Department of Community Oral Health

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https://hdl.handle.net/10566/1898

The Community Oral Health Department provides undergraduate- as well as postgraduate programmes which enable students to make a diagnosis of a population’s oral health problems, establish the causes and effects of the problems and plan effective interventions through interdisciplinary co-operation and organized efforts of society. The discipline is concerned with promoting the health of a population and therefore focuses action at community level as opposed to an individual. It is underpinned by a range of related sciences, eg. Disease Prevention, Epidemiology (Measuring Health and Disease), Health Services Management and Planning and Behavioural Sciences. The Department is also responsible for managing the outreach programmes in the country.

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Dental caries clinical and experimental investigations
(University of Pretoria, 1947) Ockerse, T
pental caries is the most prevalent of all diseases among civilized peo_ple. ~_n_ol middl~~-~o=~ay with ~full c§rfectly healthy tee!h. From various statistics obtained ffo·m- practically every country in the world, the incidence is estimated to be over 95 per cent. By this is meant that more than 95 ont of every 100 persons suffer or have suffered at some time from one or more carious teeth. Statistics are based mostly on dental examinations of school children, because of the obvious difficulty of examining large groups of adults for dental defects. There is a lamentable lack of reliable and accurate statistics concerning the incidence of dental caries in most civilized countries. Klein and Palmer (1938) reported that the incidence of dental caries (as defined above) among elementary school children in the United States is 95 per cent. Day and Sedwick (1935) found the incidence among Rochester (N.Y.) schoolchildren to be 99 per cent. The final report of the Mixed Committee of the League of Nations of 1937 shows that in Norway, of 25,000 school children examined, only 160 possessed perfect sets of teeth, or 99 per cent. affected by dental caries. Day and Sedwick (1935) state that, in the county of Shropshire in England, 97 per cent. of the children at the age of 12 had dental caries. The Director-General of Health of New Zealand, in .his annual report of 1941, states that of 52,500 children examined, 95 per cent. were affected by caries: In India, Day and Tandan (1940) reported that the incidence of dental caries among urban children in Labore was 94 per cent. In South Africa, Friel and Shaw (1931) found 93 per cent. of urban children suffering from dental caries. Staz (1938) reported that of 300 European adults examined in Johannesburg none showed caries-free mouths.
Die ontwikkeling van die epiteel en keratien in die menslike mondholte: In histologiese, elektronmikroskopiese en histochemiese studie
(University of the Western Cape, 1972) van Wyk, Christian Werner; Weber, H.W.
Histological observations revealed that oral epithelium originated from a single ectodermal layer. As the ectoderm grew so it differentiated into squamous epithelium. The first features of squamous differentiation were noticed at 8 weeks in utero in areas where keratinized mucosae were developing, and these were the changing of cuboidal to cylindrical basal cells and the subsequent growth of prickle cells from these cylindrical basal cells. The prickle cells merged with the existing primitive cells and at no stage could a separate squamous epithelial layer I such as the stratum tritermedium of the epidermis I be observed inside the mouth. At 12 weeks in utero squamous differentiation had reached a stage where acidophilic layers appeared in certain regions on the epithelial layer. The time of appearance of these layers varied from case to case. At this stage most of the primitive characteristics had disappeared from the keratinizing epithelium. Unlike the periderm of the skin which was shed into the amniotic fluid, shedding of primitive epithelial cells from the keratinizing squamous epithelium was not noticeable. Thence, the growth of keratinizing epithelium was followed by an increase of acidophilic layers, the appearance of keratohyaline granules in cells and, in some instances, full keratinization. The latter I however I was almost exclusively confined to the vermilion border of the lip. The squamous epithelium of the lining mucosa, which is unkeratinized I developed at a much slower tempo. It retained its cuboidal-shaped basal cells and the primitive features of the overlying cells were lost only at about 4- 5 months in utero I when squamous differentiation set in. At no stage was the squamous differentiation a prominent feature. At junctions between keratinized and unkeratinized epithelia and epidermis the epithelium exhibited features of both types of epithelia that were being joined. This was especially noticeable at the junction between vermilion epithelium and epidermis, where part of the vermilion epithelium displayed a prominent intermediate type of layer. Similarly, acidophilic layers of keratinizing epithelium merged imperceptibly with the walls of cells of unkeratinizing epithelium, creating a small region of an unkeratinizing type of epithelium with keratinized cells. Thus the development of the oral epithelium is through differentiation and renewal of epithelial cells: the ectodermal layer developes into an epithelial layer which is recognised by its squamous appearance. The subsequent growth is by constant renewal of this differentiated epithelium. The pattern of epithelial development I the appearance of the junctional epithelia and the manner in which acidophilic layers merge with unkeratinized epithelial cells I indicate a unity between these epithelia. According to these developmental features, the epithelium of the mouth and epidermis can be classified into less differentiated and better differentiated, but with a commonbackground for these epithelia. When the formation and the established appearance of keratin in the mouth and on the skin was compared histologically I ultrastructurally and histochemically I a unity between these features became apparent. Ultrastructurally it appeared that keratin consisted basically of 2 cytoplasmic constituents: tonofilaments and a fine granular substance. The tonofilaments were gathered at first into bundles and then broken up into finer tonofibrils. These finer fibrils mixed with a granular ground substance to form a homogenous granular filamentous material. This product can be regarded as a pre-keratin. With the addition of a keratohyaline layer to the process I keratin was formed, Apart from the keratohyaline granules several additional changes took place in cells concerned in this process I whether keratin was formed or not. These changes were flattening of cells, extensive interdigitation between cell walls, disappearance of micro-villi I loss of structure in desmosomes I thickening of cell walls and the disappearance of glycogen from cells. Some of these features were displayed in each of the types of epithelium examined here.
Mondbiologie
(University of the Western Cape, 1980) Jansen van Rensburg, B.G; Prins, F.X.
Mondbiologie as onafhanklike vak in die Republiek van Suid-Afrika het die eerste babatreë geneem op 'n senaatsvergadering van die Universiteit van Stellenbosch op 26 Maart 1971 toe die instelling van 'n Departement Mondbiologie goedgekeur is. Die skrywer is op 1 Januarie 1972 aangestel as hoof van die nuutgestigte departement in die Fakulteit Tandheelkunde aan die Universiteit van Stellenbosch. Die ontwikkeling van die vak, veral aan Afrikaanse universiteite, is in die verlede geknel deur die afwesigheid van Afrikaanse handboeke en, in steeds groeiende mate, deur die styging van die pryse van boeke. 'n Verdere remmende faktor is dat geen enkele bestaande handboek 'n oorsig gee van die meeste aspekte van mondbiologie nie. Die motivering vir die opstel van hierdie boeke (Deel I en Deel II) lê daarin dat dit wenslik is dat 'n Afrikaanstalige handleiding in die vak bestaan. Hierdie boeke het hulontstaan gehad in lesingsaantekeninge wat die skrywer oor baie jare saamgestel en probeer verbeter het. In die opstel hiervan is gepoog om materiaal uit verskillende bronne te versamel. Die leser sal gou agterkom dat geen spesifieke verwysings in die hoofinhoud aangegee word nie, maar wel algemene verwysings aan die einde van elke hoofstuk. Ook aan die einde van elke hoofstuk is 'n lys vrae •. Daar word van studente verwag om die vrae uit te werk, hoofsaaklik met behulp van hierdie handleiding en, indien nodig, met verwysing na bronne wat genoem word en in die tandheelkundebiblioteek beskikbaar is. Die inhoud van Boek I dien as inleiding tot mondbiologie en handel hoof= saaklik oor algemene aspekte van embriologie, fisiologie, makro- en mikroanatomie van die mond, sy inhoud en die sisteme wat daarmee verband hou. Die skrywer voel dat hierdie kennis 'n voorvereiste is vir 'n meer toe= gepaste studie van 'n tand en sy omgewing soos weergegee in Boek II. Soos in alle pionierspogings kom daar waarskynlik foute in hierdie werk voor. Die skrywer spreek by voorbaat sy spyt hieroor uit en wil dit graag onder die aandag van die leser bring dat die onderwerpe geselekteer is om so 'n wye veld soos moontlik te dek met inagneming van die beperkte kursusduur. Mnr. P.F. de Klerk, Senior Onderwyser in Afrikaans aan die Hoërskool D.F. Malan te Bellville, was verantwoordelik vir die taalversorging. Hier=voor is die skrywer opregte dank aan hom verskuldig. Vir haar toegewyde andag aan die tikwerk verbonde aan hierdie boeke wil ek baie graag my innige dank aan mev. C.F. du Toit bring. Mnr. A. Louw, Grafiese Kunste=naar, het die titelbladsye ontwerp. Hiervoor bedank ek hom.
The history of dentistry in South Africa since 1900
(University of the Western Cape, 1983) Grob1er, Vilma; van Rensburg, A P J
Nineteenth Century dentists in South Africa were brought under the provision of legislation in Natal and the Transvaal (1896) and the Cape Colony and the Orange Free State (1899). By the end of the Nineteenth Century a group identity had been established and the transition from a craft to a profession completed. From 1900-1958 dental societies were formed. Key dates are 1922 when the South African Dental Society, which became the Dental Society of South Africa (D.A.S.A.) after Incorporation in 1935, was constituted. Collective action by dentists, implemented through the societies, shaped the profession. From 1933-1948 the constitution of the D.A.S.A. was streamlined. The Magna Charta of Dentistry (Act 13, 1928) was enacted defining dentistry and the practice thereof. The Dental Mechanicians Act (1945) protected the mechanician, the dentist and the public against illicit practitioners. The D.A.S.A. initiated the Professional Provident Society for dentists, now extended to include all the professions. In 1936 tbe first National Congress was held, in 1953 the first International Congress, setting a future pattern. The status of the dentist was further improved by obtaining the right to use the courtesy title Dr and by the abolition of the professional licence fee (1938). The earliest .societies set up voluntary clinics for children and the indigent. The Transvaal initiated a provincial scheme for childrens' followed by the other provinces. Dental Services, a fully fledged of Health. dentistry, This evolved into branch of the Department Witwatersrand University established a dental school in 1925, followed by .the Universities of Pretoria, Stellenbosch , Western Cape and Medunsa. Facilities for postgraduate 'study exist at all these institutions. The R.E.D. Fund Aids Research Education and Development in the field of dentistry. The first unofficial Dental Journal was published in 1927, followed by the Official Bulletin (1945-1946) and finally the Official Journal of the D.A.S.A. During the Anglo Boer War the importance of healthy dentitions'for soldiers was first realised. Four conntract dentists att~nded to the British soldiers. The South African dentists served in the Army Dental Corps during the two world wars. Dentistry in South Africa is now on a par with dentistry in any country of the Western world.
Die doeltreffendheid as kariesvoorkomingsmaatreel van in 0,2% en in 0,05% neutrale natriumfluoried-mondspoelmiddel
(University of the Western Cape, 1985) van Wyk, Irma; van Wyk, C.W.
The study was carried out to 1) determine the effectiveness of the caries inhibiting effect of a weekly mouthrinsing programme in South African schools over a three year period and 2) compare neutral solutions of 0,2 per cent and 0,05 per cent NaF using a placebo of tapwater as control. Twelve to 13 year old White school children from eight randomly selected schools in the Parow School Board area of the Cape Peninsula were chosen. Participants were randomly assigned to one of the three rinsing groups. After three year's participation, the mean net increment in DFS per child was 4,7 for the 0,2 per cent NaF group; 5,9 for the 0,05 per cent NaF group and 7,5 for the placebo. These differences are statistically significant (p<:O,OOI). This meant a caries reduction of 38 per cent for the stronger and 21 per cent for the weaker sodium fluoride mouth rinse. It is concluded that such a mouth rinsing programme is a practical, feasible and an efficient approach to caries prevention in South African circumstances.
Dental health status of preschool children
(University of the Western Cape, 1985) Stephen, Eileen J. P.; Ackroyd, B.
In the past the dental health of children has been largely neglected, and not much attempt has been made to involve parents on the importance of caring for their children's teeth. With the result, dental problems begin in the early years of life and then become a greater problem as the children grow. The two common dental diseases which affect these children are dental decay or caries, and periodontal disease. However, the disease which poses the greatest challenge among children is dental decay, which is the primary cause of children losing their teeth. Studies have been done among children of this age to determine the extent of these diseases. The results of these studies have shown, that these dental diseases are becoming a major problem. In the second chapter the causes of both these diseases, as well as their prevention will be discussed. Pre-school children are at an age at which their lifestyle is totally dependent and controlled by their parents and the third chapter deals with the way that parents can influence the childs dental health behaviour. Chapter Four outlines a dental health programme for pre-school children, involving parents, teachers, as well as pre-school children, and Chapter Five describes a pilot project and its results.
Understanding and predicting preventive health behaviour in mothers of preschool children
(University of the Western Cape, 1986) Hendricks, Stephen J.H.; Freeman, R.
This study was undertaken to examine the preventive dental and medical attendance behaviour of mothers of young children. The 'Theory of Reasoned Action' used to predict intention to visit the dentist and the doctor, failed to account for more than 11% of the variance in dental behaviour and 9t in the variance in medical behaviour in all the subjects. However, on assessing these behaviours for the 2 different age groups, for the younger age group, the prediction improved to 19% for the dental intention in terms of the total attitude and subjective norm score, and to 45% and 34% respectively for the individual attitudes and subjective norms. In the older age group, the prediction improved to 20% for the dental intention in terms of the total attitude and subjective norm score, and to 39% and 30% respectively for the individual attitude and subjective norms. This finding is further supported by factor analysis of the data, whereby using a principal components analysis structure, other patterns to the data were found which indicates that preventive dental and medical behaviour is a complex behavioural category, consisting of more than one action. Two dimensionso of affect accounted for 59% of dental attitudinal data and 57.9% of the dental subjective norm data, whereas three dimensions of affect accounted for 64.5% of the medical attitudinal data and 64.8% of the medical subjective norm data. The mothers had positive attitudes to both the two dental and three medical actions highlighted by the principal components analysis. The younger mothers showed stronger attitudes associated with the treatment outcome action, whereas the older mothers showed a more positive preventive orientation by the dental data. Although two-thirds of the young mothers received dental advice from the health visitors, they were highly selective on what information to accept and put into effect. An indication here is that health messages including dental health are perceived differently by the 2 age groups even though they are from the same social class group. This finding holds in important implications for the method, approach and content of dental heath of education. In terms of the medical data, the three actions highlighted, indicated that while a health directed behaviour, in terms of a healthy outcome e.g. normal growth is important, an expectation as well as a more emotional, love and tender care factor were also implicated. A healthy baby may however not be the only factor of importance to the mother, but also the mechanisms of achieving such a state of health, matters not only in terms of the convenience but also, greatly depend on the love and level of care the mother gives the child. This aspect may even be more accentuated in one parent families, in which especially the young mother is under enormous socia-economic pressure to take up employment, foresaking time she would otherwise have spend with the child. The effect of subjective norms on preventive health behaviour shows evidence of a 'inner cicle' or 'kinship' as reference group to the mother, which mediates between and modifies the influence of the health profession in as far as compliance with health care is expected from the mother. It therefore appears that in the lower social classes, there exists an intricate social network, exercising an important effect on the way of life of the mother, and since this network may be one of the few supports she has, its influence will be exerted in various dimensions of the mothers' life including health. There appears to be a hidden pathway or code of conduct, defined by these social norms and to which the mother feels she owes her allegiance. The level of communality between the social networks and preventive dental behaviour should be further investigated. This study has clearly indicated that some of the dental and medical attitudes and subjective norms under consideration, has a marked independent yet related effect on preventive health behaviour whereas other attitudes and subjective norms acted independently or sometimes not at all. The dental health educator, must therefore determine for each community and individual which action is the most appropiate target for behavioural change. Furthermore, this study has shown that if beliefs are to be modified, referents to support such a behaviour change, must therefore be appropiate to attaining this objective. since preventive medical and dental behaviour consists of various actions, the application of the Azjen and Fishbein model, should be to a specific action of the behaviour, which assumes importance in the target community, important others. associated with Baric (20) has emphasised the role of the family as an important influence on attitude and behaviour, while Boothroyd- Broóks (39) has pointed to the contribution of society as important mediators in secular life. The results from this study would tend to support the views of Suchman(193), Baric(20) and Boothroyd-Brooks(39) that, kinship, family and social norms were important in the development of behaviour but, to sustain such a behaviour, a deeper understanding is required of the social forces operative through the social network, which shapes the mothers' health behaviour into action. be this medical or dental attendance for herself or for that of her children.
"An investigation of the oral health of a selected group of preschool children in the Western Cape"
(University of the Western Cape, 1987) Yasin-Harnekar, S.; Reddy, J
The dental clinic of the University of the Western Cape provides oral health care for many preschool children. The clinical observation was that these children presented with rampant dental caries. A recent report compi1ed by an international Joint Working Group of the Internationale Dental Federation and the World Health Organisation identified the changes in oral health in children and factors associated with these changes. South Africa presents a unique opportuni ty to study the oral health status of different ethnic and socio-economic groups. A review of the relevant literature indicated that there was a lack of published data, especially on the oral health status of preschool children. A study was designed to investigate the oral health status of a selected group of preschool children ages 2-6 years in the Western Cape. The examinations were conducted at twelve different créches by two calibrated examiners. The examinees' weight and height were also measured. The data was recorded on a revised World Health Organization Basic Oral Health Assessment form. A total of 547 children were examined with an almost equal distribution of males and females. Only 18% of the sample had a compl ete sound primary dentition, dmft = O. The mean dmft was 5.37 which ranged from 2.73 for the 2 year age group to 7.01 for the 5 year age group. The mean dt of 4.09 made up 76% of the dmft, the mean mt of 1.22 made up 23% and the ft was negligible. Seventy-eight percent of the sample had decayed teeth present and 28% had missing teeth recorded. The treatment chosen by or for these children appeared to be extractions. Observations of extensively decayed teeth and the high prevalence of dento-alveolar abscesses suggested that this treatment was of an emergency nature. There was much unmet treatment as only 22% of subjects were free of decay and those with decayed teeth present had an average of 5. The dmft distribution showed 48% had a dmft.)5. There was a statistically significant linear association between the dmf and age for all the tooth types except the cani nes. There was no significant difference in caries prevalence between males and females. The phenomenon of bilateral symmetrical occurrence of dental caries in the primary dentition was demonstrated in the present study. The maxillary central incisors were the most frequently affected teeth (55%), followed by the mandibular second molars (47%) and maxillary second molars (42%). This is contrary to the findings in European communities where the primary second molars are the most susceptible tooth types. The present study found the fifth year of 1ife to be the critical one for the primary dentition. It was at this age that the greatest increment in dmft was observed, the greatest decrease in the number of caries-free subjects, more than a twofold increase in rampant caries, and a twofold increase in the number of subjects with dento-a1veo1ar abscesses. Few hard tissue anomalies were recorded. Localized enamel hypoplasia was quite common especially of the upper incisors and second molars. Most children claimed their teeth were brushed at least once a day. But soft deposits were present in almost all age groups in all the segments. Sixty percent of the sample had the sole responsibility of brushing their own teeth with no assistance from their parents. Parental assistance with toothbrushing was limited to the younger age group. In the present study soft deposits and gingivitis were recorded mostly on the buccal of the upper posterior segments and on the lingual of the lower posterior segments. The anterior segmentshad less plaque than the posterior segments. Thi s may be due to children finding it easier to brush anteriorly than posteriorly when they do brush. Also, the other areas are less accessible and require greater manipulative skill. There was a weak correlation between the total soft deposits and total gingivits. Although 60% of the sample had six segments of soft deposits present, only 4% had )six segments of gingivitis present. However, it was found that the higher the number of segments of soft deposits present, the greater the tendency for the presence of gingivitis. The association between dmft and soft deposits was not significant but between dmft and gingivitis was significant. This may be more preci se as these two are both cumulative measures. Soft tissue lesions were generally uncommon in this age group. The children in this community were generally lighter in weight and shorter in height compared to the NCHS (1979) percentiles. Recommendations regarding ways of redressing the obviously inadequate general and oral health of this sample of children were made.
Evaluation of two radiographic scoring systems used to monitor caries progression in deciduous teeth
(University of the Western Cape, 1989) Solanki, G. C.; Sheiham, A.
The investigation was designed to evaluate the scoring systems of pitts (1984), and that of Murray and Majid(1978), when used to monitor caries progression in deciduous teeth. The evaluation.was based on the reproducibility and discrlininatory ability of the two systems. The Reproducibility Study was designed to compare the reproducibility of the two systems, and in addition, to illustrate, firstly the use of the subject as the sampling unit in measuring reproducibility, and secondly, a more sensitive method of measuring reproducibility when analysing caries progression data. The Progression Study was designed to discriminatory ability. In addition the compare use of the the effect on subject as the sampling unit in monitoring caries progression was illustrated in the analysis of this part of the investigation. A sub-sample of the posterior bitewing radiographs of 301, 5 year old children from a Duraphat clinical trial (Murray et al. 1977, Murray and Majid 1978) were re-examined. For the Reproducibility Study 150 sets of radiographs were examined a total of 4 times, (repeated examinations for each method). For the Progression Study three serial bitewing radiographs of 50 children were examined using the two methods. For the Reproducibility Study, Kendall's Tau-B was used as an approxlination of the weighted Kappa as a measure of reproducibility. While the pitts method appeared to be more reliable, the difference .between the tYK>methods was not significant( p~ 05). The surface cannot be used as an independent unit in measuring reproducibility. A method using the subject as the sampling unit was illustrated. Attention was drawn to the need to develop a measure of reproducibility for progression studies which would take into account the magnitude of the disagreement (instead of just disagreement) into the overall index of reproducibility. The use of weighted Kappa is suggested as a more appropriate measure of reproducibility. In the Progression Study Method 1 is more sensitive to the various stages of the disease process and provides a more complete overall picture of the carious process. The proportion of enamel lesions recorded for Method 1 were consistantly higher than that for Method 2. The behaviour of outer and inner enamel lesions differed considerably and Method 1 allowed the behaviour of these lesions to be considered separately. The progression rates were found to be faster with Method 2. With Method 1 30% of enamel lesions per subject had progressed to dentine or been filled 12 months later, the corresponding figure for Method 2 was 50%. Method 2 by excluding outer enamel lesions introduces two biases. The combination of these biases favour overestimating the proportion of lesions deemed to have progressed. The use of Method 2 may lead to the unnecessary loss of valuable data; more surfaces were excluded as being unreadable because of overlap. The average proportion of surfaces per subject recorded as unreadible due to overlap was 7% at baseline, 8% at 12 months and 8% at 24 months, the corresponding figures for Method 2 were 13%, 13% and 22% for Method 2. Method 1 thus appears to offer some advantages. The use of the subject as the sampling unit in analysing caries progression data offers a mnnber of advantages when canpared to the use of the surface as the sampling unit. The findings of the study indicate the proportions of high risk subjects (subjects in whom a large proportion of lesions progressed in a given time period) was low. With Method 1 in only 11% of the subjects did 80-100% of the enamel lesions progress after 12 months. The findings indicate that the Pitts system is the more useful scoring system in studies monitoring caries progression in deciduous teeth.
The oral health status of Xhosa speaking adults in Crossroads
(University of the Western Cape, 1989) Myburgh, Neil; Cohen, Bertram
There is an absence of both dental services and systematic planning to meet the oral health needs of the Black* population ~f greater Cape Town. Little epidemiological data exists upon which such planning can be based. This study describes the prevalence and treatment need related to tooth decay and periodontal disease ofaXhosa-speaking* squatter community on the outskirts of Cape Town. An age and sex stratified sample of 290 adults attending the SACLA clinic in Crossroads were examined. Examiner variability was measured by a percentage intra-examiner agreement for the DMFT of 95% and for the CPITN 84%. Cohen's kappa statistic, for tooth-specific caries detection errors was k = 0.877. The mean DMFT was 11.8 and varied little with sex or age below 55 years. After this age, the DMFT climbs steeply due largely to the rapid increase in the M value (missing teeth). The results show that for every tooth needing to be extracted, two teeth per subject required a restoration. Only three subjects already had some restorations. Periodontal health was reflected by a high prevalence of calculus (TN2 = 99%; MNS = 5.2) for the whole sample. Deep pockets were detected in 13% of those aged between 15 and 29 years, but only at a relatively low intensity (MNS = 0.1). This prevalence reached a high 60% for those aged between 45 and 64 years (MNS = 1.7). All subjects require oral hygiene instruction and gross scaling in at least four sextants, according to CPITN criteria. In conclus~on it is noted that there is a shortage of relevant epidemiological information necessary to the planning of oral health services to improve the oral health of the Xhosa-speaking community in the Western Cape. Caries prevalence rates are already high in young adults and a high tooth mortality rate and an absence of fillings, suggests that extraction is the only form of treatment made available to this community. The absence of appropriate prevention strategies such as water fluoridation is reflected in these results. The existence of small amounts of severe periodontal disease in young adults is of concern. The high prevalence of mild (and preventable) periodontal disease, seems to reflect a low awareness of the condition and/or a lack of resources to control it. It is no coincidence that such poor oral health was observed in this, a poor, peri-urban squatter community. This study, serves as a sad reminder of the maldistribution of oral health and socia-economic resources in South Africa. The socia-economic and political character of this community is reflected by the epidemiological picture of oral health observed in the study. It is clear that further data must be collected, especially a clear assessment of community-expressed needs. Active planning must take place urgently to integrate oral health with Primary Health Care to rectify the serious misuse and maldistribution of oral health resources required to improve the oral health of this population.
Die ontwikkeling van 'n innoverende kurrikulum vir die opleiding van tandheelkundiges
(University of the Western Cape, 1993) Snyman, Willem Diederik; Louw, W. J.; Kachelhoffer, P. M.
SUMMARY This study has shown that the environment in which a dentist receives his training, has, over the past decades, changed drastically, and is still changing. Also, that the existing curriculum model, in use in most dental faculties, is an anachronism and that the sands of time for a paradigm shift in terms of the curriculum, are fast running out. It follows, therefore, that the curriculum, training and evaluation programmes will, without delay, have to undergo changes in order to fulfil the requirements of the community in general and the clients of the Faculty in particular. In addition, adjustments in terms of the numbers and types of dental manpower to be trained, will have to be made. The purpose of this study was to investigate the management of dental education as a critical performance area and to develop a curriculum at the macro-level for three cadres of dental manpower, which will fulfil certain identified requirements. The curriculum model used in this study, should ideally fit in with the organisational structure of the Faculty. Therefore, this organisational structure was investigated and found to consist of a mixture of a "machine" and a "professional bureaucracy". It was also demonstrated that the disadvantages of this bureaucratic hybrid could be counteracted, whilst still retaining the advantages of the existing system, by the implementation of an "adhocracy" in the form of a matrix-functioning system. A management manual, essential for the effective functioning of a matrix system, which had already been developed for the management of teaching in the Faculty of Dentistry of the University of Pretoria, was found to be suitable, not only for this purpose, but also as a basis for future strategic planning in teaching. The rationale for the necessity of altering the traditional dental curriculum is given in the thesis and three strategies are recommended for solving the problem. Curriculum designs were carefully scrutinized and the most important of these relating to dental education, as well as the ideal positioning in terms of the SPICES curriculum strategy, have been indicated. Basic premises, with their priorities and weighted values, developed for this study were utilised in comparing the traditional model with the proposed diagonally-layered curriculum design. This proposed curriculum design, and subject structure, is illustrated in detail with the aid of diagrams. An empirical comparison showed that the proposed diagonally-layered curriculum would be an improvement on the traditional curriculum in terms of: professional and market orientation, the promotion of meta-learning, the support of teaching and evaluation, the early exposure of students to preventive clinical dentistry, the promotion of horizontal and vertical integration of various subjects and courses, rationalisation of the curriculum, easier "through-flow" possibilities for oral hygienists and dental therapists, as well as practical implementation and cost effectiveness.
The perception of occlusal conditions and profiles in a Mitchells Plain school population
(University of the Western Cape, 1993) Theunissen, Evan Trevor Lodewyk; Moola, M. H.
The prioritisation of treatment opinions by state funded orthodontic programmes has become essential in the planning of services. Numerous indices rate the severity of occlusal conditions; however, all do not adequately address the problem. It is recommended that a ranking of occlusal conditions be obtained from the community which the index is designed to serve (Shaw and Robertson, 1975). With the relocation of the Dental Faculty of the University of the Western Cape to Mitchells Plain, coupled with an increase in demand for orthodontic treatment by this community the prioritisation of orthodontic treatment needs has become essential. Two samples, one consisting of L2 14 year old school children (n = 351) and the other of senior dental students (n = 23) were selected. Four schools in MitcheIIs Plain were randomly chosen. Occlusal conditions and profiles were selected from patient records by a panel. slides were made utilising computer graphics. Respondents completed a questionnaire recording socio-demographic data, a rating of orthodontic self-image and a rating of a series of slides. In the latter the subjects were asked to view selected occlusal conditions and profiles. They responded to two questions, relating to a ranking of the severity of the condition and the consideration of the necessity of treatment for the condition. The results indicated that the majority of the school children and dental students are satisfied with their appearance. Similar ratings to those found in other studies r{ere obtained with the "ideal" class I occlusion receiving the best rating and the severe class III and severe crowding receiving the worst rating. An inverse relationship of treatment recommendation and rating was found with conditions rated best receiving a low rating of treatment. A treatment priority based on the perception of occlusal conditions and profiles L2 14 year old school children and dental students was recommended.
The prevalence of oral symptoms and perceived needs of HIV positive persons in Cape Town, South Africa
(University of the Western Cape, 1996) Camara, Cecily Jean; Schofield, Margot
The Human Immunodeficient Virus (HIV) is escalating in South Africa at an alarming rate. The impact of HIV today and in the future could have grave consequences for the South African population as it affects adults in their most productive years. To ease costs on the health system, health workers should be familiar with HIV patients needs in general, and specifically in areas such as oral disease which can contribute to the wellness or ill health of the patient. This could facilitate more appropriate and cost effective care ofHIV patients. World-wide reports indicate that the HIV virus is more prevalent in females than males. Women are also experiencing greater virulence of HIV and therefore greater severity of the disease. This research assessed whether there were differences in the prevalence and severity of oral symptoms ofHIV positive men and women. Oral health practices were also examined. As oral disease is very prevalent in HIV positive persons and has been a neglected area for research and program development, it was included in this study. This study also aimed to assess the perceived needs of patients affected by HIV. Such a study presents HIV positive patients an opportunity to participate in a process which allows patients to voice their needs and problems, as well as be involved in setting priorities. The study sought to assess whether needs differed according to the patients gender, age and symptom levels. A needs questionnaire with five domains which included medical and oral needs, social, economic, psychological and informational domains of needs was developed. The measure also included a section on demographics and oral health questions, and was administered as a structured interview. The sample consisted of 338 HIV positive males and females residing in Cape Town and its environs and attending the Out Patients' Departments of three major provincial hospitals, as well as two community clinics during May to November of 1995.
Oral health care of the patient receiving Chemotherapy and/or bone marrow transplantation
(University of the Western Cape, 1996) Solomon, Charlene S.; Shaikh, AB; Arendorf, TM
Between September 1992 and August 1995, all patients with haematological malignancies who were treated as in-patients in the Haematology Unit at Groote Schuur Hospital received a twice weekly, oral and perioral examination. Sixty patients were monitored while following the traditional hospital oral care protocol (chlorhexidine, hydrogen peroxide, sodium bicarbonate, thymol glycol, benzocaine mouth rinse and nystatin). The mouth care protocol was then changed (protocol A = chlorhexidine, benzocaine lozenges, amphotericin B lozenges) and patients monitored until the sample size matched that of the hospital mouth care regimen (n = 60). A further 60 patients were then monitored using a third protocol (protocol B = benzydamine hydrochloride, chlorhexidine, benzocaine lozenges, amphotericin B lozenges). A statistically significant reduction in oral complications was found upon introduction and maintenance of protocols A and B. The findings of this study suggest that improved oral care and a structured oral care routine reduces the number of oral complications associated with chemo- and radiotherapy.
The influence on masticatory performance of jaw movements, chewing side preference, occlusal contacf area, muscle activity and jaw tremor
(University of the Western Cape, 1996) Wilding, R.J.C.; Hobdell, M.; Lewin, A.
The primary function of the jaws and teeth in mammals is chewing and swallowing. In man there are additional functions of speech, non-verbal communication and cosmetic appeal. Chewing is a complex operation requiring both adequate skeletal structures, and a well co-ordinated muscle system. There is considerable variation in both these components of chewing within which adequate function appears to be possible, at least for a modern refined diet. For example, the dental arches may not conform to the modal arrangement and teeth may be missing, yet adequate function remains (Slagter et al 1993). There are unfortunately no baseline requirements for an adequate dentition nor the minimal chewing performance necessary to avoid indigestion. A common rule of thumb when replacing missing posterior teeth is that the extent of the prosthesis can be reduced to the premolars without seriously affecting chewing (Kayser, 1984). This arbitrary estimation has not been defined by a minimum area for functioning posterior occlusal surfaces. The same lack of quantifiable measurement is a feature of assessing orthodontic treatment goals and outcomes (Omar, McEwen and Ogston 1987). The clinical rules for correcting malocclusions, usually, have more to do with the restoration of modal tooth, arch and skeletal relationships, than with the restoration of function; if restoration of function is a concern of treatment, it is not measurable in the same way that tooth positions can be assessed on plaster casts or angles measured on a radiograph. Muscle tenderness and limited movement are both features of temporomandibular dysfunction. The boundary between normal subjects, who may have some signs of dysfunction and patients, who may not have distinctly more severe signs cannot always be made (Widmar 1992). By some definitions based on the morphology of the joint structures, even symptomless individuals could be categorised as abnormal. One of the difficulties in assessing functional incapacity of a patient with muscle pain is the absence of the same baseline data needed to assess malocclusion, or the handicap due to reduced occlusal area. It is encouraging to find that a simple test, such as measuring maximum opening, is a useful indicator of treatment progress in temporomandibular dysfunction. This sign, although simple and of limited diagnostic use, reflects the poverty of useful tests for masticatory function.
The interaction between physical sign, and chronic pain depression and nonspecific physical symptoms, in patients with temporomandibular
(University of the Western Cape, 1997) Patel, Naren; Wilding, R.J.C.
There are both physical and emotional components which are associated with the chronic pain of TMD patients. One of the difficuhies in making an accurate assessment of each component, is the lack of objective criteria for quantitative measurement of the emotional component. This need, lead to the development of Research Diagnostic Criteria (RDC) by Dworkin and LeResche (1992). The aim of this study was to use RDC criteria to record the prevalence, and associations between Axis I (physical) and AXIS TI(emotional) factors in a sample of 100 patients attending a TMD Clinic. Patients were examined using the RDC guidelines and the diagnosis classified as either, myogenic, disc displacement or arthritis. Patients completed a self-administered personal history questiotmaire which analyzed emotional factors including, chronic graded pain, depression and nonspecific physical symptoms such as headaches, faintness and lower back pain.
An evaluation of the school oral health education programme in Thamaga, Botswana
(University of the Western Cape, 1999) Moreri, Boikhutso Gladys; Myburgh, Neil
The evaluation aimed to assess the effectiveness of the school oral health education (ORE) programme in Thamaga, a rural village about 40km west of the capital Gaborone. The Oral Health Division (Botswana) had introduced the programme in schools throughout the country in 1984. The school ORE programme in Thamaga was introduced less than five years previously but not all schools could be covered before the time of the study. The delivery of weekly dental services at the primary hospital in the area had been inconsistent. The evaluation assessed the effectiveness of the programme in a cross-sectional study by comparing dental health knowledge, reported oral hygiene practices, DMFS scores and gingival bleeding index of randomly selected standard five schoolchildren, aged 10-16 years (n=135). Two schools in Thamaga were selected for the study, designated as programme (experimental) and non-programme (control) schools in this comparative study. The hypothesis proposed that children from the programme school will have better oral health (less dental caries and gingivitis), have better dental health knowledge and better oral hygiene practices than children from the non-programme school. The effects of this school ORE programme were measured firstly by a clinical examination for dental caries using the WHO DMFS index and for gingivitis using a bleeding index derived from the WHO CPI. This was to compare the proportion of children with these dental diseases in the two schools. Secondly, a close-ended questionnaire was administered to the children to assess most importantly, their knowledge of dental diseases (dental caries and gum disease) and their reported OH practices. The extent of correct dental health knowledge was minimal but about 88 percent of all the schoolchildren from both the programme and non-programme schools (n=135) reported their source of information as being the school. Generally, children from the non-programme school had higher average scores of correct responses on dental caries and gingivitis than those from the programme school. This difference in knowledge was not statistically significant (p>O.05).It was apparent from the results of the interview that the majority of the children have misinformation about disease-specific signs and symptoms, causes and prevention of dental disease, the use and benefits of fluorides and dental floss. The majority of the children reported that they do self-examination of their teeth and gums daily and the commonly reported OH practices were the use of a toothbrush and toothpaste at least twice a day. However, these reported oral hygiene practices were not commensurate with the level of gingivitis recorded. Out of all the study participants, only one child from the programme school reported using a chewing stick for cleaning teeth. The majority of the children were found to have poor periodontal health indicated by gingivitis. About 90 percent and 82 percent of the children from the programme and non-programme schools respectively had gingivitis. Only 10 percent (programme) and 18 percent (nonprogramme) of the children did not have any bleeding-gingival sites (GBI=O). The poor oral hygiene found in children from the programme school might imply that the practical aspects of plaque control and oral hygiene were not intensive enough to motivate the children. Most children were found to have minimal caries; mean DMFS scores of 0.14 (SD=0.49) and 0.12 (SD=0.45) for programme and non-programme schools respectively and 91 percent caries-free for each of the two schools. These differences were not statistically significant (p>0.05). The low prevalence of caries and the minimal difference between groups might be attributed to the following; the low prevalence of dental caries at baseline and the action of fluoride in drinking water. The study indicates that the programme has had a minimal impact if any, in the programme school. The findings suggest a need to correct the prevailing basic misinformation about dental health and motivation of teachers and the dental team to be more involved in the programmes.
The oral health status and perceived oral health needs in older adults in Guguletu
(University of the Western Cape, 1999) Kazaura, K. J.; Myburgh, Neil
Objectives: previous studies have indicated that most of the older adult population has poor oral health but only a few of them demand care for their problems' The reason for this discrepancy has never been explained adequately. The objectives of the study were' first' to assess the perceived oral health needs (with regards to social, functional and psychological impacts of oral diseases) of older adults aged 55 years and above, second, to assess the oral hearth status (periodontal disease, dental caries and oral mucosa lesions) in an adult population aged 55 years and above. Third, compare the relationship between normative and perceived need. Methods: This was a quantitative cross-sectional, descriptive study and consisted of 100 older adults who were randomly selected from three areas in Guguletu' These areas included the home for the aged Ekumphumleni' NY1 and NY2 clinics Participants aged 55 were interviewed using the structured questionnaire consists of 32 questions and clinical examination done. Frequency tables were computed and analyzed. The relationship between variables like oral health status, perceived and variety of socio-demographic variables and measures of psych-social impact of oral diseases were analysed by using the chi square test and square ratio. Results : The ability to perceive that they had a problem and the recently of the last visit to the dentist was associated with perceived need for dental care. There was a significant relationship between the presence of symptoms which were painful and perceived need for dental care mouth,p value:0.015;gums,pvalue=0.001;teeth,pvalue=0.0006)The positive attitude towards dental care and regular dental hygiene was an indicator of positive attitudes towards oral hearth care. In this study a substantial difference between perceived and normative need was also observed' 88% of the respondents perceived a need for dental care and 99% were assessed as needing treatment (normative need) but only z9o/o demanded the c,oe' 630% were dissatisfied with their functional ability to chew and expressed a need for dentures' conclusion: The aim of this study was to assess the oral health status and perceived oral health needs among older adults in Guguletu. The oral health status was poor in most were interviewed using a structured questionnaire consisting of 32question was examination done. Frequency tables were computed and analysed' The relationship between variables participants and the demand for care was lolv even though perceived need was high' The study has shown that social, functional and psychological factors influenced for care in this adult population. The cost for dentalcare and access to these services are major barriers to the demand of care perceived oral hearth needs and the impact of oral diseases are important influences in the assessment of oral health needs in the elderly' The assessment of oral health needs as perceived by the elderly facilitates the planning and implementation dental services with special consideration on the cost and accessibitity of oral healthcare.
The oral health status and perceived oral health needs in older adults in Guguletu
(University of the Western Cape, 1999) Kazaura, K. J.; Myburgh, N.
Objectives: Previous studies have indicated that most of the older adult population has poor oral health but only a few of them demand care for their problems. The reason for this discrepancy has never been explained adequately. The obj ectives of the study were, first, to assess the perceived oral health needs (with regards to social, functional and psychological impacts of oral diseases) of older adults aged 55 years and above, second, to assess the oral health status (periodontal disease, dental caries and oral mucosal lesions ) in an adult population aged 55 years and above.Third, compare the relationship between normative and perceived need. Methods: This was a quantitative cross-sectional, descriptive study and consisted of 100 older adults who were randomly selected from three areas in Guguletu. These areas included the home for the aged Ekumphumleni, NYl and NY2 clinics. Participants aged 55 years and above were interviewed using a structured questionnaire consisting of 32 questions and a clinical examination done. Frequency tables were computed and analysed. The relationship between variables like oral health status, perceived need and a variety of socio-demographic variables and measures of psycho-social impact of oral diseases were analysed by using the chi square test and odds ratio. Results: The ability to perceive that they had a problem and the recency of the last visit to the dentist was associated with perceived need for dental care. There was a significant relationship between the presence of symptoms which were painful and perceived need for dental care (mouth, p value=0.015; gums, pvalue=O.OOl; teeth, p value=0.0006) The positive attitude towards dental care and regular dental hygiene was an indicator of positive attitudes towards oral health care. In this study a substantial difference between perceived and normative need was also observed. 88% of the respondents perceived a need for dental care and 99% were assessed as needing treatment (normative need) but only 29% demanded the care. 63% were dissatisfied with their functional ability to chew and expressed a need for dentures. Conclusion: The aim of this study was to assess the oral health status and perceived oral health needs among older adults in Guguletu. The oral health status was poor in most of the participants and the demand for care was low even though perceived need was high. The study has shown that social, functional and psychological factors influence the demand for care in this adult population. The cost for dental care and access to these services are major barriers to the demand of care.Perceived oral health needs and the impact of oral diseases are important influences in the assessment of oral health needs in the elderly. The assessment of oral health needs as perceived by the elderly facilitates the planning and implementation of dental services with special consideration on the cost and accessibility of oral health care.
A profile of the Oro-facial injuries in child abuse: a hospital record based study
(University of the Western Cape, 1999) Naidoo, S; Myburgh, N
Throughout the world there is a general awareness that child abuse and neglect is a serious and growing problem. Child abuse involves every segment of society and crosses all social, ethnic, religious, and professional lines. The definition of child abuse can range from a narrow focus, limited to intentional inflicted injury, to a broad scope that covers any act that impairs the developmental potential of a child. Included in the definition are neglect (acts of omission) and physical, psychological, or sexual injury (acts of commission) by a parent or caregiver.

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