Magister Scientiae Dentium - MSc(Dent) (Community Oral Health)
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Item Awareness and knowledge of oral cancer among dental patients visiting Khartoum dental teaching hospital(University of the Western Cape, 2018) Babiker, Samah Abdelaziz Elsheikh; Myburgh, NeilBackground: Oral cancer is a major global healthcare problem. Its prevalence is increasing, and late-stage presentation is common. More than 500,000 patients are estimated to have oral cancer worldwide. Oral cavity squamous cell carcinoma (SCC) accounts for 90-94% of oral cancers. Survival rates for oral cancer are very poor, at around 50% and has not improved considerably in the previous decades even with advances in therapeutic interventions. Screening programs have been introduced for a number of major cancers and have demonstrated a compelling effect in their early detection. It’s now well established that the early detection of the malignancies is a competent way of improving the clinical outcome for patients. It’s believed that to reduce death and morbidity from this disease it is important to detect it at an early stage, when lesions are localized. Aim: To assess the level of awareness and knowledge of oral cancer among dental patients visiting Khartoum dental teaching Hospital. Method: A cross- sectional survey using a self-administered questionnaire with 18 questions was distributed to 193 patients between 18 and 65 years to collect the information. Results: The results indicate that there were more females (107; 55%) than males (86; 45%). There was a non-significant difference between alcohol consumption and awareness of oral cancer. However, the frequency results revealed that the majority of participants (98; 92 %), who reported they has heard about oral cancer, were females, while almost a quarter of participants (18; 21%) who had never heard about it, were males. This suggested that female patients were more aware of oral cancer than males. Participants, who declared hearing about oral cancer were more highly qualified educationally, whereas a quarter of them who declared they had never heard about it, were poorly qualified educationally.Item Betel nut & tobacco chewing habits in Durban, Kwazulu-Natal(University of the Western Cape, 2009) Bissessur, Sabeshni; Naidoo, SudeshniBetel nuVquid chewing is a habit that is commonly practiced in the Indian subcontinent. This age-old social habit is still practiced by Indians in Durban, Kwazulu Natal (South Africa). The betel nut/quid is prepared in a variety of ways. The quid may be prepared with or without tobacco. This habit is said to be associated with the development of premalignant lesions, namely, Oral Submucous Fibrosis (OSF) which increases the susceptibility for malignancy of the oral mucosa and the foregut. The aim of this study was to investigate the prevalence of betel nut/quid chewing (with or without tobacco), the associated habits (smoking and alcohol consumption) and awareness of the harmful effects of the chewing habit among Indians in Durban, KwaZulu-Natal. A cross-sectional study design was chosen utilising a self-administered questionnaire and semi-structured interviews to collect data. Consenting participants were requested to complete a self-administered, structured questionnaire. The study population included any person in the Durban area who chewed betel nut/quid/tobacco. Only persons willingly and who consented to be part of the study, were included. The sample size was based on convenience. People were approached at the pan shops, leisure markets, traditional functions and at the dental practice the researcher operated at. A total of 101 respondents were interviewed A significantly higher proportion of females chewed betel nut/quid from the total of the respondents. The results showed that the habit is increasingly practiced in the younger age group (20-39 years). There was evidence to show that the chewing habit is used more by the employed than the unemployed (f0.055). Of the sample population, 'l8o/o wera born in South Africa and the rest were immigrants from Pakistan, lndia and Dubai. All respondents from the migrant community were males. The most important reasons for chewing betel nut were for enjoyment and at special functions. More than two third indicated family members (aunts, uncles and cousins) influence iN a reason for chewing in comparison to influences by parents or grandparents. The study also indicated that parents were far more likely to influence betel nut chewing if grandparents did so (p-value: 0.000). ln addition, the study revealed that family members (aunts, uncles and cousins) were far more likely to influence betel nut chewing if parents did so (f0.000). The most popular ingredients chewed were betel nut, betel leaf, lime and pan masala and the most popular combinations were betel nut/lime/betel leaf quid preparation betel nut alone, betel nut/betel leaf/lime/tobacco/pan masala and betel nut/betel leaf/lime/pan masala. Two thirds of the respondents do not know that betel nut chewing is harmful to their health, thus indicating a lack of awareness on the risks associated with the chewing habit, and the majority have not attempted to give up the habit. Most of the respondents retained their chewing habits after being informed about the risks. A little more than half the study population reported neither smoking nor drinking. The present study found that betel nut/quid chewing habits continue to be enjoyed by many people and most are unawire of the hazardous effects of the habit. More younger people are using the habit as compared to previous studies. This is probably because it is an affordable and easily accessible habit. It is recommended that aggressive awareness programmes on the harmful effects of betel nut/quid chewing be developed, similar to that for smoking cessation. Government health warnings need to be instituted, for example, by having written warnings on packaging. Takes need to be imposed on the betel nut and condiments thereby reducing access to most people. Age reflections need to be imposed on purchasing of the betel nut/quid thus making access difficult for the children.Item Community drinking water fluoridation in the Southern Cape and Karoo Region: a feasibility study(University of the Western Cape, 2002) Dennis, Gilbert J.; Myburgh, NeilThe prevalence of dental decay is high among lower socio-economic groups in the Southern Cape and Karoo region. 70 - 80% of State employed dentists' time in this region is spent on attempting to reduce the pain and sepsis within the communities for which the primary treatment modality is extraction of the tooth under emergency conditions. In developing countries the prevalence of dental decay is still high. There is a general downward trend of dental decay in developing countries; and it is associated with combinations of exposure to fluoridated water and/ or other forms of fluoride exposure (e.g. in fluoridated tooth paste), the provision of preventive oral health services, an increase in dental awareness through organized oral health education programs and the readily available dental resources. This study looked at the feasibility of implementing community water fluoridation in the Southern Cape and Karoo Region by describing the primary drinking water sources, the population distribution around these sources and the actual levels of fluoride found in the water samples. Each sample was coded and with the use of a global positioning system (GPS), a set of co-ordinates obtained for each. Other options with regard to fluoride supplementation were explored as an attempt to provide an alternative intervention option for exposure to fluoride where community drinking water fluoridation was not the first option. This information will be used to record and update existing tables for fluoride levels in community drinking water of the communities in the Southern Cape and Karoo region that is currently used as a guide for prescribing fluoride supplementation as a means of prophylaxis for the prevention and reduction of dental decay. This study re-iterated the diverse set of variables that communities living in rural areas have to live with. It supports the trend that in developing countries the DMFT (12 years) and dmft (6 years) are higher than those in the same age cohorts of developed countries. This study shows that the fluoride level in borehole water is generally higher than that of dams or reservoirs. Fluoride supplementation is required in the bigger, densely populated areas as the fluoride levels of the water in these areas are below optimal and their water systems can accommodate fluoridation. The long term gains of community water fluoridation at optimal levels for entire communities by far out way the risk of developing fluorosis at above optimal levels. There needs to be a systematic review of treatment needs and treatment modalities for each community so that at some point the need for prevention strategies will be sought out by program managers as best practice for improving the general health (i.e. and oral health) of their communities. There is no single approach for solving issues in communities with different sets of variables determining their needs and so too to the question of community water fluoridation. The recommendation is that at the community level (i.e. the communities should be empowered to do their own situational analysis and prioritize their needs) people need to make decisions for themselves with regard to the type of preventive strategy that they implement. Once they have the data and an intervention option is arrived at, they should lobby with their local health provider to implement that intervention option (e.g. Exposure to fluoride as a means of improving dental health) that they have identified in their towns or villages.Item Community drinking water fluoridation in the Southern Cape and Karoo Region: A feasibility study(University of the Western Cape, 2002) Dennis, Gilbert J; Myburgh, NeilThe prevalence of dental decay is high among lower socio-economic groups in the Southern Cape and Karoo region. 70 - S0% of State employed dentists' time in this region is spent on attempting to reduce the pain and sepsis within the communities for which the primary treatment modality is extraction of the tooth under emergency conditions. In developing countries the prevalence of dental decay is still high. There is a general downward trend of dental decay in developing countries; and it is associated with combinations of: exposure to fluoridated water and or other forms of fluoride exposure (e.g. in fluoridated tooth paste), the provision of preventive oral health services, an increase in dental awareness through organized oral health education programs and the readily available dental resources. This study looked at the feasibility of implementing community water fluoridation in the Southern Cape and Karoo Region by describing the primary drinking water sources, the population distribution around these sources and the actual levels of fluoride found in the water samples. Each sample was coded and with the use of a global positioning system (GPS), a set of co-ordinates obtained for each. Other options with regard to fluoride supplementation were explored as an attempt to provide an alternative intervention option for exposure to fluoride where community drinking water fluoridation was not the first option. This information will be used to record and update existing tables for fluoride levels in community drinking water of the communities in the Southern Cape and Karoo region that is currently used as a guide for prescribing fluoride supplementation as a means of prophylaxis for the prevention and reduction of dental decay. This study re-iterated the diverse set of variables that communities living in rural areas have to live with. It supports the trend that in developing countries the DMFT (12 years) and dmft (6 years) are higher than those in the same age cohorts of developed countries. This study shows that the fluoride level in borehole water is generally higher than that of dams or reservoirsItem Compliance of public dental clinics in the Umgungundlovu district with norms and standards in the Primary Health Care Package for South Africa(University of the Western Cape, 2016) Rajcoomar, Nuerisha; Naidoo, SudeshniBACKGROUND: The majority of South African citizens are dependent on the State Health Care system for their wellbeing. Dental services are part of this system. The first line of intervention for oral disease is the primary oral health services. The National Norms and Standards for Primary Health Care sets out in detail the services to be offered by state dental clinics. This document also lists the equipment and materials that public dental clinics should be furnished with in order to deliver prescribed services. Despite this, most public dental clinics do not deliver the full spectrum of services due to the lack of materials and equipment. The end result is that patients do not receive the ideal treatment and treatment choices are based on the availability of equipment and material instead of clinical appropriateness. There was a need to determine to what extent the primary oral health clinics comply with the National Norms and Standards for Primary Health Care. The launch of the green paper of the National Health Insurance in 2011 stated that the NHI is a tool to ensure that healthcare to the entire South African population is of an equal standard. The Umgungundlovu District is one of the sites identified as a pilot district for the NHI. Prior to 1994 there was a two tiered health system in South Africa, the private health system and the public health system. It is this historical model that has shaped the current system. It was the socio-economic status of an individual that dictated within which of the two tiers treatment was sought. AIM: To determine whether public dental clinics in the Umgungundlovu District are equipped to deliver the oral health services prescribed by the Primary Health Care Package for South Africa protocol. METHODOLOGY: A cross sectional study was conducted in the Umgungundlovu district which is in KwaZulu Natal to establish which of the prescribed dental services are offered at the clinic. There are 11 dental clinics in the Umgungundlovu District and one mobile dental clinic. All clinics and the mobile clinic were included in the study. Physical inspection and a checklist were used to determine which equipment and materials were available at dental clinics of the Umgungundlovu district and to determine compliance with the National Norms and Standards for Primary Health Care. RESULTS: Dental services were provided at all the 12 dental facilities in the Umgungundlovu district. None of the clinics had 100% of required instruments, materials and equipment. Half of the clinics had more than 50% of required instruments, materials and equipment. Tooth-brushing programs and fluoride mouth rinsing programs were offered by 41.67% of the clinics, fissure sealant applications by 66.67% and topical fluoride application by 25% of the clinics. In addition, while all offered oral examination and emergency pain and sepsis care (including extractions) only half were able to take bitewing radiographs, 58.33% to carry out simple fillings of 1-3 tooth surfaces, 66.67% to provide atraumatic restorative treatment (ART). CONCLUSION: Lack of materials, instruments and equipment, the irregular supply of materials, instruments and equipment and the late supply of materials, instruments and equipment was found to limit the dental treatment offered by the clinics. None of the 12 clinics in the Umgungundlovu district were found to be compliant with the Primary Health Care Package for South Africa – a set of norms and standards document. Availability of dental services was limited in the dental clinics, except at the Edendale Dental Hospital DepartmentItem Dental caries clinical and experimental investigations(University of Pretoria, 1947) Ockerse, Tpental 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.Item Dental fluorosis and parental knowledge of risk factors for dental fluorosis(University of the Western Cape, 2016) James, Regina Mutave; Louw, A.J.Introduction: Dental fluorosis is a developmental disturbance of enamel that results from ingestion of high amounts of fluoride during tooth mineralization. Drinking water remains the main source of fluoride. Other sources of fluoride include infant formula, vegetables; canned fish as well as early, improper utilization of fluoridated toothpastes in children. Knowledge of risk factors in the causation of dental fluorosis may improve strategies to prevent dental fluorosis. Objective: To determine the prevalence of dental fluorosis among children aged 12-15 years old in Athi River sub-county, Machakos County, Kenya and assess the level of knowledge on risk factors for dental fluorosis among their parents. Methodology: This was a descriptive study with an analytic component. A total of 281 children aged 12-15 years attending public primary schools within Athi River sub-county, Machakos County were included. A self-administered questionnaire was send to parents for sociodemographic characteristics and oral health practices. Children whose parents consented were examined and dental fluorosis scored according to the Thylstrup and Fejerskov index. Fourty randomly selected children were requested to bring water samples from their homes. Retail stores located in the area were visited for purchase of six different brands of bottled water. These samples were sent to a certified laboratory for fluoride analysis and reported in milligrams of fluoride per litre. Data analysis: Data was entered into SPSS version 20 and analysed for means, ANOVA of means and chi-square test of significance for categorical variables. All tests for significance were set at 95% confidence level (α≤0.05). Results: A total of 314 self-administered questionnaires were send to parents together with consent forms for their children's participation in the study. Two hundred and eighty six responded positively, giving a response rate of 91%. The overall prevalence of dental fluorosis among children aged 12-15 years was 93.4% with only 6.6% (n=19) recording a TFI score of 0. About one quarter 70(24.4%) of children had severe fluorosis with TFI scores of ≥5. The mean TFI score for all children was 3.09 (SD=2.0), with males recording a mean TF score of 3.01 (SD=2.11) and females a mean TF score of 3.16 (SD=1.88). Out of 44 water samples analysed, 29 (65.9%) had a fluoride content of less than 0.6mg/l, 5 (11.4%) had fluoride content of 0.7 - 1.5mg/l while 10 (22.7%) of samples had a fluoride content ≥1.5mg/l. The highest fluoride content recorded was 9.3mg/l, with another sample reflecting 8.9mgF/l. Three of the bottled water samples had a fluoride content of less than 0.6mg/l, while the other half of the bottled water reported 0.7 - 0.8mg/l fluoride. A majority (87.8%) of parents indicated that they had noticed children with brown staining of their permanent teeth in their community. About 80% of parents thought dental fluorosis was caused by salty water, while only 12.9% correctly identified water with high fluoride content as being responsible for the discolored teeth. Conclusion: Although about one in five water sources sampled had fluoride content of ≥1.5mg/l, the prevalence of dental fluorosis in this community was very high. Parental knowledge on the risk factors for dental fluorosis was low. Further research is necessary to identify the water distribution networks to provide sound evidence for engaging with the county authorities on provision of safe drinking water to the community.Item Dental fluorosis and parental knowledge of risk factors for dental fluorosis(University of the Western Cape, 2016) James, Regina Mutave; Louw, AJIntroduction: Dental fluorosis is a developmental disturbance of enamel that results from ingestion of high amounts of fluoride during tooth mineralization. Drinking water remains the main source of fluoride. Other sources of fluoride include infant formula, vegetables; canned fish as well as early, improper utilization of fluoridated toothpastes in children. Knowledge of risk factors in the causation of dental fluorosis may improve strategies to prevent dental fluorosis. Objective: To determine the prevalence of dental fluorosis among children aged 12-15 years old in Athi River sub-county, Machakos County, Kenya and assesses the level of knowledge on risk factors for dental fluorosis among their parents. Methodology: This was a descriptive study with an analytic component. A total of 281 children aged 12-15 years attending public primary schools within Athi River sub-county, Machakos County were included. A self-administered questionnaire was send to parents for socio-demographic characteristics and oral health practices. Children whose parents consented were examined and dental fluorosis scored according to the Thylstrup and Fejerskov index. Fourty randomly selected children were requested to bring water samples from their homes. Retail stores located in the area were visited for purchase of six different brands of bottled water. These samples were sent to a certified laboratory for fluoride analysis and reported in milligrams of fluoride per litre. Data analysis: Data was entered into SPSS version 20 and analysed for means, ANOVA of means and chi-square test of significance for categorical variables. All tests for significance were set at 95% confidence level (α≤0.05). Results: A total of 314 self-administered questionnaires were send to parents together with consent forms for their children‟s participation in the study. Two hundred and eighty six responded positively, giving a response rate of 91%. The overall prevalence of dental fluorosis among children aged 12-15 years was 93.4% with only 6.6% (n=19) recording a TFI score of 0. About one quarter 70(24.4%) of children had severe fluorosis with TFI scores of ≥5. The mean TFI score for all children was 3.09 (SD=2.0), with males recording a mean TF score of 3.01 (SD=2.11) and females a mean TF score of 3.16 (SD=1.88). Out of 44 water samples analysed, 29 (65.9%) had a fluoride content of less than 0.6mg/l, 5 (11.4%) had fluoride content of 0.7 - 1.5mg/l while 10 (22.7%) of samples had a fluoride content ≥1.5mg/l. The highest fluoride content recorded was 9.3mg/l, with another sample reflecting 8.9mgF/l. Three of the bottled water samples had a fluoride content of less than 0.6mg/l, while the other half of the bottled water reported 0.7 - 0.8mg/l fluoride. A majority (87.8%) of parents indicated that they had noticed children with brown staining of their permanent teeth in their community. About 80% of parents thought dental fluorosis was caused by salty water, while only 12.9% correctly identified water with high fluoride content as being responsible for the discolored teeth. Conclusion: Although about one in five water sources sampled had fluoride content of ≥1.5mg/l, the prevalence of dental fluorosis in this community was very high. Parental knowledge on the risk factors for dental fluorosis was low. Further research is necessary to identify the water distribution networks to provide sound evidence for engaging with the county authorities on provision of safe drinking water to the community.Item Dental fraud in South Africa(University of the Western Cape, 2016) Putter, Renier; Naidoo, SudeshniHealthcare fraud wastes money that could be spent in the treatment of patients. The exact amount of healthcare fraud is very difficult to determine, especially in a two-tier healthcare system like South Africa. The amount and cost of dental fraud in South Africa has never been researched. If the amount and cost of fraud in a specific area can be determined, resources can be better used to combat healthcare fraud in the future.Item 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.Item Diabetic status of patients presenting for dental treatment(University of the Western Cape, 2017) Negi, Marwa Milad; Holmes, H.The prevalence of Diabetes mellitus (a non-communicable disease) is increasing worldwide. In 2008, it was declared one of the major non-communicable diseases in South Africa, affecting 4.6% of the population (cited in Pretorius, 2014). Of concern is the large number of people who are undiagnosed and thus present for treatment at a late stage of the disease. This has prompted the need for screening of patients as Diabetes Mellitus has serious immediate and long-term complications.Item 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.Item Evaluation of resin-based fissure sealants placed under field conditions(University of the Western Cape, 2015) Potgieter, Carl Edzard; Naidoo, SudeshniBACKGROUND: The application of dental sealants is a recommended procedure to prevent and control dental caries. However, despite strong evidence for the safety and effectiveness of dental sealants, their use still remains low, especially among children from lower socioeconomic communities. The World Health Organization (WHO), Centres for Disease Control and Prevention (CDC) and the Association of State and Territorial Dental Directors (ASTDD) strongly endorse the implementation of school based dental sealant programmes as a community-based preventive strategy to increase sealant use and reduce dental caries. However, in the WHO African Region, oral health is seen as a very low priority and this is compounded by limited technical and managerial resources. The availability of human resources and equipment are crucial for the successful placement of dental sealants. A gap in the research literature was identified for determining the effectiveness of fissure sealants placed under field conditions. AIM: To evaluate the caries preventive effect as well as retention status of a resin-based fissure sealant that was placed under field conditions as part of a school based sealant programme. METHODOLOGY: A cross-sectional comparative study was conducted at two primary schools in close proximity of each other in the same low socio-economic area in Beaufort West, South Africa. The study population consisted of grade two children between the ages of 7-9 years who had fully erupted first permanent molar teeth. The case group consisted of 100 learners who received dental sealants on caries-free first permanent molar teeth 12 months earlier. The control group consisted of a random selection of the same number of learners from the adjacent school. Dental caries on the occlusal surfaces of the first permanent molar teeth was detected by making use of the decayed (D) portion of the decayed, missing and filled tooth (DMFT) score, while a separate diagnosis distinguished between cavitated and non-cavitated lesions. Sealant retention was determined by a calibrated examiner who was not involved in the placement of the sealants. RESULTS: The response rate of the study was 80.0% (n=100) and 78.9% (n=356) of the fissure sealants that were originally placed were evaluated. When the sealants were placed in 2013, 52.0% of the children were female and at the 12 month follow-up, 51.3% were female. The average age of the female children at follow-up was 8 years and 4 months (99.9 months) and 8 years and 5 months (101.8 months) for the males. The standard deviation of the gender profiles differed by 1 month only and implies an equal distribution of age between female and male children throughout the study. Just less than ten per cent (7.8%) of the sealants were fully intact at the 12 month follow-up examination and 91% were totally lost, which is a higher sealant loss rate than what is generally reported on in the literature. Of the 7.8% fully retained sealants, a statistically significant proportion (p=0.044) were found on the mandibular molar teeth. The caries incidence rate in the sealed group was 7.1% versus 9.1% in the control group. Relative risk (RR) calculations was slightly lower for the sealed (RR=0.79) than the unsealed (RR=1.02) teeth. CONCLUSION: The study showed a 2% lower caries prevalence rate on the occlusal surfaces of the sealed versus the unsealed teeth. However, this does not represent a statistically significant finding (P=0.39). The study also showed a low retention rate for the resin-based sealants placed under field conditions (12 month retention rate of 7.8%). The results from this study has therefore shown that resin-based fissure sealants placed on grade 1 learners under field conditions appear to be not ideal in preventing the onset of dental caries on the occlusal surfaces of the first permanent molar teeth.Item An evaluation of the school oral health education programme in Thamaga, Botswana(University of the Western Cape, 1999) Moreri, Boikhutso Gladys; Myburgh, NeilThe 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.Item Evaluation of the use of the oral health section of the road to health chart (RtHC)(University of the Western Cape, 2016) Cader, Rugshana; Naidoo, SudeshniDental caries in preschool children remains a major dental public health problem as it affects a significant number of preschool children in both developed and developing countries. Dental caries is a multifactorial disease caused by bacteria, sugar and carbohydrates which metabolize to form acids. These acids demineralize the tooth surface which results in dental caries. Cariogenic bacteria can pass from mother to child in the first two years of the child�s life. Other causes of childhood caries result from poor feeding practices and dietary practices. The American Academy of Pediatrics (AAP) policy statement advises that screening should be conducted by the time of the first tooth appearance and at no later than 12 months of age (AAP, 2011).Item 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.Item Factors that influence the dental attendance of children under thirteen years of age at two community dental clinics in the Western Cape, South Africa.(University of the Western Cape, 2000) Mukurazhizha, T.D; Yasin-Harnekar, S.AIMS AND OBJECTIVES: Most children presenting to dental clinics have pain of varying intensity that usually, has been endured for long periods of time. A study done at Cardiff in the United Kingdom, found that only 15% of children that had dental pain visited the dentist. Therefore, understanding the motivations of patients in seeking health care is vital to the quality of life in the family and community and to the success of any oral health planning process. This study explored factors influencing the time between the initial pain experience and definitive dental treatment, that is, the time lapse. It assessed how factors such as pain, individual and community characteristics affect the timing of dental visits. METHOD: Parents or guardians accompanying children visiting two community dental clinics in Guguletu and Mitchells Plain in the Western Cape were asked to indicate how factors such as severity and duration of pain, efficacy of self-treatment, and impact on parents affected the decision to seek treatment. A total of one hundred and twenty six parents were interviewed using a structured questionnaire. The English questionnaire was translated into Xhosa and Afrikaans and used with the help of interpreters when necessary. Children attending these community dental clinics for treatment on a particular morning were included in the study sample. Children up to thirteen years of age (primary, mixed, and early permanent dentition) comprised the study sample. Only children that had a dental problem were included in the study. Children that were not accompanied by a parent or guardian were excluded. RESULTS: Close to half the children (43 - 45%) had never been to the dentist before. Parents from Mitchells Plain knew earlier of their children's dental problems (most knew14 days before visit) than those from Guguletu where most knew within the last 7 days. However, Guguletu children were presented to the dentist sooner after the painful experience (69.2% within 7 days) than Mitchells Plain where only 48.3% were presented within the same period. It was found that for these communities, the distance from the clinic, the mode of transport, and the fares charged greatly influenced dental attendance. Most families lived within 3km, and walked (more prevalent in Guguletu) or rode a taxi (more prevalent in Mitchells Plain). With taxi the most prevalent mode of transport, money was an important factor of dental attendance. Long queues at the clinic and waiting long for appointments, were cited by parents as the major hindrances to attendance. While a worsening of pain, loss of sleep and sensitivity to chewing hastened dental attendance, parental work commitment and the child's school delayed it. Most families (79%) tried some treatment at home prior to the dental visit. The remedies offered such as Disprin®, direct placement of crushed Disprin® and Panado® were a concern because they were potentially harmful. Both communities were in the low socio-economic class with Guguletu consistently the poorer of the two. They both had disrupted family life as reflected by the low rates of married parents. CONCLUSION: In the presence of pain Guguletu children were presented to the dentist sooner than those of Mitchells Plain. Accessibility of the clinics was a real concern especially in Guguletu. There was rampant inappropriate use of medications such as aspirin and antibiotics. The greatest impact of the child's pain on the parents was on affected sleep. The non-regular attendance pattern of the children closely followed that of the parents.Item Impact of HMAIDS on Mortality among the Inpatients at Motebang Hospital, Lesotho(University of the Western Cape, 2004) Mburu, Francis Kinyanjui; Naidoo, SudeshniThis was a descriptive retrospective study of the mortality trends among inpatients at Motebang Hospital in Lesotho. The hypothesis was that AIDS had modified the mortality pattern so predictably that its impact could be quantified. The rationale was that if the hypothesis could be confirmed, the mortality trends could supplement other methods of estimating the impact of HIV/AIDS such as extrapolation of data from antenatal clinics (ANC) and sexually transmitted infections (STI) sentinel surveillance sites, and that the ASSA2000 prediction model could be used reliably in Lesotho. Data for diagnosis, outcome, gender, age, and date of admission and discharge or death were collected from hospital records for the period extending from 1st January 1989 to 31't December 2003. The l5-year period was divided into three 5-year periods (198911993, 199411998, and 199912003) and the diagnoses were grouped into GBD Group I, II, and III. The data were analysed to establish time, gender and age trends. Mortality rate and number of deaths increased over the l5-year period. Group I (communicable diseases, maternal, perinatal, and nutritional conditions) contributed 69%o of all deaths. The progressive rise in mortality was most pronounced in the 15-49-year range. A bulge, on the mortality incidence by age graph of the aforementioned age range, was well established in the last five-year period (199912003). The peak of the bulge on the graph of the females occurred in the 25-29-year range, five years earlier than that on the graph of the males. This was the unique trend that had been attributed to AIDS and it was therefore clear that AIDS had modified the mortality trend among the Motebang Hospital's inpatients. The study found that AlDS -related deaths accounted for 5l-65% of the total deaths and 70-80% of the Group I deaths. Although the number of the inpatients in Group II was low, there was evidence of an increasing burden from non-communicable diseases. However, the burden from Group III [injuries] remained stable. The conclusion arising from the study was that AIDS has had a unique impact on the mortality of the Motebang Hospital's inpatients, and that this evidence could be used, inter alia, in the formulation of public policy and as a benchmark for the evaluation of current and future HIV/AIDS interventions.Item 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.Item "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, JThe 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.
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