparison of an essential oil mouth rinse and chlorhexidine on 4-day interproximal plaque regrowth
(University of the Western Cape, 2006) Jarrar, Ahmed Ali.; Stephen, L.X.G.; Faculty of Dentistry
Dental plaque is the most important etiological factor of periodontal diseases. Mechanical plaque control is the most effective way in preventing periodontal diseases. Chemical plaque control methods (such as mouthrinses) have been recommended to be used because of some drawbacks in the mechanical methods in some areas of the dentition (such as interproximal areas). But are these mouthrinses really effective in those areas? The aim of this study was to compare the effectiveness of Essential Oils mouthrinse (Listerine) on plaque formation in interproximal areas with Chlorhexidine and Sterile water.
A comparison of two saliva substitutes in the management of xerostomia during radiotherapy for cancer of the head and neck
(University of the Western Cape, 2007) Lochner, Johann Georg; Marnewick, Johan; Stephen, L.X.G.; Dept. of Oral Medicine and Periodontics; Faculty of Dentistry
The aim of the study is to compare the palliative efficacy of two saliva substitutes (Sinspeek and Xerostom) in patients during radiotherapy for cancer of the head and neck. This crossover randomised controlled clinical trial was carried out on twenty-five patients with malignant tumours of the head and neck, following four weeks of radiotherapy at tygerberg hospital. The benefit of saliva substitutes to ameliorate the effects of xerostomia is well established and proper advice and access to relevant preparations is essential.
The effect of storage time on the platelet concentration of Choukroun's platelet rich fibrin (PRF)
(University of the Western Cape, 2011) Peck, M. Thabit; Stephen, L.X.G.; Hiss, D
Wound healing is a complex process characterised by the repair and reconstitution of lost or damaged tissue. By the mid 1990s, several methods were proposed to enhance wound healing of surgical sites by introducing high concentrations of human platelets to these areas. In the early 21st century, Choukroun et al (2006b) introduced a new type of platelet concentrate that was devoid of any additives, and required no specialised equipment for its production. This concentrate was termed Platelet-rich fibrin (PRF) and although various aspects of this biomaterial had been studied, very little is currently known about its storage properties. Aim: To determine whether storage time had a significant effect on the platelet concentration of Choukroun’s PRF Method: A total of 30 patients were enrolled into the study. Three blood samples of 10ml each were drawn from each patient. Two of the blood samples (Group A and Group B) were centrifuged to form PRF. The third sample was used to measure the baseline blood platelet concentration and was therefore not centrifuged. After PRF had formed in both test groups, it was removed from the test tubes at 2 different times i.e. immediately after centrifuge (Group A) or after 60 min of storage in the blood collecting tube (Group B). The remaining blood was then tested for platelet concentration and compared to each other and the baseline reading. Results: 14 males and 16 females participated in the study (average age 41.7 years). A mean blood platelet concentration of 282.8 ± 58.3 × 109/L was recorded for the baseline reading. Group A had a mean blood platelet concentration 7.9 ± 3.03 × 109/L. Group B had a mean blood platelet concentration of 4.0 ± 1.93 × 109/L. A statistically significant difference was seen between Groups A and B (p < 0.0001). Conclusions: Storage time has a significant effect of the platelet concentration of PRF. If stored over a period of 60 min, the platelet concentration of PRF increases. Further research is required to determine whether this finding is clinically significant.
Epidemiological pattern of oral squamous cell carcinoma seen at the Tygerberg academic complex
(University of the Western Cape, 2014) Hamid, Abdullahi Alhashimi; Jeftha, Anthea; Stephen, L.X.G.
Background: Recent epidemiological reports established that there is an increase in the incidence of oral squamous cell carcinoma in young patients. Some report this to be in the absence of contributing habits such as smoking and alcohol use. Few reports of such a nature have reported a similar trend in South Africa. Aim: Describe the epidemiological pattern of oral squamous cell carcinoma seen at the Tygerberg academic complex. Method: Histopathological biopsy reports of patients diagnosed by the oral pathology department of Tygerberg hospital from 1996 to 2013 were electronically retrieved and included. Patients were grouped by age into two groups, one included patients 40 years and younger, the other included patients older than 40 years. Descriptive analysis was performed for age, sex, smoking and alcohol habits and oral site of tumor. Frequency of OSCC patients was calculated manually from the total number of oral biopsies. Chi- square or Fisher’s exact tests were used as appropriate. Probabilities of less than 0.05 were regarded as significant. Results: The total number of OSCC patients over the 18-year period was 2220. The mean age was 57.6years.The male to female ratio was 2.9:1 for all age groups and 2.2:1 for young patients. The majority of patients (96%) were above 40 years old. Smoking and alcohol were commonly reported for all age groups (91.3%) and (83.8%) for young patients. The tongue was the commonest site for all age groups (30.8%) followed by oropharynx (27.3%) while in younger patients, the oropharynx was the commonest site (30.3%) followed by tongue (29.2%). Conclusion: The study confirmed that OSCC is still an affliction of people older than 40 years and males are predominantly affected. Smoking and alcohol are strong risk factors for OSCC irrespective of patient's age. OSCC among people older than 40 years may have no great difference from the same disease affecting younger ones in terms of sex, oral habits and tumor site.
The prevalence and impact of oral lesions on the quality of life in persons with epidermolysis bullosa
(2010) Holmes, Haly Karen; Stephen, L.X.G.
Introduction:Hereditary Epidermolysis bullosa (EB) is a group of rare mechanobullous dermatological disorders in which blisters develop following gene mutations. These genes encode structural proteins that anchor the epidermis to the underlying dermis.There are four main types of Epidermolysis bullosa, with more than 20 subtypes. The medical, physical and psychosocial aspects of Epidermolysis bullosa are well documented (Lucky et al, 2005; Mellerio et al, 2005). Many studies have documented case reports of associated oral lesions (Silva et al, 2004; Pacheco and de Sousa Araugio 2008; Siqueira et al, 2008). However, no assessment of the impact of these oral lesions on the affected person's everyday life has been made. The morbidity of the oral lesions associated with EB is expected to have an impact on the quality of life of these patients.Aim:To assess the prevalence and impact of oral lesions on daily activities in persons with Epidermolysis bullosa in Cape Town, South Africa, utilizing the Oral Impact on Daily Performance (OIDP) measure. Research Design and Methodology A case-controlled, descriptive analysis of the way in which oral lesions impact on quality of life in persons with Epidermolysis bullosa was carried out using semi-structured interviews. Fourteen persons with a confirmed diagnosis of hereditary Epidermolysis bullosa who attended the dermatology clinics at the Red Cross and Groote Schuur hospitals participated in the study. The control group comprised eighteen persons closely matched for gender, age, and dental status. Three persons with EB were unavailable for inclusion in the study.Results and Discussion Fourteen persons with Epidermolysis bullosa and eighteen controls were included in the study. Epidermolysis bullosa Simplex comprised the largest sub-group (n=9). Two persons had Junctional Epidermolysis bullosa, two had recessive Dystrophic Epidermolysis bullosa and one person had Kindler syndrome. The oral manifestations observed were consistent with those reported in the literature(Chimenos et al, 2003; Silva et al, 2004; Pekinar et al, 2005). No significant oral lesions (other than tooth decay) were seen in persons in the Epidermolysis bullosa Simplex group. Oral ulcers, atrophy of the dorsal surface of the tongue and gingival erythema were seen in persons with Junctional Epidermolysis Bullosa. The two individuals with Dystrophic Epidermolysis bullosa had a maximal oral opening of 15mm and 24mm. Ankyloglossia, depapillation of the dorsal tongue, absence of palatal rugae and poor oral hygiene was seen in these two persons. The patient with Kindler syndrome presented with erythematous and inflamed gingiva and cratering in the maxillary anterior interdental area. The gingiva appeared desquamative, fragile and bled with even the slightest provocation. Healing peri-oral blisters and angular cheilitis was also seen. His mouth opening was restricted to a maximal oral aperture of 13mm and his tongue extrusion was limited to only the tip of the tongue passing over the lower anterior incisor teeth.Defects in the tooth enamel was recorded in both participants with Junctional Epidermolysis bullosa and one person with dystrophic Epidermolysis bullosa, as well as excessive occlussal tooth wear (attrition), which may have been secondary to enamel hypoplasia. The dental caries status of the Epidermolysis bullosa and control groups varied according to age. The dmf for persons with Epidermolysis bullosa (all of whom had Epidermolysis bullosa Simplex), was lower than in the control group. The DMF in EB persons (15.3) was higher than in the control group (10.1).Toothache and tooth decay were the most common perceived complaints in both the Epidermolysis bullosa and control participants, accounting for the high overall OIDP score in both groups (87.5%). No statistically significant difference was found between the two groups (85.7% and 88.9% for Epidermolysis bullosa and control group persons respectively).Conclusion:The results of the study show that oral lesions (particularly tooth decay and toothache) in persons with Epidermolysis bullosa do affect their daily activities and the impact thereof is high. Other oral manifestations, irrespective of the subtype, had little impact on the OIDP score. This may be because the EB persons become tolerant of and “learn to cope” with them.Recommendations:Epidermolysis bullosa is a rare condition and not all persons with EB will present with lesions. However, all health personnel (including oral health profession) must be cognizant of this condition, in order to manage these persons safely, without incurring harm inadvertently. Thus, the overall management of persons with Epidermolysis bullosa must encompass ways to minimize and prevent trauma; provide an optimum wound healing environment; provide pain management and judicious checks for the development of premalignant lesions. This necessitates a multidisciplinary and holistic approach, with emphasis on patient involvement. To this end, an oral health care programme should form an integral part of their management because of the risk of dental disease. Periodic recall visits will enable the monitoring of home care and minimize the need for advanced restorative procedures. In this way, one may reduce the impact any oral problems may have, so that they do not further influence the patients well being.
The prevalence and severity of periodontal disease in Type II diabetics
(University of the Western Cape, 2011) Hyslop, James R.; Stephen, L.X.G.; Hough, S.
Introduction: The relationship between Periodontal Disease and Type II diabetes has been reported in recent literature. More recent studies suggest that further research is required into the relationship of glycaemic control on Periodontitis. The main aetiological factor in Periodontal Disease is plaque; however other secondary factors such as Diabetes Mellitus, neutrophil abnormalities, smoking, socio-economic status, age, stress, Human Immunodeficiency Virus (HIV) infections, pregnancy, sex hormones, osteoporosis and several other conditions play an important causative role (Genco, 1993). Aim: The purpose of this study is to test the hypothesis that the prevalence and severity of periodontal disease is greater for patients with poorly controlled Type II Diabetes Mellitus (DM-2) compared to those with better controlled Type II Diabetes Mellitus. Methods: 'Coloured female patients', who were diagnosed with Type II diabetes were included in the study. Demographic information, medical history and HbA1c levels were recorded by the attending physician in the diabetes unit. Periodontal examination was carried out by a single examiner. This included a plaque index (PI), a gingival index (GI), bleeding on probing (BoP), probing depths (PD) and clinical attachment loss (CAL). These measurements were recorded on Ramfjord teeth. The presence of any one sextant showing PD of ≥ 4 mm or clinical loss of attachment of ≥ 3 mm was diagnosed as periodontitis. Results: Poor glycaemic control was associated with more severe periodontitis. Conclusion: The results of the study showed that it could be justified that the regression approach (correlation) be applied to the complete sample of 63 individuals. Most of these correlation coefficients were positive and significantly different from zero, indicating that 'HbA1c' had a detrimental influence on the periodontal measurements; within the limitations of the study. This link could be indirect in that some other properties of diabetes, and not necessarily 'HbA1c', affected the dental health of diabetics adversely.
Prevalence of interleukin-1 polymorphisms and its association with periodontal disease status in the Xhosa population of South Africa
(University of the Western Cape, 2007) Tareq, Abu Saleh; Stephen, L.X.G.; Dept. of Oral Medicine and Periodontics; Faculty of Science
Periodontitis is a bacterially induced chronic inflammatory disease that destroys the supporting tissues of teeth. Clinical observations and experimental evidence indicates that there is a genetic influence of risk factors for periodontitis. A specific pattern of IL-1 polymorphisms (known as the composite IL-1 genotype) has been found to influence the severity of chronic periodontitis. The objective of this study was to evaluate the association between the IL-1 gene polymorphisms and the severity of periodontal disease in a selected Xhosa ppopulation of South africa.

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