Philosophiae Doctor - PhD (Community Oral Health)

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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).
Die ontwikkeling van die epiteel en keratien in die menslike mondholte: In histologiese, elektronmikroskopiese en histochemiese studie
(University of the Western Cape, 1972) van Wyk, Christian Werner; Weber, H.W.
Histological observations revealed that oral epithelium originated from a single ectodermal layer. As the ectoderm grew so it differentiated into squamous epithelium. The first features of squamous differentiation were noticed at 8 weeks in utero in areas where keratinized mucosae were developing, and these were the changing of cuboidal to cylindrical basal cells and the subsequent growth of prickle cells from these cylindrical basal cells. The prickle cells merged with the existing primitive cells and at no stage could a separate squamous epithelial layer I such as the stratum tritermedium of the epidermis I be observed inside the mouth. At 12 weeks in utero squamous differentiation had reached a stage where acidophilic layers appeared in certain regions on the epithelial layer. The time of appearance of these layers varied from case to case. At this stage most of the primitive characteristics had disappeared from the keratinizing epithelium. Unlike the periderm of the skin which was shed into the amniotic fluid, shedding of primitive epithelial cells from the keratinizing squamous epithelium was not noticeable. Thence, the growth of keratinizing epithelium was followed by an increase of acidophilic layers, the appearance of keratohyaline granules in cells and, in some instances, full keratinization. The latter I however I was almost exclusively confined to the vermilion border of the lip. The squamous epithelium of the lining mucosa, which is unkeratinized I developed at a much slower tempo. It retained its cuboidal-shaped basal cells and the primitive features of the overlying cells were lost only at about 4- 5 months in utero I when squamous differentiation set in. At no stage was the squamous differentiation a prominent feature. At junctions between keratinized and unkeratinized epithelia and epidermis the epithelium exhibited features of both types of epithelia that were being joined. This was especially noticeable at the junction between vermilion epithelium and epidermis, where part of the vermilion epithelium displayed a prominent intermediate type of layer. Similarly, acidophilic layers of keratinizing epithelium merged imperceptibly with the walls of cells of unkeratinizing epithelium, creating a small region of an unkeratinizing type of epithelium with keratinized cells. Thus the development of the oral epithelium is through differentiation and renewal of epithelial cells: the ectodermal layer developes into an epithelial layer which is recognised by its squamous appearance. The subsequent growth is by constant renewal of this differentiated epithelium. The pattern of epithelial development I the appearance of the junctional epithelia and the manner in which acidophilic layers merge with unkeratinized epithelial cells I indicate a unity between these epithelia. According to these developmental features, the epithelium of the mouth and epidermis can be classified into less differentiated and better differentiated, but with a commonbackground for these epithelia. When the formation and the established appearance of keratin in the mouth and on the skin was compared histologically I ultrastructurally and histochemically I a unity between these features became apparent. Ultrastructurally it appeared that keratin consisted basically of 2 cytoplasmic constituents: tonofilaments and a fine granular substance. The tonofilaments were gathered at first into bundles and then broken up into finer tonofibrils. These finer fibrils mixed with a granular ground substance to form a homogenous granular filamentous material. This product can be regarded as a pre-keratin. With the addition of a keratohyaline layer to the process I keratin was formed, Apart from the keratohyaline granules several additional changes took place in cells concerned in this process I whether keratin was formed or not. These changes were flattening of cells, extensive interdigitation between cell walls, disappearance of micro-villi I loss of structure in desmosomes I thickening of cell walls and the disappearance of glycogen from cells. Some of these features were displayed in each of the types of epithelium examined here.
The history of dentistry in South Africa since 1900
(University of the Western Cape, 1983) Grob1er, Vilma; van Rensburg, A P J
Nineteenth Century dentists in South Africa were brought under the provision of legislation in Natal and the Transvaal (1896) and the Cape Colony and the Orange Free State (1899). By the end of the Nineteenth Century a group identity had been established and the transition from a craft to a profession completed. From 1900-1958 dental societies were formed. Key dates are 1922 when the South African Dental Society, which became the Dental Society of South Africa (D.A.S.A.) after Incorporation in 1935, was constituted. Collective action by dentists, implemented through the societies, shaped the profession. From 1933-1948 the constitution of the D.A.S.A. was streamlined. The Magna Charta of Dentistry (Act 13, 1928) was enacted defining dentistry and the practice thereof. The Dental Mechanicians Act (1945) protected the mechanician, the dentist and the public against illicit practitioners. The D.A.S.A. initiated the Professional Provident Society for dentists, now extended to include all the professions. In 1936 tbe first National Congress was held, in 1953 the first International Congress, setting a future pattern. The status of the dentist was further improved by obtaining the right to use the courtesy title Dr and by the abolition of the professional licence fee (1938). The earliest .societies set up voluntary clinics for children and the indigent. The Transvaal initiated a provincial scheme for childrens' followed by the other provinces. Dental Services, a fully fledged of Health. dentistry, This evolved into branch of the Department Witwatersrand University established a dental school in 1925, followed by .the Universities of Pretoria, Stellenbosch , Western Cape and Medunsa. Facilities for postgraduate 'study exist at all these institutions. The R.E.D. Fund Aids Research Education and Development in the field of dentistry. The first unofficial Dental Journal was published in 1927, followed by the Official Bulletin (1945-1946) and finally the Official Journal of the D.A.S.A. During the Anglo Boer War the importance of healthy dentitions'for soldiers was first realised. Four conntract dentists att~nded to the British soldiers. The South African dentists served in the Army Dental Corps during the two world wars. Dentistry in South Africa is now on a par with dentistry in any country of the Western world.
Die ontwikkeling van 'n innoverende kurrikulum vir die opleiding van tandheelkundiges
(University of the Western Cape, 1993) Snyman, Willem Diederik; Louw, W. J.; Kachelhoffer, P. M.
SUMMARY This study has shown that the environment in which a dentist receives his training, has, over the past decades, changed drastically, and is still changing. Also, that the existing curriculum model, in use in most dental faculties, is an anachronism and that the sands of time for a paradigm shift in terms of the curriculum, are fast running out. It follows, therefore, that the curriculum, training and evaluation programmes will, without delay, have to undergo changes in order to fulfil the requirements of the community in general and the clients of the Faculty in particular. In addition, adjustments in terms of the numbers and types of dental manpower to be trained, will have to be made. The purpose of this study was to investigate the management of dental education as a critical performance area and to develop a curriculum at the macro-level for three cadres of dental manpower, which will fulfil certain identified requirements. The curriculum model used in this study, should ideally fit in with the organisational structure of the Faculty. Therefore, this organisational structure was investigated and found to consist of a mixture of a "machine" and a "professional bureaucracy". It was also demonstrated that the disadvantages of this bureaucratic hybrid could be counteracted, whilst still retaining the advantages of the existing system, by the implementation of an "adhocracy" in the form of a matrix-functioning system. A management manual, essential for the effective functioning of a matrix system, which had already been developed for the management of teaching in the Faculty of Dentistry of the University of Pretoria, was found to be suitable, not only for this purpose, but also as a basis for future strategic planning in teaching. The rationale for the necessity of altering the traditional dental curriculum is given in the thesis and three strategies are recommended for solving the problem. Curriculum designs were carefully scrutinized and the most important of these relating to dental education, as well as the ideal positioning in terms of the SPICES curriculum strategy, have been indicated. Basic premises, with their priorities and weighted values, developed for this study were utilised in comparing the traditional model with the proposed diagonally-layered curriculum design. This proposed curriculum design, and subject structure, is illustrated in detail with the aid of diagrams. An empirical comparison showed that the proposed diagonally-layered curriculum would be an improvement on the traditional curriculum in terms of: professional and market orientation, the promotion of meta-learning, the support of teaching and evaluation, the early exposure of students to preventive clinical dentistry, the promotion of horizontal and vertical integration of various subjects and courses, rationalisation of the curriculum, easier "through-flow" possibilities for oral hygienists and dental therapists, as well as practical implementation and cost effectiveness.
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.
Determinants influencing the oral health of adults in Seychelles
(University of Western Cape, 2021) Noshir, Cynthia Yara Sheela; Brijlal, Priscilla
Oral diseases are a major public health problem in the Seychelles, amidst a contracting budget coupled by a lack of national oral health policy and strategic plan to promote oral health. The oral disease burden is attributed to numerous determinants operating at different levels –macro, population and community, and at the person level. The study set out to examine the determinants that contribute to poor oral health in the Seychelles through an exploration of the social, cultural, economic and environmental factors influencing the oral health of adults. The purpose of the study was to develop an evidence-based theoretical framework that would inform future policy and practice for oral health. Set in the mixed research paradigm, a qualitative and quantitative research approach was used to obtain a deeper understanding of the pathways and mechanisms operationalizing determinants. Using a purposive sampling approach, individual and group interviews were conducted with patients, dental staff and a representative of the upper management.
The influence on masticatory performance of jaw movements, chewing side preference, occlusal contacf area, muscle activity and jaw tremor
(University of the Western Cape, 1996) Wilding, R.J.C.; Hobdell, M.; Lewin, A.
The primary function of the jaws and teeth in mammals is chewing and swallowing. In man there are additional functions of speech, non-verbal communication and cosmetic appeal. Chewing is a complex operation requiring both adequate skeletal structures, and a well co-ordinated muscle system. There is considerable variation in both these components of chewing within which adequate function appears to be possible, at least for a modern refined diet. For example, the dental arches may not conform to the modal arrangement and teeth may be missing, yet adequate function remains (Slagter et al 1993). There are unfortunately no baseline requirements for an adequate dentition nor the minimal chewing performance necessary to avoid indigestion. A common rule of thumb when replacing missing posterior teeth is that the extent of the prosthesis can be reduced to the premolars without seriously affecting chewing (Kayser, 1984). This arbitrary estimation has not been defined by a minimum area for functioning posterior occlusal surfaces. The same lack of quantifiable measurement is a feature of assessing orthodontic treatment goals and outcomes (Omar, McEwen and Ogston 1987). The clinical rules for correcting malocclusions, usually, have more to do with the restoration of modal tooth, arch and skeletal relationships, than with the restoration of function; if restoration of function is a concern of treatment, it is not measurable in the same way that tooth positions can be assessed on plaster casts or angles measured on a radiograph. Muscle tenderness and limited movement are both features of temporomandibular dysfunction. The boundary between normal subjects, who may have some signs of dysfunction and patients, who may not have distinctly more severe signs cannot always be made (Widmar 1992). By some definitions based on the morphology of the joint structures, even symptomless individuals could be categorised as abnormal. One of the difficulties in assessing functional incapacity of a patient with muscle pain is the absence of the same baseline data needed to assess malocclusion, or the handicap due to reduced occlusal area. It is encouraging to find that a simple test, such as measuring maximum opening, is a useful indicator of treatment progress in temporomandibular dysfunction. This sign, although simple and of limited diagnostic use, reflects the poverty of useful tests for masticatory function.
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.
The neutral zone for mandibular complete dentures: A clinical trial
(University of the Western Cape, 2016) Geerts, Greta Aimée Virginie Maria; Naidoo, S; McCord, F
Rehabilitation of edentulous jaws without the option of osseointegrating implants will remain the only treatment option within reach of many older patients for the foreseeable future. Many routine prosthodontic procedures are based on dogmas, because no high-level scientific evidence exists to either accept or reject them, among these is the “neutral zone” (NZ) concept. In spite of paucity of evidence using approved patient-based outcome instruments, it is generally agreed that the NZ should be respected when constructing complete dentures. The purpose of this research project was to determine how shapes of conventional and NZ mandibular dentures differ, and if the two different types of dentures impact differently on oral health–related quality of life by using an accepted oral health-related quality of life instrument as a patient-based outcome. Thirty nine edentulous patients were selected for his prospective, randomised, cross-over, single-blinded clinical trial. Two sets of complete dentures were made for each patient. One denture set was made following conventional biometric guidelines for determining the position of the mandibular posterior denture teeth in relation to the ridge; another set was made following a functional impression of the potential denture space. Each set of dentures was worn for at least two months. A similar number of types of dentures were delivered first. Widths of residual ridges and mandibular denture arches were measured using digital measuring software. Position of denture teeth was related to the ridge. Denture dimensions were compared by means of analysis of variance using the mixed procedure. Using formula of parabola, arch-widths were compared using paired t-tests. Pre- and post-treatment patient feedback was obtained by means of the 20-item Oral Health Impact Profile (OHIP-20) and a preference score. Treatment effect size (ES) was established based on the OHIP-20 scores. Relevant associations among denture dimensions, OHIP-20 scores, preference, age, gender, marital status, education, income, period of edentulousness, and quality of denture-bearing tissue were done using the generalised linear model and correlation analysis. For all statistical analysis, level of significance was determined at p<0.05. The mean age of the sample was 62.3 years. Twenty four patients were female. Mean period of edentulousness was 31 years and mean number of denture sets worn prior to the trial was 2.5. Except for the canine region, NZ dentures were statistically wider than anatomic dentures. The difference in mean widths between the two types of dentures was larger for female patients. Older patients had smaller differences in denture dimensions. More unfavourable denture-bearing tissue was associated with a larger difference in the two types of dentures. Both types of mandibular dentures significantly improved the OHRQoL of patients. Both types of dentures had a high treatment ES. The OHIP-20 instrument could not distinguish a statistical difference in impact on OHRQoL between the two treatment options. There was a minute difference in treatment ES between the two types of treatment. The only domain representing a small clinical benefit between NZ and anatomic dentures was “physical pain”, with the NZ dentures scoring better. There was no correlation between pre- and post-treatment scores for both types of dentures. No significant associations were found between post-treatment OHIP- 20 scores on the one hand and tissue scores, gender, age, education, marital status, period of edentulousness and denture dimension differences on the other hand. Based on OHIP-20 scores, there was a significant association between denture preference and NZ dentures, but not for the other preferences. No significant associations were found between denture preferences on the one hand and tissue scores, gender, age, period of edentulousness and denture dimension differences on the other hand. Even though no significant relationship was found between preference and gender, the majority of female patients preferred the NZ denture and the majority of male patients did not express a preference.Providing new complete dentures improved OHRQoL of edentulous patients. The majority of female patients preferred the NZ compared over the ANA denture. The NZ technique appeared to have a higher positive impact on OHRQoL of female patients compared to male patients.
Parent's perception of psychosocial factors associated with health compromising behaviours related to oral health among adolescents in South Africa
(University of the Western Cape, 2016) Okagbare, Tuweyire Erherhebue; Naidoo, Sudeshni
Even though the composition of the family unit has undergone considerable change in recent decades due to a variety of socio-economic developments, it remains the first learning environment for the child. The influence of the family continues throughout adolescence and indeed throughout the life-course of the individual to varying degrees because parents are powerful role models and influence. Their subjective perception of the psychosocial factors associated with health compromising behaviours is critical in the quality of parental participation in the prevention and control of these behaviours. The aim of the present study was to investigate parents� perception of the psychosocial factors outside marital and socioeconomic status that are associated with health compromising behaviours related to oral health among adolescents. The design was a qualitative exploratory one and the research strategy was inductive, deductive and abductive. A non-probability purposive theoretical sampling method was employed and data collected from five focus group interviews using a guiding questions schedule. The sample size of 37 was determined by theoretical saturation. Participants were aged between 28 and 75 years. Each of the five focus groups was homogeneous in the sense of shared experience but diverse in terms of professions. The data analysis used in this study was the grounded theory approach and a substantive theory was generated that addressed the mitigation of adolescents� unhealthy behaviours. The substantive theory provides an effective and holistic approach to the problem of adolescent unhealthy behaviours. It went beyond the risk factors approach to comprehensively address the root causes of five adolescent health compromising behaviours viz. alcohol consumption, smoking, inadequate fruit and vegetables consumption, inadequate oral health care and inappropriate sugar consumption.
Management of defective dental Amalgam restorations-a mixed-methods study
(University of the Western Cape, 2016) Adam, Razia Zulfikar; Naidoo, Sudeshni
Much variation exists in the practice of dentistry with regard to the diagnosis of caries and the recommendations for treatment. Even though criteria for the selection of 'faulty' restorations often appear ill-defined, subjective and/or variable restoration replacement is a major component of dental practice in developed countries (Brennan and Spencer, 2006). While the prevalence of caries is decreasing in developed countries, low- and middle-income countries are experiencing an increase. The investigation of factors influencing the clinical decision-making process has identified and compared the roles of technical (e.g. oral health factors), patient and dentist factors (Brennan and Spencer, 2006; Bader and Shugars, 1995a; 1995b). A recent trend for a more conservative approach to restorative dentistry has led to the alternative management of defective dental restorations. Repair and refurbishment of defective dental restorations have been established as viable options. The purpose of this study was to provide information regarding the practices, knowledge and attitudes of South African dentists with regard to the management of defective dental amalgam restorations.
The effect of dental treatment on weight gain in children in South Africa
(University of the Western Cape, 2017) Yengopal, Veerasamy; Naidoo, Sudeshni
Background: There is an increased interest in understanding the effects of severe tooth decay on the physical, anthropometric, psychosocial, functional, and oral health related quality of life (OHRQoL) among children. Children who have severe tooth decay are thought to have lower weight, height, Body Mass Index (BMI), Haemoglobin (Hb) levels and poorer OHRQoL compared to children who are caries free. Comprehensive dental treatment under general anaesthesia (GA) appears to significantly improve these variables to levels equivalent to healthy caries free children. However, there is a paucity of high quality evidence that has demonstrated these gains in the anthropometric (Height, Weight BMI), clinical and oral health related quality of life (OHRQoL) measures following extensive dental treatment under GA. This trial sought to determine the impact of the treatment of severe dental caries on weight, height, body mass index (BMI), Hb levels and oral health related quality of life (OHRQoL) among a group of young children who had access to immediate care compared to a control group of children who waited 6 months before treatment. Methodology: This was a Community based prospective, randomized controlled intervention trial conducted in the peri-urban town of Worcester in the Western Cape Region of South Africa. The study population consisted of crèche going children, aged 2-6 years old who had severe tooth decay with a pufa score ≥ 1and attended public dental facilitates in the town. Simple random sampling using an existing lottery draw system at the clinic was used to divide the children into an immediate treatment group and a delayed treatment group (6 months later). Baseline height, weight, BMI, Hb levels were compared between treatment and no treatment groups at 6 months. OHRQol was measured from both the child and parent/caregiver perspective at baseline, 6 months later (in delayed group) and 6 months post treatment in both groups. Anthropometric variables were reported as unadjusted means and z-scores which were determined by transforming the unadjusted means against a reference group to determine the weight-for-height (WAH), weight-for-age (WAZ) and BMI-for –age (BAZ) in both groups after treatment. OHRQoL scores were dichotomized and/or categorized into high, low and no impacts. Descriptive statistics (means), correlation analyses (by age, gender) and multilevel mixed regression model analysis was undertaken to determine the effect of the treatment on the outcome variables using SPSS version 23. Results: 126 children in the immediate group (mean age 4.4 years, SD 1.2) and 125 children (mean age 3.75 years, SD 1.3) completed this trial. Comparative baseline measures significantly favoured children in the immediate group for age, height, and weight. The average number of teeth extracted under GA was 7.4 (SD 3.53) in the immediate group and 8.55 (SD 3.94) in the delayed group. Unadjusted mean scores for height, weight, BMI and Hb showed significant improvements within the groups at 6 months follow-up. When the group were compared (treatment vs. no treatment) using unadjusted or z-scores, statistically significant gains were noted for height and weight but not for BMI or Hb. Multilevel Regression modelling confirmed these findings implying that the intervention alone was not a factor in the improved Hb or BMI levels. OHRQoL significantly improved from both the child and parent/caregivers' perspective after treatment was received. In the delayed group, there was no improvement in OHRQoL scores during the 6 month waiting period but these significantly improved to comparable levels seen in the immediate group 6 months after treatment. Conclusion: This randomised controlled trial found that children with severe tooth decay who received treatment under general anaesthesia had significantly better height and weight gains than those children who has no treatment. Although gains were also noted in the BMI and Hb levels, these gains were not statically significant and their improvements could not be explained by the intervention alone (dental treatment under general anaesthesia). OHRQoL outcomes showed significant improvement from both the child and parental/caregiver perspective when comparing children who received treatment against those who did not have treatment. Children who had to wait for treatment had similar negative impacts on OHRQoL at 6 months follow-up compared to baseline. However, once they received treatment (delayed group), similar significant improvements for OHRQoL as reported in the immediate group was also found in the delayed group.
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.
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.
The neutral zone for mandibular complete dentures : a clinical trial
(University of the Western Cape, 2016) Geerts, Greta Aimée Virginie Maria; Naidoo, S; McCord, F
Rehabilitation of edentulous jaws without the option of osseointegrating implants will remain the only treatment option within reach of many older patients for the foreseeable future. Many routine prosthodontic procedures are based on dogmas, because no high-level scientific evidence exists to either accept or reject them, among these is the “neutral zone” (NZ) concept. In spite of paucity of evidence using approved patient-based outcome instruments, it is generally agreed that the NZ should be respected when constructing complete dentures. The purpose of this research project was to determine how shapes of conventional and NZ mandibular dentures differ, and if the two different types of dentures impact differently on oral health–related quality of life by using an accepted oral health-related quality of life instrument as a patient-based outcome. Thirty nine edentulous patients were selected for this prospective, randomised, cross-over, single-blinded clinical trial. Two sets of complete dentures were made for each patient. One denture set was made following conventional biometric guidelines for determining the position of the mandibular posterior denture teeth in relation to the ridge; another set was made following a functional impression of the potential denture space. Each set of dentures was worn for at least two months. A similar number of types of dentures were delivered first. Widths of residual ridges and mandibular denture arches were measured using digital measuring software. Position of denture teeth was related to the ridge. Denture dimensions were compared by means of analysis of variance using the mixed procedure. Using formula of parabola, arch-widths were compared using paired t-tests. Pre- and post-treatment patient feedback was obtained by means of the 20-item Oral Health Impact Profile (OHIP-20) and a preference score. Treatment effect size (ES) was established based on the OHIP-20 scores. Relevant associations among denture dimensions, OHIP-20 scores, preference, age, gender, marital status, education, income, period of edentulousness, and quality of denture-bearing tissue were done using the generalised linear model and correlation analysis. For all statistical analysis, level of significance was determined at p<0.05. The mean age of the sample was 62.3 years. Twenty four patients were female. Mean period of edentulousness was 31 years and mean number of denture sets worn prior to the trial was 2.5. Except for the canine region, NZ dentures were statistically wider than anatomic dentures. The difference in mean widths between the two types of dentures was larger for female patients. Older patients had smaller differences in denture dimensions. More unfavourable denture-bearing tissue was associated with a larger difference in the two types of dentures. Both types of mandibular dentures significantly improved the OHRQoL of patients. Both types of dentures had a high treatment ES. The OHIP-20 instrument could not distinguish a statistical difference in impact on OHRQoL between the two treatment options. There was a minute difference in treatment ES between the two types of treatment. The only domain representing a small clinical benefit between NZ and anatomic dentures was “physical pain”, with the NZ dentures scoring better. There was no correlation between pre- and post-treatment scores for both types of dentures. No significant associations were found between post-treatment OHIP- 20 scores on the one hand and tissue scores, gender, age, education, marital status, period of edentulousness and denture dimension differences on the other hand. Based on OHIP-20 scores, there was a significant association between denture preference and NZ dentures, but not for the other preferences. No significant associations were found between denture preferences on the one hand and tissue scores, gender, age, period of edentulousness and denture dimension differences on the other hand. Even though no significant relationship was found between preference and gender, the majority of female patients preferred the NZ denture and the majority of male patients did not express a preference. Providing new complete dentures improved OHRQoL of edentulous patients. The majority of female patients preferred the NZ compared over the ANA denture. The NZ technique appeared to have a higher positive impact on OHRQoL of female patients compared to male patients.
Implementation of oral health policies in African countries: South Africa and Nigeria as case studies
(University of Western Cape, 2014) Ogunbodede, Eyitope O.; Naidoo, Sudeshni
This study has shown conclusively that the oral health policy processes has not achieved the desired goals in both South Africa and Nigeria, and that greater advocacy for oral health is required in both countries.
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.
School-based HIV counselling and testing: providing a youth friendly service
(2012) Lawrence, Estelle; Struthers, Patricia
HIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. Thereare still major gaps in research about the best ways to provide HCT, especially to young people. School-based HCT is a model which has been suggested for providing HCT to young people in a youth friendly manner. This study was aimed at producing recommendations for providing a youth friendly school-based HCT service using the World Health Organisation (WHO) framework for youth friendly health services. It was conducted in six secondary schools in Cape Town, where a mobile HCT service is provided by a nongovernmental organisation (NGO). It was an exploratory descriptive study, using a mixed-methods approach. Twelve focus group discussions (FGDs) were held with learners to explore their needs with regards to school-based HCT. An evaluation (which consisted of observation of the HCT site, service provider interviews and direct observation of the HCT counselling process) was done to determine whether the mobile school-based HCT service was youth friendly. A learner survey was conducted with 529 learners to investigate the factors that influence the uptake of HCT and to explore learners’ behaviours and experiences under test conditions. In the FGDs, learners said that they wanted HCT to be provided in schools on condition that their fears and expressed needs were taken into account. They wanted their concerns regarding privacy and confidentiality addressed; they wanted to be provided with information regarding the benefits and procedure of HCT before testing took place; they wanted service providers to be competent to work with young people, and they wanted to be assured that those who tested positive were followed up and supported. On evaluation of the mobile school-based HCT service, it was evident that the service did not meet all the needs of the learners nor did it have all the characteristics of a youth friendly health service. The model of ‘mass testing’ used by the NGO did not fulfil learners’ expressed need for privacy with regards to HCT. Service providers were friendly and on-judgemental but had not been trained to work with young people (especially marginalised groups e.g. young men who have sex with men). The information needs of learners were not addressed, and learners were not involved in the provision of the HCT service. Learners who tested positive were not assisted in accessing care and support. The learner survey revealed a high uptake of HCT (71% of learners) at schools with learners who do not identify themselves as Black, with female learners and older learners being more likely to have had an HIV test. Factors that influenced uptake of HCT were complex, with learners reporting many different motivators and barriers to testing. Of concern was the low risk perception of learners with regards to HIV infection and the fact that learners who tested HIV positive were not being linked up with treatment and care. Based on the findings of the study, recommendations were made for proving youth friendly school based HCT. A multisectoral approach, with learner and community involvement, was suggested in order to provide a service which is equitable, accessible, acceptable, appropriate and effective.
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.

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