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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Assessment of a framework for the allocation of primary dental services
(University of the Western Cape, 2017) Antunes, Denise Silveira; Naidoo, Sudeshni; Myburgh, Neil G.; Hilgert, Juliana B.; Hugo, Fernando N.; Fisher, Paul D.
Background: Standardized and evidence-based resource allocation frameworks for timely provision of primary dental services may support equitable distribution of comprehensive dental care. However, such frameworks, which can be applicable to primary care settings in Brazil, are not available. The purpose of this study was to explore the complex issue of equity allocation of dental staff for primary dental care services, by estimating time to dental disease progression in order to analyze costs when survival targets are set for patients waiting for primary dental care. The inclusion of wait time benchmarks for dental services in the design of the framework was an attempt to increase knowledge on the quality of access experienced by people living within catchment areas of the Family Health Strategy in Brazil. In view of ever scarce resources for public health services, ethical dilemmas arise in resource allocation when allocation choices require priority setting among individuals who face similar health needs. Since equity of access must be assured for all Brazilian citizens, the present study proposed a rational resource allocation model to help decision-makers in reconciling equity access and budgets. Aim: This study aimed to compare equity of access to dental services and costs of dental staff of two models for primary care settings. Additionally, staffing requirements and staff costs were projected over a three-year time period. Both models comprised three inter-related components: (i) universal access to oral health care, (ii) comprehensiveness of primary dental care and (iii) equity of access to primary dental services. Method: The present study was part empirical and part modeling in design. In the empirical phase, a set of maximum wait times for dental care determined by experts (Model 1) vs. wait times derived from survival analysis (Model 2) was compared. A one-year follow-up of a cohort of dental patients assigned to five primary health care clinics was conducted. The event of interest was clinical deterioration in the waiting time for dental visits. At each consultation with a dentist either for routine or emergency reasons, the oral quadrants of the patient were assessed and classified according to their urgency for dental care (from 1, less urgent to 5, more urgent). In the modeling phase, costs of dental staff were estimated on the basis of survival probabilities found in Model 1 and on survival targets simulated in Model 2. The amount of staff required as calculated by combining data on: dental service needs, activity standards for dental services, workload components in dental care, cost per working hour of dental staff, and probabilities of clinical deterioration in the wait for dental visits. Main Findings: In Model 1 (wait times determined by experts), survival probabilities were found to be unevenly distributed between diagnostic categories: category 4= 0.939 (SE 0.019); category 3= 0.829 (SE 0.035); category 2= 0.351 (SE 0.061) and category 1= 0.120 (SE 0.044). The cost of dental staff in Model 1 was estimated to be R$104 110.88 (BRL). In cost simulations of Model 2, where wait times were derived from the survival analysis study, a similar 0.900 survival probability target for all sampled quadrants (n=7 376) was found regardless of their final classification in the study year. The resulting cost of Model 2 was R$99 305.89 (BRL). Conclusions: From an equity-access perspective, the survival analysis concluded that wait times for dental visits determined by the experts may engender inequitable survival probabilities for oral quadrants classified in different diagnostic categories. From a dental-staff costs perspective, one concluded that less resources were required by setting an equitable 90% survival target for all oral quadrants studied.
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, Neil
Background: 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.
Betel nut & tobacco chewing habits in Durban, Kwazulu-Natal
(University of the Western Cape, 2009) Bissessur, Sabeshni; Naidoo, Sudeshni
Betel 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.
Commercial baby food: Consumption, sugar content and labelling practices in Uganda
(University of the Western Cape, 2022) Mwesigwa, Catherine Lutalo; Naidoo, Sudeshni
There has been a worldwide increase in the consumption of processed foods in low- and middle-income countries. Processed foods are now easily available and accessible with the increased presence of transnational corporations, urbanisation and improving economies—all essential drivers of the nutritional transition. Ultra-processed foods and beverages (UPFB) have been identified as a significant contributor to total dietary energy and, in specific settings, the biggest source of sugar for infants and young children. High consumption of free sugars in early childhood is associated with poor health outcomes, including early childhood caries, overweight/obesity and an increased risk of developing other non-communicable diseases (NCDs).
Community drinking water fluoridation in the Southern Cape and Karoo Region: a feasibility study
(University of the Western Cape, 2002) Dennis, Gilbert J.; Myburgh, Neil
The 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.
Community drinking water fluoridation in the Southern Cape and Karoo Region: A feasibility study
(University of the Western Cape, 2002) Dennis, Gilbert J; Myburgh, Neil
The 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 reservoirs
A comparative analysis of traditional dental screening versus tele dentistry screening
(University of the Western Cape., 2016) Bissessur, Sabeshni; Naidoo, Sudeshni
Background: Teledentistry is the use of information and communications technology (ICT) to provide oral health care services and enhance oral health care delivery to communities in geographically challenged areas. The public health services in South Africa needs to be overhauled to address the inadequacies in the current system. As an attempt to minimise or repair the inadequacies in the public health sector, South Africa has identified the use of ICT’s as a potential tool in improving the delivery of health care. However, although SA has recognised telemedicine as a potential solution to improve access to health care, teledentistry does not feature at all in the dental public health sector. Teledentistry and mobile health has the potential to eliminate or minimise the oral health disparities that exist in South Africa with the use of health information systems. Teledentistry can be initiated in an incremental approach by 'piggy-backing' on existing telemedicine sites, thus reducing ICT costs for the public health sector. Stake holders and government officials need to embrace technology to address some of the challenges that exist in the South African public health sector. This study could aid in providing evidence-based information to assist in the introduction of teledentistry in South Africa as an innovative dental screening and management tool. The most recent SA National Oral Health Survey showed that at least 80% of dental caries in children is untreated (Department of Health, 2003) and this poses a significant public health problem. To reduce the double burden of dental caries in children and human resource shortages in the public sector, the use of teledentistry as a school screening tool has been recommended. Teledentistry screening has the potential to improve access and delivery of oral health care to children in underserved and the rural areas. The aim of the study is to compare traditional dental screening versus teledentistry screening for dental caries in children. Methodology: This study consists of two parts: the first part a concordance study and the second part the determination of user satisfaction with regards to the technology used. The concordance study assessed the diagnostic agreement between traditional and teledentistry screening of dental caries in school children aged between 6-8 years old. The methodology included traditional face-to-face dental screening by two trained and calibrated evaluators, and the teledentistry screening method included the same two evaluators together with two trained and calibrated teledentistry assistants (who were of non-dental background). For the traditional face-to-face dental screenings the two evaluators examined 233 children at selected rural primary schools and scored them for DMFT. For the teledentistry screening method the teledentistry assistants captured intraoral images of the same children and web-based stored the images in corresponding eFiles. After a two week wash out period these intraoral images were then examined by the same two evaluators and scored for DMFT. To determine concordance across methods, Kappa Statistics was applied to the data and this revealed intra-examiner reliability. To determine user satisfaction levels, close-ended questionnaires were designed based on the role of the evaluators and TAs in the teledentistry screening process. Results: The intra-rater agreement and reliability across methods for evaluator one was 98.30%, and for evaluator two it revealed a result of 95.09%. Kappa statistics thus revealed that both evaluators were in agreement between a range of 95%-98.30% of the classifications, or 92.79% of the way between random agreement and perfect agreement (p=0.000). The high concordance level indicated that there was no statistical difference between the traditional dental screening method and the teledentistry screening method (intra-rater reliability), thus suggesting that the teledentistry screening method is a reliable alternative to the traditional dental screening method. For the user satisfaction part, both of the evaluators agreed with 8 of the 13 statements (62%). The statements that were agreed upon related mainly to user satisfaction on the technology which included accessing the intraoral images for screening and the ease of scoring decayed and missing teeth off the images; time and technology suggested the screening process of the images saved time; and indicated teledentistry as being an innovative and easy system to use that will save clinical time for dental professionals. The statements they disagreed with related to the clarity of the images, scoring interproximal caries off the images, and the dental screening method of choice. Both of the TAs agreed with 7 of the 11 statements (64%). They agreed upon statements related mainly to perception of children’s attitudes & behaviour which suggested the children were comfortable during the imaging process and in addition they were excited to see pictures of their teeth; they found teledentistry to be an innovative and easy system to use; they found teledentistry to be a sterile process and hence they were happy with infection control. Both TAs disagreed with the statement that suggested clear images could be captured irrespective of poor lighting. Discordant statements related mainly to user satisfaction on technology which related to ease of using the intraoral camera, ease of storing the captured images into the eFiles and ease of deleting unwanted images. Conclusion: The key findings of this study highlights the reliability of utilising teledentistry as a dental screening and diagnostic tool which can be valuable in the delivery of oral health care in South Africa. This research study further revealed valuable data on user satisfaction levels of the evaluators and TAs, and has an impact on the utilisation of the teledentistry screening system. To ensure adoption and adaptation of the screening process all users must be satisfied with the ICTs used in the teledentistry system. User friendliness can impact negatively on the adoption of teledentistry.
Comparison of a piezoelectric and a standard surgical handpiece in third molar surgery
(UWC, 2019) Titinchi, F; Gopal, I; Morkel, J
Aim: The aim was to compare the use of a piezoelectric hand piece versus a standard surgical handpiece in removal of impacted third molars under general anaesthesia. Materials and methods: Thirty patients undergoing routine third molar removal were included in the study. Panoramic radiographs were used to assess the positioning of the impacted third molars. The patients were randomly subdivided and the split mouth technique was used in which each side (left or right) of the mouth was randomly assigned to two treatment groups. Hence each patient served as their own control. In one group, a piezoelectric handpiece was used, while a conventional handpiece was used for the second group. All aspects of preoperative care, general anaesthesia, surgery and post-operative care were standardised for the two groups. The following parameters were recorded; time of surgery, bleeding during surgery, post-operative swelling, post-operative pain, associated complications and post-operative nerve injury. Results: No statistically significant difference was found between the groups in terms of pain and swelling. There was less bleeding with the use of the piezoelectric device as compared with the standard surgical handpiece; however, the surgical time was longer. There were no reports of trauma to the lips or intra-oral soft tissue. There were two incidences (6.7%) of post-operative paraesthesia in the standard surgical handpiece group. Conclusions: The use of a piezoelectric device is an acceptable alternative to the standard surgical handpiece in third molar surgery. Its use is advocated in difficult cases especially where there is inferior alveolar nerve approximation.
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, Sudeshni
BACKGROUND: 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 Department
Correlative imaging and histopathology of a complicated sinonasal teratocarcinosarcoma
(SA Journal of Radiology, 2023) van Zyl, Tineke; Leon, Janse van Rensburg; Opperman, Johan F; Naidoo, Komeela; Merven, Marc
Sinonasal teratocarcinosarcoma (SNTCS) is a highly malignant and rare tumour characterised by a complex admixture of teratomatous and carcinosarcomatous components. In the head and neck area, it almost exclusively occurs in the sinonasal cavities; however, rare instances of nasopharyngeal and oral cavity involvement have been reported, with fewer than 100 cases reported in the literature. Contribution: The contributed case involves the correlative CT, MRI and histopathology of a sinonasal teratocarcinosarcoma with intracranial involvement
Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial
(Wiley, 2021) Effenberger, S; Greenwall, L; Cebula, M
Objectives: This cluster-randomized controlled community trial aimed to assess the efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk population in South Africa. Methods: 513 children aged 4–8 years from two schools in a township in South Africa were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised toothbrushing with fluoridated toothpaste in both groups, FV was applied in 3-month intervals by trained local non-professional assistants. Intraoral examinations were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment of teeth with cavitated lesions (i.e. newly developed or progressed, formerly non-cavitated lesions), requiring restoration or extraction over the study period. Additionally, treatment and re-treatment costs were analyzed. Results: 513 children (d1-4mft 5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV (n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration; 3.9% FV and 4.1% CO teeth were extracted, without significant differences between groups. While FV generated high initial costs, follow-up costs were comparable in both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055 ZAR vs. 950 ± 943 ZAR, p < .001). Conclusions: Regular FV application, in addition to daily supervised toothbrushing, had no significant caries-preventive effect and was not cost-effective in a primary school setting within a peri-urban, high-risk community in South Africa. Alternative interventions on community or public health level should be considered to reduce the caries burden in high-risk communities.
A critical analysis of the provision for oral health promotion in South African health policy development
(University of the Western Cape, 2004) Singh, Shenuka; Lalloo, R; Myburgh, N.G; Dept. of Community Oral Health; Faculty of Dentistry
The rhetoric of primary health care, health promotion and health service integration is ubiquitous in health policy development in post-apartheid South Africa. However the form in which oral health promotion elements have actually been incorporated into other areas of health care in South Africa and the extent to which they have been implemented, remains unclear. The central aim of this research was to critically analyse oral health promotion elements in health policies in South Africa and determine the extent to which they have been implemented. The study set out to test the hypothesis that oral health promotion is fully integrated into South African health policy and practice.
Cytotoxicity testing of various dentine bonding agents using human pulp fibroblast cell lines and a 3T3 mouse fibroblast cell line.
(University of the Western Cape, 2007) Moodley, Desi; Grobler, Sias
Introduction: Biocompatibility of all kinds of dental materials is of paramount importance In order to prevent/limit irritation or degeneration of the surrounding tissues where it is applied. Some researchers suggested that dentine bonding agents may be used for pulpal protection, while pulpal inflammation and inhibition of pulpal repair following the use of dentine bonding agents were also reported. Objectives: The first part of this study compared the cytotoxicity of human pulp cell lines to a mouse 3T3 cell line to cytotoxic challenges from dentine bonding agents. The second part of the study compared the cytotoxicity of recent dentine bonding agents namely, Scotchbond 1, Prime & Bond NTand Xeno III through artificial membranes as well as thin dentine discs (after its reaction with apatite) and Clearfil Protect Bond (CPB)as such, as well as the primer part of CPBand the bond part of CPB separately. Methods and Materials: Near confluent human pulp cells and 3T3 cells were exposed to culture medium (DMEM)extractions from the various polymerized agents mentioned above and the cell viability (survival rate) was measured using the standard MTTassay and related to the non-exposed controls. Results: Two human pulp cells lines were more sensitive to 3T3 cell lines while the other human cell line was less sensitive to the 3T3 cell line. All bonding agents as such were found to be cytotoxic towards the 3T3 cells with Xeno III (25%survival rate) and CPB (35%)the most cytotoxic. Of the two parts from CPB the bond part was the least toxic (91% survival rate), but the primer part (containing the anti-bacterial pyridinium molecule) was very toxic (30% survival rate). ScotchBond 1 (59% survival rate) and Prime & Bond NT (62% survival rate) were not statistically different (Kruskal-Wallis Test, p>0.05). However,the survival rate of Xeno III (25% through membrane as well as dentine discs) and Clearfil Protect Bond (35%) were significantly lower than that of the other two bonding agents, with Xeno III significantly the most toxic (p<0.05 ) Conclusion: In general, all 4 dentine bonding agents were cytotoxic of which Xeno III was the most toxic even after its reaction with apatite (through dentine discs). The most toxic part of CPB was found to be the primer part containing the pyridinium linked molecule. If human pulp fibroblasts are used for cytotoxicity testing of dentine bonding agents many cell lines must be used.
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.
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.
Dental fluorosis and parental knowledge of risk factors for dental fluorosis
(University of the Western Cape, 2016) James, Regina Mutave; Louw, AJ
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 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.
Dental fraud in South Africa
(University of the Western Cape, 2016) Putter, Renier; Naidoo, Sudeshni
Healthcare 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.
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.
The design, implementation and evaluation of a management information system for public dental services
(University of the Western Cape, 2014) Barrie, Robert Brian; Naidoo, Sudeshni
In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities . A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index - which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is "low tech" in that it runs on a "stand alone" personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.
The design, implementation and evaluation of a management information system for public dental services
(2013) Barrie, Robert Brian; Naidoo, Sudeshni
In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities. A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. iii This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index – which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is “low tech” in that it runs on a “stand alone” personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

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