Prof. Sudeshni Naidoo

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https://hdl.handle.net/10566/2168

Position:	Deputy Dean: Research
Faculty:	Faculty of Dentistry
Qualifications:	BDS, LDS.RCS, MDPH, DDPH.RCS, M Ch D, PhD, Dip IRE
	Research publications in this repository
More about me:	here
Tel:	021 937 3003
Fax:	021 931 2287
Email:	suenaidoo@uwc.ac.za

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Now showing 1 - 20 of 60

Endodontic treatment - reamers do break
(South African Dental Association, 2013) Naidoo, Sudeshni
During routine root canal treatment (RCT) of a lower molar tooth, a reamer fractured in one of the root canals. Should I inform the patient? What are my ethical obligations to the patient? Is a broken reamer or file a legal or practice management problem? Should I only charge the patient if the RCT is successful? When should I as a general dental practitioner refer the patient to a specialist?
Social gradient in the cost of oral pain and related dental service utilisation among South African adults
(BMC Oral Health, 2016) Ayo-Yusuf, Imade J.; Naidoo, Sudeshni
Background: Oral pain affects people's daily activities and quality of life. The burden of oral pain may vary across socio-economic positions. Currently, little is known about the social gradient in the cost of oral pain among South Africans. This study therefore assessed the social gradient in the cost of oral pain and the related dental service utilisation pattern among South African adults. Methods: Data were obtained from a nationally representative cross-sectional survey of South African adults ?16 year-old (n = 2651) as part of the South African Social Attitudes Survey conducted by the South African Human Sciences Research Council. The survey included demographic data, individual-level socio-economic position (SEP), self-reported oral health status, past six months' oral pain experience and cost. The area-level SEP was obtained from the 2010 General Household Survey (n = 25,653 households) and the 2010/2011Quarterly Labour Force Survey conducted in South Africa. The composite indices used for individual-level SEP (? = 0.76) and area-level SEP (? = 0. 88) were divided into tertiles. Data analysis was done using t-tests and ANOVA. Significance was set at p < 0.05. Results: The prevalence of oral pain among the adult South Africans was 19.4 % (95 % CI = 17.2-21.9). The most commonly reported form of oral pain was 'toothache' (78.9 %). The majority of the wealthiest participants sought care from private dental clinics (64.7 %), or from public dental clinics (19.7 %), while the poorest tended to visit a public dental clinic (45 %) or nurse/general medical practitioner (17.4 %). In the poorest areas, 21 % responded to pain by 'doing nothing'. The individual expenditure for oral pain showed a social gradient from an average of ZAR61.44 spent by those of lowest SEP to ZAR433.83 by the wealthiest (national average ZAR170.92). Average time lost from school/work was two days over the six-month period, but days lost was highest for those living in middle class neighbourhoods (3.41), while those from the richest neighbourhood had lost significantly fewer days from oral pain (0.64). Conclusions: There is a significant social gradient in the burden of oral pain. Improved access to dental care, possibly through carefully planned universal National Health Insurance (NHI), may reduce oral health disparities in South Africa.
Warnings - written is always best
(SADA, 2013) Naidoo, Sudeshni
An inferior dental block injection was administered to a 17-year-old who required the emergency extraction of his lower right molar tooth. The patient was advised not to bite his lip as he may not feel it due the numbing effects of the local anaesthetic. When the dentist returned to the surgery he noticed that the patient's lip was swollen, but that the lip mucosa was intact. He suggested that the patient must have bitten his lip and warned him against doing this again. Following the extraction of the tooth, the dental assistant repeated the same warning before the patient was dismissed. Two hours later the dentist received a call from the Casualty Department of the local hospital to report that the patient had presented to them with a swollen lip and that part of the lower lip tissue was missing. The injury was subsequently repaired by a plastic surgeon and after six months a small scar remained.
Letter about dental decay, obesity shows that sugar industry is not to be trusted
(South African Dental Association, 2014) Naidoo, Sudeshni; Sheiham, Aubrey
The South African Sugar Association (SASA) tries to trash our scientific arguments about the association of sugars with dental decay, obesity and diabetes ( "Sugar leaves a bitter taste" Cape Times August 18th) in their letter , "Confronting some fallacies of SA's sugar consumption with scientific facts", Cape Times, August 19. But the science that we report is the most up to date consensus of the leading expert committees.
Methamphetamine abuse: Oral symptoms and dental treatment needs
(South African Dental Association, 2016) Smit, Dirk A.; Naidoo, Sudeshni
BACKGROUND: Methamphetamine: a highly addictive drug commonly used in South Africa. Users often present with poor oral hygiene, grossly decayed teeth and complain of a dry mouth. The prevalence of dental caries among users is high. METHODS: A cross-sectional study design was used with a convenience sample of 308 self-reported methamphetamine users who were part of an in- or out-patient rehabilitation programme at one of 22 specialised substance addiction treatment centres in the Western Cape. RESULTS: The majority were in their late twenties, unemployed and not satisfied with the appearance of their teeth. A dry mouth and a bad taste were the most common symptoms reported. More than three quarters reported "stiff" facial muscles and more than half, grinding of their teeth. The most common reason for the last dental visit was toothache and the most common treatment at that visit was dental extraction. CONCLUSION: Lower levels of education were associated with increased numbers of extractions and a higher probability of poor oral health. Xerostomia, a bad taste and "stiff" facial muscles were the most common symptoms reported. PRACTICAL IMPLICATIONS: A thorough intra-oral examination together with comprehensive note taking is crucial for the management of patients abusing methamphetamine.
Sugar leaves a bitter taste
(South African Dental Association, 2014) Naidoo, Sudeshni; Sheiham, Aubrey
The types of foods we eat have become one of the most important issues of our time. In South Africa, diseases related to diet such as heart disease, high blood pressure, diabetes, obesity and tooth decay are increasing. However, we have no real solutions to these mounting health problems. They place a high and unsustainable financial burden on an already overloaded health care system. The issues related to changes in diet are complex and need a detailed analysis of the problem and possible solutions.
Knowledge, attitudes and practices of oral health care workers in Lesotho regarding the management of patients with oral manifestations of HIV/AIDS
(South African Dental Association, 2015) Ramphoma, K.J.; Naidoo, Sudeshni
Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) have presented with oral manifestation of HIV as the first sign of the disease. Oral health workers regularly encounter patients presenting with oral lesions associated with HIV disease and therefore need to have adequate knowledge of these conditions for diagnosis and management. The aim of the present study was to determine the knowledge, attitudes and practices of oral health care workers (OHCW) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCW in 26 public and private care facilities in all ten districts of Lesotho. A self - administered questionnaire was used to gather information. The response rate was 100%. Nearly all (94.7%) agreed that oral lesions are common in people living with HIV and/or AIDS. The majority (91.3%) named oral candidiasis (OC) as the most common lesion found in PLWHA while Kaposi's Sarcoma (KS) (34.7%) and Oral Hairy Leukoplakia (OHL) (32.6%) were mentioned as the least common oral lesions of HIV. Most correctly identified the images of oral candidiasis (97.8%), angular cheilitis (86.9%) and herpes zoster (80.4%). Only 16.7% felt they had comprehensive knowledge of oral HIV lesions, although 84.8% reported having previously received training. Almost three quarters (71%) reported that there was no need to treat HIV positive patients differently from HIV negative patients. OHCW in Lesotho demonstrated high confidence levels in their competence in managing dental patients with oral lesions associated with HIV, however, they lacked an in-depth knowledge in this regard. Amongst this group there is a need for comprehensive training with regards to diagnosis and management of oral lesions of HIV including the training of other cadres of health care workers together with nurses and community health workers.
Handling medical emergencies
(South African Dental Association, 2015) Naidoo, Sudeshni
Medical emergencies can occur at any time in the dental surgery. Routine dental operations and procedures that generally cause no harm or distress to fit and normal patients may give rise to symptoms, alarming and of sudden onset, in patients suffering from some non - obvious ailment. Some of these patients may be receiving medical treatment, and the medical emergency may arise from the disease itself, or as a direct result of the treatment they are receiving. While there will inevitably be some degree of ambiguity with what constitutes an emergency, emergency care is care without which the patient will or may be subject to serious harm, including professional harm. Dental emergencies cannot be isolated from medical emergencies. An abscess, for example, can evolve into a potentially life-threatening situation. For a dentist to ignore any or all foreseeable consequences of inaction is unprofessional and could well lead to the patient seeking a legal remedy on the grounds of negligence. It has been estimated that one or two life-threatening emergencies will occur in the life - time practice of a general dental practitioner. This experience may increase as the aging population rises and more patients with underlying medical conditions seek dental care.
Unanticipated treatment complication and legal recourse
(South African Dental Association, 2015) Naidoo, Sudeshni; Du Toit, J.
A middle - aged, partially edentulous Caucasian female patient presented to a general dentist for extraction of a mandibular tooth. The tooth was removed by the dentist, but following incomplete resolution of pain the patient returned three months later for a consultation. The dentist diagnosed an abscess following radiographic investigation and referred the patient to a specialist who diagnosed a fracture of the mandible. The fracture had occurred unbeknown to the dentist and was consequently treated by a reduction procedure. The patient has since pursued legal action against the dentist.
The prevalence of musculoskeletal disorders among dentists in KwaZulu - Natal
(South African Dental Association, 2015) Moodley, R.; Naidoo, Sudeshni
Occupational hazards in dentistry can result in injuries and reduced income if work -time is lost. Injuries include percutaneous insults, inhalation of noxious chemicals, hearing loss and musculoskeletal disorders (MSD). The prevalence of MSD among South African dentists is uncertain. This descriptive, cross-sectional study was conducted to determine that prevalence and associated risk factors among dentists in KwaZulu - Natal (KZN), South Africa. A convenience sample (n = 350) of dentists registered with the South African Dental Association (SADA) were sent a questionnaire interrogating their medical and work history and their work-related posture. One hundred and nine (31%) responded. Almost all (99.1%) reported pain in the hands, neck, lower back and / or a shoulder, while 22.5% reported hand symptoms. Nearly three quarters (73.6%) rotated their necks during clinical work and 68.6% tilted a shoulder towards their dominant hand. A strong association (p value = 0) was found between the number of years in practice and work-related pain in the neck. The prevalence of MSD was very high when compared with international data. Self - recognition is most important in preventing occupational injuries. This study suggests the need to include ergonomic work practice during training to create awareness of the risk of MSD and to promote wellbeing.
Ethical considerations when treating patients with eating disorders
(South African Dental Association, 2015) Naidoo, Sudeshni
In South Africa, the prevalence of eating disorders remains largely unknown. However with the unique, complex, social and political transformation of the country and increasing urbanization, it is anticipated that there will be an increased local risk of eating disorders. Psychological, social, biological, cultural and familial factors play a role in the development of these ailments. Adolescence is a time of significant self-awareness, identity development and critical self-evaluation and has perhaps been most impacted by socio-cultural changes in contemporary South African society. It is usually during this developmental phase that, among females predominantly, body dissatisfaction and aesthetic concerns are raised and efforts to address these worries often result in dieting. Western culture and the seductive emphasis on consumerism appear to have a powerful impact on the development of eating disorders. Consequent assimilation of the associated Western value system, where physical appearance and self-worth are seemingly synonymous, seems inevitable. The media plays a pivotal role in promoting and reinforcing the development of eating disorders as youngsters are faced with a barrage of media propaganda suggesting what is the ideal body.
Avoiding perverse incentives
(South African Dental Association, 2015) Naidoo, Sudeshni
A general dental practitioner was approached by a friend and colleague, a maxillo-facial surgeon, who had recently taken up rooms near her practice. He offered incentives to her for any surgical referrals she could provide. Furthermore, he said that since he was participating in a pharmaceutical research clinical trial, he could increase the incentive if she referred patients who were eligible for inclusion in the trial ... should the specialist's offer raise ethical concerns?
Want to date a patient? Refer first
(South African Dental Association, 2015) Naidoo, Sudeshni
In dentistry, the dentist - patient interaction often represents a long-term, close personal relationship that involves friendship as well as professional responsibility. A professional (the dentist) has two interests to consider in any professional interpersonal dentist - patient relationship: the patient's and his or her own. The dentist has a duty to place the patient's best interest (welfare) before his or her own interests. The profession and society expect dentists to exercise superior knowledge and expertise and their professional judgment to promote the best interests of their patients. Dentists should not use their position of influence to solicit or develop romantic relationships with patients. The Health Professions Council of South Africa views sexual contact between health professionals and patients as unethical, legally perilous and as a cause for professional discipline. It is often viewed by the public as an outrageous transgression. The ethical considerations of personal relationships with patients are addressed in the HPCSA guidelines to good practice, Section 5.2 'Respect for Patients', which states that health care practitioners should "Avoid improper relations with their patients, their patients' friends and their patients' family members (for example, sexual relationships or exploitative financial agreements)".
Ethical responsibilities when using locum tenens
(South African Dental Association, 2015) Naidoo, Sudeshni
Locum tenens is usually a position that is offered when a practitioner in private practice is going on holiday, attending a congress, taking study leave or is absent from practice due to illness or other reason, and therefore the appointment is of short duration. The term locum tenens originates from the Middle Ages and means "one holding a place" and in the 1970s was generally used by medical facilities where there was a shortage of medical doctors. Remuneration is usually based on a percentage of fees earned, or a set salary or a small basic salary coupled with a percentage of gross earnings above an agreed figure. Often when patients realise that their dentist will be returning in the near future, many prefer to await their return rather than being treated by a stranger, therefore it is preferable for a locum to accept a fixed salary or a basic salary plus commission.
Taking and making decisions for children in dentistry
(South African Dental Association, 2015) Naidoo, Sudeshni
In dentistry one rarely deals with life-or-death decisionmaking, however important human values are at stake during the course of any dental treatment. These include preventing pain, preserving and restoring oral function for normal speech and eating, preserving and restoring the patient's physical appearance, and promoting a sense of control over and responsibility for his or her own health. The dental management and treatment of children can be challenging to the practicing dentist in many ways including dealing with ethical issues related to the best interests of the child, obtaining valid consent or assent, surrogate decision making and access to care.
Opportunities for Teledentistry in South Africa
(South African Dental Association, 2015) Fortuin, J.B.; Naidoo, Sudeshni
Information, communication and technology (ICT) is a part of everyday life, and the constant evolution of technology has resulted in many opportunities for the health care sector. While health professionals globally have embraced the use of ICT to assist in the delivery of health care services and education there remains a lack of scientific evidence to support the practice. The uptake of ICT in low and middle-income countries has been slow, despite the fact that this is where a great need for innovative solutions is required to improve the delivery of health care services. ICT for health is being used throughout South Africa with promising results, and there is potential for the use of ICT in the field of Dentistry. This paper provides a background of ICT for health by highlighting the applications of tele-medicine, teledentistry and mHealth and examples are given of the various uses of ICT in the various disciplines of Dentistry. The benefits and challenges of teledentistry are documented and recommendations about the use of teledentistry in South Africa are discussed.
Percutaneous exposure incidents - prevalence, knowledge and perceptions of dental personnel and students at a dental training site in KwaZulu-Natal
(South African Dental Association, 2015) Moodley, I.; Naidoo, Sudeshni
Healthcare workers, including dental practitioners and dental students, are at risk of occupational exposure to blood-borne pathogens such as hepatitis B, C and HIV. The present study set out to determine the prevalence, knowledge, management and perceptions of percutaneous injuries among staff and students at a dental training institute in Durban, KwaZulu - Natal with a view to identifying policies aimed at reducing the incidence. The prevalence of percutaneous injuries experienced by dental staff and students from 2001 to 2011 was determined. The levels of knowledge and their management of percutaneous injuries were determined among current dental staff and students. The dental department sustained 40% of total Hospital injuries, and of these 76% were suffered by students and 24% by staff. 22% of the sample had sustained a percutaneous injury, and of these, 57% had endured more than one and 24%, three or more injuries. Most current respondents had reported the incident (81%) and had taken the initial dose of post exposure prophylaxis; however, only 22% had taken the medication for the recommended period of four weeks. Avoiding percutaneous injuries by adopting safe work practices is probably the best practice to prevent transmission of blood-borne infections such as Hepatitis and HIV.
Managing stress in the dental environment
(South African Dental Association, 2015) Naidoo, Sudeshni
Stress is defined as "an imbalance between a perceived demand (stressor) and a person's perceived ability to cope with, or to meet, that demand". It is well known that dentists are subject to a variety of stress-related physical and emotional problems. In dental practice it may include the difficulties in managing anxious children, or dealing with "neurotic", difficult or uncompliant adults. Stress may also take the form of personal insult if dentists are regarded as incompetent when compared with their peers, or are seen as insensitive, inconsiderate and inferior to doctors. Attempting to stay on schedule in a busy dental practice is a chronic source of stress. Not receiving commensurate payment for their services, anxiety about the future and long working hours may also act as stressors. Stress is not good for health! It is well known that stress and poor stress management increase susceptibility and vulnerability to ill health including cardiovascular disease, ulcers, colitis, hypertension, lower back pain, eye strain, marital disharmony, alcoholism, drug addiction, mental depression and even suicide. How does stress manifest in the practice? It may result in absenteeism, increased incident rate, inter-personal aggression, poor quality control, low productivity, high aggression, low productivity, high turnover, reduced morale, complaints and litigation.
Irrational requests for extractions
(South African Dental Association, 2015) Naidoo, Sudeshni
Dental professionals encounter a number of challenging ethical and legal dilemmas on a daily basis that often arise due to conflicts between the ethical principles of autonomy, non-maleficence (do no harm), beneficence (do good), justice, veracity, and fidelity. The application of ethical principles has always been important during any patient encounter, and previously a health professional's obligation was focussed on doing good and avoiding harm rather than giving in to the patient's requests. Today a patientcentred holistic approach and respect for patient autonomy is a more apparent in health care.
Radiographic exposure during pregnancy
(South African Dental Association, 2015) Naidoo, Sudeshni
A 28 year old woman in her first trimester of pregnancy attends the dental surgery as a new patient. She presents with a periapical abscess on her first molar tooth and expresses concern about the numerous unfilled cavities that may cause problems during her pregnancy. She had last visited a dentist over five years ago and brought a set of radiographs taken during one of those appointments. The proposed current treatment plan was explained together with the need to update the type and number of the radiographs that were required. She said that she was worried about the risk of miscarriage and could her old radiographs not be used instead of taking new ones?

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