Department of Anesthesiology and Sedation

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Entrepreneural trends in health care delivery: The development of retail dentistry and freestanding ambulatory services
(University of the Western Cape, 1982) Trauner, J.B; Trauner, J.B
In the 1970s, traditional delivery patterns in medicine and dentistry began to change as health care professionals sought out new ways to attract patients and to increase practice earnings. Anesthesiologists and surgeons began to build freestanding surgical facilities in competition with local hospitals.1 Physicians trained in emergency or primary medicine established urgent care centers along well-trafficked thoroughfares and catered to patients usually seen in hospital emergency rooms. And, beginning in 1977, dentists began to establish high-volume offices in shopping malls and within the confines of drug, discount, and department. store operations. While the growth of independently owned, non-hospital affiliated surgery centers dates .back to the early 1970s, the major impetus for development of urgent eire centers and retail dental offices was the lifting of restrictions on use of advertising by health professionals. Until 1977, the ethical codes of most medical and dental associations prohibited advertising by their members and these codes had.been incorporated into state licensing requirements. Then in 1977, the U.S. Supreme Court decision in Bates Y. State Bar of Arizona (433 U.S. 350) paved the way for professional advertising. For the first time, health professionals could experiment freely with neM practice forms and use standard marketing techniques to attract potential patients. A new generation of entrepreneurial professionals established medical and dental offices with expanded hours of service and ·drop-in" (non-scheduled) visits to meet the needs of an increasingly mobile populationi some began to rely upon price advertising, introductory offers, and discount coupons. while others began to adopt trade names and develop franchising programs to increase their market visibility. Obviously these new developments were not ignored by local physicians and dentists--or by their professional associations. In states where advertising was regulated under medical or dental practice acts, professional associations monitored advertising copy and reported infractions to state licensing boardsi in states with minimal restrictions on advertising. physicians and dentists began to clamor for new guidelines. Two areas of heated controversy related to advertising of fees (including use of discounts) and the development of fictitious trade names. Another point of conflict involved expanded duties for para-professionals, particularly in dentistry where activities of hygienists and auxiliaries had been narrowly defined by many state licensing boards. In the case of freestanding emergency/urgent care facilities, the overriding issue was how they should be defined and regulated. For instance, should freestanding centers be required to have the same equipment and capabilities as hospital-based emergency facilities? Should they be integrated into local or regional emergency medical service (EMS) systems? To the extent that they were viewed as ·clinics· or ·institutional facilities"--rather than freestanding medical offices--they could be made subject to state licensing restrictions and to the Certificate of Need (CON) planning process mandated by the National Health Planning and Resources Development Act (P.L. 93-641). In the case of freestanding, independently owned surgery centers, the primary opposition came from the hospital industry; in states where freestanding facilities were required to be licensed and/or undergo CON review, the hospital industry regularly took an opposing position, arguing that additional surgical facilities would compound the problem of excess capacity within the health ' care system.
Equity and the allocation of health care resources at district level: lessons from as a case study in Mitchells Plain
(University of the Western Cape, 1994) Lalloo, Ratilal; Moola, M.H; Myburgh, N.G; Dept. of Community Oral Health; Faculty of Community and Health Sciences
A comparison of the efficacy and safety of intranasal sufentanil/midazolam and ketamine/midazolam for sedation and analgesia in a paediatric population undergoing multiple dental extractions
(2005) De La Harpe, Charl Jacques; Roelofse, James
This study was designed to evaluate the efficacy and safety of intranasal sufentanil/midazolam [S/M] and ketamine/madazolam [K/M] for sedation and analgesia in preschool children that require dental surgery [extractions]. Fifty children [ASA 1] aged 5 – 7 years, requiring six or more dental extractions under general anaesthesia, were allocated to two groups of 25 children to receive either ketamine 5 mg/kg or sufentanil 20μg intranasally, 20 minutes before induction of surgery in this randomised double-blind study. All the children in both groups in addition concurrently received nasal midazolam 0,3 mg/kg. For induction of anaesthesia, sevoflurane in nitrous oxide and oxygen, was used. S/M was accepted significantly better as a nasal pre-medication [p<0.05]. Both groups were equally sedated and a smooth mask induction of anaesthesia was experienced in the majority of children. Recovery of children in both groups were similar; 82% of the S/M group were fully recovered 120 minutes post-operatively versus 80% in the K/M group [p>0,05]. Effective postoperative analgesia for multiple extractions was provided. For pain evaluation, children were divided into two groups, a non-responder group where all pain values over time were more than 40 and a responder group where pain values were equal to, or less than 40. Seventy two percent of children in the S/M group were responders as to fifty two percent in the K/M group [p>0,05]. No adverse respiratory, cardiovascular or other effects were recorded. This study showed that intranasal administration of sufentanil /midazolam or ketamine/midazolam, provides safe and effective sedation and analgesia in children aged 5–7 years undergoing multiple dental extractions.
The retentive strength of bonded amalgam restorations
(2005) Banna, Rao T.; Osman, Yusuf I.
The purpose of this in vitro study is to compare the relative retentive strength of conventional amalgam restorations and bonded amalgam restorations using resin adhesive, glass ionomer cements and resin cements.
Multidrug sedation for dental procedures in children younger than eight
(University of the Western Cape, 2005) Bester, E.J.; Roelofse, James; Faculty of Dentistry
In this case study research project I have determined that multidrug sedation in children younger than eight years are possible.Conscious sedation [or sedation where verbal contact with the patient is possible] can be used successfully to decrease anxiety and fear for unpleasant experiences, like dental procedures. Behaviour therapy in conjunction with one or more drugs can be used to depress the central nervous system in order to decrease the patient’s awareness of unpleasant stimuli. This enables treatment to be carried out without patient interference. Extensive literature surveys were done to determine the ideal drugs as well as the ideal route for conscious sedation in dental treatment for children. In this study project drugs like midazolam, propofol, alfentanyl and ketamine were titrated intravenously to achieve conscious sedation.
Fast track assessment of the conscious sedation patient at the pre treatment consultation in a dental day clinic
(University of Westen Cape, 2005) Nagtegaal, Hendrik; Roelofse, James
This thesis covered the fast track assessment of the referred dental patient for conscious sedation in a day clinic. The assessment took in consideration patient information, medical history, anatomical observations, treatment required, phobic aspects and patient expectations.
Comparative bond strengths of stainless steel orthodontic brackets bonded with different bonding agents
(University of the Western Cape, 2007) Hudson, Athol Peter Gilfillan.; Grobler, Sias; Harris, Angela; Faculty of Dentistry
The aim of this project was to compare the shear bond strengths of three light cure orthodontic adhesive resins with three different stainless steel molar brackets.
Contamination, infection and inflammation control in an experimental mucosal cyst model using athymic nude mice
(University of the Western Cape, 2007) Wang, Meng; Hille, J.J.; Faculty of Dentistry
Includes Bibliographical references (leaves 83- 94).Forty-three male athymic nude mice were implanted with human vaginal mucosal cysts under general anaesthesia with Ketamine [25mg/kg] and Medetomidine [0.5mg/kg]. Cysts in 37 mice were recovered after 9 weeks of growth. twenty three cyst linings had retained the original structure of the vaginal epithelium. No marked deifference was present between the thickness of 9 week old linings and donor vaginal epithelium. The contaminants isolated from the skin of mice before implantation were mainly normal commercals of healthy experimental animals. There was no distinct difference in the number of cases with intact cyst formation between the terramycin/vitamin cocktaik group. The frequency of poor wound healing and/ or murine epidermis ingrowth was three times higher in animals stitched with silk sutures that in those cases where nylon sutures were used.
The effect of storage time on dimensional accuracy of elastomeric impression materials
(University of the Western Cape, 2008) Osio, Mary A.; Osman, Yusuf I.; Faculty of Dentistry
Several factors play a role in stability of impressions made from elastomeric impression materials. These include; polymerization shrinkage, loss of by-products during condensation, thermal contraction from oral temperature to room temperature, imbibition when exposed to water, disinfectant or high humidity and incomplete recovery from deformation due to viscoelastic behavior. An ideal impression material should be dimensionally stable over time to allow for pour at the convenience of the operator. Several studies evaluated the dimensional accuracy of elastomeric impression materials based on various factors including effects of repeat pour, temperature, humidity, disinfectants, impression techniques, and filler loading amongst others. Most of the previous studies did not use the standardized method described by the ADA specification for elastomeric impression materials.
The effect of thermal-cycling on the bond strength of a two step and single-step dentin bonding agent
(University of the Western Cape, 2010) Omer, Amir Isam; Osman, Yusuf I.; Faculty of Dentistry
The aim and objective of this study was to determine the bond strength of a twostep and a single-step dentin bonding agent and to determine the effect of repeated thermal-cycling from 50C and 550C on the bond strength values of these dentin bonding agents.
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.
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 efficacy and safety of intravenous sedation in children under the age of 10 years
(University of the Western Cape, 2013) Swart, Ellison Margaret; Roelofse, James
This study was done to show that sedation is a safe and a viable option in young children. Dental procedures were done on children aged two to ten years. Two hundred children were included in the study. In all of these children the procedures were completed. Only two children were excluded, because an intravenous line could not be placed on the one child, and the other child was unmanageable under sedation. The safety of sedation was evaluated looking at the incidence of adverse events and complications. No serious adverse effects or complications occurred. The complications that occurred were all corrected with minimal or non-invasive interventions. Only six of the two hundred children required oxygen to correct a drop in oxygen saturation.
Demographic profile, clinical data and radiographic analysis of patients for third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape
(University of the Western Cape, 2018) Nabee, Mahomed Ridhwaan Goolam; Morkel, J.A
Aim To analyze the demographic profile, clinical data and radiographs of patients who had third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape over a 10 year period. Introduction Minor oral surgical procedures are carried out by Maxillofacial and Oral Surgeons daily. The surgical removal of third molars is a large part of Minor Oral Surgery which is common throughout the world. The general impression of third molar surgery performed by experienced professionals is the ease of the operation, however no-matter how experienced one may be, a simple procedure should never be underestimated (Carvalho and Do Egito Vasconselos, 2011). New surgical techniques, as well as extensive training, skill and experience have led to the evolution of oral surgery and allowed this procedure to be carried out in a less traumatic manner. Certain factors precipitate third molar surgery to be performed in theatre as opposed to the dental clinic setting. These factors will be discussed in this research report.

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