Magister Scientiae Dentium - MSc(Dent) (Community Oral Health)

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Oral health care of the patient receiving Chemotherapy and/or bone marrow transplantation
(University of the Western Cape, 1996) Solomon, Charlene S.; Shaikh, AB; Arendorf, TM
Between September 1992 and August 1995, all patients with haematological malignancies who were treated as in-patients in the Haematology Unit at Groote Schuur Hospital received a twice weekly, oral and perioral examination. Sixty patients were monitored while following the traditional hospital oral care protocol (chlorhexidine, hydrogen peroxide, sodium bicarbonate, thymol glycol, benzocaine mouth rinse and nystatin). The mouth care protocol was then changed (protocol A = chlorhexidine, benzocaine lozenges, amphotericin B lozenges) and patients monitored until the sample size matched that of the hospital mouth care regimen (n = 60). A further 60 patients were then monitored using a third protocol (protocol B = benzydamine hydrochloride, chlorhexidine, benzocaine lozenges, amphotericin B lozenges). A statistically significant reduction in oral complications was found upon introduction and maintenance of protocols A and B. The findings of this study suggest that improved oral care and a structured oral care routine reduces the number of oral complications associated with chemo- and radiotherapy.
Oral manifestations of HIV infection : implications for delivery of oral health care service
(University of the Western Cape, 2001) Shaikh, Najma; Moola, U.H.; Hamekar, S.
The prevalence and determinants of oral lesions related to Human Immunodeficiency Virus (HIV) infection were examined in the context of the delivery of oral health care services. This was complemented by an examination of the perceptions and experiences of oral health workers and HIV infected patients with regard to oral health care services. Method: A cross sectional study was carried out on 239 patients who attended a HIV outpatient clinic. participants' dental history and perceptions were determined through structured interviews, whilst clinical and medical details were obtained from physical examinations and clinical records. A qualitative study of oral health care workers was carried out to assess their perceptions and experiences with regard to service provision. A costing exercise was done to determine the average cost of care per visit. Results: Oral HIV lesions presented in 68.6% of the sample. Significant determinants of oral lesions presence included, CD4 cell counts <2OO (OR 2.07), smoking (OR 2.74, presence of calculus (OR 4.27) and poor access to oral care (OR 6.36). The majority of the patients sought dental care from the public sector services (670lo) and the prime reason was for emergency care (/0olo). The main barriers to care from the patient perspective were cost (337"), fear of pain (21%) and rejection (16%). The majority (87%) of the oral health care workers were in favour of providing comprehensive care at primary level. The main concerns of the oral health care providers were the management of needle-siick injuries and their skills deficiency in managing complex @ses. The average cost of care per visit was R130.73. Conclusion: Oral Iesions presented in more than two thirds of the sample. Barriers to care, lowered immune status, smoking and high calculus deposits were significantly associated with the presence of lesions. The most commonly reported barriers to seeking care were cost and fear of pain. Patients' perception of oral health and their health seeking behaviour were influenced by oral symptoms. The rising cost of treating oral lesions will impact on the delivery of health care services. Oral morbidity related to HIV infection can be reduced with the application of simple preventative, health promotive measures such as promoting smoking cessation and good oral hygiene, removal of local tooth deposits and improved acess to health services.
Oral & perioral piercing in Tshwane
(University of the Western Cape, 2007) Ebrahim, Ruebecca; Naidoo, Sudeshni
This study investigated the common sites and complications associated with oral and perioral piercings, and the oral hygiene practices of people with piercings (piercees)' The attitude and behaviour of piercers towards the prevention and control of complications was also reviewed. The piercees completed a self-administered questionnaire, and were visually examined for sites of piercings and complications, and l0 piercers took part in an interviewed questionnaire. The completed questionnaires were coded, and the responses entered into a spreadsheet for analysis. Of the 126 participants (107 females and 19 males; ages ranging from under-16 to 24) 88.10/o had a tongue piercing, lg.}4yo had a lip piercing, and 7.94Yo had both. One-hundred-and-seven (84.92%) had their piercing at a piercing or tattoo parlour, thirteen (10.31%) had the piercing procedure provided by a doctor or dentist, three went to a hairdressing salon, while one had a friend do the piercing and one individual did his own piercing. The most common post-procedure sequelae were pain (69.05%), swelling(52.38%) and difiiculty eating, speaking and swallowing (70.63%). Post-piercing complications were reported by 17.56%o (n:22) of the sample, and these included chipping of teeth (n:13), gingival recession (n: 2), damage to tongue and palate (n : 3), sore gums (n : l), and sensitivity of teeth (n: l). Those individuals who experienced chipping of teeth, had tongue piercings, and the gingival recession occurred in subjects with labial piercings or labrettes. These findings suggest that there is an association between piercings of the tongue and damage to teeth and piercing of the lower lip and gingival recession. All the piercers reported adequate cross-infection measures, and informed piercees of post-piercing care. It is apparent from the present study that few people had serious problems related to lip and tongue piercings, notwithstanding the damage to hard and soft tissue, however, the providers of these procedures, and dental personnel should inform prospective piercees of the potential risks'
A profile of the Oro-facial injuries in child abuse: a hospital record based study
(University of the Western Cape, 1999) Naidoo, S; Myburgh, N
Throughout the world there is a general awareness that child abuse and neglect is a serious and growing problem. Child abuse involves every segment of society and crosses all social, ethnic, religious, and professional lines. The definition of child abuse can range from a narrow focus, limited to intentional inflicted injury, to a broad scope that covers any act that impairs the developmental potential of a child. Included in the definition are neglect (acts of omission) and physical, psychological, or sexual injury (acts of commission) by a parent or caregiver.
A Systematic Review of the Trends in Fluorosis Globally from 1980 to 2000
(University of the Western Cape, 2003) Khan, Abdulla; Cleaton-Jones, P
This mini-thesis presents a systematic review of dental literature with the objective to investigate trends in dental fluorosis during the period 1980 to 2000. A Medline search was carried out for peer-reviewed scientific dental literature published in English from 1 January 1980 to 31 December 2000. From the publications retrieved 54 satisfied the inclusion criteria. The data on fluorosis prevalence were examined in three categories: 0 to s 0.3 ppm F, > 0.3 to :S 0.7 ppm F, and 0.7 to :S 1.4 ppm F. Since there was no significant difference in fluorosis between 1980 to1989 and 1990 to 2000 the whole period was regarded as one entity. The dose response with increasing concentrations of fluoride in water was consistent with the scientific literature. The percentage prevalences of fluorosis for the three fluoride categories were 16.7, 27.4, and 32.2, respectively. There was an increasing trend in dental fluorosis, although not statistically significant, in both fluoridated and non-fluoridated areas over time. The increase in fluoridated areas was 2-fold and that in non-fluoridated areas 16-fold which was consistent with the scientific literature, the prevalence of fluorosis more so in non-fluoridated areas. The fluorosis was mostly in the very mild to mild categories but more moderate and severe fluorosis was observed in all three categories when the data were pooled. Fluorosis increased in the period from 1980 to 2000. There is a shift from very mild to mild to moderate and severe categories. This calls for further investigation, particularly to look for statistical significance and the role of confounding variables.
A systematic review of the global trends in dental fluorosis from 1980 to 2000
(University of the Western Cape, 2003) Khan, Abdulla; Cleaton-Jones, P
This minithesis presents a systematic review of dental literature with the objective to investigate trends in dental fluorosis during the period 1980 to 2000. A Medline search was carried out for peerreviewed scientific dental literature published in English from 1 January 1980 to 31 December 2000. From the publications retrieved 54 satisfied the inclusion criteria. The data on fluorosis prevalence were examined in three categories: 0 to :S 0.3 ppm F, > 0.3 to :S 0.7 ppm F and 0.7 to :S 1.4 ppm F. Since there was no significant difference in fluorosis between 1980 to1989 and 1990 to 2000 the whole period was regarded as one entity.
The perception of occlusal conditions and profiles in a Mitchells Plain school population
(University of the Western Cape, 1993) Theunissen, Evan Trevor Lodewyk; Moola, M. H.
The prioritisation of treatment opinions by state funded orthodontic programmes has become essential in the planning of services. Numerous indices rate the severity of occlusal conditions; however, all do not adequately address the problem. It is recommended that a ranking of occlusal conditions be obtained from the community which the index is designed to serve (Shaw and Robertson, 1975). With the relocation of the Dental Faculty of the University of the Western Cape to Mitchells Plain, coupled with an increase in demand for orthodontic treatment by this community the prioritisation of orthodontic treatment needs has become essential. Two samples, one consisting of L2 14 year old school children (n = 351) and the other of senior dental students (n = 23) were selected. Four schools in MitcheIIs Plain were randomly chosen. Occlusal conditions and profiles were selected from patient records by a panel. slides were made utilising computer graphics. Respondents completed a questionnaire recording socio-demographic data, a rating of orthodontic self-image and a rating of a series of slides. In the latter the subjects were asked to view selected occlusal conditions and profiles. They responded to two questions, relating to a ranking of the severity of the condition and the consideration of the necessity of treatment for the condition. The results indicated that the majority of the school children and dental students are satisfied with their appearance. Similar ratings to those found in other studies r{ere obtained with the "ideal" class I occlusion receiving the best rating and the severe class III and severe crowding receiving the worst rating. An inverse relationship of treatment recommendation and rating was found with conditions rated best receiving a low rating of treatment. A treatment priority based on the perception of occlusal conditions and profiles L2 14 year old school children and dental students was recommended.
Orofacial manifestations of Burkttt's Lymphoma in Malawi
(University of the Western Cape, 2010) Mlotha, Jessie; Naidoo, Sudeshni
Burkitt's lymphoma (BL) accounts for 40-50%o of all childhood malignancies in Malawi. It is a highly aggressive, fast growing, mature B-cell non-Hodgkin's Lymphoma (NHL). It has one of the highest proliferation rates of any human tumour, with a doubling time of 24-48 hours making it the fastest growing human tumour. There are three forms of BL: endemic or the African form (eBL), sporadic or non-endemic form (sBL) and the immunodeficiency-associated form in HIV-AIDS. The African form most often involves the maxilla or mandible. The survival rate of a child with BL is dependent upon rapid diagnosis and treatment. The purpose of this study was to determine the orofacial manifestations in children with BL in Malawi. It was anticipated that the findings may assist in the education of oral and other health care workers in the early recognition of BL for prompt referral. Oral health workers are a critical component of the referral chain since these lesions can be life threatening. The present study was done in two parts: the first was a retrospective record-based study from 2005 to 2007 consisting of a sample of 661 cases suspected of BL and the second, a prospective study from June 2008 to October 2009 documenting 19 cases of suspected and confirmed cases of BL. A structured data capture sheet was used for data collection and a data capture sheet together with a short questionnaire collected information for the prospective study. In the retrospective study, two thirds presented with BL at various sites of which the abdomen was the most common site. The 5 to 9 year age $oup predominated with an average peak incidence of 7 years and accounting for 60.0% of all the cases. The maxilla was the most common site for orofacial BL accounting for 13.7%o followed by the mandible (7.2%), cheeks (5.7%), maxilla and mandible @5%) and cervical lymph nodes (4.1%). Of the 397 with BL, 4l.4yo were tested for HIV and 37 .97o/o were HIV-negative while 5oZ were HIV-positive. There was a male preponderance with a ratio of male to female of 1.6 to1. In the prospective study, females predominated with a male to female ratio of I to I . I and the mandible was the most common site accounting for 19.04o/o. The age group 5-9 years predominated with 68.4Yo relative frequency. In both studies, Lilongwe predominated with orofacial BL cases. Initial findings at presentation were intraosseous mass, mobile or loose teeth, displaced teeth, cervical and/or submandibular lymphadenopathy, intraoral swelling, trismus, jaw deviation, Bell's palsy, salivation, gingival enlargement, bleeding tumour, ulceration, bony or soft tissue deformity, infected tumour causing halitosis and gingival growths. Difficulties with breathing, speech and eating was largely due to bilateral swelling of both the maxilla and mandible and in other cases unilateral swelling involving both maxilla and mandible. Generally, the trend of BL had decreased from 2005 to 2007 possibly due to better access to health services, increased use of bed-treated mosquito nets for malaria prevention and knowledgeable healthcare workers. This study therefore re-iterates the need for all oral healthcare workers and other healthcare workers to be educated on the orofacial manifestations of BL for prompt referral, management. This would result in a better prognosis since BL is curable as it responds favourably to chemotherapy. The community also needs to be educated on the early signs and symptoms of BL and the importance of visiting a hospital as soon as possible.
'Risk of oral cancer associated with tobacco smoking and alcohol consumption- A case control study in the western Cape, South Africa'
(University of the Western Cape, 2003) Chandran, Rakesh; Myburgh, Neil
Tobacco and alcohol consumption are well-established, high-ranking health risk behaviour in developed countries and the developing countries are catching up rapidly. There is very strong evidence in the literature to show that these behaviours feature prominently in the web of causation of many diseases either proximally or distally contributing substantially to global morbidity and mortality. Oral cancer is an important preventable cancer proven to be directly associated with tobacco and alcohol in many overseas studies. The study examines this association in detail for the population of the Western Cape Province in South Africa in order to establish the existence, extent, dose and the duration of use relationship and the possibility of synergistic effect of these two often co-existing risk behaviours in the causation of oral cancer. A hospital based, analytical case control study using histologically confirmed cases originating from a single homogenous population group of the Western Cape was designed, Necessary data on 67 cases were collected from the Cancer Unit of Groote Schuur Hospital in Cape Town and that of 67 controls from other clinics in the same hospital using an interview schedule specifically prepared and tested in the same hospital. The cases and controls were individually matched for age, gender and ethnicity. The statistical analysis of the data shows that: (1) There is strong relationship between oral cancer and smoking (Odds Ratio 4.63, 1.74-t230 95% C.I) and alcohol use (Odds Ratio 7.21, 3.07-16.93 C.I); (2) The risk increases by six fold when the duration of use is more than 35 years in case of tobacco and eleven fold with more than 30 years of alcohol use; (3) The quantity of tobacco (> 10 cigarettes/day) and alcohol (> 500 grams/week) increases the risk of oral cancer by two fold and twenty four fold respectively; (4) Very few people in the study were able to quit the habit and thus the existence of risk reduction with cessation of the habit could not be proven statistically; (5) Statistically significant synergism exists among the people who indulge in smoking and alcohol use (Odds Ratio 9.61, 2.909-31.73 C.I). The findings of the study strongly support the efforts of the South African government to implement the tobacco legislation strictly and its campaign for responsible drinking. Concerted efforts though media campaign and education among the adolescents are strongly recommended. This study did not examine the effect of poor oral hygiene in the development of oral cancer and further research is suggested.
The oral health status and perceived oral health needs in older adults in Guguletu
(University of the Western Cape, 1999) Kazaura, K. J.; Myburgh, Neil
Objectives: previous studies have indicated that most of the older adult population has poor oral health but only a few of them demand care for their problems' The reason for this discrepancy has never been explained adequately. The objectives of the study were' first' to assess the perceived oral health needs (with regards to social, functional and psychological impacts of oral diseases) of older adults aged 55 years and above, second, to assess the oral hearth status (periodontal disease, dental caries and oral mucosa lesions) in an adult population aged 55 years and above. Third, compare the relationship between normative and perceived need. Methods: This was a quantitative cross-sectional, descriptive study and consisted of 100 older adults who were randomly selected from three areas in Guguletu' These areas included the home for the aged Ekumphumleni' NY1 and NY2 clinics Participants aged 55 were interviewed using the structured questionnaire consists of 32 questions and clinical examination done. Frequency tables were computed and analyzed. The relationship between variables like oral health status, perceived and variety of socio-demographic variables and measures of psych-social impact of oral diseases were analysed by using the chi square test and square ratio. Results : The ability to perceive that they had a problem and the recently of the last visit to the dentist was associated with perceived need for dental care. There was a significant relationship between the presence of symptoms which were painful and perceived need for dental care mouth,p value:0.015;gums,pvalue=0.001;teeth,pvalue=0.0006)The positive attitude towards dental care and regular dental hygiene was an indicator of positive attitudes towards oral hearth care. In this study a substantial difference between perceived and normative need was also observed' 88% of the respondents perceived a need for dental care and 99% were assessed as needing treatment (normative need) but only z9o/o demanded the c,oe' 630% were dissatisfied with their functional ability to chew and expressed a need for dentures' conclusion: The aim of this study was to assess the oral health status and perceived oral health needs among older adults in Guguletu. The oral health status was poor in most were interviewed using a structured questionnaire consisting of 32question was examination done. Frequency tables were computed and analysed' The relationship between variables participants and the demand for care was lolv even though perceived need was high' The study has shown that social, functional and psychological factors influenced for care in this adult population. The cost for dentalcare and access to these services are major barriers to the demand of care perceived oral hearth needs and the impact of oral diseases are important influences in the assessment of oral health needs in the elderly' The assessment of oral health needs as perceived by the elderly facilitates the planning and implementation dental services with special consideration on the cost and accessibitity of oral healthcare.
Impact of HMAIDS on Mortality among the Inpatients at Motebang Hospital, Lesotho
(University of the Western Cape, 2004) Mburu, Francis Kinyanjui; Naidoo, Sudeshni
This was a descriptive retrospective study of the mortality trends among inpatients at Motebang Hospital in Lesotho. The hypothesis was that AIDS had modified the mortality pattern so predictably that its impact could be quantified. The rationale was that if the hypothesis could be confirmed, the mortality trends could supplement other methods of estimating the impact of HIV/AIDS such as extrapolation of data from antenatal clinics (ANC) and sexually transmitted infections (STI) sentinel surveillance sites, and that the ASSA2000 prediction model could be used reliably in Lesotho. Data for diagnosis, outcome, gender, age, and date of admission and discharge or death were collected from hospital records for the period extending from 1st January 1989 to 31't December 2003. The l5-year period was divided into three 5-year periods (198911993, 199411998, and 199912003) and the diagnoses were grouped into GBD Group I, II, and III. The data were analysed to establish time, gender and age trends. Mortality rate and number of deaths increased over the l5-year period. Group I (communicable diseases, maternal, perinatal, and nutritional conditions) contributed 69%o of all deaths. The progressive rise in mortality was most pronounced in the 15-49-year range. A bulge, on the mortality incidence by age graph of the aforementioned age range, was well established in the last five-year period (199912003). The peak of the bulge on the graph of the females occurred in the 25-29-year range, five years earlier than that on the graph of the males. This was the unique trend that had been attributed to AIDS and it was therefore clear that AIDS had modified the mortality trend among the Motebang Hospital's inpatients. The study found that AlDS -related deaths accounted for 5l-65% of the total deaths and 70-80% of the Group I deaths. Although the number of the inpatients in Group II was low, there was evidence of an increasing burden from non-communicable diseases. However, the burden from Group III [injuries] remained stable. The conclusion arising from the study was that AIDS has had a unique impact on the mortality of the Motebang Hospital's inpatients, and that this evidence could be used, inter alia, in the formulation of public policy and as a benchmark for the evaluation of current and future HIV/AIDS interventions.
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
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.
The oral health status and perceived oral health needs in older adults in Guguletu
(University of the Western Cape, 1999) Kazaura, K. J.; Myburgh, N.
Objectives: Previous studies have indicated that most of the older adult population has poor oral health but only a few of them demand care for their problems. The reason for this discrepancy has never been explained adequately. The obj ectives of the study were, first, to assess the perceived oral health needs (with regards to social, functional and psychological impacts of oral diseases) of older adults aged 55 years and above, second, to assess the oral health status (periodontal disease, dental caries and oral mucosal lesions ) in an adult population aged 55 years and above.Third, compare the relationship between normative and perceived need. Methods: This was a quantitative cross-sectional, descriptive study and consisted of 100 older adults who were randomly selected from three areas in Guguletu. These areas included the home for the aged Ekumphumleni, NYl and NY2 clinics. Participants aged 55 years and above were interviewed using a structured questionnaire consisting of 32 questions and a clinical examination done. Frequency tables were computed and analysed. The relationship between variables like oral health status, perceived need and a variety of socio-demographic variables and measures of psycho-social impact of oral diseases were analysed by using the chi square test and odds ratio. Results: The ability to perceive that they had a problem and the recency of the last visit to the dentist was associated with perceived need for dental care. There was a significant relationship between the presence of symptoms which were painful and perceived need for dental care (mouth, p value=0.015; gums, pvalue=O.OOl; teeth, p value=0.0006) The positive attitude towards dental care and regular dental hygiene was an indicator of positive attitudes towards oral health care. In this study a substantial difference between perceived and normative need was also observed. 88% of the respondents perceived a need for dental care and 99% were assessed as needing treatment (normative need) but only 29% demanded the care. 63% were dissatisfied with their functional ability to chew and expressed a need for dentures. Conclusion: The aim of this study was to assess the oral health status and perceived oral health needs among older adults in Guguletu. The oral health status was poor in most of the participants and the demand for care was low even though perceived need was high. The study has shown that social, functional and psychological factors influence the demand for care in this adult population. The cost for dental care and access to these services are major barriers to the demand of care.Perceived oral health needs and the impact of oral diseases are important influences in the assessment of oral health needs in the elderly. The assessment of oral health needs as perceived by the elderly facilitates the planning and implementation of dental services with special consideration on the cost and accessibility of oral health care.
The prevalence of oral symptoms and perceived needs of HIV positive persons in Cape Town, South Africa
(University of the Western Cape, 1996) Camara, Cecily Jean; Schofield, Margot
The Human Immunodeficient Virus (HIV) is escalating in South Africa at an alarming rate. The impact of HIV today and in the future could have grave consequences for the South African population as it affects adults in their most productive years. To ease costs on the health system, health workers should be familiar with HIV patients needs in general, and specifically in areas such as oral disease which can contribute to the wellness or ill health of the patient. This could facilitate more appropriate and cost effective care ofHIV patients. World-wide reports indicate that the HIV virus is more prevalent in females than males. Women are also experiencing greater virulence of HIV and therefore greater severity of the disease. This research assessed whether there were differences in the prevalence and severity of oral symptoms ofHIV positive men and women. Oral health practices were also examined. As oral disease is very prevalent in HIV positive persons and has been a neglected area for research and program development, it was included in this study. This study also aimed to assess the perceived needs of patients affected by HIV. Such a study presents HIV positive patients an opportunity to participate in a process which allows patients to voice their needs and problems, as well as be involved in setting priorities. The study sought to assess whether needs differed according to the patients gender, age and symptom levels. A needs questionnaire with five domains which included medical and oral needs, social, economic, psychological and informational domains of needs was developed. The measure also included a section on demographics and oral health questions, and was administered as a structured interview. The sample consisted of 338 HIV positive males and females residing in Cape Town and its environs and attending the Out Patients' Departments of three major provincial hospitals, as well as two community clinics during May to November of 1995.
Mondbiologie
(University of the Western Cape, 1980) Jansen van Rensburg, B.G; Prins, F.X.
Mondbiologie as onafhanklike vak in die Republiek van Suid-Afrika het die eerste babatreë geneem op 'n senaatsvergadering van die Universiteit van Stellenbosch op 26 Maart 1971 toe die instelling van 'n Departement Mondbiologie goedgekeur is. Die skrywer is op 1 Januarie 1972 aangestel as hoof van die nuutgestigte departement in die Fakulteit Tandheelkunde aan die Universiteit van Stellenbosch. Die ontwikkeling van die vak, veral aan Afrikaanse universiteite, is in die verlede geknel deur die afwesigheid van Afrikaanse handboeke en, in steeds groeiende mate, deur die styging van die pryse van boeke. 'n Verdere remmende faktor is dat geen enkele bestaande handboek 'n oorsig gee van die meeste aspekte van mondbiologie nie. Die motivering vir die opstel van hierdie boeke (Deel I en Deel II) lê daarin dat dit wenslik is dat 'n Afrikaanstalige handleiding in die vak bestaan. Hierdie boeke het hulontstaan gehad in lesingsaantekeninge wat die skrywer oor baie jare saamgestel en probeer verbeter het. In die opstel hiervan is gepoog om materiaal uit verskillende bronne te versamel. Die leser sal gou agterkom dat geen spesifieke verwysings in die hoofinhoud aangegee word nie, maar wel algemene verwysings aan die einde van elke hoofstuk. Ook aan die einde van elke hoofstuk is 'n lys vrae •. Daar word van studente verwag om die vrae uit te werk, hoofsaaklik met behulp van hierdie handleiding en, indien nodig, met verwysing na bronne wat genoem word en in die tandheelkundebiblioteek beskikbaar is. Die inhoud van Boek I dien as inleiding tot mondbiologie en handel hoof= saaklik oor algemene aspekte van embriologie, fisiologie, makro- en mikroanatomie van die mond, sy inhoud en die sisteme wat daarmee verband hou. Die skrywer voel dat hierdie kennis 'n voorvereiste is vir 'n meer toe= gepaste studie van 'n tand en sy omgewing soos weergegee in Boek II. Soos in alle pionierspogings kom daar waarskynlik foute in hierdie werk voor. Die skrywer spreek by voorbaat sy spyt hieroor uit en wil dit graag onder die aandag van die leser bring dat die onderwerpe geselekteer is om so 'n wye veld soos moontlik te dek met inagneming van die beperkte kursusduur. Mnr. P.F. de Klerk, Senior Onderwyser in Afrikaans aan die Hoërskool D.F. Malan te Bellville, was verantwoordelik vir die taalversorging. Hier=voor is die skrywer opregte dank aan hom verskuldig. Vir haar toegewyde andag aan die tikwerk verbonde aan hierdie boeke wil ek baie graag my innige dank aan mev. C.F. du Toit bring. Mnr. A. Louw, Grafiese Kunste=naar, het die titelbladsye ontwerp. Hiervoor bedank ek hom.
Die doeltreffendheid as kariesvoorkomingsmaatreel van in 0,2% en in 0,05% neutrale natriumfluoried-mondspoelmiddel
(University of the Western Cape, 1985) van Wyk, Irma; van Wyk, C.W.
The study was carried out to 1) determine the effectiveness of the caries inhibiting effect of a weekly mouthrinsing programme in South African schools over a three year period and 2) compare neutral solutions of 0,2 per cent and 0,05 per cent NaF using a placebo of tapwater as control. Twelve to 13 year old White school children from eight randomly selected schools in the Parow School Board area of the Cape Peninsula were chosen. Participants were randomly assigned to one of the three rinsing groups. After three year's participation, the mean net increment in DFS per child was 4,7 for the 0,2 per cent NaF group; 5,9 for the 0,05 per cent NaF group and 7,5 for the placebo. These differences are statistically significant (p<:O,OOI). This meant a caries reduction of 38 per cent for the stronger and 21 per cent for the weaker sodium fluoride mouth rinse. It is concluded that such a mouth rinsing programme is a practical, feasible and an efficient approach to caries prevention in South African circumstances.
"An investigation of the oral health of a selected group of preschool children in the Western Cape"
(University of the Western Cape, 1987) Yasin-Harnekar, S.; Reddy, J
The dental clinic of the University of the Western Cape provides oral health care for many preschool children. The clinical observation was that these children presented with rampant dental caries. A recent report compi1ed by an international Joint Working Group of the Internationale Dental Federation and the World Health Organisation identified the changes in oral health in children and factors associated with these changes. South Africa presents a unique opportuni ty to study the oral health status of different ethnic and socio-economic groups. A review of the relevant literature indicated that there was a lack of published data, especially on the oral health status of preschool children. A study was designed to investigate the oral health status of a selected group of preschool children ages 2-6 years in the Western Cape. The examinations were conducted at twelve different créches by two calibrated examiners. The examinees' weight and height were also measured. The data was recorded on a revised World Health Organization Basic Oral Health Assessment form. A total of 547 children were examined with an almost equal distribution of males and females. Only 18% of the sample had a compl ete sound primary dentition, dmft = O. The mean dmft was 5.37 which ranged from 2.73 for the 2 year age group to 7.01 for the 5 year age group. The mean dt of 4.09 made up 76% of the dmft, the mean mt of 1.22 made up 23% and the ft was negligible. Seventy-eight percent of the sample had decayed teeth present and 28% had missing teeth recorded. The treatment chosen by or for these children appeared to be extractions. Observations of extensively decayed teeth and the high prevalence of dento-alveolar abscesses suggested that this treatment was of an emergency nature. There was much unmet treatment as only 22% of subjects were free of decay and those with decayed teeth present had an average of 5. The dmft distribution showed 48% had a dmft.)5. There was a statistically significant linear association between the dmf and age for all the tooth types except the cani nes. There was no significant difference in caries prevalence between males and females. The phenomenon of bilateral symmetrical occurrence of dental caries in the primary dentition was demonstrated in the present study. The maxillary central incisors were the most frequently affected teeth (55%), followed by the mandibular second molars (47%) and maxillary second molars (42%). This is contrary to the findings in European communities where the primary second molars are the most susceptible tooth types. The present study found the fifth year of 1ife to be the critical one for the primary dentition. It was at this age that the greatest increment in dmft was observed, the greatest decrease in the number of caries-free subjects, more than a twofold increase in rampant caries, and a twofold increase in the number of subjects with dento-a1veo1ar abscesses. Few hard tissue anomalies were recorded. Localized enamel hypoplasia was quite common especially of the upper incisors and second molars. Most children claimed their teeth were brushed at least once a day. But soft deposits were present in almost all age groups in all the segments. Sixty percent of the sample had the sole responsibility of brushing their own teeth with no assistance from their parents. Parental assistance with toothbrushing was limited to the younger age group. In the present study soft deposits and gingivitis were recorded mostly on the buccal of the upper posterior segments and on the lingual of the lower posterior segments. The anterior segmentshad less plaque than the posterior segments. Thi s may be due to children finding it easier to brush anteriorly than posteriorly when they do brush. Also, the other areas are less accessible and require greater manipulative skill. There was a weak correlation between the total soft deposits and total gingivits. Although 60% of the sample had six segments of soft deposits present, only 4% had )six segments of gingivitis present. However, it was found that the higher the number of segments of soft deposits present, the greater the tendency for the presence of gingivitis. The association between dmft and soft deposits was not significant but between dmft and gingivitis was significant. This may be more preci se as these two are both cumulative measures. Soft tissue lesions were generally uncommon in this age group. The children in this community were generally lighter in weight and shorter in height compared to the NCHS (1979) percentiles. Recommendations regarding ways of redressing the obviously inadequate general and oral health of this sample of children were made.
Understanding and predicting preventive health behaviour in mothers of preschool children
(University of the Western Cape, 1986) Hendricks, Stephen J.H.; Freeman, R.
This study was undertaken to examine the preventive dental and medical attendance behaviour of mothers of young children. The 'Theory of Reasoned Action' used to predict intention to visit the dentist and the doctor, failed to account for more than 11% of the variance in dental behaviour and 9t in the variance in medical behaviour in all the subjects. However, on assessing these behaviours for the 2 different age groups, for the younger age group, the prediction improved to 19% for the dental intention in terms of the total attitude and subjective norm score, and to 45% and 34% respectively for the individual attitudes and subjective norms. In the older age group, the prediction improved to 20% for the dental intention in terms of the total attitude and subjective norm score, and to 39% and 30% respectively for the individual attitude and subjective norms. This finding is further supported by factor analysis of the data, whereby using a principal components analysis structure, other patterns to the data were found which indicates that preventive dental and medical behaviour is a complex behavioural category, consisting of more than one action. Two dimensionso of affect accounted for 59% of dental attitudinal data and 57.9% of the dental subjective norm data, whereas three dimensions of affect accounted for 64.5% of the medical attitudinal data and 64.8% of the medical subjective norm data. The mothers had positive attitudes to both the two dental and three medical actions highlighted by the principal components analysis. The younger mothers showed stronger attitudes associated with the treatment outcome action, whereas the older mothers showed a more positive preventive orientation by the dental data. Although two-thirds of the young mothers received dental advice from the health visitors, they were highly selective on what information to accept and put into effect. An indication here is that health messages including dental health are perceived differently by the 2 age groups even though they are from the same social class group. This finding holds in important implications for the method, approach and content of dental heath of education. In terms of the medical data, the three actions highlighted, indicated that while a health directed behaviour, in terms of a healthy outcome e.g. normal growth is important, an expectation as well as a more emotional, love and tender care factor were also implicated. A healthy baby may however not be the only factor of importance to the mother, but also the mechanisms of achieving such a state of health, matters not only in terms of the convenience but also, greatly depend on the love and level of care the mother gives the child. This aspect may even be more accentuated in one parent families, in which especially the young mother is under enormous socia-economic pressure to take up employment, foresaking time she would otherwise have spend with the child. The effect of subjective norms on preventive health behaviour shows evidence of a 'inner cicle' or 'kinship' as reference group to the mother, which mediates between and modifies the influence of the health profession in as far as compliance with health care is expected from the mother. It therefore appears that in the lower social classes, there exists an intricate social network, exercising an important effect on the way of life of the mother, and since this network may be one of the few supports she has, its influence will be exerted in various dimensions of the mothers' life including health. There appears to be a hidden pathway or code of conduct, defined by these social norms and to which the mother feels she owes her allegiance. The level of communality between the social networks and preventive dental behaviour should be further investigated. This study has clearly indicated that some of the dental and medical attitudes and subjective norms under consideration, has a marked independent yet related effect on preventive health behaviour whereas other attitudes and subjective norms acted independently or sometimes not at all. The dental health educator, must therefore determine for each community and individual which action is the most appropiate target for behavioural change. Furthermore, this study has shown that if beliefs are to be modified, referents to support such a behaviour change, must therefore be appropiate to attaining this objective. since preventive medical and dental behaviour consists of various actions, the application of the Azjen and Fishbein model, should be to a specific action of the behaviour, which assumes importance in the target community, important others. associated with Baric (20) has emphasised the role of the family as an important influence on attitude and behaviour, while Boothroyd- Broóks (39) has pointed to the contribution of society as important mediators in secular life. The results from this study would tend to support the views of Suchman(193), Baric(20) and Boothroyd-Brooks(39) that, kinship, family and social norms were important in the development of behaviour but, to sustain such a behaviour, a deeper understanding is required of the social forces operative through the social network, which shapes the mothers' health behaviour into action. be this medical or dental attendance for herself or for that of her children.
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.

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