Research Articles (Orthodontics)

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Allergic contact dermatitis from resin‑modified glass ionomers
(Wolters Kluwer, 2019) Buchanan, Glynn Dale; Tredoux, Sheree; Gamieldien, Mohamed Yasin
Monomers in a variety of dental materials may cause allergic contact dermatitis. While resin materials have been implicated in the onset of this condition, there is a paucity of evidence linking the condition to the resin‑modified glass ionomers (RMGIs). This report documents a rare case of a dentist who developed allergic contact dermatitis following exposure to a RMGI. Contact dermatitis occurred despite the use of latex gloves, which were worn during the procedure. Both the acute and chronic stages of the condition were clinically represented. Patch testing was conducted to confirm the diagnosis. A no‑touch technique and the routine use of nitrile gloves were subsequently adopted, which resulted in an overall decrease of the condition.Dentists, auxiliary personnel, and students should be aware of the possibility of sensitization to, and the development of allergic contact dermatitis not only from conventional resin materials, but also from the RMGIs.
Application of lasers in orthodontics
(South African Dental Association, 2017) Mulder, Riaan; Melman, Geoffrey; Karic, Vesna
Laser is the acronym for Light Amplification by Stimulated Emission of Radiation, a usage that dates back to approximately 50 years ago. In 1960, the first functioning laser was built by the American physicist Maiman at the Hughes Research Laboratories by using a synthetic ruby crystal made of aluminum oxide and chromium oxide. In general, lasers are composed of the three principal parts: an energy source, an active medium and a set of two or more mirrors that form a resonator. Properties such as wavelength are determined primarily by the active medium, which can be a gas, crystal or a solid-state conductor.
Are fissure sealants still relevant as a caries preventive measure?
(South African Dental Association, 2016) Mulder, Riaan
The groundwork for fissure sealants was completed in 1955 and lead to the introduction in 1971 of the Nuva-Seal Fissure Sealant by L.D Caulk. Since caries predominantly affects the pits and fissures of the teeth of children, these sealants have been shown to be a valuable preventive procedure. FS are cost effective and provide an ideal preventive measure for children who have restricted access to dental services. However the advent of dental lasers, caries detection systems, fluoride varnishes and novel adhesive systems may have displaced FS as a preventive measure of choice. The aim of this investigation was to establish whether FS remain a relevant preventive measure for the anatomically vulnerable fissure system.
Bio-active restorative materials as alternative pit and fissure sealants in pediatric and preventative dentistry: In vitro investigation
(MedCrave, 2017) Perchyonok, Tamara; Mulder, Riaan
BACKGROUND: It has been more than 40 years since the pit and fissure sealants were first used clinically. During this time, pit and fissure sealants have been shown to be effective in reducing the risk of occlusal caries. AIM: The aim of the investigation is to further develop and evaluate a versatile designed chitosan based bio-active materials on for use as bonding free fissure sealant/fissure protectors on permanent dentition and evaluate remineralization/demineralization capacity of the materials through pH cycling, as well as shear bond strength etch and no etch prototype as well as measurement of Vickers hardness of the newly designed materials and compare the property with the commercially available standard. RESULTS: In general there was an increase in bond strength of the enamel treated with the modified Premise containing nanodiamond: chitosan materials compared to the bond strength of the conventionally bonded teeth. It is seen that release of phosphorus into the dematerializing solution (i.e. loss of phosphorus from the samples) showed larger amplitude (from 600.2mg to 101.3 mg) than the uptake of phosphorus by the samples from the re-mineralizing solution (from 125.2 mg to 66.1 mg). Therefore, the treatment with chitosan seems to act more on the demineralization of tooth enamel with little effect on the remineralization process. Regarding the net phosphorus loss (net P loss), it can be seen that net demineralization occurs in all cases. However, the net amount of phosphorous released by the control group samples was significantly higher than those groups treated with chitosan. The net P loss for the control group was 475 mg of P, whereas the groups containing chitosan had a net P loss in the range of 30-182 mg. When a 1mm layer is assessed all the materials including the Premise control indicated a conversion of above 96%, which is the upper limit of the conventional fissure sealant material which makes the newly designed bioactive materials suitable for the application as fissure sealant materials. The important aspect of any newly designed/ developed restorative material is cytotoxicity as Grobler et. al [1] investigated the cytotoxic effect of nanodiamonds and also the effect of the incorporation in a dental material (Premise), who found a higher shear bond strength (p < 5%) after 3 months of Premise treated with nanodiamonds, chitosan, cyclodextrin (CD) and combinations thereof than for the control Premise. The sequence for the Vickers hardness was: CD (32.5) < nano (34.8) < CD Nano (38.8) < Premise (39) < Chitosan Nano (42.2). Nanodiamonds (92%) and the combination of chitosan + nanodiamonds (93%) showed little cytotoxicity. The shrinkage was lower for all the additions than for Premise alone. CONCLUSION: All modified Flowable bio-active materials can be further developed in effective fissure sealant material based on the acceptable in vitro results and cytotoxicity data.
Biomaterials and designer functional applications in oral cavity
(Nova Science Publishers, 2016-05-10) Perchyonok, Tamara; Mulder, Riaan
Dental biomaterials and natural products represent two growing research fields, revealing that plant¬derived compounds may play a role not only as nutraceuticals in affecting oral health but also in improving physicochemical properties of biomaterials used in dentistry. Recently, the role of free radicals in healthcare has attracted tremendous interest in the field of medicine, dentistry and molecular biology. Free radicals can be either harmful or helpful to the human body. When there is an imbalance between input and output of free radicals, a condition called “oxidative stress” develops. To counteract oxidative stress, the body has protective antioxidant mechanisms, which aid in lowering the incidence of various human morbidities and mortalities.
Can a new paediatric sub-specialty improve child health in South Africa?
(Health & Medical Publishing Group, 2012) Swingler, George; Hendricks, Michael; Hall, David; Hall, Susan; Sanders, David; McKerrow, Neil; Saloojee, Haroon; Reid, Steve
Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the healthcare needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary healthcare will be limited by the skewed distribution of staff and the lack of suitable skills. A 'community' placement during specialist training, and the creation of a sub-specialty in Community Paediatrics and Child Health, could address the skills shortage and possibly attract health personnel to under-served areas through creating an appropriate career path. This proposal would also support the Department of Health's encouraging plans to re-engineer primary healthcare.
Cavity preparation using hard tissue lasers in operative dentistry
(South African Dental Association, 2017) Karic, Vesna; Mulder, Riaan; Melman, Geoffrey
A laser is a device that delivers coherent, monochromatic and collimated light as a form of energy. Most dental laser devices emit invisible light in the infrared portion of the electromagnetic spectrum. On May 7, 1997, the Food and Drug Administration (FDA) cleared for marketing in the United States the first erbium: yttrium - aluminum -garnet, or Er: YAG, laser for use in preparing cavities in the teeth of living human subjects.
Characteristics of children under 6 years of age treated for Early Childhood Caries at Tygerberg Oral Health Centre, South Africa
(Tufts University, School of Dental Medicine, 2008) Mohamed, Nadia; Barnes, Jo
Objective: This retrospective survey highlighted the characteristics of children less than six years of age presenting with early childhood caries(ECC) who had two or more teeth extracted under intravenous sedation at the Tygerberg Oral Health Centre in Cape Town, South Africa. This survey was carried out in order to plan a community-appropriate intervention strategy. Methods: Records of 140 patients kept by the pediatric Dentistry Division met the inclusion criteria and were included in this survey. Most of the patients originate from economically disadvantaged areas. Results: Diet, feeding and oral hygiene habits were shown to be the most significant factors that contributed to the development of ECC in these patients. All the children were either breast- or bottle-fed past one year of age. 93.6% of the children went to sleep with the bottle or while on the breast and 90% of them were fed on demand during the night. On average, breastfeeding was stopped at 9 months of age compared to bottle-feeding that, on average, was stopped at a much later mean age of 23 months. Where oral hygiene practices were concerned, 52.6% of children brushed their own teeth without supervision. Frequency of brushing varied between subjects. Conclusion: The results of this study have demonstrated that there is a need for culturally appropriate education campaigns to inform parents (especially those in disadvantaged communities) about the importance of oral health and the prevention of oral disease.
Community paediatrics and child health
(Health & Medical Publishing Group, 2015) Goga, Ameena; Feucht, Ute; Hendricks, Michael; Westwood, Anthony; Saloojee, Haroon; Swingler, George; McKerrow, Neil; Sanders, David
TO THE EDITOR: In 2012, the Postgraduate Education Committee of the Health Professions Council of South Africa (HPCSA) supported the accreditation of Community Paediatrics and Child Health (CPCH) as a paediatric subspecialty; however, full HPCSA approval is outstanding. Consequently, by February 2015 there had been no visible progress towards implementation. Power and Heese and Swingler et al. highlighted the benefits of CPCH, rendering further debates about CPCH accreditation unnecessary, particularly in a country where: (i) progress towards the fourth Millennium Development Goal is slow; (ii) glaring gaps exist between hospital-based and community care, and between private and public sector care;[3] and (iii) current under- and postgraduate paediatric training emphasises clinical subspecialties (despite reduced public sector posts), yielding graduates with limited knowledge about priority child health conditions. Primary healthcare re-engineering and the establishment of district clinical specialist teams in South Africa have starkly revealed the urgency of CPCH training. CPCH locates child health within a sociocultural-economic-political-environmental-systemic paradigm. Successful community paediatricians share four characteristics: (i) academic collaboration; (ii) finding evidencebased local solutions; (iii) establishing strong community-based partnerships; and (iv) addressing disease outside traditional biomedical models. This suggests that our sometimes narrow approach to under- and postgraduate training needs significant adaptation. The British Association for Community Child Health, affiliated to the Royal College of Paediatricians, is a successful model we can adapt. This custodian of community paediatrics directs traineeships, stipulates requirements and outlines the scope of the discipline.
A comparison of the dental age estimation methods of Phillips and Proffit in a sample of South African children
(The South African Dental Association, 2018) Elgamri, Alya; Mohamed, Nadia; Hudaon, Athol
Introduction: Dental age is an indicator of the physiological maturity of growing children. Different methods for estimating the dental age in contrast to the chronological age have been proposed. Aims and objectives: The aim of this retrospective study was to compare the accuracy of the Phillips and the Proffit methods in estimating the dental age in a mixed sample of South African children. Methods: A random selection was completed of 100 panoramic radiographs of patients with known chronological ages, ranging between 6 and 11 years. Dental age for each radlograph was esdmated using both the Phillips and the Proffit methods. Results: The Phillips method underestimated the age of combined sample by four months (statistically significant p =0.03}, whilst the age of the boys sample was underestimated by six months (statistically significant p <0.0001). For the girls' sample, the Proffit method underestimated the age by only two days (not statistically significant p =0.97). Proffit's method underestimated the age of the boys by two months (not statistically significant (P= 0.15). Conclusion: Even though It has not previously been validated, Proffit's description of dental development has been shown to be accurate in estimating the dental age.
A comparison of two liner materials for use in the ferric sulfate pulpotomy
(South African Dental Association, 2008) Mohamed, Nadia
Objectives: The aim of this study is to compare the success rate obtained when applying either a calcium hydroxide (Dycal) base or a zinc oxide-eugenol (Kalzinol) base following the traditional ferric sulfate pulpotomy. Methods: Patients were either treated in the chair or under general anaesthesia. All teeth had to have radiographic evidence of caries close to the pulp. After haemostasis was achieved with damp cotton pellets, ferric sulfate was applied to the pulpal stumps. Half of the cases then received a Dycal base followed by a cured layer of Vitrebond and a permanent amalgam restoration. The other half of the cases received a base of zinc oxide-eugenol (Kalzinol) followed by an amalgam restoration. The cases were followed up every 6 months for one year (ie. 2 follow-up visits). Radiographs were taken at each follow-up visit. Results: Overall, teeth treated with Dycal demonstrated a higher failure rate when compared with those that received the Kalzinol base. Abscess formation and internal resorption were the most common causes of failure. Even though the Kalzinol base demonstrated greater success, there were still quite a few failures. Conclusion: This study demonstrates that calcium hydroxide cannot be recommended as a medicament in primary tooth pulpotomies.
Continuous workplace-based assessment as an indication of clinical competence in paediatric dentistry
(International Network for Higher Education in Africa, 2021) Mohamed, Nadia; Smit, Liezl
An authentic workplace setting provides the ideal opportunity for assessment of students’ clinical competence at the ‘does’ level of performance. Final-year dental students in the Department of Paediatric Dentistry at the University of the Western Cape are evaluated in the clinical environment on a daily basis through multiple clinical evaluations which assess clinical and diagnostic skills over a year. An additional end-of-module clinical assessment in the form of a single blinded patient case (BPC) determines if students have reached the expected level of clinical competence in terms of patient evaluation and diagnosis. However, the reliability and feasibility of this single end-of-module clinical case have been questioned in this setting. This study aimed to determine if the current continuous workplace-based assessment (WPBA) results could be used as an indication of final-year students’ clinical competence at the end of the module. A retrospective, quantitative, cross-sectional study was conducted of all complete assessment records. The correlation between the continuous WPBA components was analysed together with an evaluation of the reliability and validity of the assessment results. The continuous formative WPBA practices were found to be both valid and reliable when using Kane’s (2013) and Royal’s (2017) frameworks for analysis. However, the BPC should be reconsidered due to feasibility and reliability concerns. Key words: Dental education, Paediatric Dentistry, clinical skills, workplace, summative, formative, continuous assessment
Dental needs of intellectually disabled children attending six special educational facilities in Cape Town
(Health & Medical Publishing Group, 2016) Roberts, T; Chetty, M; Kimmie-Dhansay, F; Fieggen, K; Stephen, Lawrence X.G.S
OBJECTIVE. To assess the dental needs of a group of children with intellectual disability (ID) attending six special educational facilities in Cape Town, South Africa. METHODS. This was a cross-sectional study based on a convenience sampling method. One hundred and fifty-seven children with ID attending six special educational facilities in Cape Town were included in the survey. Five schools were exclusively funded by the State and one school received additional private financial support. The oral examinations complied with guidelines drafted by Special Olympics Special Smiles programme and the Centers for Disease Control, USA. RESULTS. The most common dental disorders requiring management were gingival disease (69%) and untreated dental caries (68%). Almost 50% of the children had missing teeth. Twenty-nine percent needed orthodontic correction of malocclusion and 7% had structural abnormalities of their teeth that required either aesthetic or functional intervention. Fillings were evident in only 8% of the children. Females required more dental treatment than males. The dental needs of children with ID increased with age. There were no significant differences in the dental needs of children attending State-funded schools and those attending the single school that received additional financial assistance. CONCLUSION. The frequency of unmet dental needs of children with ID attending special educational facilities in Cape Town was high and the dental care available to them was minimal. The study highlights the need for improved dental services to ensure that optimal oral health is accessible to children with ID attending special educational facilities in Cape Town.
Dentinogenesis imperfecta in Osteogenesis imperfecta type XI in South Africa: a genotype–phenotype correlation
(UWC, 2019) Chetty, M
BACKGROUND: The maxillofacial and dental manifestations of Osteogenesis imperfecta (OI) have significant implications in terms of management. Although the occurrence of abnormal dentine in some forms of OI is well documented, there is scant information on the association of abnormal dentine in the Black African persons with phenotypic OI III and genotypic OI XI in South Africa. METHODS: This was a cross-sectional analytic study. A series of 64 Black South African individuals with a confirmed phenotypic diagnosis of OI III, ages ranging from 3 months to 29 years, were assessed clinically, radiographically, and at a molecular level. RESULTS: A total number of 64 saliva samples were analyzed and 3 DNA variations were identified in exon 5 of the FKBP10 gene. The homozygous mutation, c.[831dupC]; [831dupC], was identified in 23 affected persons who had no clinically obvious features of DI in their primary and secondary teeth. Radiologically, mild features of DI were evident in 10 persons in whom radiographic images were obtained and were given a Clinical–radiological score of 2. A compound heterozygous mutation, c. [831delC]; [831dupC], was identified in three siblings. An intraoral examination of these affected persons revealed no clinically apparent features of DI in their primary and secondary teeth. Due to the lack of radiological facilities, the presence or absence of DI could not be confirmed or negated. A second compound heterozygous mutation, c.[831dupC]; [1400-4C>G], was identified in a female of 29 years belonging to the Xhosa linguistic group. Her teeth appeared clinically normal but it was not possible to obtain radiographs. In 37 affected individuals, no disease-causing mutations were identified. CONCLUSION: Black African individuals in SA with the homozygous mutation in the FKBP10 gene have clinically unaffected teeth yet exhibited radiographic features of DI to varying degrees. This characterization is suggestive of a relationship between the genetic abnormality and the clinical manifestations of DI. The authors suggest that this diagnosis must include teeth that are clinically and/or radiologically aberrant, and should not exclude the presence of other, milder, dentinal aberrations associated with OI. There was no correlation between severity of OI and DI in this cohort of individuals.
Determination of orthodontic bracket and tooth adaptation using an X-ray micro-computer tomography scanner
(Elsevier, 2020) Fakir, Yaseen; Keanly, Colm; Mulder, Riaan
The determination of the orthodontic brackets’ adaptation to the curvatures of teeth is a difficult topic to study. The complexity arise due to the different designs of their fitting surfaces, margins and curvatures of orthodontic brackets. Teeth on the other hand have variation in their curvatures and the question remains how well an orthodontic brackets truly adapt to the teeth. Previous methods from the literature determined the curvature of teeth through the superimposition of circular templates onto dental plaster models as well as the use of acrylic arcs of various diameters.
Early identification and management of mandibular canine ectopia
(South African Dental Association, 2011) Hudson, Athol; Harris, Angela; Mohamed, Nadia
Mandibular canine impaction and transmigration have serious consequences for the patient, as removal of the tooth or teeth in question is often the only solution. The loss of one or both mandibular canines complicates orthodontic treatment. Early warning signs of mandibular canine ectopia are explored in this paper as well as how to assess the potential for displacement, impaction and/or transmigration. This paper highlights the value of interceptive treatment once the early signs of an aberrant mandibular canine have been detected.
Extra-oral suction
(MDPI, 2023) Noordien, Naeemah; Mulder-van Staden, Suné; Mulder, Riaan
Oral health care workers (OHCW) are exposed to pathogenic microorganisms during dental aerosol-generating procedures. Technologies aimed at the reduction of aerosol, droplets and splatter are essential. This in vivo study assessed aerosol, droplet and splatter contamination in a simulated clinical scenario. The coolant of the high-speed air turbine was colored with red concentrate. The red aerosol, droplets and splatter contamination on the wrists of the OHCW and chests of the OHCW/volunteer protective gowns, were assessed and quantified in cm2 . The efficacy of various evacuation strategies was assessed: low-volume saliva ejector (LV) alone, high-volume evacuator (HV) plus LV and an extra-oral dental aerosol suction device (DASD) plus LV. The Kruskal– Wallis rank-sum test for multiple independent samples with a post-hoc test was used. No significant difference between the LV alone compared to the HV plus LV was demonstrated (p = 0.372059). The DASD combined with LV resulted in a 62% reduction of contamination of the OHCW. The HV plus LV reduced contamination by 53% compared to LV alone (p = 0.019945). The DASD demonstrated a 50% reduction in the contamination of the OHCWs wrists and a 30% reduction in chest contamination compared to HV plus LV. The DASD in conjunction with LV was more effective in reducing aerosol, droplets and splatter than HV plus LV.
In vitro analysis of techniques that alter the surface hardness of a glass ionomer restorative material
(Jaypee Brothers Medical Publishers, 2019) Mulder, Riaan; Noordien, Naeemah; Rossouw, Shaun
Ab s t r A c t Aim: The aim of this in vitro study was to compare the eect of dierent manipulation techniques on the surface hardness of ChemFil Rock glass ionomer.Materials and methods: The changes in Vickers surface hardness ( VH) of ChemFil Rock were evaluated after the application of ve manipulation techniques and compared with one control group (n = 60). The manipulation techniques included: nger pressure set, electronic piezo producing a high frequency set, air piezo producing a low frequency set, heat-set achieved with a curing light and the last technique was a combination of electronic piezo followed by heat-set. Standard set was the control.Results: The average surface hardness for the standard set was 49.5 VH. No statistical dierences were demonstrated when the means were compared for nger pressure set (49.2 VH) or the air piezo set (48.49 VH) with standard set. The electronic piezo (54.21 VH) and the heat-set (57.5 VH) had an increased mean surface hardness when compared to other techniques. Heat-set had the highest surface hardness demonstrating a signicant statistical dierence when compared with standard set, nger pressure set, air piezo set as well as the combination of electronic piezo (p < 0.05).Conclusion: The surface hardness of the glass ionomer cement (GIC) material assessed in this study can be predictably improved by applying the heat-set technique. A command set can be achieved with the electronic piezo or the air piezo, however, the surface hardness will only increase with the use of the electronic piezo.
In vitro analysis of techniques that alter the surface hardness of a glass ionomer restorative material
(Original research, 2019) Mulder, Riaan
Glass ionomer cement as restorative materials are advantageous in pediatric restorative dentistry. The main advantages of GIC include fluoride release up to 50 μg/cm and a chemical adhesion to the tooth structure
Introducing dental students to e-learning at a South African University
(Health and Medical Publishing Group, 2012) Mohamed, Nadia; Peerbhay, Fathima
This article serves to report on the introduction of an innovative ‘blended learning’ approach in the Paediatric Dentistry Department at the University of the Western Cape (UWC) in Cape Town, South Africa. This intervention was the first of its kind to be introduced at UWC’s dentistry faculty. Methods Educational resources were placed online to supplement didactic and clinical teaching and in so-doing, compensate for the lack of chair side teaching. An online learning platform was thus provided for students to engage with. Results Forty-seven percent of students accessed the site. The evaluation of the course by these 4th and 5th year students was mostly positive. Students who did not access the site provided a variety of reasons for not doing so, with the main reasons being the ‘lack of time’ (40%) and ‘lack of IT resources’ (41%). Conclusion This intervention highlighted the fact that ‘blended learning’ definitely has its place in the dentistry curriculum, especially if minor issues like access to resources can be addressed. The Paediatric Dentistry department at the University of Western Cape is continually pursuing current trends in teaching to provide an education that is on par with global standards.

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