Research Articles (Orthodontics)

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The prediction of the size of unerupted canines and premolars in a contemporary orthodontic population
(1974-04) Tanaka, Marvin; Johnston, Lesley
Linear regression equations for the prediction of the mesiodistal widths of unerupted canines and premolars were calculated for a large sample of recent orthodontic patients. The form of the equations, as well as the size of the various confidence belts, were generally similar to those in the widely used but incompletely characterized Michigan Mixed Dentition Analysis. Although either set of tables would seem equally appropriate, a simple approximation— half the width of the mandibular incisors plus either 11.0 for the maxillary canine-premolar segments, or 10.5 for the mandibular segments— is of comparable accuracy. The
Characteristics of children under 6 years of age treated for Early Childhood Caries at Tygerberg Oral Health Centre, South Africa
(Tufts University, School of Dental Medicine, 2008) Mohamed, Nadia; Barnes, Jo
Objective: This retrospective survey highlighted the characteristics of children less than six years of age presenting with early childhood caries(ECC) who had two or more teeth extracted under intravenous sedation at the Tygerberg Oral Health Centre in Cape Town, South Africa. This survey was carried out in order to plan a community-appropriate intervention strategy. Methods: Records of 140 patients kept by the pediatric Dentistry Division met the inclusion criteria and were included in this survey. Most of the patients originate from economically disadvantaged areas. Results: Diet, feeding and oral hygiene habits were shown to be the most significant factors that contributed to the development of ECC in these patients. All the children were either breast- or bottle-fed past one year of age. 93.6% of the children went to sleep with the bottle or while on the breast and 90% of them were fed on demand during the night. On average, breastfeeding was stopped at 9 months of age compared to bottle-feeding that, on average, was stopped at a much later mean age of 23 months. Where oral hygiene practices were concerned, 52.6% of children brushed their own teeth without supervision. Frequency of brushing varied between subjects. Conclusion: The results of this study have demonstrated that there is a need for culturally appropriate education campaigns to inform parents (especially those in disadvantaged communities) about the importance of oral health and the prevention of oral disease.
A comparison of two liner materials for use in the ferric sulfate pulpotomy
(South African Dental Association, 2008) Mohamed, Nadia
Objectives: The aim of this study is to compare the success rate obtained when applying either a calcium hydroxide (Dycal) base or a zinc oxide-eugenol (Kalzinol) base following the traditional ferric sulfate pulpotomy. Methods: Patients were either treated in the chair or under general anaesthesia. All teeth had to have radiographic evidence of caries close to the pulp. After haemostasis was achieved with damp cotton pellets, ferric sulfate was applied to the pulpal stumps. Half of the cases then received a Dycal base followed by a cured layer of Vitrebond and a permanent amalgam restoration. The other half of the cases received a base of zinc oxide-eugenol (Kalzinol) followed by an amalgam restoration. The cases were followed up every 6 months for one year (ie. 2 follow-up visits). Radiographs were taken at each follow-up visit. Results: Overall, teeth treated with Dycal demonstrated a higher failure rate when compared with those that received the Kalzinol base. Abscess formation and internal resorption were the most common causes of failure. Even though the Kalzinol base demonstrated greater success, there were still quite a few failures. Conclusion: This study demonstrates that calcium hydroxide cannot be recommended as a medicament in primary tooth pulpotomies.
The mixed dentition pantomogram: A valuable dental development assessment tool for the dentist
(South African Dental Association, 2009) Hudson, Athol; Harris, Angela; Mohamed, Nadia
The mixed dentition pantomogram is routinely used in paediatric patients. This paper discusses the value of the pantomogram for early identification of problems in dental development during the mixed dentition stage. Aspects regarding dental maturity, leeway space, the sequence of eruption of the permanent teeth, anomalies and the development of the canines will be reviewed.
Maxillary canine management in the pre-adolescent: A guideline for general practitioners.
(South African Dental Association, 2010) Hudson, Athol; Harris, Angela; Mohamed, Nadia
This paper focuses on the identification of ectopic eruption patterns of the maxillary canines from the dental ages of approximately 8 to 12 years. The timing and suitability of interceptive treatment in pre-adolescents are discussed.
Early identification and management of mandibular canine ectopia
(South African Dental Association, 2011) Hudson, Athol; Harris, Angela; Mohamed, Nadia
Mandibular canine impaction and transmigration have serious consequences for the patient, as removal of the tooth or teeth in question is often the only solution. The loss of one or both mandibular canines complicates orthodontic treatment. Early warning signs of mandibular canine ectopia are explored in this paper as well as how to assess the potential for displacement, impaction and/or transmigration. This paper highlights the value of interceptive treatment once the early signs of an aberrant mandibular canine have been detected.
Perceptions regarding the shortened dental arch among dental practitioners in the Western Cape Province, South Africa
(South African Dental Association, 2012) Khan, Saadika; Chikte, Usuf; Omar, Ridwaan
AIMS and OBJECTIVES: This survey was conducted to de-termine the knowledge of and opinions related to the short-ened dental arch (SDA), among dentists in the Western Cape Province, South Africa. METHODS: The study sample included two consecutive groups, drawn by a process of randomisation from the reg-istered dentist population that included general dentists, specialists, those who had emigrated and retired dentists. A self-administered questionnaire was mailed, e-mailed and/or faxed to those selected. Reminders were either e-mailed or made by telephone over a period of six months. RESULTS: A final sample of 84 respondents with a mean age of 43 years (SD=11.9) was obtained. This represented a response rate of 23% (n= 84) from the final working sample (n=368), derived from the target group (n=618) originally con-tacted. All participants completed an informed consent form in which confidentiality was assured. Several respondents (40%) said they had heard about the SDA while at university, which would be in line with the age range of respondents in relation to introduction of the concept into dental curri-cula. As many as 62% had never read any research articles related to the concept which could partly account for the low response rate. The majority (86%) felt that patients can function with a SDA and that they would recommend ac-ceptance to their patients. CONCLUSION: Respondents know of the potential benefit that the SDA may have for their patients and see it as a viable alternative treatment option for the partially dentate patient, even though their level of current knowledge of the subject must be considered questionable.
Introducing dental students to e-learning at a South African University
(Health and Medical Publishing Group, 2012) Mohamed, Nadia; Peerbhay, Fathima
This article serves to report on the introduction of an innovative ‘blended learning’ approach in the Paediatric Dentistry Department at the University of the Western Cape (UWC) in Cape Town, South Africa. This intervention was the first of its kind to be introduced at UWC’s dentistry faculty. Methods Educational resources were placed online to supplement didactic and clinical teaching and in so-doing, compensate for the lack of chair side teaching. An online learning platform was thus provided for students to engage with. Results Forty-seven percent of students accessed the site. The evaluation of the course by these 4th and 5th year students was mostly positive. Students who did not access the site provided a variety of reasons for not doing so, with the main reasons being the ‘lack of time’ (40%) and ‘lack of IT resources’ (41%). Conclusion This intervention highlighted the fact that ‘blended learning’ definitely has its place in the dentistry curriculum, especially if minor issues like access to resources can be addressed. The Paediatric Dentistry department at the University of Western Cape is continually pursuing current trends in teaching to provide an education that is on par with global standards.
Can a new paediatric sub-specialty improve child health in South Africa?
(Health & Medical Publishing Group, 2012) Swingler, George; Hendricks, Michael; Hall, David; Hall, Susan; Sanders, David; McKerrow, Neil; Saloojee, Haroon; Reid, Steve
Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the healthcare needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary healthcare will be limited by the skewed distribution of staff and the lack of suitable skills. A 'community' placement during specialist training, and the creation of a sub-specialty in Community Paediatrics and Child Health, could address the skills shortage and possibly attract health personnel to under-served areas through creating an appropriate career path. This proposal would also support the Department of Health's encouraging plans to re-engineer primary healthcare.
Use of the passive lower lingual arch in the management of anterior mandibular crowding in the mixed dentition
(South African Dental Association, 2013) Hudson, Athol; Harris, Angela; Mohamed, Nadia; Joubert, Jo-Anne
Leeway space preservation in the mixed dentition is a well-documented method of space management. In the mandibular arch it may be saved for utilization in the correction of minor anterior crowding by the placement of a passive lower lingual arch (LLA) during the transition from the mixed dentition to the permanent dentition
Volumetric change of flowable composite resins due to polymerization as measured with an electronic mercury dilatometer
(Herbert Publications Ltd., 2013) Mulder, Riaan; Grobler, Sias Renier; Osman, Yusuf Ismail
BACKGROUND: To determine the total volumetric change and the relative speed of shrinkage of bulk fill flowable composites during polymerization. MATERIALS AND METHODS: A specially designed electronic mercury dilatometer was used to determine the volumetric change. The light intensity was 500mW/cm2. The mercury dilatometer measured the volumetric change every 0.5 seconds during the 35 second irradiation exposure time. The materials tested were Z250 as standard and control. Four bulk fill flowable composites were tested. RESULTS: The sequence of total volumetric change was found to be: Z250 < Filtek bulk fill < Xtra-Base bulk fill < SDR < Venus bulk fill. The speed of shrinkage of the bulk fill flowables was faster than that of Z250, while the 2 flowables with the highest shrinkage speed (SDR and Venus) also had the highest total volumetric change. Of the different materials tested the volumetric change of Z250 (1.13%) was the lowest and significantly less (p<0.05) than that of SDR (1.55%) and Venus (1.72%). The material with the highest filler content (Z250) also showed the lowest shrinkage (1.13%) but this effect could not be seen in the flowables. In general, it was found that a 35 second irradiation period (with a light intensity of 500mW/cm2) was satisfactory for complete polymerization of the resins. CONCLUSIONS: The volumetric changes and speed of shrinkage were higher for all 4 bulk fill flowable composites than for Z250. SDR and Venus flowables had the fastest and highest volumetric shrinkage. Clinical significance: The manufacturers of bulk fill flowable composites advocate filling layers of 4mm. However, because of the high shrinkage values found in this study it should be suggested that the standard 2mm layer increments still be used.
A review of child abuse and the role of the Dental Team in South Africa
(South African Dental Association, 2014) Mohamed, Nadia; Naidoo, Sudeshni
Introduction: Child abuse is a worldwide problem and South Africa is not immune. In Cape Town, violence against children has increased in the last ten years. Children are powerless and cannot protect themselves, and the onus is therefore on adults, caregivers, teachers, health care workers (including dental personnel) and other persons in positions of trust to speak out on their behalf. Just what constitutes abuse is a controversial issue dictated largely by culture and upbringing. However, no violence against a child can be justified even if it is considered to be a form of discipline. Abuse includes any act that negatively affects a child’s physical or emotional health and development. It can result in ‘physical, cognitive and emotional impairment’ which could have long-term effects. In broad terms, child abuse can be defined as the ‘maltreatment of children.’ Such abuse can be inflicted in many ways.
Knowledge, attitudes and practices (Kap) regarding early childhood caries among nurses working in a low socio-economic area
(Peertechz, 2015) Mohamed, Nadia; Barnes, Jo
In the poorer communities, nursing professionals are usually the first health professionals to come into contact with parents and their children. They are therefore the first port of call when patients need information about health matters and are thus able to have a positive impact on oral health and the prevention of ECC. To investigate the knowledge of nursing professionals regarding oral health in children and specifically ECC and its causes. A convenience sample was used which included all nurses who agreed to participate. Questionnaires were completed for 83 nurses at the various facilities in a low socio-economic area of Cape Town, South Africa. Information was obtained regarding their attitude towards dental care, general oral health knowledge and knowledge of feeding and oral hygiene practices. In the sample of nurses surveyed, it is clear that the knowledge regarding oral health related matters is sorely lacking. More time and resources need to be invested into equipping these nurses to provide basic oral health information to the broader community in order to alleviate the burden of ECC.
Towards bioactive containing restorative materials: from design to testing in vitro approach
(Symbiosis, 2015) Perchyonok, Tamara; Mulder, Riaan; Grobler, Sias Renier; Zhang, Shengmiao
In any repair of a tooth with permanent restorative materials, the interface is always a sensitive region. The appearance of adhesive materials was a great step forward in dealing with the problems of this region and improving the overall performance of the restorations. However, contemporary adhesive materials do have a major disadvantage, namely that their durability is limited, a limitation which often arises due to their inadequate marginal adaptation. Restorative materials in the new era aim to be “bio-active” and long lasting. As part of our continuous interest in developing the novel bioactive containing restorative materials, we evaluated the effect of the additional bio-actives (such as chitosan, β-carotene, guar gum resin and the combination of the materials) to the commercially available flowable restorative materials such as Premise on the volumetric shrinkage, flexural strength, compressive strength, the surface hardness of the “bio-active” containing composite
Community paediatrics and child health
(Health & Medical Publishing Group, 2015) Goga, Ameena; Feucht, Ute; Hendricks, Michael; Westwood, Anthony; Saloojee, Haroon; Swingler, George; McKerrow, Neil; Sanders, David
TO THE EDITOR: In 2012, the Postgraduate Education Committee of the Health Professions Council of South Africa (HPCSA) supported the accreditation of Community Paediatrics and Child Health (CPCH) as a paediatric subspecialty; however, full HPCSA approval is outstanding. Consequently, by February 2015 there had been no visible progress towards implementation. Power and Heese and Swingler et al. highlighted the benefits of CPCH, rendering further debates about CPCH accreditation unnecessary, particularly in a country where: (i) progress towards the fourth Millennium Development Goal is slow; (ii) glaring gaps exist between hospital-based and community care, and between private and public sector care;[3] and (iii) current under- and postgraduate paediatric training emphasises clinical subspecialties (despite reduced public sector posts), yielding graduates with limited knowledge about priority child health conditions. Primary healthcare re-engineering and the establishment of district clinical specialist teams in South Africa have starkly revealed the urgency of CPCH training. CPCH locates child health within a sociocultural-economic-political-environmental-systemic paradigm. Successful community paediatricians share four characteristics: (i) academic collaboration; (ii) finding evidencebased local solutions; (iii) establishing strong community-based partnerships; and (iv) addressing disease outside traditional biomedical models. This suggests that our sometimes narrow approach to under- and postgraduate training needs significant adaptation. The British Association for Community Child Health, affiliated to the Royal College of Paediatricians, is a successful model we can adapt. This custodian of community paediatrics directs traineeships, stipulates requirements and outlines the scope of the discipline.
Towards bioactive dental restorative materials with chitosan and nanodiamonds: evaluation and application
(SciDoc Publishers, 2015) Mulder, Riaan; Grobler, Sias Renier; Moodley, Desi; Perchyonok, Tamara
BACKGROUND/PURPOSES: Recently various articles showed beneficial effects of the addition of different the beneficial effect (bond strength and longevity) of the addition of different bioactive compounds towards dental materials. compounds towards dental materials. Therefore, the aim of this work was to evaluate the effect of the addition of bioactive materials and combination thereof (chitosan/nanodiamond or cyclodextrin/nanodiamond) to a dental composite. MATERIALS AND METHODS: The flowable composite Premise by Kerr was used as the standard control dental material. Premisewas also modified to contain: 10% nanodiamonds/Premise, 10% chitosan/nanodiamonds/Premise, 10% cyclodextrin/ nanodiamonds/Premise and 10% cyclodextrin/Premise and tested for their dentin bond strength, volumetric shrinkage, Vickers hardness and cytotoxicity. RESULTS AND CONCLUSION: Beneficial effects of the addition of different bioactive compounds towards dental materials were proved. A higher shear bond strength (p < 5%) was found after 3 months of Premise treated with nanodiamonds, chitosan, cyclodextrin (CD) and combinations thereof than the control Premise. The sequence for the Vickers hardness was: CD (32.5) < nano (34.8) < CD Nano (38.8) < Premise (39) < Chitosan Nano (42.2). Chitosan was found to increase the mouse 3T3 fibroblast cell survival rate (113%), while nanodiamonds (92%) and the combination of chitosan + nanodiamonds (93%) showed little cytotoxicity. The shrinkage was lower for all the additions than for Premise alone. Nanodiamonds and the combination chitosan + nanodiamonds showed little cytotoxicity towards mouse 3T3 fibroblast cells.
Lasers in paediatric dentistry
(South African Dental Association, 2016) Mulder, Riaan; Karic, Vesna; Melman, Geoffrey
Many clinicians will be faced with the un-cooperative paediatric patient presenting at their practices with a “fear of the unknown”. Establishing trust with these patients is essential in order to achieve a productive interaction with the child. The hard tissue lasers (Er:YAG and Er,Cr:YSGG) have the advantage of not producing the high pitched sound and vibrations associated with turbines. The ‘tellshow- do” method can be used to illustrate the water spray with the lowest possible energy setting of the laser in the paediatric patient’s mouth, which may assist in alleviating fear associated with the restorative procedures.
Are fissure sealants still relevant as a caries preventive measure?
(South African Dental Association, 2016) Mulder, Riaan
The groundwork for fissure sealants was completed in 1955 and lead to the introduction in 1971 of the Nuva-Seal Fissure Sealant by L.D Caulk. Since caries predominantly affects the pits and fissures of the teeth of children, these sealants have been shown to be a valuable preventive procedure. FS are cost effective and provide an ideal preventive measure for children who have restricted access to dental services. However the advent of dental lasers, caries detection systems, fluoride varnishes and novel adhesive systems may have displaced FS as a preventive measure of choice. The aim of this investigation was to establish whether FS remain a relevant preventive measure for the anatomically vulnerable fissure system.
Introduction to dental lasers
(South African Dental Association, 2016) Mulder, Riaan; Karic, Vesna; Melman, Geoffrey
It was Albert Einstein who in 1917 defined the theory of the Stimulated Emission of Radiation, developing and expanding on the work of Niels Bohr, who in 1913 had formulated the Spontaneous Emission theory. Einstein described the electrons of molecules being excited by a source of energy, usually heat, and directed in a specific way. The excited electron releases a spontaneously emitted photon which interacts with a molecule of the active medium, causing those electrons to move to a less stable, higher energy state and producing further photons. This process exponentially increases the number of identical photons which are focused by mirrors at either end of the laser tube and emitted into the delivery system. The acronym “LASER” represents “light amplification by stimulated emission of radiation”.
Dental needs of intellectually disabled children attending six special educational facilities in Cape Town
(Health & Medical Publishing Group, 2016) Roberts, T; Chetty, M; Kimmie-Dhansay, F; Fieggen, K; Stephen, Lawrence X.G.S
OBJECTIVE. To assess the dental needs of a group of children with intellectual disability (ID) attending six special educational facilities in Cape Town, South Africa. METHODS. This was a cross-sectional study based on a convenience sampling method. One hundred and fifty-seven children with ID attending six special educational facilities in Cape Town were included in the survey. Five schools were exclusively funded by the State and one school received additional private financial support. The oral examinations complied with guidelines drafted by Special Olympics Special Smiles programme and the Centers for Disease Control, USA. RESULTS. The most common dental disorders requiring management were gingival disease (69%) and untreated dental caries (68%). Almost 50% of the children had missing teeth. Twenty-nine percent needed orthodontic correction of malocclusion and 7% had structural abnormalities of their teeth that required either aesthetic or functional intervention. Fillings were evident in only 8% of the children. Females required more dental treatment than males. The dental needs of children with ID increased with age. There were no significant differences in the dental needs of children attending State-funded schools and those attending the single school that received additional financial assistance. CONCLUSION. The frequency of unmet dental needs of children with ID attending special educational facilities in Cape Town was high and the dental care available to them was minimal. The study highlights the need for improved dental services to ensure that optimal oral health is accessible to children with ID attending special educational facilities in Cape Town.

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